Fenotipificación y genotipificación en pacientes con enfermedad inflamatoria intestinal en un centro de referencia de Colombia / Phenotyping and genotyping in patients with inflammatory bowel disease in a reference center in Colombia

RESUMEN Introducción: Se ha tratado de identificar los factores genéticos relacionados con susceptibilidad para enfermedad inflamatoria intestinal (EII), y los hallazgos actuales se inclinan por un modelo de patología complejo, sin un patrón hereditario claro. Objetivo: Realizar caracterización fenotípica y genotípica de pacientes con EII en población colombiana y describir su posible asociación con predisposición. Materiales y métodos: Serie de casos, 16 pacientes con EII por criterios clínicos y anatomopatológicos, inicio de síntomas gastrointestinales después de los 18 años. Todos tuvieron asesoramiento genético pre-test y se realizaron árboles genealógicos de mínimo tres generaciones. También, genotipificación, por medio de un panel de genes múltiples que incluía genes relacionados con EII y algunos trastornos autoinmunitarios. Finalmente, se realizó análisis genómico de variantes. Resultados: 9 mujeres y 7 hombres, con edad media de diagnóstico de EII 35 años, y 32 años para aparición de síntomas gastrointestinales. 11/16(68,75%) requirieron terapia biológica. 10/16 (62,5%) presentaron refractariedad a terapia estándar. 3/16 (18,75%) tenían antecedentes familiares positivos de EII. 100% casos presentaron al menos un single nucleotide polymorphism relacionado con riesgo de EII en más de un gen. Los genes más relacionados con colitis ulcerosa (CU), fueron CD48, CD6, y TYK2 para CU, y CD6 e ITGAM para la enfermedad de Crohn. El gen más frecuente fue CD6. Se observó en 3/16 (18,75%) presencia de hasta 5 genes, 4 en 3/16 (18,75%), y tres en 5/16 (31,25%). Conclusión: En EII hay presencia de variantes genéticas con predisposición asociada, pero sin patogenicidad confirmada, y cuya sumatoria parece contribuir en su fisiopatología.

ABSTRACT Introduction: Attempts have been made to identify the genetic factors related to susceptibility to inflammatory bowel disease (IBD), and the current conclusions are in favor of a complex pathology model, without a clear hereditary pattern. Objective: To perform phenotypic and genotypic characterization of patients with IBD in Colombian population and to describe its possible association with predisposition. Materials and methods: case series, 16 patients with IBD according to clinical and pathological criteria, onset of gastrointestinal symptoms after 18 years of age. All had pre-test genetic counseling and family trees of at least three generations were made. Also, genotyping, using a multigene panel that included genes related to IBD and some autoimmune disorders. Finally, a genomic analysis of variants was performed. Results: 9 women and 7 men, with mean age of diagnosis of IBD of 35 years, and gastrointestinal symptoms appearance of 32 years. 11/16 (68.75%) required biological therapy. 10/16 (62.5%) were refractory to standard therapy. 3/16 (18.75%) had positive family history of IBD. 100% cases presented at least one single nucleotide polymorphism related to IBD risk in more than one gene. The genes most related to ulcerative colitis (UC) were CD48, CD6, and TYK2 for UC, and CD6 and ITGAM for Crohn's disease. The most frequent gene was CD6. It was found presence of up to 5 genes in 3/16 (18.75%), 4 in 3/16 (18.75%), and three in 5/16 (31.25%). Conclusion: In IBD there is the presence of genetic variants with associated predisposition, but without confirmed pathogenicity, and whose sum seems to contribute to its pathophysiology.

Adesão e persistência ao tratamento com infliximabe: análise de uma coorte de um programa de suporte ao paciente no Brasil / Adherence and persistence to treatment with infliximab: analysis of a patient support program cohort in brazil

ABSTRACT Background: Monoclonal antibodies have proven efficacy in the management of several conditions and infliximab (IFX) is one of the most important drugs of the class. Some recent data have shown low rates of both persistence and adherence to several available biologics. Objective: The objective of this study was to describe adherence and persistence rate to IFX treatment and also persistence in the patient support program (PSP), among patients diagnosed with inflammatory bowel diseases (IBD) or rheumatic diseases (RD) enrolled in the program of a large pharmaceutical company in Brazil. Methods: Retrospective observational analysis using the PSP database. IBD or RD patients using IFX enrolled on the PSP database between September 2015 and August 2019 were retrospectively evaluated to identify the persistence rate and adherence and followed up until March 1, 2020. Patients were excluded if treatment start date was prior to program entry; first infusion prior to September 1st, 2015 or after August 31st, 2019; the patients did not started treatment; and patients with "OTHERS" in "Indication" field. Persistence was assessed considering both persistence in the program ("PSP persistence") and persistence on IFX in the PSP ("IFX persistence in the PSP"). PSP persistence was defined as the proportion of patients remaining in the program at 6, 12, 24, 36 and 48 months after initiating IFX. To determine IFX persistence in the PSP, censoring was defined at the time the patient left the program, died, or was lost to follow-up. Adherence to treatment was measured by medication possession ratio ((MPR) - All days supply / elapsed days from first prescription to last day of medication possession)). Descriptive statistics were initially used. Kaplan-Meier curve, the median time estimated by the survival function, Cox regression model, and restricted mean survival time (RMST) were used to evaluate the treatment persistence time at 24 months and the logistic regression model was performed aiming to identify variables associated with adherence (MPR ≥80%). Results: A total of 10,233 patients were analyzed, 5,826 (56.9%) with the diagnosis of RD and 4,407 (43.1%) of IBD. At the end of the follow-up (median 9.1 months from PSP entry to the last infusion), persistence in the PSP was 65.6%, 48.2%, 31.0%, 20.7% and 13.1% at 6, 12, 24, 36 and 48 months, respectively. Considering persistence on IFX in the PSP, estimates were 93.7%, 87.8%, 77.0%, 62.4% and 53.0% at 6, 12, 24, 36 and 48 months, respectively. Variables associated with the risk of non-persistence were gender, country region and diagnosis of rheumatoid arthritis and ankylosing spondylitis. Median MPR was 94.2%, while the percentage of patients with MPR ≥80% was 91.0%. Variables associated with MPR≥80% were country region and diagnosis of Crohn's disease. Conclusion: Many patients leave the program without discontinuing IFX, since the 12-month persistence were very different between program and medication estimates, while high adherence rates were observed among patients enrolled in the PSP. Data highlights the benefits of a PSP.

RESUMO Contexto: Os anticorpos monoclonais têm eficácia comprovada no manejo de diversas condições e o infliximabe (IFX) é um dos medicamentos mais importantes da classe. Alguns dados recentes demonstram baixas taxas de persistência e adesão a vários dos biológicos disponíveis. Objetivo: O objetivo deste estudo foi descrever a adesão e persistência ao tratamento com IFX e a persistência no programa de suporte ao paciente (PSP), entre pacientes diagnosticados com doenças inflamatórias intestinais (DII) ou doenças reumáticas (DR) inscritos no PSP de uma grande indústria farmacêutica no Brasil. Métodos: Análise observacional retrospectiva utilizando o banco de dados do PSP. Pacientes com DII ou DR usando IFX inscritos no banco de dados do PSP entre setembro de 2015 e agosto de 2019 foram avaliados retrospectivamente para identificar a taxa de persistência e adesão e acompanhados até 1º de março de 2020. Os pacientes foram excluídos se a data de início do tratamento fosse anterior à entrada no programa; primeira infusão antes de 1º de setembro de 2015 ou após 31 de agosto de 2019; o paciente não iniciou o tratamento; e pacientes com "OUTROS" no campo "indicação". A persistência foi avaliada considerando tanto a persistência no programa ("persistência PSP") quanto a persistência em uso de infliximabe no PSP ("persistência IFX no PSP"). A persistência no PSP foi definida como a proporção de pacientes que permaneceram no programa aos 6, 12, 24, 36 e 48 meses após o início do IFX. Para determinar a persistência do IFX no PSP, a censura foi definida quando o paciente deixou o programa, morreu ou perdeu o acompanhamento. A adesão ao tratamento foi medida pela razão de posse do medicamento (MPR)): todos os dias de fornecimento / decorridos da primeira prescrição ao último dia de posse do medicamento). A estatística descritiva foi inicialmente utilizada. A curva de Kaplan-Meier, o tempo mediano estimado pela função de sobrevida, o modelo de regressão de Cox e o tempo de sobrevida médio restrito (RMST) foram utilizados para avaliar o tempo de persistência do tratamento em 24 meses e o modelo de regressão logística foi realizado para identificar variáveis associadas à adesão (MPR ≥80%). Resultados: Foram analisados 10.233 pacientes, 5.826 (56,9%) com diagnóstico de DR e 4.407 (43,1%) de DII. Ao final do seguimento (mediana de 9,1 meses desde a entrada no PSP até a última infusão), a persistência no PSP foi de 65,6%, 48,2%, 31,0%, 20,7% e 13,1% aos 6, 12, 24, 36 e 48 meses, respectivamente. Considerando a persistência no IFX no PSP, as estimativas foram de 93,7%, 87,8%, 77,0%, 62,4% e 53,0% aos 6, 12, 24, 36 e 48 meses, respectivamente. As variáveis associadas ao risco de não persistência foram sexo, região do país e diagnóstico de artrite reumatoide e espondilite anquilosante. A mediana do MPR foi de 94,2%, enquanto o percentual de pacientes com MPR ≥80% foram de 91,0%. As variáveis associadas a MPR ≥80% foram região do país e diagnóstico de doença de Crohn. Conclusão: Muitos pacientes abandonam o programa sem interromper o IFX, pois a persistência em 12 meses foi muito diferente entre as estimativas do programa e da medicação, enquanto altas taxas de adesão foram observadas entre os pacientes inscritos no PSP. Os dados destacam os benefícios de um PSP.

Composição da gordura corporal em pacientes com doenças inflamatórias intestinais: um estudo comparativo entre dobras cutâneas e ultrassonografia / Body fat composition in patients with inflammatory bowel diseases: a comparative study between skinfolds and ultrasonography

ABSTRACT Background: Inflammatory bowel diseases (IBD) are associated with important changes in nutritional status. Objective: The aim of the study was to compare body fat composition between two anthropometric methods: skinfolds and ultrasonography, in patients with IBD. Methods: Single-center cross-sectional study with IBD patients in remission or active disease. For the agreement analysis between the body fat assessment methods, the Bland Altman method was used. Results: A total of 101 patients with IBD were included, 75 with Crohn's disease and 26 with ulcerative colitis. Approximately 56% of the patients with Crohn's disease and 65.4% of those with ulcerative colitis had a body fat composition above normal levels, with no significant difference between the diseases (P=0.63). The Bland-Altman concordance analysis showed that the methods for assessing the percentage of fat by the adipometer and ultrasound were not in full agreement (P=0.001), despite both presented good correlation (CC 0.961; P=0.000). Conclusion: The analysis of body fat percentage in patients with IBD was different between the skinfolds and ultrasound. Both methods can be used to assess the of body fat percentage of patients with IBD. However, monitoring of body fat sequentially and longitudinally should always be performed using the same method throughout the disease course. Prospective longitudinal studies are warranted to precisely define the role of these two methods of measuring body composition in patients with IBD.

RESUMO Contexto: As doenças inflamatórias intestinais (DII) estão associadas a alterações importantes no estado nutricional. Objetivo: O objetivo do estudo foi comparar a composição da gordura corporal entre dois métodos antropométricos: dobras cutâneas e ultrassonografia, em pacientes com DII. Métodos: Estudo transversal de centro único com pacientes com DII em remissão ou doença ativa. Para a análise de concordância entre os métodos de avaliação da gordura corporal foi utilizado o método de Bland-Altman. Resultados: Foram incluídos 101 pacientes com DII, 75 com doença de Crohn e 26 com colite ulcerativa. Aproximadamente 56% dos pacientes com doença de Crohn e 65,4% daqueles com colite ulcerativa apresentaram composição de gordura corporal acima dos níveis normais, sem diferença significativa entre as doenças (P=0,63). A análise de concordância de Bland-Altman mostrou que os métodos de avaliação do percentual de gordura pelo adipômetro e ultrassonografia não foram totalmente concordantes (P=0,001), apesar de ambos apresentarem boa correlação (CC 0,961; P=0,000). Conclusão: A análise do percentual de gordura corporal em pacientes com DII foi diferente entre as dobras cutâneas e a ultrassonografia. Ambos os métodos podem ser usados para avaliar o percentual de gordura corporal de pacientes com DII. Entretanto, o monitoramento da gordura corporal de forma sequencial e longitudinal deve ser sempre realizado utilizando o mesmo método durante todo o curso da doença. Estudos longitudinais prospectivos são necessários para definir com precisão o papel desses dois métodos de medição da composição corporal em pacientes com DII.

A spurious elevation of serum creatinine level in a patient with Crohn's disease without histologic kidney damage: a case report and review of the literature / Elevação espúria do nível de creatinina sérica em ­paciente com doença de Crohn sem lesão renal histológica: relato de caso e revisão da literatura

ABSTRACT Patients with inflammatory bowel disease (IBD) are prone to develop kidney injury. Renal involvement in IBD patients is usually diagnosed by the measurement of serum creatinine and the estimation of the glomerular filtration rate. We describe a patient with IBD who presented with large fluctuations in his serum creatinine level (~3.0-fold) without significant histologic abnormalities and with a normal cystatin C level. This appears to be related to a high-protein diet and intermittent fasting. Even though the impact of a high-protein diet on mild elevations of the serum creatinine level has been described, large fluctuations in serum creatinine from diet alone, as seen in this case, have never been reported, raising the question about the potential contribution of inflamed bowel on gut absorption or metabolism of creatinine. This case highlights the importance of a detailed history, including the dietary habits, when encountering a patient with increased serum creatinine level, and careful interpretation of serum creatinine in a patient with a creatinine high-protein diet or underlying IBD.

RESUMO Pacientes com doença inflamatória intestinal (DII) são propensos a desenvolver lesão renal. O envolvimento renal em pacientes com DII é geralmente diagnosticado pela medição da creatinina sérica e pela estimativa da taxa de filtração glomerular. Descrevemos um paciente com DII que apresentou grandes flutuações em seu nível de creatinina sérica (~3,0 vezes) sem anormalidades histológicas significativas e com nível normal de cistatina C. Isso parece estar relacionado a uma dieta rica em proteínas e jejum intermitente. Ainda que o impacto de uma dieta rica em proteínas em elevações leves do nível de creatinina sérica tenha sido descrito, nunca foram relatadas grandes flutuações na creatinina sérica apenas devido à dieta, como observado neste caso, o que levanta a questão sobre a possível contribuição do intestino inflamado na absorção intestinal ou no metabolismo da creatinina. Esse caso destaca a importância de um histórico detalhado, incluindo os hábitos alimentares, ao se deparar com um paciente com nível de creatinina sérica aumentado, e a interpretação cuidadosa da creatinina sérica em um paciente com dieta rica em proteínas ou DII subjacente.

Evaluation of bowel wall flow by color Doppler ultrasound in the assessment of inflammatory bowel disease activity in pediatric patients / Avaliação do fluxo parietal pela ultrassonografia com Doppler em cores no diagnóstico de atividade na doença inflamatória intestinal em pacientes pediátricos

Abstract Objective: To assess inflammatory bowel disease (IBD) activity with Doppler ultrasound in pediatric patients, comparing the accuracy of the ultrasound findings with that of the concentrations of fecal calprotectin (FC). Materials and Methods: In a consecutive series, we evaluated 53 examinations of 44 pediatric patients seen between 2014 and 2020: 28 with Crohn's disease, 15 with ulcerative colitis, and one with IBD unclassified. The diagnosis of IBD was made in accordance with the Porto criteria. The alteration studied in the greatest detail was bowel wall flow, which was classified by the lead investigator and two pediatric radiologists, all of whom were blinded to the FC concentrations and the other ultrasound findings. Bowel wall flow was categorized as low if there were up to 2 Doppler ultrasound signals/cm2, moderate if there were 3-5 signals/cm2, and high if there were more than 5 signals/cm2. Results: The agreement among the radiologists was substantial (kappa = 0.73). In cases in which ultrasound showed low bowel wall flow, the median FC concentration was 92 µg/g (interquartile range, 33-661 µg/g), whereas it was 2,286 µg/g (interquartile range, 1,728-5,612 µg/g) in those in which ultrasound showed high bowel wall flow. In the sample as a whole, the sensitivity and specificity of ultrasound was 89.7% and 92.0%, respectively, for the detection of inflammatory activity; 95.5% and 90.9%, respectively, for the detection of Crohn's disease; and 81.3% and 100.0%, respectively, for the detection of ulcerative colitis. Conclusion: Ultrasound of the bowel wall showed a strong correlation with FC concentrations in the assessment of inflammatory activity in pediatric patients with IBD.

Resumo Objetivo: Avaliar a atividade da doença inflamatória intestinal (DII) por ultrassonografia (US) com Doppler em cores, comparada à concentração de calprotectina fecal (CF) em pacientes pediátricos. Materiais e Métodos: Em uma série consecutiva, no período entre 2014 e 2020, foram avaliados 53 exames de 44 pacientes pediátricos: 28 casos de doença de Crohn, 15 de colite ulcerativa e um de colite indeterminada. O diagnóstico da DII foi feito pelos critérios de Porto. O fluxo parietal foi a alteração estudada mais detalhadamente e classificada pelo pesquisador principal e por dois radiologistas pediátricos cegados aos valores de CF e de US Doppler. Baixo fluxo parietal foi definido pela captação de até 2 sinais de US Doppler/cm2, fluxo moderado entre 3 e 5 sinais/cm2 e alto fluxo mais de 5 sinais/cm2. Resultados: Houve concordância substancial entre os radiologistas (kappa = 0,73). Nos exames com baixo fluxo parietal a CF média foi 92 μg/g (intervalo interquartil: 33-661 μg/g) e nos exames com alto fluxo a CF média foi 2.286 μg/g (intervalo interquartil: 1.728-5.612 μg/g). Na amostra total, a US demonstrou sensibilidade de 89,7% e especificidade de 92,0% para detecção da atividade inflamatória, 95,5% e 90,9% na doença de Crohn e 81,3% e 100,0% na colite ulcerativa, respectivamente. Conclusão: Houve forte correlação entre a US da parede intestinal e os valores da concentração de CF na avaliação da atividade inflamatória na DII de pacientes pediátricos.

Consenso colombiano de Falla Intestinal Crónica en Síndrome de Intestino Corto / Colombian Consensus on Chronic Intestinal Failure in Short Bowel Syndrome

Introducción. Los términos falla intestinal crónica, síndrome de intestino corto (SIC) y nutrición parenteral total son muy frecuentes en la práctica clínica cotidiana.El objetivo de esta guía fue establecer un marco de referencia de práctica clínica basado en el mejor de nivel de evidencia en pacientes con falla intestinal crónica secundaria a síndrome de intestino corto. Métodos. Se estableció un grupo de expertos interdisciplinarios en el manejo de la falla intestinal crónica quienes, previa revisión de la literatura escogida, se reunieron de manera virtual acogiendo el método Delphi para discutir una serie de preguntas seleccionadas, enfocadas en el contexto terapéutico de la falla intestinal crónica asociada al síndrome de intestino corto. Resultados. La recomendación del grupo de expertos colombianos es que se aconseje a los pacientes con SIC consumir dietas regulares de alimentos integrales que genere hiperfagia para compensar la malabsorción. Las necesidades proteicas y energéticas dependen de las características individuales de cada paciente; la adecuación del régimen debe ser evaluada a través de pruebas clínicas, antropométricas y parámetros bioquímicos. Se sugiere, especialmente a corto plazo después de la resección intestinal, el uso de análogos de somatostatina para pacientes con yeyunostomía de alto gasto en quienes el manejo de líquidos y electrolitos es problemático. En pacientes con SIC, que son candidatos a tratamiento con enterohormonas, Teduglutida es la primera opción. Conclusión. Existen recomendaciones en el manejo integral de la rehabilitación intestinal respaldadas ampliamente por este consenso y es importante el reconocimiento de alternativas terapéuticos enmarcadas en el principio de buenas prácticas clínicas.

Introduction. The terms chronic intestinal failure, short bowel syndrome (SBS), and total parenteral nutrition are very common in daily clinical practice. The objective of this guideline was to establish a reference framework for clinical practice based on the best level of evidence in patients with chronic intestinal failure secondary to short bowel syndrome. Methods. A group of interdisciplinary experts in the management of chronic intestinal failure was established who, after reviewing the selected literature, met virtually using the Delphi method to discuss a series of selected questions, focused on the therapeutic context of chronic intestinal failure associated with short bowel syndrome. Results. The recommendation of the Colombian expert group is that patients with SBS be advised to consume regular diets of whole foods that generate hyperphagia to compensate malabsorption. Protein and energy needs depend on the individual characteristics of each patient; the adequacy of the regimen must be evaluated through clinical, anthropometric tests and biochemical parameters. The use of somatostatin analogue is suggested, especially in the short term after bowel resection, for patients with high-output jejunostomy in whom fluid and electrolyte management is problematic. In SBS, who are candidates for enterohormonal therapy, Teduglutide is the first choice. Conclusion. There are recommendations on the comprehensive management of intestinal rehabilitation that are widely supported by this consensus and it is important to recognize therapeutic alternatives framed in the principle of good clinical practice.

Perfil dos enfermeiros especialistas em doença inflamatória intestinal no Brasil / Profile of inflammatory bowel disease nurses in brazil

ABSTRACT Background: Nurses play a fundamental role within the inflammatory bowel disease (IBD) multidisciplinary team. Objective: To identify the profile of IBD nurses in Brazil and their work process organization and characterize the health services where they work. Methods: A questionnaire-based research was developed. The inclusion criteria were nurses with experience in IBD care, nurses with scientific research published in an indexed journal or in process, nurses with master's or doctorate degrees concluded or in progress, and educator nurses with expertise in IBD. Results: Seventy-four nurses were included, among whom 66 (89.19%) were women; their mean age was 40.63±9.98 years. Sixty-six percent work in the Southeast region, and more than half (54.05%) had a specialization course. Only four (5.41%) nurses worked exclusively with patients with IBD. The main areas of activity were outpatient clinics (39%) and ostomy care (35%). Nursing care was based on the nursing process (51.35%), and the main topics approached in nursing appointment were treatment adherence (72.97%), and ostomy (68.92%). Forty-seven (63.51%) nurses had knowledge on immunosuppressive medications and 52 (70.27%) on biological therapy. Most health services were integrated with a hospital that has clinical (72.97%) and surgical hospitalization units (67.57%), and 46 (62.16%) of them had an infusion center. Conclusion: Describing the work process of IBD nurses can supplement their organization of the IBD assistance process, as they do not follow any specific consensus. In addition, the characteristics necessary for IBD care are not found in all health services.

RESUMO Contexto: Enfermeiros desempenham um papel fundamental na equipe multidisciplinar das doenças inflamatórias intestinais. Objetivo: Identificar o perfil dos enfermeiros especialistas em doença inflamatória intestinal no Brasil e a organização do processo de trabalho e caracterizar os serviços de saúde onde atuam. Métodos: Estudo transversal, desenvolvido com aplicação de questionário. Os critérios de inclusão foram enfermeiros com experiência na assistência às doenças inflamatórias intestinais, enfermeiros com pesquisas científicas publicadas em periódico indexado ou em andamento, enfermeiros com mestrado ou doutorado concluídos ou em andamento e enfermeiros educadores com expertise em doenças inflamatórias intestinais. Resultados: Foram incluídos 74 enfermeiros, dos quais 66 (89,19%) eram mulheres; a média de idade foi de 40,63±9,98 anos. Sessenta e seis por cento trabalham na região Sudeste, e mais da metade (54,05%) possui curso de especialização. Apenas quatro (5,41%) enfermeiros trabalhavam exclusivamente com pacientes com doença inflamatória intestinal. As principais áreas de atuação foram: ambulatório (39%) e cuidados com ostomia (35%). A assistência de enfermagem foi pautada no processo de enfermagem (51,35%) e os principais temas abordados na consulta de enfermagem foram adesão ao tratamento (72,97%) e estomia (68,92%). Quarenta e sete (63,51%) enfermeiros tinham conhecimento sobre medicamentos imunossupressores e 52 (70,27%) sobre terapia biológica. A maioria dos serviços de saúde estava integrada a um hospital que possui unidades de internação clínica (72,97%) e cirúrgica (67,57%), sendo que 46 (62,16%) deles possuíam centro de infusão. Conclusão: Descrever o processo de trabalho do enfermeiro em doença inflamatória intestinal brasileira pode complementar a organização no processo de assistência à doença inflamatória intestinal, uma vez que não segue nenhum consenso específico. Além disso, as características necessárias para o cuidado das doenças inflamatórias intestinais não são encontradas em todos os serviços de saúde.

Asociación entre la vitamina D y las enfermedades inflamatorias intestinales

La vitamina D es una hormona conocida desde larga fecha, por sus efectos sobre la salud ósea y la regulación del metabolismo del fósforo y calcio. Desde el descubrimiento de receptores para esta molécula en un gran número de células del organismo, se ha abierto el campo para el estudio de sus efectos sobre el sistema inmune. Sus relaciones con las células del sistema inmune, genes y microbiota hace que el interés sea grande en relación con enfermedades inmunomediadas. Muchos datos indican que esta vitamina tiene efectos preventivos, moduladores y controladores de los efectos adversos de las Enfermedades Inflamatorias Intestinales (EII) en la salud ósea, aunque es difícil demostrar la causalidad de forma taxativa. En esta revisión intentamos resumir la situación actual y los temas de controversia en este interesante campo, centrándonos en las enfermedades inflamatorias intestinales.

Vitamin D is a hormone known for a long time, for its effects on bone health and the regulation of phosphorus and calcium metabolism. Since the discovery of receptors for this molecule in a large number of cells in the body, the field has been opened for the study of its effects on the immune system. Its relationships with the cells of the immune system, genes, and microbiota cause great interest in relation to immune-mediated diseases. Many data indicates that this vitamin has preventive, modulating and controlling effects of the adverse effects of Inflammatory Bowel Diseases (IBD) on bone health, although it is difficult to definitively demonstrate causality. In this review, we try to summarize the current situation and controversial issues in this interesting field, focusing on inflammatory bowel diseases.

Effects of Mimosa caesalpiniifolia pre-formulation on the intestinal barrier during sodium dextran sulfate-induced colitis in Wistar rats / Efectos de la preformulación de Mimosa caesalpiniifolia sobre la barrera intestinal durante la colitis inducida por sulfato de dextrano sódico en ratas Wistar

Introduction. Anti-inflammatories, immunosuppressants, and immunobiological are commonly used in the treatment of inflammatory bowel disease. However, some patients do not present an adequate response or lose effective response during the treatment. A recent study found a potential anti-inflammatory effect of the hydroalcoholic extract of Mimosa caesalpiniifolia on trinitrobenzene sulfonic acid-induced colitis in Wistar rats. Objective. To evaluate the effects of M. caesalpiniifolia pre-formulation on the intestinal barrier using dextran sulfate sodium-induced colitis model. Materials and methods. Leaf extracts were prepared in 70% ethanol and dried with a Buchi B19 Mini-spray dryer using 20% Aerosil® solution. Thirty-two male Wistar rats were randomized into four groups: basal control, untreated colitis, pre-formulation control (125 mg/kg/day), and colitis treated with pre-formulation (125 mg/kg/day). Clinical activity index was recorded daily and all rats were euthanized on the ninth day. Colon fragments were fixed and processed for histological and ultrastructural analyses. Stool samples were collected and processed for analysis of the short-chain fatty acid. Results. Treatment with the pre-formulation decreased the clinical activity (bloody diarrhea), inflammatory infiltrate, and the ulcers. Pre-formulation did not repair the epithelial barrier and there were no significant differences in the goblet cells index. There was a significant difference in butyrate levels in the rats treated with the pre-formulation. Conclusions. The pre-formulation minimized the clinical symptoms of colitis and intestinal inflammation, but did not minimize damage to the intestinal barrier.

Introducción. Los antiinflamatorios, inmunosupresores e inmunobiológicos se utilizan comúnmente para tratar la enfermedad intestinal inflamatoria. Sin embargo, algunos pacientes no presentan una respuesta adecuada o pierden respuesta efectiva durante el tratamiento. En un estudio reciente, se encontró un potencial efecto antiinflamatorio del extracto hidroalcohólico de Mimosa caesalpiniifolia en la colitis inducida por el ácido trinitrobenceno sulfónico utilizando ratas Wistar. Objetivo. Evaluar los efectos de la preformulación de M. caesalpiniifolia sobre la barrera intestinal durante la colitis inducida por sulfato de dextrano sódico. Materiales y métodos. Los extractos de hojas se prepararon con una solución que contenía 70 % de etanol y se secaron con un secador por aspersión Mini B19 de Buchi usando una solución con 20 % de Aerosil®. Treinta y dos ratas Wistar macho se aleatorizaron en cuatro grupos: control basal, colitis sin tratar, control con preformulación (125 mg/kg/ día) y colitis tratada con preformulación (125 mg/kg/día). El índice de actividad clínica se registró diariamente y todas las ratas se sacrificaron el noveno día. Los fragmentos de colon se fijaron y se procesaron para análisis histológicos y ultraestructurales. Se recolectaron muestras de heces y se procesaron para el análisis de ácidos grasos de cadena corta. Resultados. El tratamiento con la preformulación disminuyó la actividad clínica (diarrea sanguinolenta), el infiltrado inflamatorio y las úlceras. La preformulación no reparó la barrera epitelial y no hubo diferencias significativas en el índice de células caliciformes. Se obtuvo una diferencia significativa en los niveles de butirato en las ratas tratadas con la preformulación. Conclusiones: La preformulación minimizó los síntomas clínicos de colitis e inflamación intestinal pero no minimizó el daño a la barrera intestinal.

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

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

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

¿Ha disminuido la colectomía por crisis de colitis ulcerosa?

Background: Treatment for moderate-severe active ulcerative colitis (UC) includes steroids, biologic therapy and total colectomy. Aim: To describe the features of patients with moderate to severe active UC, their hospital evolution and need for colectomy. Material and Methods: Non-concurrent cohort study of all patients admitted to our institution with a diagnosis of moderate or severe UC crisis between January 2008 and May 2019. Truelove Witts (TW) criteria were used to categorize disease severity. Twelve-month colectomy-free survival was estimated with Kaplan-Meier survival analysis. Results: One hundred-twenty patients aged 16 to 89 (median 35) years had 160 admissions for acute moderate to severe UC. Median admission per patient was 1 (1-3), and median hospital stay was six days (1-49). Cytomegalovirus and Clostridioides difficile were found in 17.5 and 14.2% of crises, respectively. Corticosteroids were used in all crises and biologic therapy in 6.9% of them. Emergency or elective colectomies were performed in 18.3 and 6.7% of patients, respectively. The need for emergency total colectomy decreased from 24.6 to 7.8% (Risk ratio 3.16, p < 0.01) between de first and second half of the study period. Kaplan-Meier analysis for long term colectomy-free survival in both periods confirmed this decrease (p < 0.01). Conclusions: Medical treatment for moderate to severe UC crises had a 86.3% success and a small percentage required emergency total colectomy. Emergency surgery decreased in the last decade.

Fecal calprotectin levels in acute anterior uveitis in patients with spondyloarthritis / Níveis de calprotectina fecal na uveite anterior aguda em pacientes com espondiloartrites

ABSTRACT Purpose: This study measured fecal calprotectin levels in a series of patients with anterior uveitis in order to determine whether anterior uveitis patients with associated spondyloarthritis have higher levels of fecal calprotectin than patients with anterior uveitis of other etiologies. A third group of patients with spondyloarthritis without uveitis was also evaluated to understand the role of acute anterior uveitis in increasing fecal calprotectin. Methods: In this cross-sectional study, 28 patients were divided into three groups: (a) Group 1, spondyloarthritis and uveitis (n=9); (b) Group 2, spondyloarthritis without uveitis (n=10); and (c) Group 3, uveitis without spondyloarthritis (n=9). The levels of fecal calprotectin were determined. Results: Groups 1 and 2 showed higher median fecal calprotectin levels (101.0 and 93.0 µg/g, respectively) compared with Group 3 (9.0 µg/g) (p=0.02). However, no relationship between fecal calprotectin levels and the presence of uveitis with spondyloarthritis could be demonstrated. Conclusion: Patients with spondyloarthritis with or without acute anterior uveitis have significantly elevated levels of fecal calprotectin. This test may be useful for differentiating spondyloarthrit-associated uveitis from uveitis of other etiologies.

RESUMO Objetivo: Este estudo avaliou os níveis de calprotectina fecal em uma série de pacientes com uveíte anterior na tentativa de determinar se pacientes com uveíte associada com espondiloartrites apresentam níveis mais elevados desta proteína do que pacientes com uveíte anterior de outras etiologias. Um terceiro grupo com espondiloartrites sem uveíte também foi incluído na avaliação para entendimento do papel da uveíte anterior no aumento da calprotectina fecal. Métodos: Estudo transversal de 28 pacientes divididos em três grupos: (a) com espondiloartrites e uveíte (n=9); (b) com espondiloartrites sem uveíte (n=10) e (c) com uveíte sem espondiloartrites (n=9). A dosagem de calprotectina fecal foi avaliada. Resultados: Pacientes com uveíte anterior associada a espondiloartrites apresentaram valores medianos maiores de calprotectina fecal (101 µg/g) que os valores dos pacientes com uveíte sem espondiloartrites (9 µg/g), pacientes com espondiloartrites sem uveíte que também demonstraram valores maiores (93.0 µg/g) que os dos pacientes com uveíte sem espondiloartrites (p=0,02). Conclusão: Pacientes com espondiloartrites com e sem uveíte anterior aguda demonstraram níveis significativamente elevados de calprotectina fecal. Este teste pode ser útil na diferenciação entre uveítes associadas com espondiloartrites de uveítes de outras etiologias. Entretanto, não foi possível demonstrar associação entre o aumento dos níveis de calprotectina fecal e a presença da uveíte em espondiloartrites.

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

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

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

Manifestaciones hepatobiliares asociadas a la enfermedad inflamatoria intestinal / Hepatobiliary manifestations associated with inflammatory bowel disease

La enfermedad inflamatoria intestinal (EII) engloba dos entidades, la enfermedad de Crohn (EC) y la colitis ulcerativa (CU), las cuales son enfermedades inmunomediadas, crónicas y recurrentes que, aunque afectan al intestino, pueden ir acompañadas de manifestaciones extraintestinales de tipo hepatobiliar en el 5 % de los casos. Entre ellas, las más frecuentes son la enfermedad por hígado graso no alcohólico (EHGNA), la colelitiasis, la colangitis esclerosante primaria (CEP), la colangitis relacionada con IgG4, la hepatitis autoinmune (HAI), el síndrome de superposición HAI/CEP, así como la lesión hepática inducida por fármacos (DILI); y otras menos frecuentes como la colangitis biliar primaria (CBP), la trombosis de la vena porta, los abscesos hepáticos, la hepatitis granulomatosa, las hepatitis B y C, la reactivación de la hepatitis B por terapia inmunosupresora, y la amiloidosis. Estas manifestaciones hepatobiliares cursan con una fisiopatología similar o inclusive la misma de la EII, en la que participan el sistema inmune innato y adaptativo, alteración de la microbiota (disbiosis), permeabilidad intestinal, factores de riesgo genéticos (comunes para EII y manifestaciones hepatobiliares) y desencadenantes ambientales. La primera manifestación de un trastorno hepatobiliar es la alteración del perfil de función hepática, por lo que el abordaje diagnóstico se debe dirigir a evaluar y monitorizar las enzimas hepáticas y su asociación a algún patrón diferencial de alteración hepatocelular o colestásico, con el fin de tomar decisiones oportunas con respecto a la suspensión, indicación o modificación de algún medicamento, o cualquier otro abordaje que impida o retrase la evolución de la enfermedad hepatobiliar, y al mismo tiempo garantice el control de la EII, mejorando potencialmente el pronóstico de estos pacientes.

Inflammatory bowel disease (IBD) encompasses two entities, Crohn's disease (CD) and ulcerative colitis (UC), which are chronic, recurrent, immune-mediated inflammatory diseases that, although affect the gut, may be accompanied by extraintestinal hepatobiliary manifestations in 5% of the cases. Among them, the most frequent are non-alcoholic fatty liver disease (NAFLD), cholelithiasis, primary sclerosing cholangitis (PSC), IgG4-related cholangitis, autoimmune hepatitis (AIH), AIH/PSC overlap syndrome, as well as drug-induced liver injury (DILI); and other less frequent such as primary biliary cholangitis (PBC), portal vein thrombosis, liver abscesses, granulomatous hepatitis, hepatitis B and C, reactivation of hepatitis B due to different drugs, and amyloidosis. These hepatobiliary manifestations present with a pathophysiology similar or even the same as that of IBD, where several factors participate, including the innate and adaptive immune system, an interaction with the components of the microbiota, leaky gut, genetic risk factors (common for both IBD and hepatobiliary manifestations) and environmental triggers. The first manifestation of a hepatobiliary disorder is the alteration of the liver profile; therefore, the diagnostic approach should be aimed at evaluating and monitoring liver enzymes and their association with some differential pattern of hepatocellular or cholestatic changes, in order to make appropriate decisions regarding the suspension or modification of any medication, or any other approach that prevents or delays the evolution of hepatobiliary disease, and at the same time guarantees control of IBD, improving the prognosis of these patients.

Bilateral uveitis in silent ulcerative colitis: case report

Silent or subclinical inflammatory bowel diseases (IBD) is a relatively new term that has been used to describe individuals with asymptomatic active mucosal bowel inflammation, often unaware of their disease due to either the lack of or mild inflammatory symptoms. These patients are at risk for gastrointestinal and extra-gastrointestinal manifestations, with more advanced complications. In this article we intend to describe a case report of a patient with chronic history of many organ involvements including ocular, skin, and musculoskeletal, which was later placed under the umbrella of silent ulcerative colitis. (AU)

Manifestaciones bucales de la enfermedad de Crohn y colitis ulcerosa en adultos mayores / Oral manifestations of Crohn´s disease and ulcerative colitis in of elderly adults

Objetivo: identificar las manifestaciones clínicas bucales de la enfermedad de Crohn y colitis ulcerosa en pacientes adultos mayores. Métodos: se efectuó un estudio descriptivo transversal con un universo de 50 adultos mayores, previamente diagnosticados por los especialistas gastroenterólogos, y prescritos con enfermedad de Crohn y colitis ulcerosa. Estos, confirmados por los hallazgos clínicos, histopatológicos y endoscópicos, remitidos a consulta estomatológica del Policlínico de Especialidades del Hospital Clinicoquirúrgico Universitario "Saturnino Lora Torres" de Santiago de Cuba, entre marzo de 2019 y marzo de 2020, practicándose el examen intrabucal, descripción de las lesiones bucales y su diagnóstico clínico. Para la recolección del dato primario se confeccionó un modelo con las variables: edad, sexo, enfermedad inflamatoria intestinal, localización anatómica, signos y síntomas clínicos orales en ambas patologías. Se creó una base de datos en SPSS versión 22.0 en Windows para el procesamiento y análisis de la información, usándose la técnica estadística descriptiva y agrupándose los datos en frecuencias absolutas y relativas. Resultados: en la serie resaltaron las personas de sexo femenino y el grupo de edades de 60 a 74 años, la pioestomatitis vegetante fue el signo bucal específico más común y la úlcera aftosa recurrente la lesión inespecífica de mayor predominio en ambas patologías. El dolor, el síntoma clínico de mayor afectación y el dorso de lengua el sitio de mayor predilección para su instalación. Conclusiones: las expresiones clínicas bucales más relevantes en pacientes adultos mayores con enfermedad de Crohn y colitis ulcerosa fueron la pioestomatitis vegetante y la úlcera aftosa recurrente.

Objective: Identify the oral clinical manifestations of Crohn´s disease and ulcerative colitis in elderly adults' patients. Methods: a cross-sectional descriptive study was carried out with a universe of 50 older adults previously diagnosed by gastroenterologist specialists, prescribing the presence of Crohn's disease and ulcerative colitis, confirmed by clinical, histopathologica and endoscopic findings, referred to the stomatological consultation of the Specialities Policlinic of the "Saturnino Lora Torres" University Clinical Surgical Hospital of Santiago de Cuba, from March 2019 to the same month of 2020, performing intraoral examination, description of oral lesions and their clinical diagnosis. For the collection of the primary data, a model was made with the variables: age, sex, inflammatory bowel disease, anatomical location, oral clinical signs and symptoms in both pathologies. A database was created in SPSS version 22.0 in Windows for the processing and analysis of the information, using the descriptive statistical technique and grouping the data in absolute and relative frequencies. Results: in the casuistry, females and the age group of 60 to 74 years prevailed, vegetative pyostomatitis was the most common specific oral sign and recurrent aphthous ulcer was the most prevalent non-specific lesion in both pathologies, pain being the most affecting clinical symptom and the back of the tongue is the most preferred site for its installation. Conclusions: the most relevant oral clinical expressions in elderly patients adults with Crohn´s disease and ulcerative colitis were pyostomatitis vegetative and recurrent aphthous ulcer.

A survey on disability status of patients with inflammatory bowel disease in China / 中华消化杂志

Objective:To investigate the disability status of patients with inflammatory bowel disease (IBD) in China and to identify the influencing factors of the inflammatory bowel disease disability index (IBD-DI).Methods:From October 1 to December 31, 2021, a total of 1 170 IBD patients were recruited from 7 IBD centers and WeChat public platforms in China. All the patients were surveyed by the IBD-DI questionnaire, which included demographic information, disease activity, medication history, treatment and surgical history. Demographic information included gender, age, income status, etc. Multiple linear regression was used to analyze the influencing factors of IBD-DI.Results:Among the 1 170 IBD patients, 746 patients (63.76%) were male and 424 patients (36.24%) were female; there were 871 cases (74.44%) of Crohn′s disease(CD), 277 cases (23.68%) of ulcerative colitis (UC) and 22 cases (1.88%) of inflammatory bowel disease undassified (IBDU). The age was 36.00 years old (29.00 years old, 45.00 years old), and the IBD-DI score was 9.00 (5.00, 15.00). The results of multiple linear regression analysis revealed that the disease activity ( β=0.65, t=22.33, P<0.001), current treatment with enteral nutrition ( β=0.09, t=3.06, P<0.001), and history of perianal surgery ( β=0.06, t=2.12, P=0.034) were influencing factors of IBD-DI in the CD patients. Disease activity ( β=0.65, t=14.37, P<0.001), household per capita annual income ( β=-0.16, t=-3.59, P<0.001), current usage of immunosuppressants ( β=0.12, t=2.66, P=0.008), current treatment with enteral nutrition ( β=0.12, t=2.57, P=0.011), and the duration of each exercise ( β=-0.12, t=-2.67, P=0.008) were influencing factors of IBD-DI in UC patients. Conclusions:Disability is common in Chinese IBD patients, and their IBD-DI were different. Disease activity is the most important factor affecting IBD-DI. The IBD-DI is higher in IBD patients receiving enteral nutrition treatment, CD patients with a history of perianal surgery and UC patients with current usage of immunosuppressants. However, household per capita annual income and the duration of each exercise are negatively correlated with IBD-DI in UC patients.

Recommendations for the management of treatment and vaccination in inflammatory bowel disease patients complicated with coronavirus disease 2019 / 中华消化杂志

Coronavirus disease 2019 (COVID-19) has become a worldwide pandemic. During the rapid spread time, it is a great challenge for patients with inflammatory bowel disease (IBD) who use immunosuppressive drugs from vaccination and drug application. This article is intended to supplement and revise the recommendations of the Inflammatory Bowel Disease Group of the Chinese Society of Gastroenterology in 2020 on the "Management of patients with inflammatory bowel disease during epidemic of novel coronavirus pneumonia", mainly including the treatment and vaccination of IBD patients complicated with COVID-19. It is expected to guide clinicians in drug use, vaccination of IBD patients at an appropriate time, also help patients getting through the epidemic period of COVID-19.

Effects of biologics on psychological status and quality of life in patients with inflammatory bowel disease: a multicenter study / 中华内科杂志

Objective:To investigate the effects of biologics on psychological status and quality of life in patients with inflammatory bowel disease (IBD).Methods:A cross-sectional survey was conducted in 42 hospitals in 22 provinces (autonomous regions and municipalities directly under the central government) from September 2021 to May 2022. General clinical information and the use of biologics were obtained from adult patients diagnosed with IBD who voluntarily participated in the study. Psychological status was evaluated using the Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Pittsburgh Sleep Quality Index (PSQI), and Inflammatory Bowel Disease Questionnaire (IBDQ) assessment tools. Counts were analyzed via the Chi-square test, and datasets that were not normally distributed were analyzed via nonparametric tests. P<0.05 was considered statistically significant. Results:A total of 2 478 valid questionnaires were collected. The GAD-7 score of the biologics group was significantly lower than that of the non-use group [6 (2, 9) vs. 7 (3, 10), Z=-3.49, P<0.001]. IBDQ scores [183 (158, 204) vs. 178 (152, 198), Z=-4.11, P<0.001], intestinal symptom scores [61 (52, 67) vs. 58 (49, 65), Z=-5.41, P<0.001], systemic symptom scores [28 (24, 32) vs. 27 (23, 31), Z=-2.37, P=0.018], emotional ability scores [69 (58, 77) vs. 67 (56, 75), Z=-3.58, P<0.001] and social ability scores [26 (22, 29) vs. 25 (22, 29), Z=-2.52, P=0.012] in the biologics group were significantly higher than in the non-use group. GAD-7 scores [5 (2, 9) vs. 6 (3, 10), Z=-3.50, P<0.001] and PSQI scores [6 (4, 9) vs. 6 (4, 9), Z=-2.55, P=0.011] were significantly lower in the group using infliximab than in the group not using it. IBDQ scores were significantly higher in patients using vedolizumab than in those not using it [186 (159, 205) vs. 181 (155, 201), Z=-2.32, P=0.021] and were also significantly higher in the group treated with adalimumab than in the group not treated with adalimumab [187 (159, 209) vs. 181 (155, 201), Z=-2.16, P=0.030]. However, ustekinumab had no significant effect on any of the scores. Conclusion:The use of biologics is strongly associated with improvements in anxiety status and quality of life in IBD patients.

Research progress in effects of pyroptosis on intestinal inflammatory injury / 中南大学学报(医学版)

Inflammatory injury of the intestine is often accompanied by symptoms such as damage to intestinal mucosa, increased intestinal permeability, and intestinal motility dysfunction. Inflammatory factors spread throughout the body via blood circulation, and can cause multi-organ failure. Pyroptosis is a newly discovered way of programmed cell death, which is mainly characterized by the formation of plasma membrane vesicles, cell swelling until the rupture of the cell membrane, and the release of cell contents, thereby activating a drastic inflammatory response and expanding the inflammatory response cascade. Pyroptosis is widely involved in the occurrence of diseases, and the underlying mechanisms for inflammation are still a hot spot of current research. The caspase-1 mediated canonical inflammasome pathway of pyroptosis and caspase-4/5/8/11-mediated non-canonical inflammasome pathway are closely related to the occurrence and development of intestinal inflammation. Therefore, investigation of the signaling pathways and molecular mechanisms of pyroptosis in intestinal injury in sepsis, inflammatory bowel diseases, infectious enteristic, and intestinal tumor is of great significance for the prevention and treatment of intestinal inflammatory injury.