Clinical characteristics and long -term prognosis of elderly onset Crohn 's disease / 中南大学学报(医学版)

OBJECTIVES@#With the increase in aging population in China, elderly Crohn's disease (CD) patients need to receive more attention. This study aims to explore the clinical characteristics and disease process of elderly onset CD (EOCD) patients in a single center.@*METHODS@#From January 2002 to January 2022, a total of 221 patients with CD from the Seventh Medical Center of Chinese PLA General Hospital were enrolled. According to the Montreal CD classification standard, the patients were further divided into 4 groups: an EOCD group (≥60 years old, n=25), a middle age onset CD (MOCD) group (40-59 years old, n=46), a young onset CD (YOCD) group (17-40 years old, n=131), and a childhood onset CD (COCD) group (6-16 years old, n=19). We compared the clinical characteristics and long-term prognosis among them.@*RESULTS@#Females were predominant in the EOCD group (15/25, 60%). The number of people without smoking in the EOCD group (80%) was lower than that in COCD group (100%), higher than that in the YOCD group (70.2%) and the MOCD group (69.6%) (all P<0.05). Patients with perianal diseases at diagnosis were rare in the EOCD group (0%), lower than that in the COCD group (21.1%) and the YOVD group (19.8%) (all P<0.05). Stenosis was the most common disease behavior in the EOCD group (63.0%), significantly higher than that in the COCD group (15.8%), the YOCD group (36.6%) and the MOCD group (43.5%) (all P<0.05). The EOCD group was easier to be misdiagnosed as tumor (24%), higher than that in the COCD group (0%), the YOCD group (6.9%) and the MOCD group (19.6%) (all P<0.05). The EOCD group was prone to comorbidities (52%), and 20% of them were complicated with multiple comorbidities (P<0.05). During the follow-up, the all-cause mortality of EOCD was 12%, and the CD-related mortality was 8%, which was significantly higher than the other groups (all P<0.05). The use of immunosuppressants in the EOCD group (4.8%) was lower than that in the COCD group (12.8%), the YOCD group (16.8%) and the MOCD group (16.1%), but there was no statistical significance among the 4 groups (P=0.467). In addition, there was no significant difference in the rate of intestinal resection among the 4 groups (P=0.062).@*CONCLUSIONS@#In EOCD patients, females were predominant, smoking was less common, and they were prone to comorbidity. At the initial stage of diagnosis, it is easy to be misdiagnosed as tumor, and the disease behavior mainly showed stricture type, less complicated with perianal diseases. During the follow-up, all-cause mortality and CD-related mortality of EOCD patients were significantly higher than those of the non-elderly onset CD patients.

Días de hospitalización por colitis ulcerosa y enfermedad de Crohn según sexo entre los años 2018-2021, Chile / Chile hospital length of stay due to ulcerative colitis and Crohn's disease according to sex between the years 2018-2021, Chile

Introducción: La enfermedad inflamatoria intestinal (EII), como la Enfermedad de Crohn (EC) y la Colitis Ulcerosa (CU), ha experimentado un aumento en las tasas de egreso hospitalario en países en vías de desarrollo, generando una carga adicional a los sistemas de salud y, por ende, mayores costos. Actualmente, en Chile, no se disponen de datos sobre la incidencia y prevalencia de estas enfermedades. Objetivo: Analizar las tasas de egreso hospitalario por CU y EC entre los años 2018-2021 en Chile según el Departamento de Estadística e Información en Salud (DEIS). Materiales y métodos: Estudio descriptivo, observacional y ecológico. Se utilizó una muestra de 9.109 sujetos, de todos los rangos etarios, hospitalizados con diagnóstico de EC y CU entre 2018-2021. La base de datos se obtuvo del DEIS. No se necesitó aprobación por comité de ética. Resultados: Entre los años 2018-2021, la tasa de egreso hospitalario de CU (9,08) fue mayor que la EC (3,88). Entre 2019-2020 se presentó la mayor caída de las tasas con un descenso de 1,10 para EC y 1,49 para CU. Las mujeres tuvieron una mayor tasa general en ambas enfermedades (4,15 para EC y 10,04 para CU). Las mujeres con EC presentaron una mayor estadía hospitalaria con un promedio de 8,69 días. Conclusión: Los resultados obtenidos actualizan la situación epidemiológica nacional respecto a los días de hospitalización por CU y EC, y podrían contribuir a cuantificar los costos de la EII para generar políticas de salud pública.

Introduction: In developing countries, Inflammatory Bowel Disease (IBD) such as Crohn's disease (CD) and ulcerative colitis (UC) has seen an increase in hospital discharge rates, causing an overload on healthcare systems and higher costs. Currently, in Chile, there is no available data on the incidence and prevalence of these diseases. Objective: This study aimed to analyze UC and CD hospital discharges in Chile between the years 2018-2021 according to the Department of Health Statistics and Information (DEIS). Materials and methods: Descriptive, observational, and ecological study. The sample included 9,109 subjects of all age ranges, hospitalized with CD and UC diagnoses between 2018-2021. The database was obtained from DEIS. Ethics committee approval was not required. Results: Between 2018-2021, the hospital discharge rate for UC was higher than for CD. The most significant rate drop occurred between 2019-2020, with a decrease of 1.10 for CD and 1.49 for UC. Women had the highest rates in both diseases (4.15 for CD and 10.04 for UC). Women with CD presented a longer hospital stay, with an average of 8.69 days. Conclusion: The obtained data provide updated information on the national epidemiological situation regarding hospital length of stay due to UC and CD, and could contribute to measuring IBD costs for the creation of public health policies.

Epidemiological study on the incidence of inflammatory bowel disease in Yinzhou District, Ningbo City from 2011 to 2020 / 北京大学学报(医学版)

OBJECTIVE@#To describe the distribution characteristics of inflammatory bowel disease among permanent residents in Yinzhou District, Ningbo City, and to understand the disease burden and development trend of inflammatory bowel disease in this area.@*METHODS@#Using the retrospective cohort design, we collected the registration information of all permanent residents in the residents' health files of the Yinzhou Regional Health Information Platform from 2010 to 2020, and used electronic medical records to follow up their inflammatory bowel disease visits. A one-year wash-out period was set, and the patients who were diagnosed with the primary diagnosis for the first time after one year of registration were re-garded as new cases. The incidence density and 95% confidence interval (CI) of inflammatory bowel disease were estimated by Poisson distribution.@*RESULTS@#From 2011 to 2020, a total of 1 496 427 permanent residents in Yinzhou District were included, of which 729 996 were male (48.78%). The total follow-up person-years were 8 081 030.82, and the median follow-up person-years were 5.41 [interquartile range (IQR): 5.29]. During the study period, there were 1 217 new cases of inflammatory bowel disease, of which males (624 cases, 51.27%) were more than females (593 cases, 48.73%). The total incidence density was 15.06/100 000 person-years (95%CI: 14.23, 15.93). Among all new cases, there were 1 106 cases (90.88%) of ulcerative colitis, with an incidence density of 13.69 per 100 000 person-years (95%CI: 12.89, 14.52); 70 cases (5.75%) of Crohn's disease, with an incidence density of 0.87 per 100 000 person-years (95%CI: 0.68, 1.09); and 41 cases (3.37%) of indeterminate colitis, with an incidence density of 0.51 per 100 000 person-years (95%CI: 0.36, 0.69). The median age of onset of ulcerative colitis was 50.82 years old (IQR: 18.77), with the highest proportion (15.01%) in the 45-49 years group. The incidence density of ulcerative colitis gradually increased with age, reaching a relatively high level in the 45-49 years group (20.53/100 000 person-years; 95%CI: 17.63, 23.78), followed by a slight increase. And the incidence density in the 65-69 years group was the highest (25.44/100 000 person-years; 95%CI: 20.85, 30.75), with a rapid decrease in the 75-79 years group. The median age of onset of Crohn's disease was 44.34 years (IQR: 33.41), with the highest proportion (12.86%) in the 25-29 years group. Due to the small number of new cases of Crohn's disease, the age distribution fluctuated greatly, with peaks both in young and old people. From 2011 to 2020, the incidence density of inflammatory bowel disease in Yinzhou District was at a low level from 2011 to 2013, and showed a rapid upward trend from 2014 to 2016, reaching a peak of 24.62 per 100 000 person-years in 2016 (95%CI: 21.31, 28.30), and slightly decreased in 2017-2020.@*CONCLUSION@#The incidence density of inflammatory bowel disease in Yinzhou District from 2011 to 2020 was at a relatively high level, and medical institutions and health departments need to pay attention to the burden of disease caused by it.

HucMSC-Ex alleviates inflammatory bowel disease via the lnc78583-mediated miR3202/HOXB13 pathway / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

As a group of nonspecific inflammatory diseases affecting the intestine, inflammatory bowel disease (IBD) exhibits the characteristics of chronic recurring inflammation, and was proven to be increasing in incidence (Kaplan, 2015). IBD induced by genetic background, environmental changes, immune functions, microbial composition, and toxin exposures (Sasson et al., 2021) primarily includes ulcerative colitis (UC) and Crohn's disease (CD) with complicated clinical symptoms featured by abdominal pain, diarrhea, and even blood in stools (Fan et al., 2021; Huang et al., 2021). UC is mainly limited to the rectum and the colon, while CD usually impacts the terminal ileum and colon in a discontinuous manner (Ordás et al., 2012; Panés and Rimola, 2017). In recent years, many studies have suggested the lack of effective measures in the diagnosis and treatment of IBD, prompting an urgent need for new strategies to understand the mechanisms of and offer promising therapies for IBD.

Aspectos epidemiológicos das doenças intestinais inflamatórias na região oeste do Estado de Minas Gerais / Epidemiologic aspects of inflammatory bowel disease in the western region of minas gerais state

ABSTRACT BACKGROUND: Crohn's disease (CD) and ulcerative colitis (UC), two of the main inflammatory bowel diseases (IBD), have been increasingly diagnosed in South America. Although IBD have been intensively studied in the last years, epidemiologic data in Brazil are scarce. OBJECTIVE: To study the clinical and epidemiologic profile of IBD patients treated in the Clinical Hospital of the Federal University of Uberlândia from 1999 to 2014. METHODS: We performed a retrospective study of the medical records of patients diagnosed with IBD, according to the international classification of diseases (ICD) - ICD K50 for CD and ICD K51 for UC - confirmed by endoscopic examination in the case of both diseases. We analyzed the following variables: age; sex; ethnicity; smoking habit; primary diagnosis; site of disease manifestation; main clinical manifestations; IBD-related complications; extraintestinal manifestations; and established drug and/or surgical treatment. RESULTS: We evaluated 183 IBD cases (91 UC and 92 CD cases). The estimated prevalence rate of UC was 15.06/100.000 inhabitants and of CD was 15.23/100.000. The CU and CD female to male incidence ratios were 1.7 and 1.8, respectively. The average age of patients diagnosed with UC was 39.4 years and of those diagnosed with CD was 31.1 years. White-skinned people were the most affected by UC (66.0%) and CD (69.0%). Few patients were submitted to surgical procedures as treatment alternative. CONCLUSION: The estimated prevalence of IBD in this population was low compared to that of populations of North America, but high compared to that of other regions considered to present low incidence, such as some Asian and Latin American countries.

RESUMO CONTEXTO: A doença de Crohn (DC) e a retocolite ulcerativa (RCU), duas das principais doenças inflamatórias intestinais (DIIs), têm sido cada vez mais diagnosticadas na América do Sul. Embora a DII tenha sido intensamente estudada nos últimos anos, os dados epidemiológicos no Brasil são escassos. OBJETIVO: Estudar o perfil clínico e epidemiológico dos pacientes com DII atendidos no Hospital das Clínicas da Universidade Federal de Uberlândia de 1999 a 2014. MÉTODOS: Foi realizado um estudo retrospectivo dos prontuários de pacientes com diagnóstico de DII, de acordo com a classificação internacional de doenças (CID) - CID K50 para DC e CID K51 para RCU - confirmado por exame endoscópico para ambas as doenças. Analisamos as seguintes variáveis: idade; sexo; etnia; hábito tabágico; diagnóstico primário; local de manifestação da doença; principais manifestações clínicas; complicações relacionadas a DII; manifestações extraintestinais; tratamentos medicamentoso e/ou cirúrgico instituídos. RESULTADOS: Foram avaliados 183 casos de DII (91 casos de RCU e 92 casos de DC). A prevalência estimada de RCU foi de 15,06/100.000 habitantes e de DC foi de 15,23/100.000. As taxas de incidência entre pacientes do sexo feminino e masculino foram de 1,7 para RCU e 1,8 para DC. A idade média dos pacientes com diagnóstico de RCU foi de 39,4 anos e daqueles com DC foi de 31,1 anos. A raça branca foi o grupo étnico mais afetado por RCU (66,0%) e DC (69,0%). Poucos pacientes foram submetidos a procedimentos cirúrgicos como alternativas de tratamento. CONCLUSÃO: A prevalência estimada de DII nesta população foi baixa em comparação com populações da América do Norte, mas elevada em comparação com outras regiões consideradas de baixa incidência, como alguns países da Ásia e da América Latina.

Tratamiento quirúrgico de las complicaciones en la enfermedad de Crohn / Surgical Treatment of Complicated Crohn's Disease

Introducción: La enfermedad de Crohn consiste fundamentalmente en el control de los síntomas para alcanzar la remisión clínica, cuando esto no se logra o aparecen complicaciones, puede ser necesario el tratamiento quirúrgico. Objetivo: Evaluar los resultados del tratamiento quirúrgico de los pacientes con enfermedad de Crohn complicada. Método: Se realizó un estudio ambispectivo, descriptivo y longitudinal con una muestra de 20 pacientes con enfermedad de Crohn complicada que acudieron a la consulta de cirugía general y gastroenterología del Hospital Clínico Quirúrgico "Hermanos Ameijeiras" y del Instituto de Gastroenterología, en el periodo de enero del 2010 a mayo del 2019. Se recogieron todas las variables demográficas; estudios hemoquímicos, por imágenes y endoscópicos. Resultados: La mayor incidencia de las complicaciones por enfermedad de Crohn se observó en pacientes mayores de 50 años, con un tiempo de evolución entre 1 y 10 años. La fístula y el plastrón fueron las principales causas de tratamiento quirúrgico. La vía de acceso laparoscópica mostró ventajas respecto a la convencional. El desequilibrio hidromineral y la infección del sitio quirúrgico fueron las principales complicaciones postoperatorias, con mortalidad baja. Conclusiones: El tratamiento quirúrgico electivo, planificado y secuencial de pacientes con enfermedad de Crohn complicada ofrece buenos resultados y es posible utilizar la vía de acceso videoasistida con resultados alentadores en pacientes seleccionados(AU)

Introduction: The managment of Crohn's disease consists in symptoms control for achieving clinical remission. When this is not accomplished or complications reappear, surgical treatment may be necessary. Objective: To assess the outcomes of surgical treatment of patients with complicated Crohn's disease. Method: An ambispective, descriptive and longitudinal study was carried out with a sample of twenty patients with complicated Crohn's disease who attended the general surgery and gastroenterology consultation at Hermanos Ameijeiras Clinical Surgical Hospital and the Gastroenterology Institute, in the period from January 2010 to May 2019. All demographic variables were collected, as well as the results of hemochemical, imaging and endoscopic studies. Results: The highest incidence of complications from Crohn's disease was observed in patients over fifty years of age and with an evolution time between one and ten years. Fistula and plastron were the main causes for surgical treatment. The laparoscopic approach showed advantages over the conventional one. Hydromineral imbalance and surgical site infection were the main postoperative complications, with low mortality. Conclusions: Elective, planned and sequential surgical treatment of patients with complicated Crohn's disease offers good outcomes. It is possible to use the video-assisted approach, with encouraging outcomes in selected patients(AU)

Prevalência e fatores associados ao supercrescimento bacteriano do intestino delgado em pacientes com doença de Crohn: estudo retrospectivo em um centro de referência / Prevalence and factors associated with small intestinal bacterial overgrowth in patients with crohns disease: a retrospective study at a referral center

ABSTRACT BACKGROUND: Small intestinal bacterial overgrowth (SIBO) appears to be common in patients with Crohn's disease (CD). The rate of SIBO has been estimated at 25%-88% in this setting. However, different demographic, socioeconomic, and disease-related factors may exist between South American and North American or European populations that may limit the generalization of these findings, as the data are mainly derived from North American or European studies. OBJECTIVE: We studied the prevalence and predictors of SIBO in CD outpatients. METHODS: In this retrospective study, between June 2011 and June 2016, the medical records of 110 CD patients were assessed for presence of SIBO using the H2/CH4 glucose breath test. Univariate analysis was performed to investigate the potential association between SIBO and demographic, disease-related data, systemic markers of inflammation (C-reactive protein and erythrocyte sedimentation rate). RESULTS: The SIBO rate was high in CD patients (30%). Patients with and without SIBO were comparable according to demographics, systemic inflammatory biomarkers, and disease characteristics, except to the stricturing phenotype more common in the SIBO-positive CD patients (48.5% vs 19.5%, P=0.001). CONCLUSION: In Brazilian CD patients, SIBO is a highly prevalent condition. Stricturing phenotype demonstrated association with SIBO. An individualized screening plan followed by the timely treatment for SIBO should be carried out as part of quality of care improvement in CD individuals.

RESUMO CONTEXTO: O supercrescimento bacteriano de intestino delgado (SBID) parece ser comum em pacientes com doença de Crohn (DC). A taxa de SBID tem sido estimada entre 25-88% neste cenário. Entretanto, diferenças demográficas, socioeconômicas e dos fatores relacionados à doença podem existir entre as populações da América do Sul e da América do Norte ou europeias que podem limitar a generalização destes achados, uma vez que os dados são derivados principalmente de estudos norte-americanos ou europeus. OBJETIVO: Estudar a prevalência e os preditores de SBID em pacientes ambulatoriais com DC. MÉTODOS: Neste estudo retrospectivo os registros médicos de 110 pacientes com DC que haviam sido submetidos ao teste respiratório do hidrogênio e metano expirados para o diagnóstico de SBID, entre junho de 2011 e junho de 2016, foram avaliados. Análise univariada foi realizada para investigar a potencial associação entre SBID com os dados demográficos, relacionados à DC e marcadores sistêmicos de inflamação (proteína C-reativa e velocidade de hemossedimentação). RESULTADOS: A prevalência de SBID foi elevada em pacientes com DC (30%). Os pacientes com e sem SBID foram comparáveis de acordo com os dados demográficos e de biomarcadores de inflamação sistêmica, bem como das características da DC, exceto pelo fenótipo estenosante, mais comum nos pacientes com DC e SBID (48,5% vs 19,5%, P=0,001). CONCLUSÃO: Em pacientes brasileiros com DC, SBID é uma condição altamente prevalente. O fenótipo estenosante demonstrou associação com o SBID. O planejamento de um screening individualizado seguido por tratamento apropriado para SBID deve ser incluído como parte da melhoria na qualidade de cuidados a ser oferecida para os pacientes com DC.

Epidemiological profile and hospitalization data of patients with inflammatory bowel disease / Perfil epidemiológico e caráter de internação dos pacientes portadores de doença inflamatória intestinal

Abstract Objective: This study's objective was to understand the epidemiologic profile of the patients with inflammatory bowel disease in the state of Tocantins, Brazil. Methods: This is a descriptive study of secondary data, which was gathered by using the Informatics Department of the Brazilian Health System, and it corresponds to the cases registered from January of 2010 to December of 2017. The data of interest were those related to the total number of admissions, age range, gender, ethnicity, city of hospitalization, and type of care. Results: There were 340 hospital admissions due to inflammatory bowel diseases in Tocantins, of which 204 (60%) were female patients and 136 (40%), male patients; the predominant age group was between 20 and 59 years old (65.88%). These hospitalizations lasted an average of 4.7 days and 98.23% of them occurred as a matter of urgency. Conclusion: The study demonstrated that the epidemiological profile of the inflammatory bowel disease in the state of Tocantins consists of female patients, aged between 20 and 59 years, with hospitalizations lasting 4.7 days and mainly urgent, demonstrating that it is necessary to implement screening measures in order to make the diagnosis earlier, thus preventing possible complications.

Resumo Objetivo: Conhecer o perfil epidemiológico dos pacientes portadores da doença inflamatória intestinal no estado do Tocantins. Metodologia: Trata-se de estudo descritivo de dados secundários obtidos a partir do Sistema de Internações Hospitalares do Sistema Único de Saúde, que se compreendem entre Janeiro de 2010 e Dezembro de 2017. Os dados de interesse foram aqueles relacionados ao número total de internações, à faixa etária, sexo, raça, município de internação dos pacientes e caráter dos atendimentos. Resultados: Houve 340 internações hospitalares em razão das doenças inflamatórias intestinais em Tocantins, das quais 204 (60%) foram pacientes femininos e 136 (40%) pacientes masculinos, e a faixa etária predominante foi entre 20 e 59 anos (65,88%). Essas internações duraram em média 4,7 dias e 98,23% delas ocorreram com caráter de urgência. Conclusão: O estudo demonstrou que o perfil epidemiológico da doença inflamatória intestinal no Tocantins constitui-se por pacientes femininos, tendo de 20 a 59 anos, internações de 4,7 dias e predominantemente de urgência, o que torna necessário a implantação de medidas de rastreio de forma a tornar o diagnóstico mais precoce, prevenindo, então, possíveis complicações.

Epidemiología y fenotipo de la enfermedad de Crohn en un hospital de referencia en Lima Perú / Epidemiology and phenotype of Crohn's disease in a reference hospital in Lima Peru

RESUMEN La enfermedad de Crohn (EC) es una patología inflamatoria crónica del tracto digestivo con gran impacto en la calidad de vida de los pacientes. La epidemiología mundial está cambiando en los últimos años y su prevalencia está aumentando en Latinoamérica. Objetivo: Evaluar las características epidemiológicas, fenotipo, curso clínico, diagnóstico y tratamiento de la EC. Materiales y métodos: Estudio observacional, descriptivo, retrospectivo de pacientes con diagnóstico de EC desde enero 2004 a diciembre 2019 en el servicio de gastroenterología del Hospital Nacional Guillermo Almenara Irigoyen, LimaPerú. Resultados: Se incluyó 55 pacientes, con edad promedio de 56 ± 8,2 años. Predominio masculino (62%). El tiempo promedio de diagnóstico fue de 18 ± 6,1 meses. Los síntomas más frecuentes fueron: dolor abdominal 72,7% y baja de peso 60%. Las manifestaciones extraintestinales se presentaron en 20%. La localización ileal (36,4%) fue la más frecuente, seguida de la colónica (32,7%). Predominó el fenotipo inflamatorio en la mitad de los pacientes, seguido de estenosante en 25,5%. La actividad clínica y endoscópica más frecuente fue moderada. Para el tratamiento de inducción y mantenimiento, los corticoides sistémicos y la terapia biológica con anti-TNF fueron los más utilizados respectivamente. Aproximadamente un tercio de pacientes requirieron cirugía durante la evolución de la enfermedad. La mortalidad fue del 5,4%. Conclusiones: La EC es una enfermedad cada vez más frecuente en nuestro país, con características epidemiológicas y fenotípicas que difieren de otros continentes.

ABSTRACT Crohn's disease (CD) is a chronic inflammatory pathology of the digestive tract with great impact on the quality of life of patients. Global epidemiology is changing in recent years and its prevalence is increasing in Latin America. Objective: To evaluate the epidemiological characteristics, phenotype, clinical course, diagnosis and treatment of CD. Materials and methods: Retrospective, descriptive, observational study of patients diagnosed with CD from January 2004 to December 2019 in the gastroenterology service of the Guillermo Almenara Irigoyen National Hospital, Lima-Peru. Results: 55 patients with an average age of 56 ± 8.2 years were included. Male predominance (62%). The average diagnosis time was 18 ± 6.1 months. The most frequent symptoms were: abdominal pain 72.7% and weight loss 60%. Extraintestinal manifestations occurred in 20%. The ileal location (36.4%) was the most frequent, followed by colonic (32.7%). The inflammatory phenotype predominated in half of the patients, followed by stenosing in 25.5%. The most frequent activity clinical and endoscopic was moderate. For induction and maintenance treatment, systemic corticosteroids and biological therapy with anti-TNF were the most widely used, respectively. Approximately a third of patients required surgery during the evolution of the disease. Mortality was 5.4%. Conclusions: CD is an increasingly frequent disease in our country, with epidemiological and phenotypic characteristics that differ from other continents.

Impacto do afastamento do trabalho por doenças inflamatórias intestinais no Brasil / Impact of work disability due to inflammatory bowel diseases in Brazil

As doenças inflamatórias intestinais (DII) podem ter impactos sociais e econômicos no Brasil, onde sua prevalência aumentou recentemente. Este estudo tem como objetivo principal avaliar a incapacidade por DII na população brasileira, descrevendo proporções com fatores demográficos e como objetivo secundário, a avaliação de possíveis fatores de risco de afastamento do trabalho por Doença de Crohn (DC) em um centro de referência em DII da Universidade do Estado do Rio de Janeiro (UERJ), cujo resultado pode refletir outras regiões do país. A análise foi realizada utilizando-se a plataforma do Sistema Único de Informações sobre Benefícios da Previdência Social, com um primeiro cruzamento de dados de auxílios doença e aposentadorias por invalidez com DC e Retocolite Ulcerativa (RCU) entre 2010-2014. Dados adicionais como valores médios de benefícios, duração do benefício, idade, sexo e região foram obtidos através da mesma plataforma. Um segundo cruzamento entre auxílios doença e aposentadorias por invalidez foi feito somente para DC entre 2010-2018 no estado do Rio de Janeiro e foram pesquisados os mesmos dados adicionais. Uma subanálise foi realizada nos casos de incapacidade em comum com os pacientes com DC da UERJ, para avaliação das características que teriam maior chance de atuar como fator de risco para afastamento do trabalho, se comparando com a população de DC desse ambulatório que não teve afastamento pelo Instituto Nacional do Seguro Social (INSS). No Brasil, a incapacidade temporária ocorreu com maior frequência na RCU enquanto a permanente na DC. A DC afastou pacientes mais jovens que a RCU e ambas mais mulheres que homens. As ausências temporárias do trabalho por DC e RCU foram maiores no Sul e as menores ausências por DC foram observadas no Norte e Nordeste. A média de dias de incapacidade foi longa, de quase um ano, sendo maiores na DC em comparação à RCU, porém ambos tenderam a diminuir de 2010 à 2014. O valor dos benefícios pagos pelas DII representou aproximadamente 1% de todos os benefícios da mesma natureza no país, sendo 51% dos gastos com DC. No RJ, a prevalência da DC foi de 26 por 100.000/habitantes, com custo indireto de 0,8% dos benefícios totais, apresentando taxa de 16,6% de incapacidade, similar a encontrada no grupo de pacientes da UERJ. Os fatores de risco de incapacidade por DC na UERJ foram idade menor que 40 anos a época do diagnóstico, tempo de duração da doença, cirurgia intestinal prévia e fístula anovaginal. Dos afastados, 19% apresentaram depressão ou ansiedade associados. A média de tempo entre o diagnóstico de DC e a incapacidade foi de 3 anos. No Brasil, as DII frequentemente causam incapacidade prolongada e podem gerar aposentadorias precoces, com programas de reabilitação profissional ainda pouco explorados. As tendências de redução das taxas de incapacidade no Brasil podem refletir melhorias no acesso a cuidados de saúde e a medicamentos. Os custos indiretos baseados apenas no absenteísmo em empregos foram significativos e a demonstração desse impacto socioeconômico e de fatores de risco de incapacidade podem auxiliar no planejamento de políticas públicas para o país.

Inflammatory bowel diseases (IBD) can lead to Brazil's social and economic impacts, where their prevalence has recently increased. This study's main objective is to evaluate the disability due to IBD in the Brazilian population describing proportions with demographic factors. Secondly, it assesses possible risk factors of absence from work due to Crohn's disease (CD) in a referral center of IBD of the State University of RJ (UERJ), which results may reflect other regions of the country. The analysis was performed using the Unified Social Security Benefits Information System platform, with the first crossing of data on sickness benefits and disability pensions with CD and Ulcerative Colitis (UC) between 2010- 2014. Additional data, such as average benefit values, benefit duration, age, sex, and region of the country, were obtained through the same platform. A second crossing between sickness benefits and disability pensions was made only for CD between 2010-2018 in the state of Rio de Janeiro (RJ) for the evaluation of the same additional data. A subanalysis was made in cases of CD disability in common with patients at UERJ, to assess the characteristics that would have a greater chance as a risk factor for absence from work, compared to the population of CD of this clinic that had no disability by the Institute National Social Security (INSS). In Brazil, temporary disability occurred more frequently in the UC while the permanent one in CD. Disability occurred in patients with CD younger than UC and both more in women than in men. Temporary absences from work due to CD and UC were more significant in the South, and the lowest absences due to CD were observed in the North and Northeast. The average number of days of disability was long, almost one year, being higher in CD than in UC, but both tended to decrease from 2010 to 2014. IBD's benefits represented approximately 1% of all the benefits of sickness in the country, with 51% of DC spending. In RJ, the prevalence of CD was 26 per 100,000 / inhabitants, with an indirect cost of 0.8% of total benefits, with a rate of 16.6% of disability, similar to that found in the group of patients at UERJ. The risk factors for CD disability in UERJ were age under 40 at the time of diagnosis, duration of the disease, previous intestinal surgery, and anovaginal fistula. Of those on absence from work 19% had associated depression or anxiety. The average time between the diagnosis of CD and disability was three years. In Brazil, IBDs often cause prolonged disability and can lead to early retirements, with professional rehabilitation programs still little explored. Trends in the reduction of disability rates in Brazil may reflect improvements in access to healthcare and medicines. The indirect costs with IBD in Brazil, based only in absenteeism, were significant, and demonstrating this socioeconomic impact and risk factors for disability can help plan public policies for the country.

Deficiência de vitamina D entre pacientes com doença inflamatória intestinal na Argentina: um estudo transversal / Vitamin d deficiency among inflammatorybowel disease patients in argentina: a cross-sectional study

ABSTRACT BACKGROUND: An association has been established between low serum values of vitamin D and inflammatory bowel disease. There is a lack of evidence on whether this association is still observed in regions where sun exposure throughout the year is higher. OBJECTIVE: To compare the prevalence of vitamin D deficiency between inflammatory bowel disease patients and healthy controls. METHODS: Inflammatory bowel disease patients were consecutively enrolled as cases. Age and gender-matched healthy subjects who agreed to undertake a determination of serum vitamin D were enrolled as controls. Demographic features, medical treatment, need for hospital admission at diagnosis, steroid treatment, smoking, need for surgical treatment were evaluated as factors associated with vitamin D deficiency. RESULTS: Overall, 59 patients with a diagnosis of either Crohn's disease or ulcerative colitis were enrolled, as well as 56 controls. Median age was 41 years (19-79) and 56% were male. Vitamin D deficiency was observed in 66.1% of inflammatory bowel disease patients versus 21.42% of healthy controls (OR 7.15 (3.1-16.48), P=0.001). Among inflammatory bowel disease patients, male gender, disease duration, moderate-to-severe disease and hospital admission at the moment of diagnosis were found to be associated with vitamin D deficiency. On multivariate analysis, only longer disease duration [(OR 1.01 (1-1.06)] and hospital admission at diagnosis [(OR 5.63 (1.01-31.61)] were found to be significantly associated with the latter. CONCLUSION: Vitamin D deficiency was more frequent among inflammatory bowel disease patients. Longer disease duration and need for hospital admission at diagnosis were associated to vitamin D deficiency among these patients.

RESUMO CONTEXTO: Uma associação foi estabelecida entre os baixos valores séricos de vitamina D e doença inflamatória intestinal. Falta evidência se esta associação ainda é observada em regiões onde a exposição ao sol durante todo o ano é maior. OBJETIVO: Comparar a prevalência de deficiência de vitamina D entre pacientes com doença inflamatória intestinal e indivíduos controles saudáveis. MÉTODOS: Pacientes com doença inflamatória intestinal foram consecutivamente selecionados. Indivíduos saudáveis combinados da mesma idade e gênero que concordaram em fornecer uma determinação da vitamina D do soro foram considerados como controles. Características demográficas, tratamento médico, necessidade de admissão hospitalar no diagnóstico, tratamento de esteroides, tabagismo, necessidade de tratamento cirúrgico foram avaliados como fatores associados à deficiência de vitamina D. RESULTADOS: No geral, 59 pacientes com diagnóstico de doença de Crohn ou colite ulcerosa foram observados, bem como 56 controles. A idade mediana era de 41 anos (19-79) e 56% eram do sexo masculino. A deficiência de vitamina D foi observada em 66,1% dos pacientes com doença inflamatória intestinal versus 21,42% dos controles saudáveis (OR 7,15 (3.1-16.48), P=0,001). Entre os pacientes com doença inflamatória intestinal, sexo masculino, duração da doença, doença de moderada a severa e admissão hospitalar no momento do diagnóstico foram associados com a deficiência de vitamina D. Na análise multivariada, apenas a duração da doença [(OR 1; 1 (1-1,06)] e a admissão hospitalar no diagnóstico [(OR 5,63 (1,01-31,61)] foram encontradas significativamente associadas ao último. CONCLUSÃO: A deficiência de vitamina D foi mais frequente entre os pacientes com doença inflamatória intestinal. Maior duração da doença e necessidade de admissão hospitalar no diagnóstico foram associadas à deficiência de vitamina D entre esses pacientes.

Registro prospectivo durante un año de enfermedad inflamatoria intestinal en población pediátrica argentina / One-year prospective registry of inflammatory bowel disease in the Argentine pediatric population

Introducción. La enfermedad inflamatoria intestinal (EII) comprende la colitis ulcerosa (CU) y la enfermedad de Crohn (EC). Su diagnóstico es cada vez más frecuente en pediatría y la incidencia es desconocida en Argentina. El objetivo de este trabajo fue determinar la incidencia anual de EII en menores de 18 años de nuestro país, los aspectos epidemiológicos y las formas clínicas de presentación. Población y métodos. Estudio prospectivo, multicéntrico y observacional que abarcó todo el territorio nacional. Se incluyeron menores de 18 años con diagnóstico de EII de centros públicos y privados entre el 1/6/2012 y el 31/5/2013, a través de protocolo en la web. Resultados. Participaron 17 centros, y se registraron 50 pacientes en 10 centros. La incidencia fue 0, 4/100 000 < 18 años; EC, 20; CU, 25; y EII no clasificable, 5. Distribución según sexo: 26 varones y 24 mujeres. La edad media al momento del diagnóstico fue de 9, 7 años y la demora diagnóstica, de 16, 5 meses. Los síntomas y signos más frecuentes fueron diarrea crónica con sangre y/o moco, dolor abdominal y adelgazamiento. El retraso del crecimiento fue menor de lo esperado. Las manifestaciones extraintestinales se presentaron en el 24% en CU y en el 25% en EC. La localización más frecuente en EC fue ileocolónica, y, en CU, pancolónica. No se observó CU con formas graves. Conclusiones. La incidencia fue menor que la reportada por otros registros. Se considera conveniente la creación de un registro permanente, que no solo permita conocer la incidencia, sino también servir de apoyo a los centros referentes que diagnostican y tratan esta patología.

Introduction. Inflammatory bowel disease (IBD) includes ulcerative colitis (UC) and Crohn's disease (CD). IBD diagnosis has become increasingly common in pediatrics but its incidence is unknown in Argentina. The objective of this study was to determine the annual incidence of IBD in children and adolescents younger than 18 years in Argentina, its epidemiological aspects, and clinical presentations. Population and methods. Prospective, observational, multicenter study conducted in Argentina. Children and adolescents younger than 18 years from public and private facilities, diagnosed with IBD between June 1st, 2012 and May 31st, 2013 were included via a web protocol. Results. Seventeen sites participated in the study; 50 patients were recruited from 10 sites. IBD incidence was 0.4/100 000 among individuals <18 years; CD, 20; UC, 25; and idiopathic IBD, 5. Distribution by sex: 26 boys and 24 girls. Patients' mean age at diagnosis was 9.7 years, and delay in the diagnosis was 16.5 months. The most common symptoms and signs were chronic diarrhea with blood and/or mucus, abdominal pain, and weight loss. Growth retardation was less common than expected. Extraintestinal manifestations were observed in 24% of UC cases and in 25% of CD cases. The most common location of CD was the ileum and colon, and of UC was the entire colon (pancolonic). There were no cases with severe UC. Conclusions. The incidence was lower than that reported in other registries. We recommend the development of an ongoing registry, to establish the incidence of IBD, but also to serve as backup for referring facilities where this disease is diagnosed and treated.

Inflammatory bowel disease: outpatient treatment profile / Doença inflamatória intestinal: perfil do paciente em tratamento ambulatorial

ABSTRACT BACKGROUND Crohn’s disease and ulcerative colitis are the two major forms of inflammatory bowel disease. The incidence and prevalence of both conditions have increased and are progressively increasing. These diseases are frequently recurrent and clinically highly severe. In Brazil, the lack of epidemiological data related to such diseases has left these patients in a vulnerable state and contributed to increased morbidity. OBJECTIVE To describe the profiles of patients with inflammatory bowel disease treated in an outpatient service in Brazil. METHODS This descriptive, exploratory, and retrospective documentary study with a quantitative approach was performed in an outpatient treatment service for inflammatory bowel disease, at a university polyclinic located in Rio de Janeiro, Brazil, from May to July 2016. The study included 556 patients and was approved by the research ethics committee of the institution (CAAE no. 55179316.6.0000.5259/2016). RESULTS The data showed a high prevalence of inflammatory bowel disease in white female patients. Crohn’s disease was diagnosed in more patients than was ulcerative colitis; the ileocolon was the most commonly affected location in patients with Crohn’s disease. The stenotic phenotype was prevalent in patients with Crohn’s disease. CONCLUSION The prevalence of the stenotic phenotype in Crohn’s disease in relation to others demonstrates the need for further investigations in this field of study in Brazil. In conclusion, the data showed that the epidemiologic profile of the study population is similar to that published in the national and international literature.

RESUMO CONTEXTO A Doença de Crohn e a retocolite ulcerativa idiopática são as duas principais formas de doença inflamatória intestinal e possuem crescente incidência e prevalência, tendem a ser progressivas, cursam com recidivas frequentes e assumem formas clínicas de alta gravidade. No Brasil a escassez de dados epidemiológicos relacionados a tais agravos deixa essas pessoas em estado de vulnerabilidade e contribui para o aumento da morbidade. OBJETIVO Descrever o perfil dos pacientes portadores de doença inflamatória intestinal atendidos em um ambulatório de doenças inflamatórias intestinais do estado do Rio de Janeiro. MÉTODOS Trata-se de uma pesquisa documental retrospectiva, exploratória, descritiva em abordagem quantitativa, realizada de maio a julho de 2016, em uma policlínica universitária, localizada no Rio de Janeiro, em ambulatório de tratamento de doenças inflamatórias intestinais. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da instituição CAAE: 55179316.6.0000.5259 /2016, e contou com 556 participantes. RESULTADOS Os dados revelam um predomínio das doenças inflamatórias intestinais, nos pacientes do sexo feminino, de cor branca. A doença de Crohn foi diagnosticada em um maior número de indivíduos em relação a retocolite ulcerativa idiopática. Os dados do perfil de localização intestinal mostram a região ileocolônica como mais afetada na doença de Crohn. Foi evidenciado predomínio do fenótipo estenosante na doença de Crohn. CONCLUSÃO O predomínio do fenótipo estenosante na doença de Crohn, evidencia a necessidade de estudos aprofundados sobre a temática no Brasil. No mais, os dados obtidos demonstram um perfil epidemiológico da população semelhante ao divulgado em estudos nacionais e internacionais.

INFLAMMATORY BOWEL DISEASE IN HISPANIC COMMUNITIES: a concerted South American approach could identify the aetiology of Crohn’s disease and ulcerative colitis / Doença inflamatória intestinal nas comunidades Hispânicas: uma orquestrada abordagem Sul-Americana poderia identificar a etiologia da doença de Crohn e da retocolite ulcerativa

Despite intensive research we remain ignorant of the cause of both Crohn’s disease and ulcerative colitis. The dramatic rise in incidence, particularly of Crohn’s disease, points towards environmental factors as playing a significant role. A major purpose of this review is to stimulate a co-ordinated international effort to establish an on-going data base in Central and South America in which new cases are registered and through which investigations into aetiology can be conducted. In both Brazil and Mexico there is evidence that the incidence of ulcerative colitis is increasing, as also is the case for Crohn’s disease in Brazil. The pattern of disease is, therefore, directly comparable to that reported from Europe and the USA during the 1970s and 1980s, but much lower than contemporary data from Spain. Although the incidence is similar to that reported from Portugal, the studies from Almada and Braga were conducted a decade before that from Sao Paulo. The situation in Brazil compares dramatically with Uruguay and Argentina where the reported incidence of inflammatory bowel disease is significantly less. However, with growing industrialisation it is likely that there will be an explosion of inflammatory bowel disease in some areas of Central and South America over the next 20 years. The creation of a network of researchers across South and Central America is a real possibility and through a Concerted Action there is the possibility that major strides could be made towards understanding the cause of inflammatory bowel disease and so develop preventive strategies. .

Apesar da pesquisa intensa, ainda permanecemos ignorantes quanto à causa da doença de Crohn e da retocolite ulcerativa. O aumento dramático da incidência, particularmente da doença de Crohn, aponta para fatores ambientais desempenhando um papel significativo. Um grande propósito desta revisão é estimular um esforço internacional coordenado para estabelecer uma base de dados em curso na América Central e do Sul, na qual novos casos são registrados e através dos quais investigações sobre a etiologia seriam realizadas. No Brasil e no México, há evidências de que a incidência da colite ulcerosa está aumentando, como também é o caso da doença de Crohn no Brasil. O padrão da doença é, portanto, diretamente comparável àquela relatada da Europa e dos Estados Unidos durante a década de 1970 e 1980, mas muito mais baixa do que dados contemporâneos da Espanha. Embora a incidência seja semelhante à relatada a partir de Portugal, os estudos de Almada e Braga ocorreram uma década antes do que em São Paulo. A situação no Brasil compara-se dramaticamente com Uruguai e Argentina, onde a incidência relatada de doença inflamatória intestinal é significativamente menor. No entanto, com a crescente industrialização é provável que haja uma explosão de doença inflamatória intestinal em algumas áreas da América Central e do Sul nos próximos 20 anos. A criação de uma rede de pesquisadores em toda a América Central e do Sul é uma possibilidade real e, através de uma ação articulada, há a possibilidade de que grandes avanços poderiam ser feitos no sentido de compreender a causa da doença inflamatória intestinal e então desenvolverem-se estratégias preventivas. .

Caracterización de pacientes con enfermedad de Crohn atendidos en el Instituto de gastroenterología de Cuba / Characterization of patients with Crohn's disease cared for at the institute of gastroenterology of Cuba

INTRODUCCIÓN. La enfermedad de Crohn es un proceso crónico inflamatorio que afecta cualquier segmento del tubo digestivo. Su causa permanece aún desconocida. OBJETIVO. caracterizar a los pacientes con enfermedad de Crohn atendidos en el Instituto de Gastroenterología de Cuba desde enero 2011 hasta diciembre 2012. MÉTODOS. se realizó un estudio descriptivo de corte transversal donde se estudiaron variables como edad de diagnóstico, sexo, color de la piel, provincia y lugar de procedencia, hábito de fumar, localización de la enfermedad, manifestaciones clínicas, complicaciones intestinales y extraintestinales, medicamentos utilizados, causas de tratamiento quirúrgico y de muerte. RESULTADOS. fueron estudiados 80 pacientes con enfermedad de Crohn, con una edad media de diagnóstico de 35,1 ± 15 años. No hubo diferencias entre los sexos y predominó el color de la piel blanca. Se observó un mayor número de pacientes de la provincia La Habana, zona urbana, y de no fumadores. Fue mayor la localización ileocólica seguida de la ileal. Las manifestaciones clínicas más frecuentes fueron diarrea, dolor abdominal y distensión abdominal. CONCLUSIONES. las complicaciones intestinales fueron relativamente poco frecuentes, y predominaron la estenosis y las fistulas. Las extraintestinales más frecuentes fueron las articulares, seguidas de las hepatobiliares y las hematológicas. El tratamiento medicamentoso más utilizado fue azulfidina, mesalazina y prednisona administrada por vía oral. Las causas más frecuentes que motivaron el tratamiento quirúrgico fueron la estenosis benigna y la oclusión intestinal. Las causas de mortalidad fueron septicemia y tumor cerebral, con un paciente cada una.

INTRODUCTION: crohn's disease is a chronic inflammatory condition affecting any portion of the digestive tract. Its cause is still unknown. OBJECTIVE: characterize patients with Crohn's disease cared for at the Institute of Gastroenterology of Cuba from January 2011 to December 2012. METHODS: a descriptive cross-sectional study was conducted based on variables such as age at diagnosis, sex, race, province and place of residence, smoking, disease site, clinical manifestations, intestinal and extraintestinal complications, drugs used, reasons for surgical treatment and death. RESULTS: eighty patients with Crohn's disease were studied. Mean age at diagnosis was 35.1±15 years. No differences were found between the sexes and the white race predominated. There was a larger number of patients from Havana, from urban areas, and non-smokers. The ileocolic site was the most common, followed by the ileal site. The most frequent clinical manifestations were diarrhea, abdominal pain and abdominal distension. CONCLUSIONS: intestinal complications were relatively infrequent, with a predominance of stenosis and fistulas. Joint-related complications were the most common, followed by hepatobiliary and hematological complications. The drug therapy most commonly used was azulfidine, mesalazine and prednisone administered orally. The most frequent reasons for surgical treatment were benign stenosis and intestinal occlusion. The causes of mortality were septicemia and brain tumor, with one patient each.