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Background: Early surgical resection is an emerging concept for patients with ileocaecal Crohn's disease (CD). The aim of this study was to compare postoperative outcomes after ileocaecal resections between patients with luminal and complicated CD. Methods: A retrospective analysis of patients operated for ileocaecal CD during an 8-year period in ten tertiary referral academic centres from Latin America was performed. Patients were allocated into 2 groups: those operated for early (luminal) disease (Early Crohn's Disease -ECD-) and for complications of CD (Complicated Crohn's disease -CCD-). A comparative analysis was performed regarding short-term outcomes of surgery, considering overall postoperative complications as main outcome. Results: 337 patients were included in the analysis, 60 (17.80%) in the ECD group. Smoking and exposure to perioperative biologic drugs were more prevalent in CCD group. CCD patients had increased requirement of urgent surgery (26.71 vs. 15%, p = 0.056), longer operative time (164.25 vs. 90.53 min, p< 0.01), lower rates of primary anastomosis (90.23 vs. 100%, p = 0.012), increased rate of overall postoperative complications (33.21 vs. 16.67%, p = 0.013), more reoperations (13.36 vs. 3.33%, p = 0.026), and higher rates of major anastomotic fistulas and hospital stay. On multivariable analysis, smoking (p = 0.001,95%CI: 2.59–32.11), operative time (p = 0.022,95%CI:1–1.02), associated procedures (p = 0.036,95%CI:1.09–15.72) and intraoperative complications (p = 0.021,95%CI:1.45–92.31) were independently related to presenting postoperative complications. Conclusion: Early (luminal) ileocaecal resections were associated to lower rates of overall postoperative complications. Proper timing for surgery, avoiding delays in surgical indication can impact postoperative outcomes.

The food pyramid is a pre-established nutritional education tool. The integration between the intestinal microbiome, food groups, and SCFA-producing bacteria, which benefit from the ingestion of these foods, has the potential to further improve and innovate healthy eating. The diet-microbiome interaction needs to be incorporated into nutrition science, and the food pyramid might assist in this interaction and nutritional learning. Against this context, this brief communication proposes through the food pyramid, the interactions between the intestinal microbiota, food groups, and SCFAs-producing bacteria.

Inflammatory bowel diseases (IBDs) are chronic diseases that demand continuous interaction between patients and healthcare providers. Quality of care (QoC) is a factor that contributes to a patient's adherence to treatment and its success.To evaluate QoC in patients from a single IBD reference center.This cross-sectional study included 133 patients from a single Brazilian IBD public health center. QoC was evaluated through the QoC Through the Eyes of Patients with IBD (QUOTE-IBD) questionnaire (based on patient perspectives), which measures eight dimensions of care. We compared QoC among patients with Crohn's disease and ulcerative colitis and analyzed the clinical and psychological factors associated with QoC satisfaction. Clinical evaluations assessed disease characteristics, quality of life, anxiety, and depression levels.Sixty-nine patients with Crohn's disease and 64 with ulcerative colitis were interviewed. The mean age was 37.26 years ± 13.05 years, and 63.91% of the patients were women. The mean duration of the disease was 8.44 years ± 7.59 years, where most patients were in remission (70.31% of patients with ulcerative colitis and 62.32% with Crohn's disease). The total QoC score of the sample was 8.61 years ± 1.31 points, indicating that the QoC provided by the center was unsatisfactory. According to univariate logistic regression, patients with Crohn's disease had higher satisfaction rates than those with ulcerative colitis [odds ratio (OR): 2.746; 95% confidence interval (CI): 1.360-5.541;Patients from the IBD public center reported good doctor-patient relationships, but had problems related to the healthcare structure. Evaluation of healthcare centers is of paramount to improve QoC for the patients involved.

This is the first study on the epidemiology of inflammatory bowel diseases (IBDs) in Rio Grande do Sul (RS), the southernmost state of Brazil with the country's fifth largest population. Crohn's disease (CD) and ulcerative colitis (UC) are collectively termed IBDs. They have high incidence and prevalence rates in high-income countries, although in recent years there has been a change in the classic geographical distribution of IBDs, with growing rates in traditionally low-incidence regions.To estimate the incidence and prevalence of IBDs in the RS state, Brazil, between 2014 and 2019.This is a cross-sectional descriptive observational study. Patients with IBD who had initiated treatment and met the inclusion criteria of the RS state free drug distribution program were included. Data were obtained from registration or renewal records of the RS state specialty pharmacy. The male, female, and total populations were estimated according to mid-year data from the Brazilian Institute of Geography and Statistics, which served as a reference for calculating the incidence and prevalence rates of IBDs during the study period. Results were described using mean, standard deviation, and range.We included 1082 patients with IBD, of whom 57.5% were female and 42.5% were male. Patients with CD accounted for 72.45% of the sample, and those with UC accounted for 27.54%. IBD prevalence during the study period was 9.51 per 100000 population, of which 6.89 corresponded to people with CD and 2.62, to people with UC. Incidence rates per 100000 population/year were 2.54 in 2014, 2.61 in 2015, 1.91 in 2016, 0.80 in 2017, 0.83 in 2018, and 0.96 in 2019. The mean IBD incidence rate per 100000 population was 1.61, of which 1.17 corresponded to CD and 0.44, to UC. The mean age was 41 years, and patients were mostly aged 30-40 years. Prevalence by region was higher in the state capital metropolitan area: 12.69 per 100000 population.Our results demonstrated an IBD prevalence of 9.51% and incidence of 1.61 per 100000 population. The patients were predominantly female, and CD was more prevalent than UC.

Made available in DSpace on 2022-04-29T08:30:08Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Background and aims: The role of thiopurines in therapeutic algorithms of Crohn's disease (CD) and Ulcerative colitis (UC) is being questioned. This work aimed to investigate current practice and future perspectives of Inflammatory Bowel Disease (IBD) physicians regarding the efficacy, safety, and role of precision medicine with thiopurines in IBD. Methods: A 29-questions web-based survey was developed and distributed to IBD physicians worldwide. Results: We collected the complete answers of 408 physicians from 50 countries. Most participants were experienced physicians in IBD; 26.0% met our definition of “IBD expert”. Four physicians reported to not use thiopurines in clinical practice. Most respondents used thiopurines in monotherapy and in combination therapy, both in CD and UC. Respondents tended to consider thiopurines as drugs with a good safety profile, with the agreement of 61.5% of the overall cohort. A minority of physicians (~6%) considered that thiopurines will not be used in the future in IBD patients, while 57.8% believed that these drugs will still be used, in mono and combination therapy. Conclusion: Despite the many emerging treatments in IBD, according to the beliefs of most physicians surveyed, thiopurines will still be an important part of the treatment algorithm of both CD and UC. Department of Gastroenterology Viseu Unit Tondela-Viseu Hospital Centre IBD Center Fondazione Policlinico Universitario A. Gemelli IRCCS Universita Cattolica Department of Medicine I Agaplesion Markus Hospital Goethe-University Department of Gastroenterology Oslo University Hospital IBD Unit Department of Gastroenterology Hospital Clínico Universitario de Santiago de Compostela Division of Gastroenterology and Hepatology University Hospital Department of Internal Medicine São Paulo State University (Unesp) Medical School Colorectal Surgery Unit IBD outpatient clinics Catholic University of Paraná (PUCPR) Department of Gastroenterology and Inserm NGERE U1256 University Hospital of Nancy University of Lorraine Department of Biomedicine Unit of Pharmacology and Therapeutics University of Porto Department of Gastroenterology São João University Hospital MedInUP Centre for Drug Discovery and Innovative Medicines Department of Internal Medicine São Paulo State University (Unesp) Medical School

Made available in DSpace on 2022-05-01T09:31:07Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Cutaneous involvement is one of the most common extraintestinal manifestations of inflammatory bowel disease (IBD). More commonly, pyoderma gangrenosum and erythema nodosum are noted, but psoriasis, aphthous stomatitis, Sweet's syndrome, and vasculitis may also occur. Leukocytoclastic vasculitis (LCV) is a rare cutaneous manifestation, characterized by the appearance of palpable purpura, urticaria, and ulcer-necrotic lesions predominantly in the lower extremities that improve with immunosuppressive therapy. In this case, we report a patient with CD and LCV. We also searched the literature on the diagnosis and treatment of LCV in patients with CD. Female, 31, presented with diarrhea containing mucus and blood, abdominal pain, arthralgia, and enanthematous plaques and ulcers with a hematinic background in the lower extremities. The results of the colonoscopy were compatible with CD and skin biopsy showed signs of LCV. Systemic autoimmune disease and primary vasculitis were ruled out. The patient received treatment with a systemic corticosteroid and the skin lesions improved. Outpatient treatment with antitumor necrosis factor therapy was initiated to promote skin healing and IBD clinical remission. As LCV is a rare manifestation of IBD, it is necessary to distinguish this dermatopathy from other systemic vasculitis. The engagement of a multidisciplinary team is essential for the correct diagnosis and management. São Paulo State University (Unesp) Medical School Clinica Universidad de Los Andes São Paulo State University (Unesp) Medical School

Made available in DSpace on 2021-06-25T15:03:40Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-05-06 BACKGROUND Acute severe ulcerative colitis (ASUC) is a complication of ulcerative colitis associated with high levels of circulating tumor necrosis factor alpha, due to the intense inflammation and faster stool clearance of anti-tumor necrosis factor drugs. Dose-intensified infliximab treatment can be beneficial and is associated with lower rates of colectomy. The aim of the study was to present a case of a patient with ASUC and megacolon, treated with hydrocortisone and accelerated scheme of infliximab that was monitored by drug trough level. CASE SUMMARY A 22-year-old female patient diagnosed with ulcerative colitis, presented with diarrhea, rectal bleeding, abdominal pain, vomiting, and distended abdomen. During investigation, a positive toxin for Clostridium difficile and colonic dilatation of 7 cm consistent with megacolon were observed. She was treated with oral vancomycin for pseudomembranous colitis and intravenous hydrocortisone for severe colitis, which led to the resolution of megacolon. Due to the persistent severe colitis symptoms, infliximab 5 mg/kg was prescribed, monitored by drug trough level (8.8 mu g/mL) and fecal calprotectin of 921 mu g/g (< 30 mu g/g). Based on the low infliximab trough level after one week from the first infliximab dose, the patient received a second infusion at week 1, consistent with the accelerated regimen (infusions at weeks 0, 1, 2 and 6). We achieved a positive clinical and endoscopic response after 6 mo of therapy, without the need for a colectomy. CONCLUSION Infliximab accelerated infusions can be beneficial in ASUC unresponsive to the treatment with intravenous corticosteroids. Longitudinal studies are necessary to define the best therapeutic drug monitoring and treatment regimen for these patients. Sao Paulo State Univ Unesp, Med Sch, Dept Internal Med, Av Prof Mario Rubens Guimaraes Montenegro S-N, BR-18618687 Botucatu, SP, Brazil Clin Univ Los Andes, Med Dept, Gastroenterol, Inflammatory Bowel Dis Program, Santiago 7550000, Chile Sao Paulo State Univ Unesp, Med Sch, Dept Internal Med, Av Prof Mario Rubens Guimaraes Montenegro S-N, BR-18618687 Botucatu, SP, Brazil

Made available in DSpace on 2021-06-25T11:14:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-03-28 BACKGROUND Coronavirus disease 2019 (COVID-19) pandemic is still evolving globally, and Brazil is currently one of the most affected countries. It is still debated whether patients with inflammatory bowel disease (IBD) are at a higher risk for developing COVID-19 or its complications. AIM To assess geographical distribution of IBD patients at the highest risk and correlate these data with COVID-19 mortality rates in Brazil. METHODS The Brazilian IBD Study Group (Grupo de Estudos da Doença Inflamatória Intestinal do Brasil) developed a web-based survey adapted from the British Society of Gastroenterology guidelines. The included categories were demographic data and inquiries related to risk factors for complications from COVID-19. Patients were categorized as highest, moderate or lowest individual risk. The Spearman correlation test was used to identify any association between highest risk and mortality rates for each state of the country. RESULTS A total of 3568 patients (65.3% females) were included. Most participants were from the southeastern and southern regions of Brazil, and 84.1% were using immunomodulators and/or biologics. Most patients (55.1%) were at moderate risk, 23.4% were at highest risk and 21.5% were at lowest risk of COVID-19 complications. No association between the proportion of IBD patients at highest risk for COVID-19 complications and higher mortality rates was identified in different Brazilian states (r = 0.146, P = 0.467). CONCLUSION This study indicates a distinct geographical distribution of IBD patients at highest risk for COVID-19 complications in different states of the country, which may reflect contrasting socioeconomic, educational and healthcare aspects. No association between high risk of IBD and COVID-related mortality rates was identified. Department of Gastroenterology University of São Paulo School of Medicine IBD Unit Gastroenterology Department Gastrosaúde Clinic School of Medicine Federal University of Bahia IBD Outpatient Clinics Universidade Federal de Juiz de Fora Health Sciences Postgraduate Program Pontifícia Universidade Católica do Paraná (PUCPR) Departamento de Ciências da Saúde Universidade do Oeste de Santa Catarina (UNOESC) Botucatu Medical School Paulista State University (UNESP) IBD Outpatient Clinics Pontificia Universidade Católica do Paraná (PUCPR) Botucatu Medical School Paulista State University (UNESP)

Background: Physicians must acquire the necessary skills to provide Inflammatory Bowel Disease (IBD) patients with state-of-the-art clinical care, aiming to improve patient’s quality of life and disease outcomes. Purpose: To describe the queries and experiences of doctors enrolled in an IBD education course and to evaluate the impact of the course. Methods: A retrospective study included 100 physicians, of which 78 attended the course. A questionnaire was applied evaluating how the course had an impact on their IBD-knowledge. The 20-hour-course consisted of practical “real-life” activities and theoretical discussions. Results: The majority of doctors’ expertise was in gastroenterology (53%) and coloproctology (44%). A significant portion had no experience with biological therapy for ulcerative colitis (19.4%) or Crohn’s disease (5.05%). The main topics doctors wanted to discuss were biological therapy (93%), new drugs (74%) and differential diagnosis (64%). A considerable number of physicians did not feel confident at prescribing biological therapy before the course (44.4%), a percentage that decreased to 8.5% after the course (p Discussion: The ideal course should have a practical and theoretical component, as well as the support of an experienced multidisciplinary team. A real-life practical-theoretical IBD course proved a success at increasing IBD knowledge.

Background: Inflammatory Bowel Disease is a term that covers intestinal diseases, including ulcerative colitis and Crohn’s disease. Due to the condition of chronic and complex disease, the disease requires specialized nursing care and management in the context of a multi-disciplinary approach. As a guarantee of quality nursing care, it is essential to carry out the nursing process. Considering the commitment to assist the patient with Crohn’s disease, the nurse, through the nursing consultation, is able to diagnose the patient’s needs, proceed to the prescription of care and later evaluate the interventions, having the opportunity to develop work aimed at improving the quality of life of these patients. Objective: To describe the nursing process in a patient with Crohn’s disease. Methods: Exploratory case report study, carried out at the outpatient clinic for inflammatory bowel diseases of a public hospital in the countryside of the state of Sao Paulo, from June 2019 to October 2019. Data collection was performed through anamnesis, physical examination and analysis of medical records. Results: Female patient, 34 years old, diagnosed with Crohn’s disease. With the completion of the nursing process, it was possible to identify five nursing diagnoses and the elaboration of interventions and outcomes. The nursing evaluation was continuous and the patient adhered to the proposed interventions. Final considerations: The systematization and organization of the work of the nursing team proved to be essential for quality care, with efficiency and effectiveness, guaranteeing the patient comfort, general well-being and good rehabilitation.

BACKGROUND: Inflammatory bowel diseases (IBD) are chronic inflammatory affections of recurrent nature whose incidence and prevalence rates have increased, including in Brazil. In long term, they are responsible for structural damage that impacts quality of life, morbidity and mortality of patients. OBJECTIVE: To describe the profile of physicians who treat IBD patients as well as the characteristics of IBD care, unmet demands and difficulties. METHODS: A questionnaire containing 17 items was prepared and sent to 286 physicians from 101 Brazilian cities across 21 states and the Federal District, selected from the register of the State Commission of the “Study Group of Inflammatory Bowel Disease of Brazil” (GEDIIB). RESULTS: The majority of the physicians who answered the questionnaire were gastroenterologists and colorectal surgeons. More than 60% had up to 20 years of experience in the specialty and 53.14% worked at three or more locations. Difficulties in accessing or releasing medicines were evident in this questionnaire, as was referrals to allied healthy professionals working in IBD-related fields. More than 75% of physicians reported difficulties in performing double-balloon enteroscopy and capsule endoscopy, and 67.8% reported difficulties in measuring calprotectin. With regard to the number of patients seen by each physician, it was shown that patients do not concentrate under the responsibility of few doctors. Infliximab and adalimumab were the most commonly used biological medicines and there was a higher prescription of 5-ASA derivatives for ulcerative colitis than for Crohn’s disease. Steroids were prescribed to a smaller proportion of patients in both diseases. The topics “biological therapy failure” and “new drugs” were reported as those with higher priority for discussion in medical congresses. In relation to possible differences among the country’s regions, physicians from the North region reported greater difficulty in accessing complementary exams while those from the Northeast region indicated greater difficulty in accessing or releasing medicines. CONCLUSION: The data obtained through this study demonstrate the profile of specialized medical care in IBD and are a useful tool for the implementation of government policies and for the Brazilian society as a whole.

Giovana Signorelli Astolfi Cury,1 Debora Mayumi Takamune,1 Giedre Soares Prates Herrerias,1 Adriana Rivera-Sequeiros,2 Jaqueline Ribeiro de Barros,1 Julio Pinheiro Baima,1 Rogerio Saad-Hossne,1 Ligia Yukie Sassaki1 1São Paulo State University (Unesp), Medical School, Botucatu, Brazil; 2Department of Internal Medicine, San Juan de Dios del Aljarafe Hospital, Seville, SpainCorrespondence: Giovana Signorelli Astolfi Cury, Tel +5514 38801171, Fax +55 14 38801667, Email curygigi@gmail.comBackground: Inflammatory bowel diseases are chronic conditions characterized by incapacitating symptoms, which can compromise patient’s quality of life and social interaction. As social media use is continuously increasing and Facebook is one of the most accessed social media worldwide, this study aimed to evaluate the use of Facebook and identify clinical and psychological factors associated with addiction and compensatory use among patients.Methods: This case-control study enrolled 100 outpatients and 100 healthy individuals, who were classified into the patient and control groups, respectively. Facebook use was evaluated using the questionnaire Psycho-Social Aspects of Facebook Use (PSAFU). The IBD Questionnaire and the 36-Item Short-Form Health Survey (SF-36) were used to measure Health-related quality of life. Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale; self-esteem, using the Rosenberg Self-Esteem scale.Results: The patient group included 54 patients with Crohn’s disease and 46 with ulcerative colitis. Facebook use was similar between the patient and control groups in all evaluated aspects (p=0.21). In the patient and the control groups, the compensatory use of Facebook was directly related to the symptoms of depression (patients: R = 0.22; p = 0.03; controls: R = 0.34; p = 0.0006) and inversely related to self-esteem scale (patients: R = − 0.27; p = 0.006; controls: R = − 0.37; p = 0.0001). Facebook addiction showed an inverse correlation with self-esteem (patients: R = − 0.32; p = 0.001; controls: R = − 0.24; p = 0.02) and quality of life (patients: IBDQ score, R = − 0.30; p = 0.003; controls: SF-36 score, R = − 0.29; p = 0.004).Conclusion: The use of Facebook was not different between study groups. Psychological aspects such as depression and low self-esteem were associated with the compensatory use of Facebook in both groups, which may be related to unsatisfactory personal aspects of social interaction.Keywords: Facebook, addiction, compensatory use, inflammatory bowel disease

Background Hidradenitis suppurativa is a chronic inflammatory skin disorder associated with inflammatory bowel disease. However, it can arise as a paradoxical side effect of anti-TNF treatment. Methods The article reports on three patients with Crohn's disease who developed hidradenitis suppurativa during the treatment with adalimumab. Results Case 1: A 38-year-old female exhibited an infiltrative lesion in the inguinal region and vulva, consistent with hidradenitis suppurativa, after three months of adalimumab. These lesions were treated with partial vulvectomy. Case 2: After adalimumab treatment, a 27-year-old female, originally diagnosed with ileocolonic Crohn's disease, went into clinical and endoscopic remission. The patient eventually presented two hyperchromic nodules in the inguinal region, which were diagnosed as hidradenitis suppurativa. The patient showed improvement after treatment with oral doxycycline and local therapy. Case 3: A 34-year-old female with fistulizing and stenosing ileocolonic Crohn's disease, started adalimumab in 2010, with optimization in 2015. One year after, the patient developed bilateral, erythematous, hardened, inguinal nodulations with purulent drainage, consistent with hidradenitis suppurativa. Treatment with oral doxycycline, fusidic acid, and infiltration with triamcinolone resulted in partial improvement of the lesions. In 2018, the lesions deteriorate. The patient underwent surgical treatment. Conclusion Patients with inflammatory bowel disease are more likely to the development of other mediated inflammatory diseases, such as hidradenitis suppurativa. Hidradenitis suppurativa may appear as a paradoxical reaction to anti-TNF therapy. Clinical teams must be aware of this type of complication. Early diagnosis and treatment are essential for controlling the disease and preventing the onset of complications.

Background: The inflammatory bowel disease nurse plays a key role in the multidisciplinary team. The aim of the study was to evaluate the inflammatory bowel disease knowledge before and after the educational intervention with nurses. Methods: A cross-sectional, descriptive and comparative study was performed from June to August 2016. The sample consisted of 26 nurses from the nursing staff of a public university hospital in Sao Paulo State, Brazil. The study was divided into three phases: pre-educational intervention, educational intervention and post-educational intervention (test application). A p-value < 0.05 was considered to indicate statistically significance. Results: The study included 26 general nurses with an average of 9.20 ± 5.78 years of experience. There was an increase in safety in administering biological therapy after the course (from 33.34% to 78.26%), and an increase in knowledge about the main inflammatory bowel disease symptoms (64.29% vs 96.30%, p = 0.0224), and about infliximab infusion (35.71% vs 74.07%, p = 0.0404). Conclusion: The educational intervention effectively contributed to the increase of knowledge of the nursing staff.

Made available in DSpace on 2022-04-29T08:37:18Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-11-26 Background Anti-tumor necrosis factor agents were the first biologic therapy approved for the management of Crohn's disease (CD). Heart failure (HF) is a rare but potential adverse effect of these medications. The objective of this report is to describe a patient with CD who developed HF after the use of infliximab. Case Summary A 50-year-old woman with a history of hypertension and diabetes presented with abdominal pain, diarrhea, and weight loss. Colonoscopy and enterotomography showed ulcerations, areas of stenosis and dilation in the terminal ileum, and thickening of the intestinal wall. The patient underwent ileocolectomy and the surgical specimen confirmed the diagnosis of stenosing CD. The patient started infliximab and azathioprine treatment to prevent post-surgical recurrence. At 6 mo after initiating infliximab therapy, the patient complained of dyspnea, orthopnea, and paroxysmal nocturnal dyspnea that gradually worsened. Echocardiography revealed biventricular dysfunction, moderate cardiac insufficiency, an ejection fraction of 36%, and moderate pericardial effusion, consistent with HF. The cardiac disease was considered an infliximab adverse effect and the drug was discontinued. The patient received treatment with diuretics for HF and showed improvement of symptoms and cardiac function. Currently, the patient is using Conclusion This reported case supports the need to investigate risk factors for HF in inflammatory bowel disease patients and to consider the risk-benefit of introducing infliximab therapy in such patients presenting with HF risk factors. Department of Internal Medicine São Paulo State University (Unesp) Medical School Department of Pathology São Paulo State University (Unesp) Medical School Inflammatory Bowel Disease Program Digestive Disease Center ClínicaUniversidad de los Andes Department of Internal Medicine São Paulo State University (Unesp) Medical School Department of Pathology São Paulo State University (Unesp) Medical School

BACKGROUND: Crohn’s disease (CD) is an inflammatory bowel disease characterized by a chronic and recurrent inflammation of the gastrointestinal tract caused by an interaction of genetic and environmental factors. OBJECTIVE: To compare the quality and acceptance of two different oral contrast volumes for computed tomography enterography in Crohn’s disease patients. METHODS: A cross-sectional study was conducted in 58 consecutive Crohn’s disease patients who randomly received an oral contrast agent composed of 78.75 g polyethylene glycol diluted in either 1,000 mL or 2,000 mL of water. An examination was performed to evaluate the presence of inflammation or complications in the small bowel. The variables included the quality of intestinal segment filling and luminal distension, and oral contrast agent acceptance and tolerance in the patients. Statistical analysis included descriptive statistics and association tests. RESULTS: A total of 58 patients were assessed, in which 58.6% were female, 34.5% exhibited clinically-active disease, and 63.8% were receiving biologic therapy. As for comparative analysis between the two different volumes of oral contrast, no statistically significant difference was found regarding bowel loop filling (P=0.58) and adequate luminal distension (P=0.45). Patients who received a larger volume (2,000 mL) exhibited side-effects more frequently (51.7% vs 31.0%; P=0.06) and had greater difficulty ingesting the agent (65.5% vs 37.9%; P=0.07) compared with a volume of 1,000 mL. CONCLUSION: The quality of computed tomography enterography was not influenced by the contrast volume. However, acceptance and tolerance were better in the 1,000 mL group. RESUMO CONTEXTO: A doença de Crohn (DC) é uma doença inflamatória intestinal caracterizada por uma inflamação crônica e recorrente do trato gastrointestinal causada por uma interação de fatores genéticos e ambientais. OBJETIVO: Comparar a qualidade e aceitação de dois volumes diferentes de contraste oral para enterografia por tomografia computadorizada em pacientes com doença de Crohn. MÉTODOS: Um estudo transversal foi conduzido em 58 pacientes com doença de Crohn que receberam aleatoriamente um agente de contraste oral composto por 78,75 g de polietilenoglicol diluído em 1.000 mL ou 2.000 mL de água. Um exame foi realizado para avaliar a presença de inflamação ou complicações no intestino delgado. As variáveis incluíram a qualidade do preenchimento do segmento intestinal e distensão luminal e aceitação e tolerância do contraste oral nos pacientes. A análise estatística incluiu estatística descritiva e testes de associação. RESULTADOS: Foram avaliados 58 pacientes, dos quais 58,6% eram mulheres, 34,5% apresentavam doença clinicamente ativa e 63,8% estavam recebendo terapia biológica. Quanto à análise comparativa entre os dois diferentes volumes de contraste oral, não foi encontrada diferença estatisticamente significativa em relação ao enchimento da alça intestinal (P=0,58) e distensão luminal adequada (P=0,45). Pacientes que receberam um volume maior (2.000 mL) exibiram efeitos colaterais com mais frequência (51,7% vs 31,0%; P=0,06) e tiveram maior dificuldade para ingerir o agente (65,5% vs 37,9%; P=0,07) em comparação com um volume de 1.000 mL. CONCLUSÃO: A qualidade da entero-tomografia computadorizada não foi influenciada pelo volume de contraste. No entanto, aceitação e tolerância foram melhores no grupo de 1.000 mL.

Made available in DSpace on 2022-04-29T08:33:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Background: Challenging differential diagnosis Adalimumab is a biological anti-tumor necrosis factor (TNF) agent which induces and maintains remission in patients with moderate-to-severe Crohn disease (CD). An adverse effect of its use is reactivation of latent in-fections, such as tuberculosis (TB). TB is caused by Mycobacterium tuberculosis and continues to be an impor-tant public health problem in some developing countries, such as Brazil. The present report describes the case of a patient with CD who developed pulmonary TB while receiving adalimumab therapy. A 38-year-old penitentiary worker presented with colonic CD that was intolerant to azathioprine and was started on adalimumab. After 3 months, he experienced coughing, fever, and weight loss, and was diagnosed with pulmonary TB. A chest X-ray and tuberculin skin test performed before he started taking adalimumab were negative for latent TB. The patient was treated for 9 months to cure his infection. The use of adalimumab was suspended while the TB was investigated and he took mesalazine to achieve clinical and endoscopic remission of CD. Adequate screening and chemoprophylaxis for latent TB are indicated in patients at high risk of infection. In patients with inflammatory bowel disease, after anti-TNF therapy is started, strict monitoring is required so that opportunistic infections can be detected early and morbidity and mortality reduced in this population. Department of Internal Medicine São Paulo State University (UNESP) Medical School Department of Radiology São Paulo State University (UNESP) Medical School Department of Surgery São Paulo State University (UNESP) Medical School Department of Internal Medicine São Paulo State University (UNESP) Medical School Department of Radiology São Paulo State University (UNESP) Medical School Department of Surgery São Paulo State University (UNESP) Medical School

Background: : Biological therapy with anti-Tumour Necrosis Factor (TNF)-α agents revolutionised the treatment of inflammatory bowel disease over the last decades. However, there may be an increased risk of postoperative complications in Crohn’s disease (CD) patients treated with anti-TNF-α agents prior to abdominal surgery. Objective:: To evaluate the effects of preoperative anti-TNF-α therapy on the incidence of complications after surgery. Methods: : A critical assessment of the results of clinical trial outcomes and meta-analyses on the available data was conducted. Results: : Based on the outcomes of previous reports including meta-analyses, preoperative use of anti- TNF-α agents modestly increased the risk of overall complications and particularly infectious complications after abdominal surgery for CD. Nevertheless, previous studies have several limitations. The majority of them were retrospective research with heterogeneous outcome measures and single centre trials with relatively small sample size. In retrospective studies, the standard protocol for assessing various types of postoperative complications was not used. The most serious limitation of the previous studies was that multiple confounding factors such as malnutrition, use of corticosteroids, and preoperative sepsis were not taken into consideration. Conclusion:: Among patients treated with preoperative anti-TNF-α therapy, the risk of overall complications and infectious complications may slightly increase after abdominal surgery for CD. Nevertheless, the previous reports reviewed in this study suffered from limitations. To rigorously evaluate the risk of anti-TNF-α therapy prior to surgery, large prospective studies with standardised criteria for assessing surgical complications and with proper adjustment for confounding variables are warranted.

Made available in DSpace on 2019-10-06T16:17:06Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-02-01 Studies comparing gut microbiota profiles of inflammatory bowel disease (IBD) patients have shown several changes in microbiota composition, with marked reduction of local biodiversity relative to that of healthy controls. Modulation of the bacterial community is a promising strategy to reduce the proportion of harmful microorganisms and increase the proportion of beneficial bacteria; this is expected to prevent or treat IBD. The exact mechanism of fecal microbiota transplantation (FMT) remains unknown; however, replacing the host microbiota can reestablish gut microbial composition and function in IBD patients. The present report describes an ulcerative colitis patient who underwent FMT. A 17-year-old male with moderate to severe clinical activity, which was refractory to mesalazine, azathioprine, and infliximab, underwent FMT as alternative therapy. The patient exhibited clinical improvement after the procedure; however, the symptoms returned. A second FMT was performed 8 months after the first procedure, but the patient did not improve. In conclusion, despite the FMT failure observed in this patient, the procedure is a promising therapeutic option for IBD patients, and more in-depth studies of this method are needed. Department of Internal Medicine São Paulo State University (Unesp) Medical School Department of Surgery São Paulo State University (Unesp) Medical School Department of Microbiology and Immunology São Paulo State University (Unesp) Institute of Biosciences Department of Internal Medicine São Paulo State University (Unesp) Medical School Department of Surgery São Paulo State University (Unesp) Medical School Department of Microbiology and Immunology São Paulo State University (Unesp) Institute of Biosciences

Made available in DSpace on 2019-10-06T16:02:07Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-09-01 Inflammatory bowel disease (IBD) affects young people of reproductive age. Therefore, a broad discussion is needed about the possible disease effects in pregnancy, as well as the risks of fetal exposure to the medications used, especially biological therapy. This study aimed to describe the management of 4 Crohn's disease patients who received anti-TNF therapy during pregnancy and present a literature review. We reported 4 cases composed of young women who became pregnant while receiving anti-TNF agents. The patients presented a satisfactory response to the clinical treatment and the pregnancies progressed without complications. We did not observe maternal or embryonic toxicity, or unfavorable outcomes. The available data point to inflammatory activity as the main risk factor for unfavorable gestational evolution to date, and showed anti-TNF therapy to be safe during pregnancy and breastfeeding. However, the benefits and risks must be discussed with the patient and management decisions should be taken on an individual basis. Medical School Department of Internal Medicine São Paulo State University (UNESP), Av. Prof. Mario Rubens Guimaraes Montenegro, s/n Medical School Department of Surgery São Paulo State University (UNESP) Medical School Department of Internal Medicine São Paulo State University (UNESP), Av. Prof. Mario Rubens Guimaraes Montenegro, s/n Medical School Department of Surgery São Paulo State University (UNESP)

Background: With the paradigm shift related to the overspread use of biological agents in the treatment of inflammatory bowel diseases (IBD), several questions emerged from the surgical perspective. Whether the use of biologicals would be associated with higher rates of postoperative complications in ulcerative colitis (UC) patients still remains controversial. Aims: We aimed to analyze the literature, searching for studies that correlated postoperative complications and preoperative exposure to biologics in UC patients, and synthesize these data qualitatively in order to check the possible impact of biologics on postoperative surgical morbidity in this population. Methods: Included studies were identified by electronic search in the PUBMED database according to the PRISMA (Preferred Items of Reports for Systematic Reviews and Meta-Analysis) guidelines. The quality and bias assessments were performed by MINORS (methodological index for non-randomized studies) criteria for non-randomized studies. Results: 608 studies were initially identified, 22 of which were selected for qualitative evaluation. From those, 19 studies (17 retrospective and two prospective) included preoperative anti-TNF. Seven described an increased risk of postoperative complications, and 12 showed no significant increase postoperative morbidity. Only three studies included surgical UC patients with previous use of vedolizumab, two retrospective and one prospective, all with no significant correlation between the drug and an increase in postoperative complication rates. Conclusions: Despite conflicting results, most studies have not shown increased complication rates after abdominal surgical procedures in patients with UC with preoperative exposure to biologics. Further prospective studies are needed to better establish the impact of preoperative biologics and surgical complications in UC.

Made available in DSpace on 2021-06-25T10:51:56Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-14 BACKGROUND Understanding the treatment landscape of inflammatory bowel diseases (IBD) is essential for improving disease management and patient outcomes. Brazil is the largest Latin American country, and it presents socioeconomic and health care differences across its geographical regions. This country has the highest increase in IBD incidence and prevalence in Latin America, but information about the clinical and treatment characteristics of IBD is scarce. AIM To describe the sociodemographic, clinical, and treatment characteristics of IBD outpatients in Brazil overall and in the Southeast, South and Northeast/Midwest regions. METHODS Multicenter, cross-sectional study with a 3-year retrospective chart review component. Patients with moderate-to-severe Crohn's disease (CD) or ulcerative colitis (UC) were consecutively enrolled between October 2016 and February 2017. Active CD at enrollment was defined as a Harvey Bradshaw Index ≥ 8 or a CD Activity Index ≥ 220 or a calprotectin level > 200 μg/g or an active result based on colonoscopy suggestive of inadequate control during the previous year; active UC was defined as a partial Mayo score ≥ 5. Descriptive statistics were used to analyze all variables. RESULTS In a total of 407 included patients, CD was more frequent than UC, both overall (264 CD/143 UC patients) and by region (CD:UC ratios of 2.1 in the Southeast, 1.6 in the South and 1.2 in the Northeast/Midwest). The majority of patients were female (54.2% of CD; 56.6% of UC), and the mean ages were 45.9 ± 13.8 years (CD) and 42.9 ± 13.0 years (UC). The median disease duration was 10.0 (range: 0.5-45) years for both IBD types. At enrollment, 44.7% [95% confidence interval (CI): 38.7-50.7] of CD patients and 25.2% (95%CI: 18.1-32.3) of UC patients presented with active disease. More than 95% of IBD patients were receiving treatment at enrollment; CD patients were commonly treated with biologics (71.6%) and immunosuppressors (67.4%), and UC patients were commonly treated with mesalazine [5-Aminosalicylic acid (5-ASA)] derivates (69.9%) and immunosuppressors (44.1%). More than 50% of the CD patients had ileocolonic disease, and 41.7% presented with stricturing disease. One-quarter of CD patients had undergone CD-related surgery in the past 3 years, and this proportion was lower in the Northeast/Midwest region (2.9%). CONCLUSION In Brazil, there are regional variations in IBD management. CD outweighs UC in both frequency and disease activity. However, one-quarter of UC patients have active disease, and most are receiving 5-ASA treatment. Department of Internal Medicine Federal University of Rio de Janeiro Department of Surgery and Anatomy Ribeirão Preto Medical School University of São Paulo Department of Internal Medicine São Paulo State University (UNESP) Medical School IBD Unit Federal University of Bahia Department of Clinical Medicine Medical School Universidade Federal de Minas Gerais Department of Gastroenterology Escola Paulista de Medicina Hospital de Clinicas Universidade Federal do Parana Department of Proctology Beneficencia Portuguesa Hospital Kaiser Day Hospital Department of Gastroenterology and Hepatology Sciences Hospital de Clínicas Universidade Federal do Rio Grande do Sul Department of Gastroenterology Faculdade de Medicina do ABC Department of General Medicine Gastroenterology Unit University Hospital Federal University of Piaui Department of Gastroenterology Faculdade de Medicina Universidade Federal de Goiás Department of Surgery Botucatu Medical School São Paulo State University (UNESP) Department of Gastroenterology UNIFESP IBD Unit Gastroenterology Department Hospital Nossa Senhora das Graças Department of Proctology Kaiser Hospital Dia Health Sciences Center Epidemiology Unit State University of Piaui Department of Gastroenterology CMIP Centro Mineiro de Pesquisa Scientific Affairs Takeda Pharmaceuticals Brazil Clinical Research Takeda Pharmaceuticals Brazil Department of Medicine University Hospital of Federal University of Juiz de Fora Department of Internal Medicine São Paulo State University (UNESP) Medical School Department of Surgery Botucatu Medical School São Paulo State University (UNESP)

Made available in DSpace on 2021-06-25T10:56:26Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Objective: Background: Case Report: Conclusions: Rare disease Hemangiomas are benign vascular neoplasms that originate from fast-growing embryonic mesodermal tissue and have a proliferation of endothelial cells, which manifest themselves in different forms, locations, and di-mensions. Owing to its rarity and similarity of symptoms with other chronic bowel diseases, intestinal hem-angioma is a differential diagnosis to be considered in patients presenting with symptoms such as abdominal pain and anemia. A 46-year-old woman with a history of diffuse abdominal pain and abdominal distension for 20 years presented with a worsening of symptoms in the past year. She denied weight loss or changes in bowel habits or stool appearance. Laboratory investigations showed microcytic hypochromic anemia. Colonoscopy results were nor-mal. A contrast-enhanced abdominal computed tomography scan showed focal and concentric thickening of the small intestine, measuring 8.3 cm, and associated with calcifications, intestinal dilation, mesenteric lymph node enlargement, and vascular dilatation and consistent with infectious granulomatous diseases such as intestinal tuberculosis, carcinoid tumor, Crohn’s disease, and lymphoma. The tuberculin skin test resulted in a strong 25-mm reaction. We suspected intestinal tuberculosis or expansive injury, and the patient underwent exploratory laparotomy with visualization of a 4-to 5-cm bluish/blackish vegetating lesion located 220 cm from the Treitz angle. The anatomopathological study showed cavernous hemangioma of the small intestine, measuring 2.6×1.0 cm. The patient recovered well and remained asymptomatic. Although rare, intestinal hemangioma should be on the list of differential diagnoses for chronic intestinal dis-eases, especially if there is anemia due to coexisting iron deficiency. Department of Internal Medicine São Paulo State University (Unesp) Medical School Department of Gastroenterology Clinica Universidad de los Andes Department of Surgery Medicine São Paulo State University (Unesp) Medical School Department of Internal Medicine São Paulo State University (Unesp) Medical School Department of Surgery Medicine São Paulo State University (Unesp) Medical School