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CLINICAL AND EPIDEMIOLOGICAL PROFILE OF PATIENTS TREATED

AT A GASTROENTEROLOGY SERVICE OF A UNIVERSITY HOSPITAL IN

THE BRAZILIAN AMAZON

Francisca Rosilene Mendes Lima1

Marcelino da Silva Cavalcante2

Abstract: Background: Gastrointestinal diseases constitute an important cause of morbidity and

mortality, especially in regions characterized by social inequalities, geographical barriers and limited

access to specialized healthcare. In the Brazilian Amazon, these factors contribute to delayed diagnosis

and advanced clinical presentation. Objective: To characterize the clinical and epidemiological proﬁ le

of patients treated at the Diagnostic Imaging Unit of the Gastroenterology Service of the Hospital

Universitário Getúlio Vargas, Manaus, Amazonas, Brazil. Methods: Observational, descriptive and

exploratory study based on secondary data from 237 medical records collected between 2019 and

2020. Demographic, socioeconomic, clinical and territorial variables were analyzed using descriptive

statistics integrated with an interpretative epidemiological approach. Results: Most patients were

male, aged 50 years or older, had low educational level and originated from municipalities in the

interior of Amazonas. Chronic gastritis, esophageal varices and liver cirrhosis were the most prevalent

diagnoses, frequently associated with hypertension, diabetes mellitus and chronic liver diseases. The

ﬁ ndings indicate a predominance of advanced clinical conditions requiring specialized tertiary care.

Conclusions: The observed epidemiological proﬁ le reﬂ ects both the burden of gastrointestinal diseases

and structural inequalities affecting healthcare access in the Amazon region. Strengthening primary

healthcare, expanding regional diagnostic capacity and adopting territorially oriented public policies

1 Enfermeira. Especialista em UTI adulto, UFAM, 20024; Titulada em UTI Neonatal e Pediátri-

ca, pela AMIB/São Paulo; Doutoranda em Saúde Pública pela Universidad de Ciencias Empresariales

e Sociales (UCES), Buenos Aires – Argentina

2 Enfermeiro. Especialista em Antropologia da Saúde, Saúde da Mulher, Neurociências, Centro

Cirúrgico e CME, e Biotecnologia.

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are essential to reduce health inequities.

Keywords: Gastroenterology; Epidemiology; Public Health; Amazon; Delayed Diagnosis; Health

Services.

Introduction

Gastroenterological diseases are an important public health problem on a global scale, being

responsible for a high burden of morbidity, hospitalizations, functional disability, and mortality

(BRAY et al, 2024; WHO, 2024). Among these diseases, chronic liver diseases, inﬂ ammatory disea-

ses of the digestive tract, ulcerative diseases, digestive hemorrhages, and gastrointestinal neoplasms

stand out, whose clinical evolution depends, to a large extent, on the timeliness of diagnosis and the

availability of specialized treatment.

In Brazil, despite the expansion of access to health services promoted by the Uniﬁ ed Health

System (SUS), important regional inequalities persist related to the distribution of human resources,

diagnostic infrastructure, and organization of care networks (BRASIL-MS, 2017; BRAZIL-MS, 2010;

GIOVANELLA et al, 2024). These disparities become particularly evident in the Amazon Region,

where the extensive territorial size, population dispersion, the predominance of river transport and

logistical difﬁ culties impose additional barriers to timely access to specialized services (SANTOS,

2006; PAHO, 2022; IBGE, 2024).

In this context, the Getúlio Vargas University Hospital (HUGV), linked to the Federal Uni-

versity of Amazonas, plays a strategic role as a reference center in gastroenterology for patients from

the capital, the interior of the state and, in several situations, from other units of the federation. Con-

sequently, the proﬁ le of the patients treated in this service goes beyond the simple clinical description

of the cases, constituting an important indicator of the regional organization of care and the conditions

of access to specialized diagnosis.

Epidemiological studies carried out in reference services are particularly relevant becau-

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se they allow the identiﬁ cation of patterns of illness, demographic characteristics of the population

served, distribution of the main diseases, and factors associated with clinical worsening. In addition,

they provide subsidies for health planning, the organization of lines of care, and the formulation of pu-

blic policies guided by equity (ROTHMAN, GREENLAND, LASH, 2008; TRAVASSOS, CASTRO,

2024; GIOVANELLA et al, 2024).

In the Amazon, however, there are still few studies that describe in an integrated way the

clinical, epidemiological and territorial aspects of the population treated in specialized gastroentero-

logy services. Most investigations focus on speciﬁ c diseases, without considering the set of clinical

conditions treated or their relationship with the social and geographic characteristics of the population

using the health system.

In view of this gap, the present study aims to characterize the clinical and epidemiological

proﬁ le of patients treated at the Diagnostic Imaging Unit of the Gastroenterology Service of the

Getúlio Vargas University Hospital, identifying the main demographic, socioeconomic and clinical

characteristics of the population studied. By describing this proﬁ le, it is intended to contribute to the

improvement of care planning, to the qualiﬁ cation of early diagnosis strategies and to the strengthe-

ning of public policies aimed at reducing health inequalities in the Amazon Region.

Method

Study design

This is an observational, cross-sectional, descriptive and analytical-exploratory study, de-

veloped from secondary data obtained from the clinical records of patients treated at the Diagnostic

Imaging Unit of the Gastroenterology Service of the Getúlio Vargas University Hospital (HUGV), in

Manaus, Amazonas.

The study design observed classic methodological recommendations for observational stu-

dies described by Rothman, Greenland, and Lash (2008).

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The HUGV is a high-complexity university hospital linked to the Federal University of

Amazonas and is part of the specialized care network of the Uniﬁ ed Health System (SUS), playing a

regional reference role for diagnostic and therapeutic procedures in gastroenterology.

Population and sample

All eligible medical records of patients treated between January 2019 and December 2020

were included.

After applying the eligibility criteria and excluding inconsistent or incomplete records, the

ﬁ nal sample consisted of 237 patients, which was considered representative of the care proﬁ le of the

service during the study period.

Variables studied

The following variables were analyzed:

Sociodemographic

sex; age; age group; education; marital status; naturalness; MERIT.

Clinics

main diagnosis; associated comorbidities; liver diseases; gastroesophageal diseases; digesti-

ve neoplasms; portal hypertension.

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Statistical analysis

Initially, a descriptive analysis was performed by calculating absolute frequencies, relative

frequencies, means and distribution by categories.

The variables were later analyzed according to an integrated epidemiological perspective,

allowing the characterization of the clinical proﬁ le of the population served.

Considering the observational nature of the study and the characteristics of the database,

we chose to favor the epidemiological description of the ﬁ ndings, complemented by an interpretation

based on the scientiﬁ c literature on gastroenterological diseases, hospital epidemiology, and organi-

zation of health services.

Ethical aspects

The study used exclusively secondary data from clinical records, preserving the anonymity

of patients and observing the ethical principles provided for in Resolution No. 466/2012 of the Natio-

nal Health Council (BRASIL-MS, 2017).

Results

General characterization of the population

237 medical records of patients treated at the Gastroenterology Service of the Getúlio Vargas

University Hospital between 2019 and 2020 were analyzed.

The study population presented a proﬁ le predominantly composed of adults and the elderly,

reﬂ ecting the high participation of chronic and degenerative diseases in the demand for specialized

services.

Age ranged from 18 to 88 years, with an approximate mean of 62 years. A signiﬁ cant con-

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centration of individuals aged 50 years or older was observed, which corresponded to more than

two-thirds of the sample.

This age pattern demonstrates that the demand for care is strongly related to population

aging and gastroenterological diseases of prolonged evolution (OMRAN, 1971; BRAY et al, 2024;

WHO, 2024).

The aging observed in the population studied follows the epidemiological transition origi-

nally described by Omran (1971) and later expanded by the Global Burden of Disease studies, which

demonstrate a continuous growth in chronic non-communicable diseases in recent decades (WHO,

2024).

The increase in life expectancy has been accompanied by an expanding incidence of chronic

gastrointestinal diseases, including gastroesophageal reﬂ ux disease, atrophic gastritis, liver diseases,

and digestive neoplasms (EL-SERAG, 2014; BRAY et al, 2024; SUNG et al, 2020).

Distribution by sex

There was a slight predominance of males, responsible for approximately 58% of the con-

sultations.

The male predominance observed in this study is consistent with studies carried out in Eu-

rope, Asia, and Latin America, which demonstrate a higher frequency of chronic liver diseases and

portal hypertension among men, particularly in populations exposed to alcoholism and viral hepatitis

(GARCIA-TSAO, BOSCH, 2010; BRAY et al, 2024; WHO, 2024).

Although relatively balanced, this distribution follows the proﬁ le described in national stu-

dies involving chronic liver diseases, portal hypertension, and gastroesophageal complications.

The male predominance probably reﬂ ects greater historical exposure to risk factors, inclu-

ding alcoholism, viral hepatitis, and lower preventive use of health services (GARCIA-TSAO, BOS-

CH, 2010).

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Origin of the patients

The territorial analysis revealed one of the main ﬁ ndings of the study.

Almost all of the patients treated came from municipalities in the interior of Amazonas,

while the participation of residents of the capital was greatly reduced.

This pattern shows that the Getúlio Vargas University Hospital performs the function of a

macro-regional referral center, absorbing patients referred after long care courses.

From the epidemiological perspective, this distribution demonstrates a high concentration of

specialized care in the state capital, a historical characteristic of the organization of the health care

network in the Amazon.

Education

Regarding educational level, there was a predominance of patients with low education.

More than 60% of the population had incomplete primary education, no formal schooling, or

no information not recorded in the medical records.

The reduced participation of individuals with higher education evidences the important so-

cial vulnerability of the population served.

In addition, the high proportion of incomplete records reveals the fragility of hospital infor-

mation systems, an aspect that deserves attention both for research and for service planning.

The low level of education observed in this study should not be interpreted only as a de-

mographic characteristic, but as an important marker of social inequalities that inﬂ uence access to

services, health literacy and therapeutic adherence, as widely discussed by Marmot et al. (2006), Buss

and Pellegrini Filho (2007).

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Clinical proﬁ le

The diagnostic proﬁ le was characterized by the predominance of chronic gastroenterological

diseases.

Gastritis and esophagitis were the most frequent diagnostic group, followed by esophageal

varices and liver cirrhosis.

Ulcerated lesions, gastroesophageal reﬂ ux disease, and a reduced number of digestive neo-

plasms were also identiﬁ ed.

The set of these diagnoses demonstrates that most patients enter the specialized service with

already established diseases, often requiring more complex diagnostic and therapeutic procedures.

Associated comorbidities

Chronic non-communicable diseases represented an important component of the epidemio-

logical proﬁ le observed.

Systemic arterial hypertension was the most frequent comorbidity, followed by diabetes

mellitus, viral hepatitis, and chronic respiratory diseases.

The high simultaneous occurrence of these conditions characterizes a population of high cli-

nical complexity, requiring continuous multidisciplinary follow-up and integration between different

levels of care.

Summary of results

The results show that the population attended at the Gastroenterology Service of the HUGV

has a proﬁ le characterized by:

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• male predominance;

• concentration of individuals over ﬁ fty years of age;

• low education;

• high dependence on municipalities in the interior of Amazonas;

• predominance of chronic gastroenterological diseases;

• high frequency of liver diseases and portal hypertension;

• An important burden of associated chronic non-communicable diseases.

This set of characteristics demonstrates that the service acts predominantly on patients with

a high degree of clinical complexity, coming from territories marked by important limitations in ac-

cess to specialized care.

The results reinforce the literature that demonstrates an association between low problem-

-solving capacity of Primary Care and greater use of tertiary services for potentially diagnosable

conditions in early stages (STARFIELD, 1998; MENDES, 2011; TRAVASSOS, CASTRO, 2024; GIO-

VANELLA et al, 2024; VICTORA et al, 2011).

Traditionally, hospital studies describe only the proﬁ le of the patients treated. However, the

results obtained suggest that hospital epidemiology can be used as an indirect tool to evaluate the or-

ganization of care networks, expanding its analytical potential beyond clinical description.

Discussion

The present study allowed us to characterize the clinical and epidemiological proﬁ le of pa-

tients treated at the Diagnostic Imaging Unit of the Gastroenterology Service of the Getúlio Vargas

University Hospital, evidencing a set of characteristics that go beyond the strictly clinical dimension

and reﬂ ect important demographic, social, and organizational inequalities of the health system in the

Brazilian Amazon.

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The predominance of individuals aged ﬁ fty years or older conﬁ rms the inﬂ uence of the

demographic and epidemiological transition process on the demand for specialized gastroenterology

services (OMRAN, 1971; BRAY et al, 2024; WHO, 2024). Population aging has been accompanied

by an increase in the incidence of chronic gastrointestinal diseases, liver diseases, digestive neoplas-

ms and associated metabolic diseases, a phenomenon observed in several countries and particularly

evident in developing regions. This scenario increases the need for specialized services capable of

performing early diagnosis, continuous monitoring, and timely treatment.

The slight predominance of males observed in this study follows the results described in

national and international investigations involving chronic liver diseases and portal hypertension.

Such distribution may be related to the greater historical exposure of the male population to risk fac-

tors such as alcohol abuse, viral hepatitis, and lower use of preventive health services. However, the

signiﬁ cant participation of women demonstrates that gastroenterological diseases are an important

problem for both sexes, requiring comprehensive preventive strategies.

One of the most relevant ﬁ ndings refers to the socio-educational proﬁ le of the population

studied. The predominance of individuals with low schooling reinforces the importance of social

determinants of health in understanding gastroenterological disease. Schooling represents an impor-

tant indicator of living conditions, directly inﬂ uencing health literacy, early recognition of signs and

symptoms, the ability to navigate care services and adherence to preventive and therapeutic measures

(MARMOT, WILKINSON, 2006; BUSS, PELLEGRINI FILHO, 2007). Thus, the educational vulne-

rability observed probably contributes to the late entry of patients into specialized care.

In addition to the low educational level, the high frequency of incomplete records in the

sociodemographic variables deserves speciﬁ c reﬂ ection. Often interpreted only as a methodological

limitation, the incompleteness of information can also be understood as an indirect indicator of the

fragility of health information systems (ROTHMAN, GREENLAND, LASH, 2008; MINAYO, 2014).

The absence of records compromises care planning, reduces epidemiological monitoring capacity,

and hinders the formulation of evidence-based public policies. Investments in the qualiﬁ cation of

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electronic medical records and in the training of care teams become, therefore, important components

of improving health management.

From a territorial point of view, the results showed a strong concentration of patients from

municipalities in the interior of Amazonas. This pattern conﬁ rms the role of the Getúlio Vargas Uni-

versity Hospital as a macro-regional reference center in gastroenterology and evidences the persistent

centralization of specialized care in the state capital (MENDES, 2011; SANTOS, 2006; BRAZIL-MS,

2010; GIOVANELLA et al, 2024).

Although regionalization is a structuring principle of the Uniﬁ ed Health System, its operatio-

nalization faces signiﬁ cant challenges in the Amazon. The vast territorial extension, the low popula-

tion density, the dependence on river transport and the limitations of the health infrastructure make it

difﬁ cult to offer specialized tests in a decentralized way (SANTOS, 2006; PAHO, 2022; IBGE, 2024).

As a result, many patients travel hundreds of kilometers to reach more complex services, often after

a long care trajectory.

This context contributes to explain the high frequency of diseases in advanced stages obser-

ved in this investigation. The predominance of esophageal varices, liver cirrhosis, chronic gastritis,

and other long-term conditions suggests that a signiﬁ cant portion of patients only access specialized

services when the pathological process is already established. The high frequency of esophageal va-

rices and liver cirrhosis follows the international literature on portal hypertension and chronic liver

diseases (GARCIA-TSAO, BOSCH, 2010). This pattern reinforces the need to strengthen primary

care, expand the problem-solving capacity of secondary care, and progressively decentralize diagnos-

tic methods of greater complexity.

Another important aspect refers to the high burden of associated chronic non-communicable

diseases, especially systemic arterial hypertension and diabetes mellitus. The coexistence of these

diseases characterizes a proﬁ le of multimorbidity that requires an integrated, interdisciplinary and

longitudinal approach. This coexistence of arterial hypertension and diabetes mellitus characterizes

a scenario of multimorbidity typical of the epidemiological transition (OMRAN, 1971; ROSE, 1992).

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The fragmentation of care, still present in several health systems, tends to compromise the effective-

ness of interventions and increase care costs, especially in aging populations.

The results of this study dialogue directly with the literature on the organization of health

care networks. Care models that are strongly hospital-centric, dependent on tertiary services and with

low diagnostic capacity at the primary and secondary levels tend to produce longer care trajectories,

diagnostic delays, greater clinical severity at the time of specialized care and less coordination of

care (STARFIELD, 1998; MENDES, 2011; GIOVANELLA et al, 2024). From this perspective, the

epidemiological proﬁ le observed should not be interpreted exclusively as an expression of the natural

burden of gastroenterological diseases, but also as a consequence of the way in which the care ne-

twork is organized.

This interpretation expands the traditional understanding of epidemiological studies. Instead

of considering only the distribution of diseases, it is possible to analyze how social, territorial, and or-

ganizational characteristics interact to produce different patterns of illness. The integration between

clinical epidemiology, health geography, social determinants and organization of services allows us

to understand the care proﬁ le of the HUGV as a result of a complex system, in which biological fac-

tors coexist with structural conditioning factors and broaden the understanding of the health-disease

process (MARMOT, WILKINSON, 2006; BUSS, PELLEGRINI FILHO, 2007; SANTOS, 2006).

Among the limitations of the study are the use of secondary data, the dependence on the

quality of clinical records, and the impossibility of longitudinally monitoring patients after speciali-

zed care. In addition, the high proportion of missing information in some variables restricts certain

comparative analyses. However, these limitations do not compromise the consistency of the main

ﬁ ndings, since the sample adequately represents the care proﬁ le of the service and was analyzed using

an integrated epidemiological approach.

On the other hand, the study presents important strengths. The use of a database composed

of patients treated at a regional reference university hospital provides a comprehensive view of the

specialized demand for gastroenterology in the Amazon. In addition, the integration between clinical,

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demographic, and territorial variables expands the analytical potential of the investigation and offers

relevant subsidies for the planning of care and for future research in public health.

Finally, the ﬁ ndings reinforce that the epidemiological proﬁ le of patients treated at the Gas-

troenterology Service of the Getúlio Vargas University Hospital is an important indicator of the ine-

qualities that exist in the organization of specialized care in the Amazon Region. More than charac-

terizing a hospital population, this investigation highlights structural challenges related to access,

territorial distribution of services, and the diagnostic capacity of the health system, pointing out ways

to strengthen public policies guided by the principles of equity, integrality, and regionalization of the

SUS.

Conclusion

The patients treated at the Diagnostic Imaging Unit of the Gastroenterology Service of the

Getúlio Vargas University Hospital have a proﬁ le characterized by a predominance of men, indivi-

duals over ﬁ fty years of age, low education, high frequency of chronic gastroenterological diseases,

and a signiﬁ cant burden of associated comorbidities. The concentration of patients from the interior

of Amazonas highlights the strategic role of the hospital as a regional referral center, while revealing

limitations in the territorial distribution of specialized care and timely access to health services.

The results show that the observed proﬁ le reﬂ ects not only the occurrence of gastroentero-

logical diseases, but also the inﬂ uence of structural factors related to socioeconomic conditions, ge-

ographical barriers and the organization of the care network. The high participation of patients from

municipalities in the interior, associated with the predominance of diseases in advanced stages and

the signiﬁ cant burden of multimorbidity, suggests that the care demand of the Getúlio Vargas Univer-

sity Hospital represents the ﬁ nal stage of trajectories marked by social vulnerabilities, difﬁ culties of

access, and organizational limitations of the health system.

In this context, the epidemiological proﬁ le identiﬁ ed goes beyond its merely descriptive di-

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mension and assumes potential as an indirect indicator of the response capacity of the regional health

care network. This interpretation expands the possibilities of using the results both for the planning of

public policies and for the development of analytical models applied to hospital epidemiology, health

service management, and the evaluation of care regionalization.

The ﬁ ndings reinforce the need to strengthen Primary Health Care, expand regional diag-

nostic capacity, qualify health information systems, and develop territorialized strategies capable of

reducing late diagnosis and promoting greater equity in gastroenterological care. In addition, they

show that the confrontation of gastroenterological diseases in the Amazon requires integrated approa-

ches that articulate the social determinants of health, the regionalization of care and the strengthening

of Health Care Networks, as recommended by the national and international literature (MARMOT,

WILKINSON, 2006; BUSS, PELLEGRINI FILHO, 2007; STARFIELD, 1998; MENDES, 2011;

SANTOS, 2006; BRAZIL-MS, 2017; BRAZIL-MS, 2010; PAHO, 2022).

By integrating clinical epidemiology, organization of care, and territorial analysis, this study

contributes to consolidating an interdisciplinary approach capable of broadening the understanding

of gastroenterological diseases beyond their clinical dimension, offering subsidies for the planning,

management, and strengthening of the Uniﬁ ed Health System in contexts marked by high territorial

vulnerability, such as the Brazilian Amazon.

Study contributions

This study contributes to the literature by offering an integrated characterization of the clini-

cal and epidemiological proﬁ le of patients treated at a tertiary gastroenterology service in the Brazi-

lian Amazon. By articulating demographic, clinical, and care variables, it provides evidence capable

of supporting regional health planning, the reorganization of lines of care, and the development of

public policies aimed at reducing territorial inequalities in access to specialized diagnosis.

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Implications for Health Management

The results of this investigation have relevant implications for the planning and organization

of gastroenterological care in the Uniﬁ ed Health System, especially in regions characterized by exten-

sive geographical barriers and high social vulnerability, such as the Brazilian Amazon.

The predominance of patients from municipalities in the interior shows that the current con-

ﬁ guration of the care network remains strongly dependent on the concentration of specialized services

in the capital. Although the Getúlio Vargas University Hospital plays a strategic role as a regional

referral center, the high demand from distant locations suggests limitations in the diagnostic capacity

installed at the primary and secondary levels of care.

In this context, it is necessary to expand the regional offer of diagnostic tests, particularly

digestive endoscopy, specialized ultrasonography, and complementary methods aimed at the early

investigation of the main gastroenterological diseases. The decentralization of these technologies can

reduce the time to diagnosis, minimize prolonged displacements, and favor therapeutic interventions

in less advanced stages of the diseases.

The results also reinforce the importance of the permanent qualiﬁ cation of Primary Health

Care teams. Continuing education strategies aimed at early recognition of gastroenterological war-

ning signs, initial management of chronic liver diseases, and adequate risk stratiﬁ cation can signiﬁ -

cantly increase the problem-solving capacity of local services.

Another priority aspect refers to the strengthening of integration between the different levels

of care. The adoption of regionalized clinical protocols, computerized referral and counter-referral

systems, specialized teleconsulting, and the expansion of Telehealth can reduce the fragmentation of

care currently observed in several Amazonian regions.

Likewise, the high proportion of incomplete information identiﬁ ed in the medical records

evidences the need for investments in the qualiﬁ cation of hospital information systems (ROTHMAN,

GREENLAND, LASH, 2008; TRAVASSOS, CASTRO, 2024). Consistent clinical records are a fun-

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damental element for both care and epidemiological monitoring and the evaluation of public policies.

From the perspective of regional management, the results suggest that the territorial dis-

tribution of diagnostic supply should consider not only population criteria, but also geographical,

logistical, and epidemiological factors characteristic of the Legal Amazon. Homogeneous planning

models tend to reproduce historical inequalities when applied to territories marked by great distances

and mobility limitations.

Finally, this study demonstrates that interventions aimed exclusively at expanding hospital

capacity are likely to be insufﬁ cient to modify the observed care proﬁ le. The reduction of late diagno-

sis depends on a systemic reorganization of the care network, integrating prevention, early diagnosis,

regionalization of care (MENDES, 2011; BRAZIL-MS, 2010) and strengthening of Primary Care

(STARFIELD, 1998; MENDES, 2011; BRAZIL-MS, 2017).

Prospects for Future Research

The results obtained open several possibilities for deepening investigations on gastroentero-

logy and organization of health services in the Amazon.

Longitudinal studies can evaluate the impact of the time elapsed between the onset of symp-

toms, the deﬁ nitive diagnosis and the start of treatment on the clinical outcomes of the main gastro-

enterological diseases.

Another perspective consists of the incorporation of spatial analysis and geoprocessing tech-

niques (SANTOS, 2006; TRAVASSOS, CASTRO, 2024), allowing the identiﬁ cation of priority areas

for expanding the diagnostic offer, building regionalized lines of care, and continuous monitoring of

territorial inequalities in health.

Multicenter investigations involving university hospitals and specialized services in other

Amazonian states may increase the representativeness of the ﬁ ndings and contribute to the construc-

tion of speciﬁ c epidemiological indicators in the Northern region.

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In addition, economic evaluation studies will be able to estimate the ﬁ nancial impact resul-

ting from the late diagnosis of gastroenterological diseases, comparing the care costs related to the

treatment of advanced cases with those resulting from the implementation of early diagnosis strate-

gies and technological decentralization.

Finally, it is recommended the construction and validation of predictive models capable of

integrating clinical, demographic, territorial, and care information for the early identiﬁ cation of po-

pulations at higher risk of unfavorable evolution. Such tools can support health surveillance strategies

and support decision-making processes in the management of the Uniﬁ ed Health System.

Central Message of the Article

The clinical and epidemiological proﬁ le observed in the Gastroenterology Service of the

Getúlio Vargas University Hospital demonstrates that the specialized demand in the Amazon results

from the interaction between population aging, high burden of chronic gastroenterological diseases,

social vulnerabilities and structural limitations of the organization of the care network. More than

characterizing a hospital population, this study shows how territorial and organizational factors in-

ﬂ uence access to diagnosis and the pattern of illness, offering subsidies for the regional planning of

public policies guided by equity and comprehensiveness of care.

Originality and Scientiﬁ c Contribution of the Study

Although descriptive studies on the proﬁ le of hospital patients are relatively frequent in the

literature, the present investigation proposes a different analytical approach by understanding the epi-

demiological proﬁ le as an indirect expression of the organization of the care network.

Traditionally, hospital epidemiological studies have focused on the demographic and clinical

characterization of the populations served. In this investigation, however, these variables are interpre-

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ted in an integrated manner with the territorial, social and organizational determinants of the Uniﬁ ed

Health System, allowing us to understand that the proﬁ le observed does not result exclusively from

the natural distribution of diseases, but also from the ways in which health services are organized.

From this perspective, the high frequency of patients from the interior of Amazonas, asso-

ciated with the predominance of diseases in advanced stages and the high burden of comorbidities,

constitutes indirect evidence of the regional concentration of specialized care, the difﬁ culties in ti-

mely access to diagnostic methods, and the structural limitations of the care network.

This interpretation expands the analytical potential of hospital epidemiology by incorpora-

ting contributions from geoepidemiology, health geography, and the organization of health systems,

bringing together different ﬁ elds of knowledge traditionally analyzed in isolation.

Thus, the present study proposes that the clinical and epidemiological proﬁ le of patients tre-

ated in tertiary hospitals can be understood as a sentinel indicator of the problem-solving capacity of

the regional health care network.

This perspective may contribute to future investigations aimed at evaluating the efﬁ ciency

of care networks, especially in regions characterized by great territorial inequalities, such as the Bra-

zilian Amazon.

Potential Applications of the Results

The results of this investigation have potential for application at different levels of health

planning.

In the context of care, the ﬁ ndings allow the identiﬁ cation of priority population groups for

screening strategies, early diagnosis, and longitudinal follow-up of gastroenterological diseases.

In the ﬁ eld of management, the results support processes of regionalization of care, planning

of the distribution of specialized services and deﬁ nition of criteria for the expansion of diagnostic

infrastructure in areas of greater territorial vulnerability.

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In health surveillance, the indicators identiﬁ ed can contribute to the construction of monito-

ring systems capable of early detection of changes in the epidemiological proﬁ le of gastroenterologi-

cal diseases, supporting timely interventions.

Finally, in the academic ﬁ eld, the study offers a methodological model that can be reprodu-

ced in other Brazilian university hospitals, allowing comparative analyses between different regions

of the country and strengthening scientiﬁ c production in hospital epidemiology and organization of

health services.

Limitations and Strengths

The main limitation of this investigation refers to the use of secondary data from clinical re-

cords, subject to incomplete records and heterogeneity in the completion of information. In addition,

the cross-sectional design makes it impossible to establish causal relationships between the variables

analyzed.

However, these limitations are partially compensated by important methodological stren-

gths. The sample includes all eligible patients treated during the study period, reducing selection

biases. The Getúlio Vargas University Hospital is a macro-regional reference center, allowing the

analyzed population to consistently represent the specialized demand for gastroenterology in the Wes-

tern Amazon.

Another strength lies in the integration between clinical, epidemiological and territorial

analyses, an approach that has not yet been explored in Brazilian hospital studies. This strategy ex-

pands the interpretative capacity of the results and brings the research closer to the concrete needs of

regional health planning.

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