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Rev. Ciênc. Méd. Biol. (Impr.) ; 22(1): 52-57, jun 22, 2023.
Article in English | LILACS | ID: biblio-1442845


Rationale: the use of anti-TNFα therapy, such as Infliximab (IFX), in patients with Chron's disease (CD) can lead to changes in body composition. Objective: to evaluate the body composition and functional capacity of patients with CD. Method: Cross-sectional study with patients with CD in clinical remission using IFX. For anthropometric evaluation, it was measured: weight, height and waist circumference; functional capacity by the hand grip strength test and body composition by bioelectric impedance. After that, the fat-free mass index and body fat index were calculated. Continouns variables were analyzed by Pearson or Spearman coefficient. For the multiple linear regression model, the time of use of IFX was used as a dependent variable and waist circumference, fat-free mass index, phase angle and handgrip strength were used as independent variables. Results: forty-three patients were evaluated, with an average of 43.1± 13.5 years of age. Of the total, 44.2% were overweight and 44.2% had increased waist circumference, 58.1% were classified with high to very high fat-free mass, 30.2% were below the adequacy parameter for fat-free mass index and 11.6% had reduced functional capacity. Conclusion: overweight, as well as increased waist circumference and body fat, is common in CD patients in clinical remission using Infliximab. Most patients had preserved functional capacity, however there wasn't association with time of use of IFX.

Introdução: o uso de terapia anti-TNFα, como o Infliximabe (IFX), em pacientes com doença de Chron (DC) pode levar a alterações na composição corporal. Objetivo: avaliar a composição corporal e capacidade funcional de pacientes com DC. Metodologia: estudo transversal com pacientes com DC em remissão clínica, em uso de IFX. Foi realizada avaliação antropométrica (peso, estatura e circunferência da cintura); avaliação de capacidade funcional (teste de força de pressão manual); e avaliação de composição corporal (impedância bioelétrica) com cálculo do índice de massa livre de gordura e índice de gordura corporal. Variáveis contínuas foram analisadas pelo coeficiente de correlação de Pearson ou Spearman. Para o modelo de regressão linear múltipla, o tempo de uso do IFX foi utilizado como variável dependente e circunferência da cintura, índice de massa magra, ângulo de fase e força de preensão manual foram utilizados como variáveis independentes. Resultados: foram avaliados 43 pacientes, com média de idade de 43,1± 13,5 anos. 44,2% estavam acima do peso e 44,2% possuíam circunferência da cintura aumentada, 58,1% foram classificados com índice de gordura corporal de alto a muito alto, 30,2% estavam abaixo do parâmetro de adequação para o índice de massa livre de gordura e 11,6% apresentaram capacidade funcional reduzida. Conclusão: o excesso de peso e o aumento de circunferência da cintura e gordura corporal é frequente em pacientes com DC em remissão clínica e em uso de IFX. A maioria dos pacientes apresentou capacidade funcional preservada, porém não houve associação com o tempo de uso do IFX.

Humans , Male , Female , Adult , Body Composition , Crohn Disease , Muscle Strength , Infliximab , Anthropometry , Cross-Sectional Studies
Journal of Integrative Medicine ; (12): 194-204, 2023.
Article in English | WPRIM | ID: wpr-971652


OBJECTIVE@#This study was conducted to explore the mechanism of intestinal inflammation and barrier repair in Crohn's disease (CD) regulated by moxibustion through bile acid (BA) enterohepatic circulation and intestinal farnesoid X receptor (FXR).@*METHODS@#Sprague-Dawley rats were randomly divided into control group, CD model group, mild moxibustion group and herb-partitioned moxibustion group. CD model rats induced by 2,4,6-trinitrobenzene sulfonic acid were treated with mild moxibustion or herb-partitioned moxibustion at Tianshu (ST25) and Qihai (CV6). The changes in CD symptoms were rated according to the disease activity index score, the serum and colon tissues of rats were collected, and the pathological changes in colon tissues were observed via histopathology. Western blot, immunohistochemistry (IHC) and immunofluorescence were used to evaluate the improvement of moxibustion on intestinal inflammation and mucosal barrier in CD by the BA-FXR pathway.@*RESULTS@#Mild moxibustion and herb-partitioned moxibustion improved the symptoms of CD, inhibited inflammation and repaired mucosal damage to the colon in CD rats. Meanwhile, moxibustion could improve the abnormal expression of BA in the colon, liver and serum, downregulate the expression of interferon-γ and upregulate the expression of FXR mRNA, and inhibit Toll-like receptor 4 (TLR4) and myeloid differentiation factor 88 (MyD88) mRNA. The IHC results showed that moxibustion could upregulate the expression of FXR and mucin2 and inhibit TLR4 expression. Western blot showed that moxibustion inhibited the protein expression of TLR4 and MyD88 and upregulated the expression of FXR. Immunofluorescence image analysis showed that moxibustion increased the colocalization sites and intensity of FXR with TLR4 or nuclear factor-κB p65. In particular, herb-partitioned moxibustion has more advantages in improving BA and upregulating FXR and TLR4 in the colon.@*CONCLUSION@#Mild moxibustion and herb-partitioned moxibustion can improve CD by regulating the enterohepatic circulation stability of BA, activating colonic FXR, regulating the TLR4/MyD88 pathway, inhibiting intestinal inflammation and repairing the intestinal mucosal barrier. Herb-partitioned moxibustion seems to have more advantages in regulating BA enterohepatic circulation and FXR activation. Please cite this article as: Shen JC, Qi Q, Han D, Lu Y, Huang R, Zhu Y, Zhang LS, Qin XD, Zhang F, Wu HG, Liu HR. Moxibustion improves experimental colitis in rats with Crohn's disease by regulating bile acid enterohepatic circulation and intestinal farnesoid X receptor. J Integr Med. 2023; 21(2): 194-204.

Rats , Animals , Crohn Disease/pathology , Moxibustion/methods , Toll-Like Receptor 4/metabolism , Rats, Sprague-Dawley , Myeloid Differentiation Factor 88/metabolism , Colitis , Inflammation , Enterohepatic Circulation , RNA, Messenger/metabolism
Article in Chinese | WPRIM | ID: wpr-985942


Objective: By investigating the correlation between quantitative parameters of contrast enhanced ultrasound (CEUS) and commonly used activity assessment indicators of Crohn's disease (CD), and comparing the predictive power of laboratory inflammatory indicators with CEUS on Crohn's disease (CD), the significance of CEUS was evaluated. Methods: A case-control study. From October 2019 to December 2021, the clinical data of 67 patients with CD who were diagnosed by endoscopy and underwent contrast-enhanced ultrasonography were retrospectively analyzed in the First Affiliated Hospital with Nanjing Medical University, and their routine ultrasound and CEUS parameters, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fecal calprotectin (FC), Crohn's disease activity index (CDAI) and simplified endoscopic score for Crohn's disease (SES-CD) were collected. Using SES-CD as the standard, the patients were divided into a remission group and an active group, and the correlation of laboratory inflammatory indexes and contrast-enhanced ultrasound parameters with CDAI and SES-CD were evaluated. Besides, the ROC curve was used to analyze the predictive efficacy of each index on CD endoscopic activity. Results: A total of 67 patients were included in this study. According to the SES-CD score, there were 17 patients in the remission group and 50 patients in the active group. Except for the coefficient of the enhancement wash in slope and time to peak (TTP), the peak intensity (PI), area under the angiography curve, and laboratory inflammatory indexes were significantly different between the two groups (P<0.05), which also showed a moderate positive correlation with CDAI and SES-CD (P<0.05). ROC analysis showed that among the non-invasive indicators, PI and area under the angiography curve had the highest AUCs for predicting CD endoscopic activity, which were 0.912 and 0.891, respectively; with SES-CD taking >3 as the cut-off value, the corresponding sensitivities were 78.0% and 72.0%, with specificities of 100.0% and 94.1%, respectively. Conclusion: CEUS can objectively and repeatedly evaluate the disease activity of CD patients, and has great clinical application value, which can be used as a reliable imaging method for diagnosis and follow-up of patients with Crohn's disease.

Humans , Crohn Disease/diagnosis , Case-Control Studies , Retrospective Studies , Endoscopy, Gastrointestinal , C-Reactive Protein/analysis , Severity of Illness Index
Chinese Journal of Pediatrics ; (12): 606-613, 2023.
Article in Chinese | WPRIM | ID: wpr-985917


Objective: To explore the mechanism of intestinal tissue damage induced by macrophages activated by WNT2B high-expressed fibroblasts. Methods: This study involved biological information analysis, pathological tissue research and cell experimental research. The biological information of the colon tissue from the children with inflammatory bowel disease in previous study was analyzed again with single-cell sequencing. The pathological tissues were collected by colonoscopy from 10 children with Crohn's disease treated in the Department of Gastroenterology of Guangzhou Women and Children's Medical Center from July 2022 to September 2022. According to the findings of colonoscopy, tissues with obvious inflammation or ulceration were classified as the inflammatory group, while tissues with slight inflammation and no ulceration were classified as the non-inflammatory group. HE staining was performed to observe the pathological changes of the colon tissues. Macrophage infiltration and CXCL12 expression were detected by immunofluorescence. In terms of cell experiments, fibroblasts transfected with WNT2B plasmid or empty plasmid were co-cultured with salinomycin treated or non-treated macrophages, respectively; the expression of proteins through Wnt classical pathway were detected by western blotting. Macrophages treated with SKL2001 were used as the experimental group, and those with phosphate buffer as the control group. The expression and secretion of CXCL12 in macrophages were detected by quantitative Real-time PCR and enzyme-linked immunosorbent assay (ELISA). T-test or rank sum test were used for the comparison between groups. Results: Single-cell sequencing analysis suggested that macrophages were the main cells in inflammatory bowel disease colon tissue, and there was interaction between WNT2B high-expressed fibroblasts and macrophages. HE staining of the 10 patients ((9.3±3.8) years old, 7 males and 3 females) showed that the pathological score of colon tissue in the inflammatory group was higher than that in the non-inflammatory group (4 (3, 4) vs. 2 (1, 2) points, Z=3.05, P=0.002). Tissue immunofluorescence indicated that the number of infiltrating macrophages in the inflammatory group was significantly higher than that in the non-inflammatory group under high power field of view (72.8±10.4 vs.8.4±3.5, t=25.10, P<0.001), as well as the number of cells expressing CXCL12 (14.0±3.5 vs. 4.7±1.9, t=14.68, P<0.001). In cell experiments, western blotting suggested an elevated level of glycogen synthase kinase-3β phosphorylation in macrophages co-cultured with fibroblast transfected with WNT2B plasmid, and salinmycin could reverse this change. Real-time PCR suggested that the transcription level of CXCL12 in the experimental group was higher than that in the control group (6.42±0.04 vs. 1.00±0.03, t=183.00, P<0.001), as well as the expression and secretion of CXCL12 by ELISA ((465±34) vs. (77±9) ng/L, t=13.21, P=0.006). Conclusion: WNT2B high-expressed fibroblasts can secrete WNT2B protein and activate the Wnt classical signaling pathway thus enhancing the expression and secretion of CXCL12 in macrophages, inducing the development of intestinal inflammation of Crohn's disease.

Child , Male , Humans , Female , Child, Preschool , Adolescent , Crohn Disease , Inflammatory Bowel Diseases , Colon , Inflammation , Colonoscopy , Glycoproteins , Wnt Proteins
Article in Chinese | WPRIM | ID: wpr-987006


OBJECTIVE@#To investigate the effect of pachymic acid (PA) against TNBS-induced Crohn's disease (CD)-like colitis in mice and explore the possible mechanism.@*METHODS@#Twenty-four C57BL/6J mice were randomized equally into control group, TNBS-induced colitis model group and PA treatment group. PA treatment was administered via intraperitoneal injection at the daily dose of 5 mg/kg for 7 days, and the mice in the control and model groups were treated with saline. After the treatments, the mice were euthanized for examination of the disease activity index (DAI) of colitis, body weight changes, colon length, intestinal inflammation, intestinal barrier function and apoptosis of intestinal epithelial cells, and the expressions of TNF-α, IL-6 and IL-1β in the colonic mucosa were detected using ELISA. The possible treatment targets of PA in CD were predicted by network pharmacology. String platform and Cytoscape 3.7.2 software were used to construct the protein-protein interaction (PPI) network. David database was used to analyze the GO function and KEGG pathway; The phosphorylation of PI3K/AKT in the colonic mucosal was detected with Western blotting.@*RESULTS@#PA significantly alleviated colitis in TNBS-treated mice as shown by improvements in the DAI, body weight loss, colon length, and histological inflammation score and lowered levels of TNF-α, IL-6 and IL-1β. PA treatment also significantly improved FITC-dextran permeability, serum I-FABP level and colonic transepithelial electrical resistance, and inhibited apoptosis of the intestinal epithelial cells in TNBS-treated mice. A total of 248 intersection targets were identified between PA and CD, and the core targets included EGFR, HRAS, SRC, MMP9, STAT3, AKT1, CASP3, ALB, HSP90AA1 and HIF1A. GO and KEGG analysis showed that PA negatively regulated apoptosis in close relation with PI3K/AKT signaling. Molecular docking showed that PA had a strong binding ability with AKT1, ALB, EGFR, HSP90AA1, SRC and STAT3. In TNBS-treated mice, PA significantly decreased p-PI3K and p-AKT expressions in the colonic mucosa.@*CONCLUSION@#PA ameliorates TNBS-induced intestinal barrier injury in mice by antagonizing apoptosis of intestinal epithelial cells possibly by inhibiting PI3K/AKT signaling.

Animals , Mice , Mice, Inbred C57BL , Crohn Disease , Phosphatidylinositol 3-Kinases , Proto-Oncogene Proteins c-akt , Interleukin-6 , Molecular Docking Simulation , Tumor Necrosis Factor-alpha , Colitis/chemically induced , Inflammation , Apoptosis , ErbB Receptors
ABCD arq. bras. cir. dig ; 36: e1740, 2023. graf
Article in English | LILACS | ID: biblio-1447009


ABSTRACT BACKGROUND: Liver transplantation represents the best therapeutic modality in end-stage chronic liver disease, severe acute hepatitis, and selected cases of liver tumors. AIMS: To describe a double retransplant in a male patient diagnosed with Crohn's disease and complicated with primary sclerosing cholangitis, severe portal hypertension, and cholangiocarcinoma diagnosed in the transplanted liver. METHODS: A 48-year-old male patient diagnosed with Crohn's disease 25 years ago, complicated with primary sclerosing cholangitis and severe portal hypertension. He underwent a liver transplantation in 2018 due to secondary biliary cirrhosis. In 2021, a primary sclerosing cholangitis recurrence was diagnosed and a liver retransplantation was indicated. Recipient's hepatectomy was very difficult by reason of complex portal vein thrombosis requiring extensive thromboendovenectomy. Intraoperative ultrasound with liver doppler evaluation was performed. Two suspicious nodules were incidentally diagnosed in the donor's liver and immediately removed for anatomopathological evaluation. RESULTS: After pathological confirmation of carcinoma, probable cholangiocarcinoma, at frozen section, the patient was re-listed as national priority and a new liver transplantation was performed within 24 hours. The patient was discharged after 2 weeks. CONCLUSIONS: The screening for neoplasms in donated organs should be part of our strict daily diagnostic arsenal. Moreover, we argue that, for the benefit of an adequate diagnosis and the feasibility of a safer procedure, the adoption of imaging tests routine for the liver donor is essential, allowing a reduction of the costs and some potential risks of liver transplant procedure.

RESUMO RACIONAL: O transplante de fígado representa a melhor modalidade terapêutica na doença hepática crônica terminal, hepatite aguda grave e casos selecionados de tumores hepáticos. OBJETIVOS: Descrever um retransplante duplo em paciente do sexo masculino, diagnosticado com doença de Crohn e complicado com colangite esclerosante primária, hipertensão portal grave e colangiocarcinoma diagnosticado no fígado transplantado. MÉTODOS: Paciente do sexo masculino, 48 anos, diagnosticado com doença de Crohn há 25 anos e complicado com colangite esclerosante primária e hipertensão portal grave. Foi submetido a um transplante de fígado em 2018 devido a cirrose biliar secundária. Em 2021, foi diagnosticada recidiva de colangite esclerosante primária e indicado retransplante hepático. A hepatectomia do receptor foi de alta complexidade devido à trombose complexa da veia porta, exigindo extensa tromboendovenectomia. Foi realizada ultrassonografia intraoperatória com doppler hepático. Dois nódulos suspeitos foram diagnosticados incidentalmente no fígado do doador e imediatamente removidos para avaliação anatomopatológica. RESULTADOS: Após confirmação patológica de carcinoma, provável colangiocarcinoma, pela congelação, o paciente foi relistado como prioridade nacional, e novo transplante hepático foi realizado em 24 horas. O paciente teve alta após 2 semanas. CONCLUSÕES: O rastreamento de neoplasias em órgãos doados deve fazer parte de nosso estrito arsenal diagnóstico diário. Além disso, defendemos que, em benefício de um diagnóstico correto e da viabilidade de um procedimento mais seguro, a adoção de uma rotina de exames de imagem é essencial em doadores hepáticos, permitindo a redução dos custos e alguns riscos potenciais do procedimento de transplante hepático.

Humans , Male , Middle Aged , Bile Duct Neoplasms/surgery , Cholangitis, Sclerosing/surgery , Crohn Disease/complications , Liver Transplantation , Cholangiocarcinoma/surgery , Cholangiocarcinoma/diagnostic imaging , Reoperation , Bile Duct Neoplasms/pathology , Bile Duct Neoplasms/diagnostic imaging , Bile Ducts, Intrahepatic , Cholangitis, Sclerosing/etiology , Cholangiocarcinoma/pathology , Ultrasonography, Doppler , Living Donors , Hypertension, Portal/etiology
J. coloproctol. (Rio J., Impr.) ; 43(1): 43-48, Jan.-Mar. 2023.
Article in English | LILACS | ID: biblio-1430691


Perianal fistula is a common complication of Crohn disease, and it is a great burden on the life and psychology of patients, but its treatment is still a difficult problem to face. In recent years, progress in the treatment of Crohn disease has progressed rapidly due to the advent of biological agents, but there has been a lack of research on perianal fistula in Crohn disease, and the direction of research has been scattered; therefore, the author reviews the traditional treatment of perianal fistula in Crohn disease in the context of the available literature and discusses emerging and potential therapeutic approaches. (AU)

Crohn Disease/complications , Rectal Fistula/surgery , Rectal Fistula/etiology , Oxygen/therapeutic use , Biological Therapy , Rectal Fistula/drug therapy , Mesenchymal Stem Cells , Immunosuppressive Agents/therapeutic use
Article in English | WPRIM | ID: wpr-982356


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.

Female , Middle Aged , Humans , Aged , Child , Adult , Adolescent , Young Adult , Crohn Disease/epidemiology , Prognosis , Constriction, Pathologic , Aging , Hospitals, General
Rev. AMRIGS ; 66(3): 01022105, jul.-set. 2022.
Article in Portuguese | LILACS | ID: biblio-1425065


A Doença de Crohn Metastática é uma condição rara, não contígua ao trato gastrintestinal, que acomete, usualmente, pernas e braços, sendo face e genitais menos acometidos. Tem predileção feminina ­ 63% dos casos. As lesões se apresentam nas formas de nódulos, ulcerações ou placas eritematosas. O caso relatado é de uma mulher de 42 anos que possui a Doença de Crohn há 10 anos e, há 18 meses, convive com o surgimento de placa eritemato-descamativa infiltrada, associada a edema dos lábios em hemiface direita. Foram realizados testes para micobactéria e fungo, tendo resultados negativos. Ao exame anatomopatológico, apresentou-se dermatite granulomatosa associada a infiltrado linfocitário e plasmocitário, confirmando, assim, o diagnóstico de Doença de Crohn Metastática da face. A paciente já fazia uso de Certolizumabe em monoterapia, aumentando-se a dose. Associou-se Tacrolimo tópico, com melhora das lesões. É de suma importância a investigação minuciosa para o diagnóstico correto da doença, visto que pode ser confundida com manifestação orofacial da Doença de Crohn ou outra doença granulomatosa da face. O diagnóstico precoce auxilia no tratamento correto e na minimização do prejuízo estético e funcional causado pela doença, melhorando a qualidade de vida do paciente.

Metastatic Crohn's Disease is a rare condition, not contiguous to the gastrointestinal tract, which usually affects the legs and arms, with the face and genitals being less affected. It occurs predominantly in women - 63% of the cases. The lesions appear as nodules, ulcerations, or erythematous plaques. The case report is of a 42-year-old woman who has had Crohn's disease for 10 years and, for 18 months, has been living with the appearance of an infiltrated erythematous desquamative plaque associated with edema of the lips on the right hemiface. The patient underwent tests for mycobacteria and fungus, with negative results. The anatomopathological exam showed granulomatous dermatitis associated with lymphocytic and plasmacytic infiltrate, thus confirming the diagnosis of metastatic Crohn's disease of the face. The patient was already using Certolizumab in monotherapy, and the dose was increased. Topical Tacrolimus was associated with the treatment causing an improvement in the lesions. A thorough investigation is of utmost importance for the correct diagnosis of the disease since it can be mistaken for an orofacial manifestation of Crohn's Disease or another granulomatous disease of the face. Early diagnosis helps in the correct treatment and in minimizing the aesthetic and functional damage caused by the disease, improving the patient's quality of life.

Crohn Disease
J. coloproctol. (Rio J., Impr.) ; 42(2): 178-186, Apr.-June 2022. graf, ilus
Article in English | LILACS | ID: biblio-1394409


ABSTRACT Background and Aims The present systematic review and meta-analysis was designed to estimate the safety and effectiveness of ustekinumab in the treatment of Crohn disease (CD) in clinical trials and observational studies. Methods We retrieved all the related publications from the PubMed, Cochrane, EBSCO, Google Scholar and EMBASE databases using a systematic search strategy. We only included clinical trials and observational studies that were published in English. Results Only 31 studies that met the eligibility criteria out of the 733 identified studies were included. The overall clinical response rate in the cohort studies was of 0.539 (95% confidence interval [95%CI]: 0.419-0.659), and in the clinical trials it was of 0.428 (95%CI: 0.356-0.501). The pooled clinical remission rate was of 0.399 (95%CI: 0.295-0.503) in randomized control trials (RCTs,) and of 0.440 (95%CI: 0.339-0.542) in cohort studies. The rate of adverse effects was of 0.158 (95%CI: 0.109-0.207) in cohort studies and of 0.690 (95%CI: 0.633-0.748) in RCTs. Conclusion Ustekinumab is effective in the treatment of CD. However, more research is required on the safety profiles because there was considerable variation among the included studies. (AU)

Humans , Crohn Disease/drug therapy , Ustekinumab/therapeutic use , Remission Induction , Treatment Outcome , Ustekinumab/adverse effects , Infections
J. coloproctol. (Rio J., Impr.) ; 42(2): 126-130, Apr.-June 2022. tab, ilus
Article in English | LILACS | ID: biblio-1394412


Study Aim: The aim of the present study was to compare in real life the characteristics of treatment with infliximab according to the presence or absence of anoperineal involvement in Crohn's disease. Methods: We performed a single-center, prospective, non-interventional study, on patients with Crohn's disease in remission who had been treated with infliximab for at least 1 year. Patients with poor treatment compliance, on antibiotics, or those with a stoma were excluded. Results: We included 52 patients in this study: 34 with anoperineal lesions with or without luminal lesions, and 18 with luminal lesions only. Patients with anoperineal lesions were more likely to have undergone surgery (70.6% versus 38.9%, p = 0.027), had a shorter median time to infliximab treatment initiation (0.5 versus 5.5 years, p = 0.005), a higher mean dose of infliximab (6.6 versus 5.1 mg/kg, p = 0.015), and were more likely to receive combination treatments including infliximab (52.9% versus 11.1%, p = 0.008) than patients with luminal involvement only. Conclusions In our study, infliximab treatment was initiated more quickly, at higher doses, and more in combination therapy for anoperineal Crohn's disease than for luminal damage alone. Additional studies are required to confirm this finding and to assess the tolerance of this treatment throughout patient management. (AU)

Humans , Male , Female , Adult , Middle Aged , Anal Canal/injuries , Perineum/injuries , Combined Modality Therapy , Infliximab/therapeutic use , Azathioprine/therapeutic use , Crohn Disease , Rectal Fistula , Infliximab/administration & dosage
Article in English | LILACS | ID: biblio-1402182


Inflammatory bowel disease (IBD) is a chronic inflammatory disorder of the gastrointestinal tract, occurring main-ly in the young, socioeconomically active age group. Both the recurrent-remitting course of symptoms and the chronicity of the disease impact patients' quality of life (QoL). Objective: determine the contributing factors asso-ciated with QoL in IBD patients in a tertiary service. Methods: a cross-sectional study of patients seen at the IBD outpatient clinic of the Federal University of Pelotas from January to November 2020, with clinical and laboratory data collection. Disease assessment was performed using Crohn's Disease Activity Index for Crohn's disease and Mayo score for ulcerative colitis and quality of life through the Inflammatory Bowel Disease Questionnaire (IBDQ). Results: the presence of a history of depression resulted in a significant impact on the overall QoL (p = 0.005) and mainly in the systemic symptoms (p = 0.04), social (p <0.001), and emotional (p = 0.008) domains. Regarding disease activity, statistical significance was evidenced in the intestinal symptoms domain (p <0.001) and overall QoL (p <0.001). Conclusion: a history of psychiatric illness and IBD disease activity were predictors of poorer QoL assessed by the IBDQ (AU)

A doença inflamatória intestinal (DII) é um distúrbio inflamatório crônico do trato gastrointestinal ocorrendo prin-cipalmente na faixa etária jovem socioeconomicamente ativa. Tanto o curso recorrente-remitente dos sintomas quanto a cronicidade da doença impactam a qualidade de vida (QoL) dos pacientes. Objetivo: avaliar a qualidade de vida de pacientes com DII em um serviço terciário. Métodos: estudo transversal de pacientes atendidos no ambulatório de DII da Universidade Federal de Pelotas no período de janeiro a novembro de 2020, com coleta de dados clínicos e laboratoriais. A atividade de doença foi avaliada pelo Crohn's Disease Activity Index para os casos de Doença de Crohn e escore de Mayo para os casos de retocolite ulcerativa e QoL por meio do Inflammatory Bowel Disease Questionnaire (IBDQ). Resultados: a presença de história de depressão resultou em impacto significativo na QoL (p = 0,005) e principalmente nos domínios sintomas sistêmicos (p = 0,04), social (p < 0,001) e emocional (p = 0,008). Em relação à atividade da doença, evidenciado significância estatística nos domínios sintomas intes-tinais (p < 0,001) e qualidade global (p < 0,001). Conclusão: há evidências de que os pacientes com história de depressão e não remissão da DII apresentam maior impacto na qualidade de vida avaliados pelo IBDQ (AU)

Humans , Proctocolitis/psychology , Quality of Life , Crohn Disease/psychology , Depression/diagnosis
J. coloproctol. (Rio J., Impr.) ; 42(1): 59-62, Jan.-Mar. 2022. tab
Article in English | LILACS | ID: biblio-1375766


Abstract It is uncertain whether terminal ileum intubation should be performed routinely during colonoscopy, as there is uncertainty regarding its diagnostic value. The aim of the present study is to assess the diagnostic yield of terminal ileum intubation during colonoscopy according to indications for colonoscopy. This is a cross-sectional study in which the results of 294 total colonoscopy procedures were reviewed; ileal intubation was performed in 269 (91.49%) patients. The indications for colonoscopy, the results of ileoscopy, and the histopathological results of ileal biopsies were evaluated. A total of 54 (20%) out of 269 patients who had successful intubation into the terminal ileumshowed macroscopic abnormalities on the terminal ileum. Biopsies were positive in 4 out of 54 (7.4%); all were of Crohn disease. Two were erosions (9.5%.) and 2 were ulcers (18.8%). The two erosions were presented as abdominal pain, abdominal pain and alternating bowel motion. Those with ulcers were presented with diarrhea and perianal disease. Conclusions Considering the low diagnostic yield of ileal intubation during colonoscopy, the decision to performileoscopy or not during colonoscopy needs to bemade on a case-by-case basis. However, routine ileal intubation, brief attempts should be considered despite low diagnostic yield. (AU)

Humans , Colonoscopy/methods , Ileum/pathology , Ulcer/diagnosis , Crohn Disease , Abdominal Pain , Cross-Sectional Studies , Intubation, Gastrointestinal
Rev. colomb. gastroenterol ; 37(1): 48-56, Jan.-Mar. 2022. tab
Article in English | LILACS | ID: biblio-1376905


Abstract Introduction: Inflammatory bowel disease (IBD) is an immune-mediated disease whose incidence in Latin America has increased in recent years. Aim: To analyze the demographic and clinical characteristics of patients with IBD treated in a university hospital and present the epidemiological data compared to other centers in Colombia. Patients and methods: Descriptive study of patients with IBD (1996-2019) at the Hospital Universitario Fundación Santa Fe de Bogotá. Analysis of data from centers in Medellín, Cali, Bogotá, and Cartagena. Results: Of 386 patients, 277 presented with ulcerative colitis (UC), 102 with Crohn's disease (CD), and seven with unclassifiable colitis. IBD was more frequent in women (53 %). Mortality was less than 1 %. The involvement of UC was mainly pancolitis (42.6 %). The greater the extent of the disease, the higher the hospitalization and surgery rates (OR 3.70, P < 0.01). Thirteen percent of patients with UC received biologics. Compromise due to CD was mainly ileocolonic (43.6 %) and ileal (43.6 %). The predominant clinical pattern of CD was structuring (50%). Forty-five percent received biologicals and 56 % surgery. Primary sclerosing cholangitis (PSC) was found in 4 % of patients (n = 15). Two patients with PSC developed colorectal cancer (OR 4.18; p 0.008), while 13 patients with UC developed colon cancer and seven dysplastic changes. Three patients with CD developed colon cancer. Conclusions: The results were compared to other reference centers. We found similar trends in the clinical behavior and treatment of IBD, with higher hospitalization and surgery rates in our cases.

Resumen Introducción: la enfermedad inflamatoria intestinal (EII) es una enfermedad inmunomediada, cuya incidencia en Latinoamérica ha aumentado en los últimos años. Objetivo: analizar las características demográficas y clínicas de los pacientes con EII tratados en un hospital universitario y presentar los datos epidemiológicos con respecto a otros centros en Colombia. Pacientes y métodos: estudio descriptivo de pacientes con EII (1996-2019) en el Hospital Universitario Fundación Santa Fe de Bogotá. Análisis de datos de centros de Medellín, Cali, Bogotá y Cartagena. Resultados: de 386 pacientes, 277 presentaron colitis ulcerativa (CU), 102 enfermedad de Crohn (EC) y 7 colitis no clasificable. La EII fue más frecuente en mujeres (53 %). La mortalidad fue menor de 1 %. El compromiso de la CU fue principalmente la pancolitis (42,6 %). Entre mayor la extensión de la enfermedad, más alta fue la tasa de hospitalización y cirugías (OR 3,70; p < 0,01). El 13 % de los pacientes con CU recibió biológicos. El compromiso por la EC fue principalmente ileocolónico (43,6 %) e ileal (43,6 %). El patrón clínico predominante de la EC fue estenosante (50%). El 45 % recibió biológicos y 56% cirugía. La colangitis esclerosante primaria (CEP) se encontró en 4 % de los pacientes (n = 15). Dos pacientes con CEP desarrollaron cáncer colorrectal (OR 4,18; p 0,008), mientras que 13 pacientes con CU desarrollaron cáncer de colon y 7 cambios displásicos. 3 pacientes con EC desarrollaron cáncer de colon. Conclusiones: se compararon los resultados en relación con otros centros de referencia. Encontramos tendencias similares en el comportamiento clínico y en el tratamiento de la EII, con mayores tazas de hospitalizaciones y cirugías en nuestros casos.

Humans , Male , Female , Inflammatory Bowel Diseases , Colitis, Ulcerative , Colitis , Data Analysis , Patients , Behavior , Colorectal Neoplasms , Crohn Disease , Incidence , Hospitals
Arch. latinoam. nutr ; 72(1): 50-59, mar. 2022. ilus, tab
Article in English | LILACS, LIVECS | ID: biblio-1368371


Crohn's disease (CD) is an inflammatory condition that can affect the entire gastrointestinal tract due to an exacerbated and inadequate immune system response. Objective. This study aimed to conduct a systematic review, through clinical trials, about the use of probiotics in humans with CD. Materials and methods. Research was carried out in the PubMed, Scopus and Science Direct databases using the keywords "Crohn's disease" and "probiotics". We conducted the review by searching clinical trials published from 2000 to December 2019. Results. Of 2,164 articles found, only nine were considered eligible for this review. The studies investigated patients with CD at different stages of the pathology, and in three studies the potential effect of probiotics in the active phase was observed; in two, in the remission phase; and in four, after intestinal surgery. The sample size of the studies ranged from 11 to 165 individuals and the age of the participants between 5 and 71 years. Gram-positive bacteria were used in six clinical interventions and in two studies yeasts were used. As for the significant results obtained with the treatment with probiotics, in one study there was beneficial clinical effects in patients and, in another, there was an improvement in intestinal permeability. Conclusion. Currently, it is not possible to establish a recommendation for probiotic therapy to control CD due to the few clinical trials with significant results. There is a need for more research on clinical intervention with probiotics in CD to clarify the action, define doses and time of use(AU)

La enfermedad de Crohn (EC) es una afección inflamatoria que puede afectar todo el tracto gastrointestinal debido a una respuesta del sistema inmunitario exacerbada e inadecuada. Objetivo. Realizar una revisión sistemática, a través de ensayos clínicos, sobre el uso de probióticos en humanos con EC. Materiales y métodos. La investigación se realizó en las bases de datos PubMed, Scopus y Science Direct utilizando las palabras clave "enfermedad de Crohn" y "probióticos". La revisión se hizo en ensayos clínicos publicados desde 2000 hasta diciembre 2019. Resultados. De 2164 artículos encontrados, solo nueve fueron considerados elegibles. Los estudios investigaron pacientes con EC en diferentes etapas de la patología, y en tres estudios se observó el efecto potencial de los probióticos en la fase activa; en dos, en remisión; y en cuatro, tras cirugía intestinal. El tamaño de la muestra fue entre 11 y 165 individuos y la edad entre 5 y 71 años. Se utilizaron bacterias grampositivas en seis intervenciones clínicas y en dos estudios se utilizaron levaduras. En cuanto a los resultados significativos obtenidos con el tratamiento con probióticos, en un estudio hubo efectos clínicos beneficiosos en los pacientes y, en otro, hubo una mejora en la permeabilidad intestinal. Conclusión. Actualmente, no es posible establecer una recomendación de terapia con probióticos para el control de la EC debido a los pocos ensayos clínicos con resultados significativos. Existe la necesidad de más investigación sobre la intervención clínica con probióticos en EC para aclarar la acción, definir dosis y tiempo de uso(AU)

Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Crohn Disease , Probiotics , Gastrointestinal Tract , Gram-Positive Bacteria , Permeability , Yeasts , Inflammatory Bowel Diseases , PubMed , Immune System
Article in Chinese | WPRIM | ID: wpr-940995


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.

Adolescent , Adult , Female , Humans , Male , Middle Aged , Chronic Disease , Colitis, Ulcerative/epidemiology , Crohn Disease/epidemiology , Incidence , Inflammatory Bowel Diseases/epidemiology , Retrospective Studies
Neumol. pediátr. (En línea) ; 17(3): 103-106, 2022. ilus
Article in Spanish | LILACS | ID: biblio-1425999


Los antagonistas del Factor de Necrosis Tumoral-α, son medicamentos que en los últimos años han tenido un incremento de su uso en pacientes con condiciones inflamatorias inmunomediadas en pediatría, como la Artritis Idiopática Juvenil y la Enfermedad Inflamatoria Intestinal. El uso de estos medicamentos en adultos tiene una fuerte asociación con la primoinfección o reactivación por Mycobacterium tuberculosis, pero en niños la evidencia es limitada. Se presentan 2 casos de pacientes tratados con adalimumab, quienes, a pesar de un buen control de su enfermedad y una prueba de tuberculina negativa al inicio de la terapia, desarrollaron tuberculosis miliar en el seguimiento, con importantes implicaciones para su salud. El tamizaje de tuberculosis latente con tuberculina/IGRAS (Interferón-γ release assays, por sus siglas en inglés) y un alto índice de sospecha de tuberculosis, son las herramientas disponibles para una adecuada identificación de la tuberculosis en pacientes que reciben crónicamente estas terapias.

Tumor Necrosis Factor-α antagonists are drugs that in recent years have seen an increase in their use in patients with immune-mediated inflammatory conditions in pediatrics such as Juvenile Idiopathic Arthritis and Inflammatory Bowel Disease. The use of these drugs in adults has a strong association with primary infection or reactivation by mycobacterium tuberculosis, but in children the evidence is limited. We present 2 cases of patients treated with adalimumab who, despite good control of their disease and a negative tuberculin test at the beginning of therapy, developed miliary tuberculosis during follow-up with important implications for their health. Screening for latent tuberculosis with tuberculin / IGRAS (Interferón-γ release assays) and a high index of suspicion for tuberculosis are the tools available for an adequate identification of tuberculosis in patients who receive these therapies chronically.

Humans , Male , Female , Child , Adolescent , Tuberculosis, Miliary/chemically induced , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Adalimumab/adverse effects , Arthritis, Juvenile/drug therapy , Tuberculosis, Miliary/diagnostic imaging , Crohn Disease/drug therapy
REVISA (Online) ; 11(3): 370-379, 2022.
Article in Portuguese | LILACS | ID: biblio-1397721


Objetivo: descrever o perfil de pacientes com doença de Crohn e retocolite ulcerativa, em ambulatório. Método: estudo epidemiológico transversal, descritivo, com coleta de dados secundários. As informações foram coletadas por meio de prontuário eletrônico da rede pública de saúde. Resultados: selecionados 68 pacientes, dos quais 22 (32,4%) eram do sexo masculino e 46 (67,6%) feminino. Ao diagnóstico 48 (70,6%) pacientes apresentavam retocolite, e 20 (29,4%) Crohn. Nestes, o padrão mais encontrado (30%) foi de acometimento colônico, enquanto que na retocolite, a maioria (45,8%) apresentou pancolite. Os pacientes tiveram, em média, 10 meses de sintomas antes do diagnóstico. O medicamento mais utilizado nas doenças inflamatórias intestinais foi o aminossalicilato. Cerca de 9% foram submetidos à cirurgia. Nenhum paciente apresentou óbito. Conclusão: a maioria dos achados foram ao encontro dos estudos nacionais atuais. Porém, a heterogeneidade da doença e a carência de estudos, parecem ser os principais fatores para divergências.

Objective: to describe the profile of patients with Crohn's disease and ulcerative colitis in an outpatient clinic. Method: cross-sectional, descriptive epidemiological study with secondary data collection. The information was collected through an electronic medical record of the public health network. Results: 68 patients were selected, of whom 22 (32.4%) were male and 46 (67.6%) were female. At diagnosis, 48 (70.6%) patients had colitis, and 20 (29.4%) Crohn's. In these, the most common pattern (30%) was colonic involvement, while in colitis, the majority (45.8%) presented pancolitis. Patients had, on average, 10 months of symptoms before diagnosis. The most widely used medicine in inflammatory bowel diseases was aminossaicylate. About 9% underwent surgery. No patient died. Conclusion: most of the findings were in line with current national studies. However, the heterogeneity of the disease and the lack of studies seem to be the main factors for divergences.

Objetivo: describir el perfil de los pacientes con enfermedad de Crohn y colitis ulcerosa en un ambulatorio. Método: estudio epidemiológico descriptivo transversal con recolección de datos secundarios. La información fue recolectada a través de una historia clínica electrónica de la red de salud pública. Resultados: Se seleccionaron 68 pacientes, de los cuales 22 (32,4%) eran hombres y 46 (67,6%) eran mujeres. En el momento del diagnóstico, 48 (70,6%) pacientes tenían colitis y 20 (29,4%) enfermedad de Crohn. En estos, el patrón más común (30%) fue la afectación colónica, mientras que en la colitis, la mayoría (45,8%) presentó pancolitis. Los pacientes tenían, en promedio, 10 meses de síntomas antes del diagnóstico. El medicamento más utilizado en las enfermedades inflamatorias intestinales fue el aminossaicilato. Alrededor del 9% se sometió a cirugía. Ningún paciente murió. Conclusión: la mayoría de los hallazgos estuvieron en línea con los estudios nacionales actuales. Sin embargo, la heterogeneidad de la enfermedad y la falta de estudios parecen ser los principales factores de divergencias.

Inflammatory Bowel Diseases , Crohn Disease , Colitis, Ulcerative , Epidemiology
Article in English | WPRIM | ID: wpr-929071


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.

Humans , Chronic Disease , Colitis, Ulcerative/therapy , Crohn Disease/epidemiology , Diarrhea , Homeodomain Proteins , Inflammatory Bowel Diseases , Mesenchymal Stem Cells/cytology , MicroRNAs , RNA, Long Noncoding , Recurrence , Umbilical Cord/cytology