Calidad de vida relacionada con la salud por IBDQ-32 en pacientes colombianos con enfermedad inflamatoria intestinal en remisión: Un estudio de corte transversal

En Colombia no hay datos acerca de la percepción de la calidad de vida (CdV) en enfermedad infamatoria intestinal (EII). Se plantea como objetivo determinar la percepción de la CdV mediante el cuestionario IBDQ-32 en pacientes con EII a partir de una muestra de pacientes de diferentes centros de referencia. Se realizó un estudio de corte transversal en adultos, con EII en remisión clínica, en seguimiento ambulatorio, en 3 instituciones en diferentes ciudades, entre junio 2022 a noviembre 2022, se identificaron sujetos elegibles, se recolectó información en fechas distintas, acerca aspectos sociodemográficos y clínicos, se evaluó el cuestionario IBDQ-32 en una ocasión y se realizó análisis descriptivo y analítico de las variables evaluadas. Como resultado, se obtuvieron 80 pacientes, 70% mujeres, edad media 38,5 (rango18-72; SD 13,25) años. 67,5% colitis ulcerosa (CU), 32,5% enfermedad de Crohn (EC). Se encontró compromiso moderado de la CdV (mediana 150 puntos, rango-intercuartílico 118,3-181,5) en EII, en CU mediana 151 (rango-intercuartílico 120-174,75) puntos, mientras en EC 133(rango-intercuartílico 106,25-186,25) puntos. Hubo mayor afección en dominio sistémico, con medianas 21 (rango-intercuartílico 15,8-27) puntos, y 18,5 (rango-intercuartílico 12,8-25,3) puntos, para CU y EC, respectivamente. Y, los menos afectados correspondieron al dominio digestivo y función social, en CU medianas 48,5 (rango-intercuartílico 40-58,3), y 27 (rango-intercuartílico 20,8-33); en EC medianas 43 (rango-intercuartílico 35,5-61,75) y 24,5 (rango-intercuartílico 18-32,5), respectivamente. No se encontraron diferencias estadísticamente significativas. Este estudio aporta información única acerca CdV de los pacientes con EII en Colombia. Se requiere seguir reforzando el acompañamiento, apoyo, y educación a los pacientes con EII.

In Colombia there are no data about perception of quality of life (QoL) in inflammatory bowel disease (IBD). The aim of this study was to determine the perception of QoL by means of the IBDQ-32 questionnaire in patients with IBD from a sample of patients from different referral centers. We carried out a cross-sectional study in adults with IBD in clinical remission, in outpatient follow-up, in 3 institutions in different cities, between June 2022 and November 2022, eligible subjects were identified, information was collected on different dates, about socio-demographic and clinical aspects, and the IBDQ-32 questionnaire was evaluated on one occasion. Descriptive and analytical analysis of the variables evaluated was performed. 80 patients, 70% women, mean age 38.5(range 18-72; SD 13.25) years. 67.5% ulcerative colitis (UC), 32.5% Crohn´s disease (CD). Moderate QoL involvement (median 150 points, interquartile range118.3-181.5) was found in IBD, in UC median 151 (interquartile range120-174.75) points, while in CD 133 (interquartile range106.25-186.25) points. There was greater involvement in the systemic domain, with median 21 (interquartile range 15.8-27) points, and 18.5 (interquartile range 12.8-25.3) points, for UC and CD, respectively. The least affected corresponded to the digestive domain and social function, in median UC 48.5 (interquartile range 40-58.3), and 27(interquartile range 20.8-33); in median CD 43 (interquartile range 35.5-61.75) and 24.5(interquartile range 18-32.5), respectively. No statistically significant differences were found. This study provides unique information about QoL of patients with IBD in Colombia. It is necessary to continue reinforcing the accompaniment, support, and education of patients with IBD.

Enfermedad Inflamatoria Intestinal en el adulto mayor: Características clínicas y manejo en un hospital de referencia

La enfermedad inflamatoria intestinal (EII) en adultos mayores se caracteriza por su variabilidad clínica, distintos diagnósticos diferenciales y manejo terapéutico. El objetivo de la presente investigación es evaluar las características clínicas y manejo de los pacientes adultos mayores con EII. Se realizó un estudio observacional, descriptivo, retrospectivo de enero del 2011 a diciembre del 2019 en pacientes con EII en el Servicio de Gastroenterología del Hospital Nacional Guillermo Almenara Irigoyen, Lima-Perú. Fueron evaluados 55 pacientes con EC y 107 con CU; 45,6% de pacientes con EII eran adultos mayores. De ellos, 28 tenían EC y 46 CU. Los adultos mayores con EC presentaron fenotipo inflamatorio y localización colónica predominantemente, mientras en CU, la colitis extensa e izquierda fueron las más frecuentes. Asimismo, los ancianos tuvieron menor puntaje CDAI (279,8 vs 323,2) y menor índice de Mayo (7,1 vs 9,2) con relación a los pacientes jóvenes, sin diferencias significativas. Respecto al tratamiento, se observó un menor uso de azatioprina (2 vs 8, p<0,03) y Anti-TNF (9 vs 18, p<0,01) en los adultos mayores con EC. La necesidad de cirugía y la frecuencia de complicaciones post quirúrgicas fueron similares entre ambos grupos. En conclusión, casi la mitad de los pacientes con EII son adultos mayores. La localización colónica fue la más frecuente en EC, y en CU la colitis extensa e izquierda. Observamos un menor uso de azatioprina y terapia biológica en adultos mayores, sin diferencias significativas en el uso de corticoides y aminosalicilatos respecto a los jóvenes.

Inflammatory bowel disease (IBD) in elderly patients is characterized by its clinical variability, different differential diagnoses and therapeutic management. The objective of our investigation is to evaluate the clinical characteristics and management of elderly patients with IBD. We developed an observational, descriptive, retrospective study from January 2011 to December 2019 in patients with IBD at the Gastroenterology Service of Guillermo Almenara Irigoyen National Hospital, Lima-Peru. 55 patients with CD and 107 with UC were evaluated; 45.6% of patients with IBD are older adults. Of these, 28 had CD and 46 UC. Older adults with CD presented predominantly an inflammatory phenotype and colonic location, while extensive and left-sided colitis were the most frequent in UC. Elderly patients had a lower CDAI score (279.8 vs 323.2) and a lower Mayo index (7.1 vs 9.2) in relation to the younger, without significant differences. Regarding treatment, a lower use of azathioprine (2 vs 8, p <0.03) and Anti-TNF (9 vs 18, p <0.01) was observed in the elderly with CD. The need for surgery and the frequency of post-surgical complications were similar between both groups. In conclusion, nearly half of IBD patients are older adults. The colonic location was the most frequent in CD, and in UC extensive and left colitis. We observed a lower use of azathioprine and biological therapy in elderly patients, without significant differences in the use of corticosteroids and aminosalicylates compared to younger people.

Comportamiento clínico, epidemiológico, endoscópico e histológico de la Colitis Ulcerosa en Pediatría / Clinical, epidemiological, endoscopic and histological behavior of Ulcerative Colitis in Pediatrics

RESUMEN Introducción: las enfermedades inflamatorias intestinales constituyen un grupo heterogéneo de patologías inmunológicas crónicas, de curso no predecible, que incluye a la enfermedad de Crohn, la colitis ulcerosa y la colitis indeterminada, donde la susceptibilidad a la enfermedad, fenotipo y respuesta al tratamiento está determinada por la compleja interacción entre factores genéticos y ambientales. Objetivo: determinar los aspectos clínicos, epidemiológicos, endoscópicos e histológicos de la colitis ulcerosa en la edad pediátrica, en Pinar del Río en el período de enero de 2018 a diciembre 2019. Métodos: se realizó un estudio observacional, descriptivo y transversal en un universo y muestra constituido por 41 niños diagnosticados con la enfermedad en este periodo de tiempo. Para el análisis de los resultados se utilizaron los métodos de la estadística descriptiva como las frecuencias absolutas y relativas. Resultados: predominó el sexo masculino con una edad de entre uno y cinco años, como factores de riesgo predominaron los antecedentes de infecciones anteriores, la dieta inadecuada y el tiempo de lactancia materna menor de cuatro meses. Las manifestaciones clínicas más frecuente fueron: diarreas, rectorragia y el dolor abdominal. Conclusiones: se presentó la enfermedad con mayor frecuencia en menores de cinco años, de raza blanca y procedencia urbana. Las manifestaciones digestivas que predominaron fueron las diarreas con sangre, la rectorragia y las extradigestivas la pérdida de peso. La presencia de eritema, perdida del patrón vascular y las presencia de ulceras fueron los hallazgos endoscópicos más frecuentes encontrados. En el 85,5 % de los casos se presenta la colitis ulcerosa.

ABSTRACT Introduction: inflammatory bowel diseases constitute a heterogeneous group of chronic immunologic pathologies, of unpredictable course, including Crohn's disease, ulcerative colitis and indeterminate colitis, where disease susceptibility, phenotype and response to treatment is determined by the complex interaction between genetic and environmental factors. Objective: to determine the clinical, epidemiological, endoscopic and histological aspects of ulcerative colitis in the pediatric age in Pinar del Río in the period from January 2018 to December 2019. Methods: an observational, descriptive and transversal study was carried out in a universe and sample constituted by 41 children diagnosed with the disease in this period of time. For the analysis of the results, descriptive statistical methods such as absolute and relative frequencies were used. Results: the predominant sex was male with an age between 1 and 5 years, and the predominant risk factors were a history of previous infections, inadequate diet and breastfeeding for less than 4 months. The most frequent clinical manifestations were: diarrhea, rectorrhagia and abdominal pain. Conclusions: the disease occurred more frequently in children under 5 years of age, of white race and urban origin. The predominant digestive manifestations were bloody diarrhea, rectorrhagia and extra-digestive manifestations were weight loss. The presence of erythema, loss of vascular pattern and the presence of ulcers were the most frequent endoscopic findings. Ulcerative colitis was present in 85.5 % of the cases.

Inflammatory bowel diseases: characteristics, evolution, and quality of life / Doenças inflamatórias intestinais: características, evolução e qualidade de vida

ABSTRACT - BACKGROUND: Inflammatory bowel diseases present progressive and potentially debilitating characteristics with an impact on health-related quality of life (QoL) throughout the course of the disease, and this parameter may even be used as a method of evaluating response to treatment. AIM: The aim of this study was to analyze epidemiological data, medications in use, previous surgeries, and hospitalizations in patients with inflammatory bowel diseases, and to determine the impairment in QoL of these patients. METHODS: This is a prospective, cross-sectional, observational study in patients with inflammatory bowel disease followed up in a tertiary hospital in São Paulo-SP, Brazil. General and disease-related, evolution, and quality-of-life data were analyzed using a validated quality-of-life questionnaire, namely, Inflammatory Bowel Disease Questionnaire (IBDQ). RESULTS: Fifty-six individuals were evaluated, with an equal number of patients with Crohn's disease and ulcerative colitis. A higher prevalence of previous surgeries (p=0.001) and hospitalizations (p=0.003) for clinical-surgical complications was observed in patients with Crohn's disease. In addition, the impairment of QoL also occurred more significantly in these patients (p=0.022), and there was a greater impact on females in both forms of inflammatory bowel disease (p=0.005). CONCLUSIONS: Patients with Crohn's disease are more commonly submitted to surgeries and hospitalizations. Patients affected by both forms of inflammatory bowel disease present impairments in QoL, which are mainly related to intestinal symptoms, and females are more affected than men.

RESUMO - RACIONAL: As doenças inflamatórias intestinais apresentam características progressivas e potencialmente debilitantes com impacto na qualidade de vida relacionada à saúde durante todo o curso da doença, podendo esse parâmetro inclusive ser utilizado como método de avaliação da resposta ao tratamento. OBJETIVO: Analisar dados epidemiológicos, medicamentos em uso, cirurgias e internações prévias em pacientes com doenças inflamatórias intestinais e determinar o comprometimento na qualidade de vida desses pacientes. MÉTODOS: Estudo prospectivo, transversal e observacional em portadores de doença inflamatória intestinal acompanhados em hospital de ensino de São Paulo-SP. Foram analisadas as características gerais e relacionados às doenças, evolução e qualidade de vida utilizando um questionário validado, o Inflammatory Bowel Disease Questionnaire (IBDQ). RESULTADOS: Cinquenta e seis indivíduos foram avaliados, com igual número de pacientes com Doença de Crohn e Retocolite Ulcerativa. Foi observada maior prevalência de cirurgias prévias (p=0,001) e de internações por complicações clínico-cirúrgicas em portadores de doença de Crohn (p=0,003). Além disso, o prejuízo da qualidade de vida também ocorreu de forma mais relevante nesses pacientes (p=0,022) e houve maior impacto no sexo feminino em ambas as formas de doença inflamatória intestinal (p=0,005). CONCLUSÃO: Os portadores de doença de Crohn são mais comumente submetidos a cirurgias e internações. Os pacientes acometidos por ambas as formas de doença inflamatória intestinal apresentam prejuízos na qualidade de vida, principalmente relacionados aos sintomas intestinais e de forma mais negativa no sexo feminino.

Based on the Ancient and Modern Medical Records Cloud Platform to dig the Medication rules of Traditional Chinese Medicine in the treatment of ulcerative colitis / 国际中医中药杂志

Objective:The medical records collected on the Ancient and Modern Medical Record Cloud Platform were used to explore the medication rules of Traditional Chinese Medicine for the treatment of ulcerative colitis.Methods:By selecting the medical cases of the modern medical database and medical cases of famous doctors in the ancient medical database on the cloud platform to analyze the frequency, attribution, association, and complex network of those medicines.Results:A total of 209 medical records were obtained, including 319 Traditional Chinese Medicines, of which the core medicines were Rhizoma Coptidis, Radix Aucklandiae, Poria, Radix Paeoniae Alba, and Radix Glycyrrhizae. The properties of those medicines were warm, mild, and cold. The main taste is bitter and sweet, and most of them attibute to spleen, stomach, and liver meridians. The core pair medicine is Radix Aucklandiae-Rhizoma Coptidis. The core prescription was composed of nine herbs including Rhizoma Atractylodis Macrocephalae, Radix Paeoniae Alba, Radix Scutellariae, Radix Aucklandiae, Rhizoma Coptidis, Radix Glycyrrhizae, Radix Pulsatillae, Poria, and Radix Codonopsis. Conclusion:The treatment of ulcerative colitis with Traditional Chinese Medicine mainly include Sijunzi Decoction and Xianglian Pill, accompanied with those medicines which could clear heat with detoxication function, cool the blood and stop diarrhea, By doing so, ulcerative colitis could be treated both in the surface and the root.

Analysis of clinical features of 43 cases of inflammatory bowel disease complicated with intra- and extra-intestinal tumors / 中华消化杂志

Objective:To analyze the clinical characteristics of patients with inflammatory bowel disease (IBD) complicated with intra- and extra-intestinal tumors, and so as to provide reference for clinical practice.Methods:From October 2008 to March 2022, the clinical data of 2 360 IBD patients diagnosed at the First Affiliated Hospital of Air Force Military Medical University were collected, and the IBD patients complicated with intra- and extra-intestinal tumors were screened out. IBD with colorectal cancer, small intestine cancer and intestinal lymphoma were enrolled into intra-intestinal tumor group, IBD complicated with other tumors except intra-intestinal tumors were enrolled into extra-intestinal tumor group. The clinical characteristics of the 2 groups were retrospectively compared, and the risk factors affecting survival of IBD complicated intra- and extra-intestinal tumor were analyzed. Kaplan-Meier method was used to draw the survival curve, Cox regression model was performed to analyze the prognostic risk factors, and independent sample t test, Fisher′s exact test and log-rank test were used for statistical analysis. Results:A total of 43 IBD patients with intra- and extra-intestinal tumor were screened out, and the overall tumor incidence rate was 1.82% (43/2 360). The rate of IBD complicated with intra-intestinal tumor accounted for 1.27% (30/2 360). Among them, the rate of ulcerative colitis (UC) complicated with intra-intestinal tumor was 1.48% (25/1 685), and the rate of Crohn′s disease (CD) complicated with intra-intestinal tumor was 0.74% (5/675). The rate of IBD with extra-intestinal tumor accounted for 0.55% (13/2 360). Among them, the rate of UC complicated with extra-intestinal tumor was 0.71% (12/1 685), and the rate of CD complicated with extra-intestinal tumor was 0.15% (1/675). There were no significant differences in the rate of intra- and extra-intestinal tumors between UC and CD patients (both P>0.05). In the intra-intestinal tumor group, the age when diagnosed with IBD and the age when tumor diagnosed were (37.0±13.8) years old and (47.7±13.5) years old, which were both lower than those of the extra-intestinal tumor group ((51.8±6.2) years old and (60.7±7.8) years old), and the differences were statistically significant ( t=-3.69 and -3.24, P=0.001 and 0.002). The lesion location when tumor diagnosed of UC patients with intra-intestinal tumor mainly was extensive colonic type(64.0%, 16/25), followed by left part colonic type and rectal type in turn (28.0%, 7/25 and 8.0%, 2/25). In UC patients with extra-intestinal tumor, mainly was rectal type (8/12), followed by left part colonic type (3/12) and extensive colonic type (1/12) in turn. There was statistically significant difference bwtween the UC patients with intra- and extra-intestinal tumor in the extent of lesions when tumor diaghosed (Fisher′s exact test, P<0.001). The activity of IBD of intra-intestinal tumor group when tumor diagnosed mainly was severe activity phase (46.7%, 14/30), followed by moderate activity phase, mild activity phase and remission phase in turn (33.3%, 10/30; 20.0%, 6/30 and 0). The activity of IBD of extra-intestinal tumor group when tumor diagnosed mainly was remission phase (7/13), followed by moderate activity phase, mild activity phase and severe activity phase in turn (3/13, 2/13 and 1/13). There were statistically significant differences between the 2 groups in the composition of IBD activity when tumor diagnosed (Fisher′s exact test, P<0.001). The survival analysis indicated the median survival time of IBD complicated with intra-intestinal tumor group was 145.9 months, and that of the extra-intestinal tumor group was 29.9 months. The results of multivariate Cox analysis showed that the occurrence of extra-intestinal tumor was an independent risk factor of patient survival rate( HR=5.119, 95% confidence interval 1.485 to 17.643, P=0.010). Conclusions:IBD patients had a high risk of developing intra- and extra-intestinal tumors. The intra-intestinal tumor group mainly is extensive colonic type and severe active period, while the extra-intestinal tumor group mainly is rectal type and remission period. Compared with that of the extra-intestinal tumor group, the age at time of IBD onset and tumor diagnosed of intestinal tumor are younger, and the survival time is longer.

Analysis of the polymorphisms and haplotypes of cyclin-dependent kinase inhibitor 2B antisense RNA 1 gene in patients with ulcerative colitis / 中华消化杂志

Objective:To investigate the relationship between polymorphisms and haplotypes of cyclin-dependent kinase inhibitor 2B antisense RNA 1 ( CDKN2 B- AS1) gene and the risk of ulcerative colitis (UC). Methods:From January 2012 to January 2021, a total of 534 UC patients diagnosed at the Department of Gastroenterology, the Second Affiliated Hospital of Wenzhou Medical University (Yuying Children′s Hospital) and during the same period 560 gender- and age-matched healthy controls were selected. Genotypes of CDKN2 B- AS1 (rs1063192, rs10757274, rs10757278, rs1333048, rs2383207) in venous blood were determined by matrix assisted laser desorption ionization time-of-flight mass spectrometry technique. Unconditional logistic regression was used to analyze the difference in the distribution of CDKN2 B- AS1 gene polymorphisms between UC patients and healthy controls, as well as the influence on the clinicopathologic characteristics of UC patients. Software Haploview 4.2 was used to analyze the linkage disequilibrium and haplotype. Chi-square test was used for statistical analysis. Results:The frequencies of variant genotype (AG+ GG) and variant allele (G) of rs1063192 in UC patients were higher than those in healthy controls (32.4%, 173/534 vs. 24.8%, 139/560; 18.1%, 193/1 068 vs. 13.7%, 153/1 120), and the differences were statistically significant ( OR=1.45 and 1.40, 95% confidence interval(95% CI) 1.12 to 1.89 and 1.11 to 1.77, P=0.006 and 0.004, corrected P=0.030 and 0.020). The frequency of variant allele (G) of rs10757274 in UC patients was lower than that in healthy controls (34.7%, 371/1 068 vs. 39.5%, 442/1 120), and the difference was statistically significant ( OR=0.82, 95% CI 0.69 to 0.98, P=0.025). However, the difference was not significant after Bonferroni correction (corrected P>0.05). According to the Montreal classification, the frequency of homozygous variant genotype (GG) of rs1063192 in the patients with extensive colitis was higher than that in patients with proctitis plus left-sided colitis (6.6%, 14/211 vs. 1.9%, 6/323), and the difference was statistically significant ( OR=3.92, 95% CI 1.47 to 10.42, P=0.006, corrected P=0.030). There was linkage disequilibrium among rs10757274, rs2383207, rs10757278 and rs1333048 of CDKN2 B- AS1 gene. The frequency of haplotype GGGC in UC patients was lower than that in healthy controls (33.3%, 355.5/1 068 vs. 37.8%, 423.4/1 120), and the frequency of haplotype AGGC in UC patients was higher than that in healthy controls (6.7%, 71.7/1 068 vs. 3.6%, 40.3/1 120), and the differences were statistically significant ( χ2=4.81 and 11.16, P=0.028 and<0.001). Conclusions:The variation of rs1063192 in CDKN2 B- AS1 gene may increase the risk of UC. The risk of extensive colitis in patients carrying homozygous variant genotype (GG) of rs1063192 may rise. Among the haplotypes composed of rs10757274, rs2383207, rs10757278 and rs1333048, the risk of UC may decrease in the individuals carrying haplotype GGGC. However, the risk of UC may increase in the individuals carrying haplotype AGGC. The correlation between the variation of 10757274 and the risk of UC still needs to be further verified by expanding the sample size.

Risk factor analysis of 46 cases of ulcerative colitis complicated with thromboembolism / 中华消化杂志

Objective:To analyze the independent risk factors of ulcerative colitis (UC) with thromboembolism (TE), in order to diagnose UC with TE as early as possible and take corresponding preventive measures, so as to improve the prognosis and reduce the mortality of UC with TE.Methods:From January 1, 2011 to December 31, 2020, at the First Affiliated Hospital of Xinjiang Medical University, from January 1, 2015 to December 31, 2020, at the Second Affiliated Hospital of Xinjiang Medical University, from January 1, 2015 to December 31, 2020, at the Fifth Affiliated Hospital of Xinjiang Medical University, during hospitalization 46 patients diagnosed with UC with TE were enrolled. According to the ratio of 1∶2, at same period 92 simple UC patients were selected as control. The condition of embolization of UC patients with TE was analyzed. The clinical data(hypertension history, length of hospital stay, etc.), the degree of disease activity, laboratory test indicators (prothrombin time (PT), D-dimer, fibrin degradation product(FDP), hemoglobin(Hb), mean platelet volume(MPV), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), etc.)of the patients of UC with TE and UC without comorbidities were compared. Multivariate logistic regression was used to analyze the independent risk factors of UC with TE. Independent sample t test, Mann-Whitney U test, Chi-square test or Fisher′s exact probability method were used for statistical analysis. Results:Among the 46 cases of UC with TE, 14 cases (30.4%) had single site venous TE, mainly venous thrombosis of lower limbs; 20 cases (43.5%) had single site arterial TE, mainly myocardial infarction and cerebral infarction; 12 cases (26.1%) had multi-site TE. The proportion of patients with hypertension history and with severe active period of UC, and the levels of D-dimer, FDP, ESR and CRP in patients with UC with TE were all higher than those in patients without comorbidities(52.2%, 24/46 vs.33.7%, 31/92, 45.7%, 21/46 vs.19.6%, 18/92, (822.03±654.33) μg/L vs.(230.28±225.62) μg/L, 5.77 mg/L(6.87 mg/L) vs. 2.10 mg/L(1.55 mg/L), (46.32±28.27) mm/1 h vs.(33.08±24.30) mm/1 h, 22.05 mg/L(46.42 mg/L) vs. 5.58 mg/L(11.58 mg/L)); the hospital stay and PT were longer than those in patients without comorbidities ((12.76±10.18) d vs.(8.66±4.89) d, (14.13±6.06) s vs.(11.86±1.42) s); the Hb and MPV were lower than those in patients without comorbidities ((110.91±31.38) g/L vs.(123.83±27.67) g/L, (9.60±0.94) fL vs.(10.04±1.16) fL; and the differences were statistically significant( χ2=4.37 and 10.29, t=-5.96, Z=-5.78, t=-2.85, Z=-3.87, t=-2.58, -2.50, 2.47 and 2.47; all P<0.05). The results of multivariate logistic regression analysis showed that severe activity period of UC ( OR=3.079, 95% confidence interval (95% CI) 1.100 to 8.615), hypertension history ( OR=4.454, 95% CI 1.467 to 13.519), and D-dimer level( OR=1.003, 95% CI 1.001 to 1.005) were all independent risk factors of UC with TE(all P<0.05). Conclusions:Lower extremity venous, myocardial infarction and cerebral infarction are common in UC with TE. Severe activity period of UC, history of hypertension and D-dimer level are independent risk factors of UC with TE. These above factors should be paid attention to and corresponding prevention should be taken.

A survey of inflammatory bowel disease in China based on the Google Trends, Baidu index and WeChat index / 中华消化杂志

Objective:To analyze the epidemiological trends and population characteristics of inflammatory bowel disease(IBD)in China by searching keywords related to IBD through Google Trends, Baidu index, and WeChat index, so as to provide a reference for national epidemiological studies on IBD.Methods:IBD-related hot words such as "inflammatory bowel disease" , "Crohn′s disease" , "ulcerative colitis" , "gastroesophageal reflux disease (GERD)" , "irritable bowel syndrome (IBS)" and " Helicobacter pylori ( H. pylori)" were selected. The search volume and trends of the above keywords in the world and China were analyzed through Google Trends, Baidu index and WeChat index. The epidemiological characteristics of IBD in China were summarized. Descriptive methods were used for statistical analysis. Results:The results of Google Trends analysis showed that among 5 common digestive diseases (GERD, IBS, H. pylori infection, IBD and peptic ulcer), GERD was the most concerned disease, while IBD was not the focus among the common digestive diseases. When the global searching scope was limited to IBD related hot words, Crohn′s disease was the disease of primary concern among IBD-related diseases. In South America, South Asia, and parts of Africa, ulcerative colitis was mainly concerned, and in China and countries of Southeast Asia, IBD was more concerned. The searching results of Baidu index indicated that among the national search for IBD-related hot words, the 3 keywords of "inflammatory bowel disease" , "ulcerative colitis" and "Crohn′s disease" were all highly searched, the overall daily average of the search indexes of the 3 keywords were 325, 1 320 and 2 559, respectively, and the searching volume of "Crohn′s disease" was higher than "inflammatory bowel disease" and "ulcerative colitis" . The national wide trends of search volume for "inflammatory bowel disease" , "ulcerative colitis" and "Crohn′s disease" were similar, the search heat gradually decreased from the east coast to the northwest of China, which basically coincided with the three-level ladder trend of China′s economic development, suggesting that the level of economic development was related to the incidence of IBD. The results of Baidu index analysis showed that the main populations who searched IBD-related keywords were young adults and women aged from 20 to 39 years old. The results of WeChat index analysis revealed that the searching volume of "inflammatory bowel disease" , "ulcerative colitis" and "Crohn′s disease" were 205 000, 195 000 and 120 000, respectively, and the search volume for " inflammatory bowel disease" was the highest. The official account (90.27%) and the video account (7.43%) occupied the main sources of IBD-related information on mobile terminals. Conclusions:The IBD-associated internet activities reveal a global lack of public awareness of IBD. China also faces the same problem. The search trend is consistent with the epidemiology of IBD, which may be helpful for future epidemiological research of IBD in China. Mobile media will be a potential force in promoting the patient education and disease management of IBD in China.

Analysis of skin manifestations in 50 children with inflammatory bowel disease / 中华皮肤科杂志

Objective:To analyze skin manifestations of pediatric inflammatory bowel disease (IBD) .Methods:Children with IBD were collected from pediatric wards in Peking University Third Hospital from January 2010 to January 2022, and their skin manifestations were retrospectively analyzed.Results:A total of 50 children with IBD were included, including 27 with Crohn′s disease and 23 with ulcerative colitis. Twenty-five (50%) patients had skin manifestations, including specific skin manifestations in 11 (22%) and relevant skin manifestations in 11 (22%) . Specific skin manifestations included cutaneous perianal Crohn′s disease in 2 cases, and anal fistula and/or perianal abscess in 9 cases; relevant skin manifestations included erythema nodosum in 5 cases, aphthous stomatitis in 3 cases, psoriasis in 1 case, polyarteritis nodosa in 1 case, and Henoch-Sch?nlein purpura in 1 case. Compared with the ulcerative colitis group, the Crohn′s disease group was more prone to suffer from specific skin manifestations and relevant skin manifestations, and there were significant differences in the prevalence of specific and relevant skin manifestations between the two groups (both P < 0.05) . Of the 27 children with Crohn′s disease, 19 (70%) had one or more skin manifestations, 2 of whom successively presented with 4 different skin manifestations. One child with Crohn′s disease and 1 with ulcerative colitis had 3 different skin manifestations in different periods. The fecal calprotectin level was elevated in all children with skin manifestations, and in 12 (48%) children without skin manifestations. The skin lesions of 5 children were improved or subsided after dose adjustment (1 case) or switch (4 cases) of biological agents. Conclusions:Half of the children with IBD have skin manifestations, and children with Crohn′s disease are more prone to have specific and relevant skin manifestations. Different skin manifestations could be observed in the same child in different periods. Multidisciplinary teamwork is conducive to the overall control of this disease.

A preliminary study on the improved efficacy of mesalazine combined with vitamin D 3 in ulcerative colitis / 中华内科杂志

Objective:To analyze the influence of vitamin D 3 supplementation on the clinical efficacy of mesalazine in patients with ulcerative colitis (UC). Methods:From January 2015 to December 2020, patients with mild-to-moderate active UC were retrospectively and continuously enrolled, who accepted mesalazine treatment for at least 12 months at the Second Affiliated Hospital of Wenzhou Medical University. According to simultaneous supplement of vitamin D 3 (125 IU/d), the patients were divided into study group and control group. Demographic and disease characteristics, serum 25-hydroxyvitamin D[25(OH)D] levels and other information were collected through retrieving hospital database. Student′s t-test, Mann-Whitney U test and Chi-square test were applied for comparison of disease characteristics. The changes of modified Mayo scores[ΔMayo] and 25(OH)D[Δ25(OH)D] were compared before and after treatment by paired t-test, Wilcoxon signed rank test and Chi-square test. Multiple linear regression model was used to analyze the independent factors affecting ΔMayo and Δ25(OH)D, and variables with P-values less than 0.20 in the univariate analysis were allowed for further multivariate analysis. Results:A total of 74 UC patients (44 males, 30 females), with median age (range) 39.5 (20-76) years old, were analyzed and respectively assigned into study group ( n=36) and control group ( n=38). In study group, the average level of serum 25(OH)D was significantly increased at month 12 compared with that at baseline [(22.87±7.30) μg/L vs. (18.15±7.48) μg/L, P<0.001]. However, no significant elevation of serum 25(OH)D was found in control group [(19.17±8.49) μg/L vs. (19.82±9.47) μg/L, P=0.466]. Furthermore, there was a significant decrease of modified Mayo score [-3(-4.75, -1.25) vs.-2(-3.25, 0), P=0.034] and a higher clinical remission rate (55.6% vs. 28.9%, P=0.020) at month 12 in study group than those in control group. In addition, according to the baseline level of serum 25(OH)D before mesalazine treatment, 74 UC patients were divided into vitamin D deficiency group ( n=38, serum 25(OH)D<20 μg/L) and non-deficiency group ( n=36, serum 25(OH)D≥20 μg/L). At month 12 in vitamin D deficiency group, patients with vitamin D3 supplementation had a greater decline in modified Mayo score [-4(-5.75, -2) vs.-2(-4, 0), P=0.048] and a higher clinical remission rate (60.0% vs. 22.2%, P=0.019) compared with those without. Conclusions:In patients with mild-to-moderate active UC receiving mesalazine treatment, vitamin D3 supplementation may improve the clinical efficacy, especially in patients with vitamin D deficiency.

Consenso brasileiro de manejo das doenças inflamatórias intestinais em pacientes pediátricos: Consenso da Organização Brasileira para doença de Crohn e colite (GEDIIB) / Brazilian consensus on the management of inflammatory bowel diseases in pediatric patients: a consensus of the brazilian organization for crohn's disease and colitis (gediib)

ABSTRACT Background: Approximately 25% of patients with inflammatory bowel disease (IBD) develop the disease during childhood or adolescence and treatment aims to control active symptoms and prevent long-term complications. The management of Crohn's disease (CD) and ulcerative colitis (UC) can be especially challenging in children and adolescents, related to particularities that may affect growth, development, and puberty. Objective: This consensus aims to provide guidance on the most effective medical and surgical management of pediatric patients with CD or UC. Methods: Experts in Pediatric IBD representing Brazilian gastroenterologists (Brazilian Organization for Crohn's Disease and Colitis [GEDIIB]) developed this consensus. A rapid review was performed to support the recommendations/statements. Medical and surgical recommendations were structured and mapped according to the disease type, disease activity, and indications and contraindications for medical and surgical treatment. After structuring the statements, the modified Delphi Panel methodology was used to conduct the voting. The process took place in three rounds: two using a personalized and anonymous online voting platform and one face-to-face. Whenever participants did not agree with a specific recommendation, an option to explain why was offered to enable free-text responses and provide the opportunity for the experts to elaborate or explain disagreement. The consensus of recommendations in each round was accepted when reached ≥80% agreement. Results and conclusion: The recommendations are presented according to the stage of treatment and severity of the disease in three domains: management and treatment (drug and surgical interventions), criteria for evaluating the effectiveness of medical treatment, and follow-up/ patient monitoring after initial treatment, follow-up/ patient monitoring after initial treatment. Surgical recommendations were grouped according to disease type and recommended surgery. The target audience for this consensus was general practitioners, gastroenterologists, and surgeons interested in the treatment and management of pediatric CD and UC. Additionally, the consensus aimed to support the decision-making of health insurance companies, regulatory agencies, and health institutional leaders and/or administrators.

RESUMO Contexto: Aproximadamente 25% dos pacientes desenvolvem doença inflamatória intestinal (DII) durante a infância ou adolescência, e o tratamento visa controlar os sintomas ativos e prevenir complicações a longo prazo. O tratamento da doença de Crohn (DC) e retocolite ulcerativa (RCU) pode ser especialmente desafiador em crianças e adolescentes, relacionado a particularidades que podem afetar o crescimento, o desenvolvimento e a puberdade. Objetivo: Este consenso visa fornecer orientações sobre o tratamento clínico e cirúrgico mais eficaz de pacientes pediátricos com DC ou RCU. Métodos: Gastroenterologistas brasileiros especialistas em DII Pediátrico membro da Organização Brasileira para Doença de Crohn e Colite (GEDIIB) desenvolveram este consenso. Uma revisão rápida foi realizada para apoiar as recomendações/declarações. As recomendações médicas e cirúrgicas foram estruturadas e mapeadas de acordo com o tipo de doença, atividade da doença e indicações e contraindicações para tratamento médico e cirúrgico. Após a estruturação das declarações, foi utilizada a metodologia modificada do Painel Delphi para conduzir a votação. O processo ocorreu em três rodadas: duas por meio de uma plataforma de votação online personalizada e anônima e uma presencial. Sempre que os participantes não concordavam com a recomendação específica, uma opção para explicar o motivo era oferecida para permitir respostas em texto livre e dar a oportunidade para os especialistas elaborarem ou explicarem a discordância. O consenso das recomendações em cada rodada foi aceito quando houve concordância ≥80%. Resultados e conclusão: As recomendações são apresentadas de acordo com o estágio de tratamento e gravidade da doença em três domínios: manejo e tratamento (intervenções medicamentosas e cirúrgicas), critérios para avaliar a eficácia do tratamento médico, acompanhamento/monitoramento do paciente após tratamento. As recomendações cirúrgicas foram agrupadas de acordo com o tipo de doença e cirurgia recomendada. O público-alvo deste consenso foram clínicos gerais, gastroenterologistas e cirurgiões interessados no tratamento e manejo da RCU e DC pediátrica. Além disso, o consenso visava apoiar a tomada de decisão das operadoras de planos de saúde, agências reguladoras e líderes e/ou administradores de instituições de saúde.

Segundo Consenso Brasileiro no manejo da retocolite ulcerativa em adultos: um consenso da Organização Brasileira para Doença de Crohn e Colite (GEDIIB) / Second brazilian consensus on the management of ulcerative colitis in adults: a consensus of the brazilian organization for crohn's disease and colitis (gediib)

ABSTRACT Background: Inflammatory bowel diseases are immune-mediated disorders that include Crohn's disease (CD) and ulcerative colitis (UC). UC is a progressive disease that affects the colorectal mucosa causing debilitating symptoms leading to high morbidity and work disability. As a consequence of chronic colonic inflammation, UC is also associated with an increased risk of colorectal cancer. Objective: This consensus aims to provide guidance on the most effective medical management of adult patients with UC. Methods: A consensus statement was developed by stakeholders representing Brazilian gastroenterologists and colorectal surgeons (Brazilian Organization for Crohn's Disease and Colitis [GEDIIB]). A systematic review including the most recent evidence was conducted to support the recommendations and statements. All recommendations/statements were endorsed using a modified Delphi Panel by the stakeholders/experts in inflammatory bowel disease with at least 80% or greater consensus. Results and conclusion: The medical recommendations (pharmacological and non-pharmacological) were mapped according to the stage of treatment and severity of the disease onto three domains: management and treatment (drug and surgical interventions), criteria for evaluating the effectiveness of medical treatment, and follow-up/patient monitoring after initial treatment. The consensus targeted general practitioners, gastroenterologists and surgeons who manage patients with UC, and supports decision-making processes by health insurance companies, regulatory agencies, health institutional leaders, and administrators.

RESUMO Contexto: As doenças inflamatórias intestinais são doenças imunomediadas que incluem a doença de Crohn (DC) e a retocolite ulcerativa (RCU). A RCU é uma doença progressiva que acomete a mucosa colorretal causando sintomas debilitantes levando a alta morbidade e incapacidade laboral. Como consequência da inflamação crônica do cólon, a RCU também está associada a um risco aumentado de câncer colorretal. Objetivo: Este consenso visa fornecer orientações sobre o manejo médico mais eficaz de pacientes adultos com RCU. Métodos: As recomendações do consenso foram desenvolvidas por gastroenterologistas e cirurgiões colorretais referências no Brasil (membros da Organização Brasileira para Doença de Crohn e Colite [GEDIIB]). Uma revisão sistemática, incluindo as evidências mais recentes, foi conduzida para apoiar as recomendações. Todas as recomendações foram endossadas pelas partes interessadas/especialistas em doença inflamatória intestinal usando um Painel Delphi modificado. O nível de concordância para alcançar consenso foi de 80% ou mais. Resultados e conclus ão: As recomendações médicas (farmacológicas e não farmacológicas) foram mapeadas de acordo com o estágio de tratamento e gravidade da doença em três domínios: manejo e tratamento (intervenções medicamentosas e cirúrgicas), critérios para avaliar a eficácia do tratamento médico, e acompanhamento/monitoramento do paciente após o tratamento inicial. O consenso foi direcionado a clínicos gerais, gastroenterologistas e cirurgiões que tratam pacientes com RCU e apoia os processos de tomada de decisão por companhias de seguro de saúde, agências reguladoras, líderes institucionais de saúde e administradores.

Investigating the influence of moxibustion on colonic mucosal barrier in rats with dextran sulfate sodium-induced ulcerative colitis / 针灸推拿医学（英文版）

Objective: To observe the effect of moxibustion on the colonic mucosal barrier of rats with ulcerative colitis (UC) induced by dextran sulfate sodium (DSS). Methods: Forty male Sprague-Dawley rats were randomly divided into a normal group and a modeling group, with 20 rats in each group. Rats in the modeling group were subjected to preparing experimental UC models by drinking 4％ DSS for seven consecutive days. Two modeled rats and two normal rats were randomly selected for model identification. After the success of UC model was confirmed, the remaining 18 modeled rats were randomly divided into three groups, a model group, a model + herbal cake-partitioned moxibustion group, and a model + mild moxibustion group, with six rats in each group; the remaining normal rats were randomly divided into three groups, a normal group, a normal + herbal cake-partitioned moxibustion group, and a normal + mild moxibustion group, with six rats in each group. After 7 d of intervention with the herbal cake-partitioned moxibustion or the mild moxibustion, hematoxylin-eosin (HE) staining technique was used to observe the pathological changes of colon tissue under a light microscope; Western blotting and/or immunohistochemical techniques were used to detect the protein expression levels of Occludin, Claudin, junction adhesion molecular 1 (JAM1), mucin 2 (MUC2), and transforming growth factor beta1 (TGF-β1) in rat colon tissue. Results: Compared with the normal group, the colon tissue was severely damaged, the pathological score was significantly increased, and the protein expression levels of Occludin, Claudin, JAM1, MUC2, and TGF-β1 were significantly decreased in the model group (P<0.01); while there were no significant differences in the colonic histopathological score, protein expression levels of Occludin, Claudin, JAM1, MUC2, and TGF-β1 in the normal + herbal cake-partitioned moxibustion group and the normal + mild moxibustion group (P>0.05). Compared with the model group, the model + herbal cake-partitioned moxibustion group and the model + mild moxibustion group showed repaired colon tissue, ulcer healing, significantly reduced pathological score, and significantly increased protein expression levels of JAM1, MUC2, and TGF-β1 (P<0.05); the Occludin protein expression level in the colon tissue of the model + mild moxibustion group was increased (P<0.01). Conclusion: Neither herbal cake-partitioned moxibustion nor mild moxibustion influences the colonic histopathology and intestinal mucosal barrier-related protein expression in the normal rats; both herbal cake-partitioned moxibustion and mild moxibustion can up-regulate the protein expression levels of JAM1, MUC2, and TGF-β1 in the colon tissue of UC rats. Mild moxibustion can up-regulate Occludin protein expression. This may be a mechanism of moxibustion in reducing colonic mucosa inflammation in UC.

The value of laboratory parameters in predicting endoscopic manifestations of ulcerative colitis after treatment / 中华消化杂志

Objective:To explore the significance of laboratory parameters in predicting the endoscopic manifestations of ulcerative colitis (UC) after treatment.Methods:From January 2015 to December 2020, the clinical data of 68 patients with UC hospitalized and treated in Peking University People′s Hospital were retrospectively and continuously collected. According to the degree of bleeding, vascular pattern, erosion and ulcer under endoscopy before and after treatment, they were divided into progressive group (post-treatment ulcerative colitis endoscopic index of severity (UCEIS) score higher than pre-treatment) and non-progressive group (post-treatment UCEIS score equal to or lower than pre-treatment). The baseline platelet count, platelet volume, platelet hematocrit, platelet distribution width, serum albumin, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and related laboratory parameters were compared between the two groups. And analyzed the significance of related laboratory indexes in predicting the endoscopic manifestations of UC after treatment. Independent sample t test and receiver operating characteristic curve (ROC) analysis were used for statistical analysis. Results:According to the degree of bleeding under endoscopy before and after treatment, the patients were divided into progressive group (12 cases) and non-progressive group (56 cases). The baseline platelet count and platelet volume of the progressive group were higher than those of the non-progressive group ((375.58±154.30) ×10 9/L vs. (288.22±103.76) ×10 9/L, (9.29±1.13) fL vs.(8.52±1.29) fL), and the differences were statistically significant ( t=2.40 and 2.08, P=0.019 and 0.049). According to the degree of vascular texture under endoscopy before and after treatment, the baseline platelet volume and serum albumin level of the progressive group (9 cases) were higher than those of the non-progressive group (59 cases) ((9.58±1.18) fL vs. (8.54±1.26) fL, (41.49±5.08) g/L vs. (36.63±6.14) g/L), and the baseline CRP of the progressive group was lower than that of the non-progressive group (2.26 mg/L(0.95 mg/L) vs.8.64 mg/L (26.08 mg/L) ), and the differences were statistically significant ( t=2.32, 2.32, and z=-2.27, P=0.022, 0.047 and 0.045). According to the degree of erosion and ulcer under endoscopy before and after treatment, CRP and ESR of the progressive group (16 cases) were lower than those of the non-progressive group (52 cases) ((2.21 mg/L(5.26 mg/L) vs. 10.63 mg/L(29.97 mg/L), 14.50 mm/1 h (15.25 mm/1 h) vs.17.00 mm/1 h (11.00 mm/1 h)), and the differences were statisticaly significant ( z=-3.64 and -2.42, P=0.001 and 0.020). The cutoff value of baseline platelet count to assess the progression of bleeding under endoscopy after treatment was 336×10 9/L (sensitivity=0.636, specificity=0.852, area under the curve=0.698). The cutoff value of baseline CRP to assess the progression of erosion and ulcer under endoscopy after treatment was 3.44 mg/L (sensitivity=0.750, specificity=0.727, area under the curve=0.727). Conclusions:The baseline platelet volume, serum albumin and ESR are suggestive of endoscopic mucosal changes in patients with UC after treatment. The baseline platelet count and CRP can predict the efficacy in patients with UC.

Study on the effectiveness of the proportion of inflammatory cells in the lamina propria of intestinal mucosa in predicting mucosal histological healing in patients with ulcerative colitis / 中华消化杂志

Objective:To determine a simpler and more practical scoring standard for predicting mucosal histological healing in ulcerative colitis (UC).Methods:From April 11, 2017 to February 8, 2021, 68 UC patients diagnosed with mucosal healing under endoscopy and hospitalized at Department of Gastroenterology, the Tenth People′s Hospital of Tongji University and during the same period 60 healthy individuals who underwent endoscopy for health checkup were retrospectively analyzed. Modified Mayo score and ulcerative colitis endoscopic index of severity (UCEIS), the modified Nancy index and Robarts histopathology index were determined based on the collected clinical data, endoscopic reports and histopathological evaluation. The proportions of neutrophils, eosinophils, and plasma cells in the colonic mucosal lamina propria were calculated. The proportions of activated neutrophils and T cells in the colonic mucosal lamina were calculated according to CD177 and CD40L, respectively. The new clinical and laboratory diagnostic formulas were determined by multivariate logistic regression analysis, the effectiveness of the equations was evaluated by receiver operating characteristic curve (ROC).Results:Among the 68 patients with UC, the modified Mayo score was 0.7 (0.4, 1.1), the UCEIS was 0.5 (0.3, 0.8), the Nancy index was 5.9±3.2, and the Robarts histopathology index was 2.6±1.7. According to multivariate logistic regression analysis, the formula for clinical diagnosis of histological healing was Y1=-21.09+ 355.9 X1+ 305.8 X2+ 44.91 X3 ( X1, X2 and X3 were the proportions of neutrophils, eosinophils, and plasma cells, respectively). The results of ROC analysis indicated that Y1<-0.747 was the cut-off value of diagnosis of histological healing, and the area under the curve (AUC) was 0.986 and 95% confidence interval ( CI) was 0.922 to 1.000 ( P<0.001), the sensitivity was 97.10% and the specificity was 91.20%. The formula of laboratory diagnosis of histological healing was Y2=-10.57+ 469.1 X1 + 132.7 X2 + 101.2 X3 + 18.56 X4 ( X1, X2, X3, and X4 were the proportions of CD177 + neutrophils, eosinophils, CD40L + T cells and plasma cells, respectively). The results of ROC analysis indicated that Y2<1.960 was the cut-off value of diagnosis of histological healing, and the AUC was 0.980, 95% CI was 0.913 to 0.999 ( P<0.001), the sensitivity was 84.78%, and the specificity was 100.00%. The new clinical and laboratory diagnostic criteria were positively correlated with the Nancy histological index ( r=0.411 and 0.308, P=0.001 and 0.011), and Robarts histopathology index ( r=0.311, 0.273, P=0.010 and 0.024). Conclusions:Compared with the Nancy index, the new clinical and laboratory diagnostic criteria are simpler and more practical. The new clinical diagnostic formula Y1<-0.747 and the new laboratory diagnosis formula Y2<1.960 are the independent factors for predicting histological healing in UC patients.

Predictive value of mucosal vascular pattern under narrow-band imaging colonoscopy in colonic epithelial proliferation of patients with ulcerative colitis / 中华消化杂志

Objective:To investigate the predictive value of mucosal vascular pattern (MVP) in colonic epithelial proliferation of patients with ulcerative colitis (UC) under narrow-band imaging (NBI) colonoscopy.Methods:From December 1, 2012 to January 31, 2015, 42 patients with UC visiting Peking Union Medical College Hospital and receiving NBI colonoscopy were selected. The images of 119 colorectal lesions of all the patients under the conventional white light and NBI endoscopy were collected and at least one biopsy of each lesion was obtained for histological assessment. All the endoscopic images were randomly allocated to one endoscopist (associated chief physician) for the MVP and the Mayo endoscopic score (MES) assessment. The degree of mucosal inflammation was graded from 0 to 4 according to the histological colitis score. The degree and distribution of Ki-67 expression were evaluated by immunohistochemical staining. Student-Newman-Keuls (SNK)- q test and Spearman rank correlation analysis were used for statistical analysis. Results:Under NBI colonoscopy, the MVP of patients with UC was divided into clear type, obscure type and absent type. According to the morphology of mucosal glandular duct, the absent type was divided into crypt opening subtype and villous subtype. There was a positive correlation between MVP under NBI mode and the MES under white light mode ( r=0.80, P<0.001). The Ki-67 staining indexes of MVP obscure type, absent type, crypt opening subtype and villous subtype of absent type were all higher than that of MVP clear type (30.3±12.8, 45.9±12.5, 45.5±12.1 and 46.3±13.1 vs. 15.6±7.3), and the differences were statistically significant (SNK- q test, all P<0.001); and the Ki-67 staining indexes of MVP absent type, crypt opening subtype and villous subtype of MVP absent type were all higher than that of MVP obscure type, and the differences were statistically significant (SNK- q test, all P<0.001). There was a positive correlation between the MVP type under NBI colonoscopy and the distribution of Ki-67 expression ( r=0.49, P<0.001). The Ki-67 staining indexes of inflammation grade 2, 3 and 4 were higher than that of grade 1 (28.8±10.9, 40.2±11.6 and 49.5±10.3 vs. 17.1±8.4), and the difference was statistically significant (SNK- q test, all P<0.001); the Ki-67 staining indexes of inflammation grade 3 and 4 were higher than that of grade 2, and Ki-67 staining index of inflammation grade 4 was higher than that of grade 3, and the differences were statistically significant (SNK- q test, all P<0.001). The distribution of Ki-67 expression was positively correlated with the degree of histological inflammation ( r=0.56, P<0.001). Conclusions:The MVP under NBI colonoscopy may indirectly predict the colonic epithelial proliferation of patients with UC, which may be closely related to the degree of mucosal inflammation.

C-reactive protein levels and prevalence of leukopenia in patients with inflammatory bowel disease treated with azathioprine and/or mesalazine: a real-life study

ABSTRACT Objective To examine serum C-reactive protein levels and the prevalence of leukopenia in patients with Crohn's disease or ulcerative colitis undergoing treatment with azathioprine and/or mesalazine. Methods Retrospective observational study based on clinical and laboratory data collected from medical records of 76 adult patients with inflammatory bowel disease treated with azathioprine, mesalazine or both. Sex, age, diagnosis, number of blood samples and elevated serum C-reactive protein levels during the follow-up period were recorded. The following variables were analyzed in terms of C-reactive protein levels and leukopenia episodes: sex, age, diagnosis of inflammatory bowel disease and type of drug. Statistical analyses included multiple logistic regression and the Fisher's exact test for qualitative variables. Results Leukopenia was observed in 18.4% of patients and was associated with older age and higher doses of medication. In 44% of patients, C-reactive protein levels were high. However, symptoms were not associated with abnormal levels of this marker. Conclusion Regardless of symptoms, serum C-reactive protein levels were not a reliable indicator of controlled inflammatory bowel disease. Leukopenia was independently associated with older age and higher doses of medication and is a common side effect, which should be routinely monitored.

Manifestaciones cutáneas de la enfermedad inflamatoria intestinal / Cutaneous manifestations of Inflammatory Bowel Disease / Manifestações Cutâneas De Doença Inflamatória Intestinal

En los últimos años se ha evidenciado un aumento en la incidencia y prevalencia de la enfermedad inflamatoria intestinal, que comprende dos entidades: la enfermedad de Crohn y la colitis ulcerativa. Ambas, y paradójicamente su tratamiento, pueden desencadenar manifestaciones cutáneas con una amplia variedad de manifestaciones clínicas en piel, que son un reto diagnóstico para el médico. Solo el conocimiento de estos fenotipos clínicos permitirá el diagnóstico temprano, con el objetivo de lograr el abordaje diagnóstico y el tratamiento oportunos y de evitar secuelas a largo plazo.

In recent years, there is evidence of an increase in the incidence and prevalence of inflammatory bowel disease, in which two entities are involved: Chron disease and ul-cerative colitis. Both of these diseases and, paradoxically, their treatment with anti-TNF may trigger skin manifestations, whose variety of clinical presentations on the skin can represent a diagnostic challenge for the clinician. Only the knowledge of these clinical phenotypes will allow an early diagnosis to be carried out, in order to achieve a timely diagnostic approach and treatment, and to avoid long-term sequelae.

Nos últimos anos, tem havido um aumento na incidência e prevalência da doença infla-matória intestinal, que compreende duas entidades: doença de Crohn e colite ulcerosa. Ambos, e paradoxalmente o seu tratamento, podem desencadear manifestações cutâ-neas com uma grande variedade de manifestações clínicas na pele, o que constitui um desafio diagnóstico para o médico. Somente o conhecimento desses fenótipos clínicos permitirá o diagnóstico precoce, com o objetivo de alcançar uma abordagem diagnóstica e terapêutica oportuna e evitar sequelas a longo prazo.

Comportamiento de las enfermedades inflamatorias del intestino en el Servicio Provincial de Coloproctología de Camagüey / Behavior of the inflammatory diseases of the intestine in Camagüey's provincial Colon-proctology service

RESUMEN Fundamento: la enfermedad inflamatoria del intestino se define como una afectación inflamatoria crónica del tubo digestivo de causa desconocida que evoluciona de modo recurrente con brotes, remisiones que pueden presentar diversas complicaciones y manifestaciones extra digestivas. Objetivo: describir el comportamiento de las enfermedades inflamatorias del intestino en el Servicio Provincial de Coloproctología del Hospital Universitario Manuel Ascunce Domenech. Métodos: se realizó un estudio descriptivo y transversal, desde abril de 2016 hasta abril de 2018. El universo de estudio estuvo constituido por los 100 pacientes diagnosticados por estudios de endoscopía y biopsia de enfermedad inflamatoria del intestino en el servicio ya mencionado. La fuente primaria de la investigación estuvo dada por un formulario diseñado por los autores. Resultados: los pacientes diagnosticados de colitis ulcerosa ocuparon el primer lugar con predominio de la edad de diagnóstico entre 30-39 años; casi la mitad de los pacientes estudiados presentaron antecedentes familiares positivos de enfermedad inflamatoria intestinal, la localización distal fue la más frecuente para la colitis ulcerosa, mientras que para el Crohn solo fue la perineal reportado con un solo caso; las manifestaciones clínicas intestinales más frecuentes correspondieron a las diarreas. Conclusiones: la colitis ulcerativa resultó ser más frecuente que la enfermedad de Crohn y que la colitis inespecífica con la edad de diagnóstico entre 30-39 años, con predominio de antecedentes familiares de primer orden de la enfermedad, en la colitis ulcerosa prevaleció la localización distal y en el Crohn fue perineal donde la diarrea fue el síntoma más frecuente en ambas.

ABSTRACT Background: the inflammatory disease of the intestine defines like an inflammatory chronic affectation of the alimentary canal of unknown etiology that evolves of recurrent mode with sprouts and remissions and can present various complications and extra digestive manifestations. Objective: to describe the behavior of the inflammatory diseases of the intestine in Provincial Colon-proctology Service of the Teaching Hospital Manuel Ascunce Domenech. Methods: a descriptive cross-sectional study was carried out from April, 2016 to April, 2018. The universe of study was constituted for the 100 patients diagnosed by endoscopy's studies and biopsy of inflammatory disease of the intestine in the aforementioned service. The investigation's primary source was given for a fill-out form designed by the authors. Results: the patients diagnosed of ulcerous colitis occupied the first place with a predominance of age diagnosis between 30-39 years old, almost half of the studied patients presented familiar background of intestinal inflammatory disease, the distal localization showed the most frequent for the ulcerative idiopathic colitis, while for Crohn the most frequent localization was perinea localization with just a case; the clinical intestinal manifestation more frequent corresponded to the diarrheas. Conclusions: the ulcerative colitis turned out to be more frequent than the disease of Crohn and then unspecified colitis with an age diagnosis between 30-39 years old; and with predominance of first-rate family record of the disease; in the ulcerative colitis prevailed the location distal and in the Crohn it was perineal being the diarrhea the most frequent symptom in both.