Potential impact of COVID-19 on colorectal disease management / Impacto potencial da COVID-19 no manuseio das doenças colorretais

Abstract The current recommendations for management of colorectal diseases are still evolving, due to the limited experience on this issue. As the new coronavirus can be transmitted through breath droplets, by contact and orofecally, there is no consensus of how this fact may affect the investigation and treatment of anorectal diseases. Thus, high-quality multicenter studies are urgently needed to provide better information to both patients and the multiprofessional team, in order to build an effective pandemic response plan in our specialty. As a greater operative risk for infected patients has already been demonstrated, the next step lies on the identification of new therapeutic strategies that could minimize this effect on an individual basis. There is a present understanding that the COVID-19 pandemic should change some traditional practices. Therefore, the surgical treatment of suspected or known COVID-19 case demands specific insights. This article analyses potential influences regarding the treatment of patients with Colorectal Cancer (CRC) and Inflammatory Bowel Diseases (IBD). At present, elective surgery must be avoided, and the colorectal surgeon must carefully evaluate the risks and benefits of such decision. Within this context, a change toward nonsurgical and less aggressive modalities of CRC treatment may help to postpone definitive treatment. We also discuss the concerns regarding the viral infection among the population, the influence on clinical symptoms and the proposed modifications on therapeutic schemes.

Resumo As recomendações atuais para manuseio das doenças colorretais ainda estão em evolução, devido à limitada experiência nesse tema. Como o novo coronavírus pode ser transmitido em gotículas da respiração, por contato ou por via oro-fecal, ainda não existe consenso de como este fato pode afetar a investigação e o tratamento de doenças anorretais. Assim, são necessários estudos multicêntricos de qualidade para prover melhor informação ao paciente e equipe multiprofissional, possibilitando a formulação de uma resposta efetiva à pandemia em nossa especialidade. Uma vez que o risco operatório de pacientes infectados é maior, o passo subsequente reside em identificar novas estratégias terapêuticas que possam minimizar esse efeito individualmente. Assim, reconhece-se atualmente que a pandemia pelo COVID-19 deve alterar algumas práticas tradicionais. Consequentemente, o tratamento cirúrgico de um doente infectado ou suspeito demanda reflexões específicas. Esse artigo analisa influências potenciais relacionadas ao tratamento do Câncer Colorretal (CCR) e Doenças Inflamatórias Intestinais (DII). No atual momento, cirurgias eletivas devem ser postergadas e o cirurgião colorretal deve avaliar cuidadosamente os riscos e benefícios dessa decisão. Nesse contexto, uma mudança na direção de modalidades não-cirúrgicas e menos agressivas do CCR pode favorecer a prorrogação do tratamento definitivo. Aqui também se discutem as preocupações sobre a infecção viral em pacientes com DII, sua influência sobre os sintomas clínicos e as modificações propostas nos esquemas terapêuticos.

Early and long-term outcome of surgical intervention in children with inflammatory bowel disease / Resultados em curto e longo prazos da intervenção cirúrgica em crianças com doença inflamatória intestinal

ABSTRACT Background: Although children with inflammatory bowel disease (IBD), disease control is possible through medical procedures, but surgical intervention is indicated in some cases. Aim: To evaluated long-term surgical outcomes in children with IBD. Methods: This retrospective cohort study was done on 21 children suffering IBD with surgical indication admitted to a referral children hospital in Tehran in 2019. The baseline information was collected by reviewing the recorded files and children were followed-up to assess surgical outcome. Results: The rate of early complications after surgery was 47.6%; they included intestinal perforation in 4.8%, peritonitis in 4.8%, wound infection in 23.8%, pelvic abscesses in 14.3%, deep vein thrombosis in 4.8%, intestinal obstruction in 9.5%, pancreatitis in 9.5% and anal fissure in 4.8%. The mean duration of follow-up for patients was 6.79±4.24 years. The rate of delayed complications during follow up was 28.6%. Accordingly, long-term free-complication survival rate during 5-10 years after surgery was 92.3% and 56.4%, respectively. Among the early features, lack of prior drug treatment and bleeding as indication for surgery, were two predictors of long-term surgical complications. Conclusion: Standard surgery in the treatment of IBD in children with surgical indication is associated with favorable outcome, although short- and long-term surgical complications are also predictable.

RESUMO Racional: Em crianças com doença inflamatória intestinal (DII) o controle da doença é possível através de procedimentos médicos; contudo, intervenção cirúrgica é necessária em alguns casos. Objetivo: Avaliar os resultados cirúrgicos em longo prazo em crianças com DII. Métodos: Este estudo é coorte retrospectiva realizado em 21 crianças com DII com indicação cirúrgica admitida em um hospital infantil de referência em Teerã, Iran, em 2019. As informações foram coletadas através da revisão dos arquivos e as crianças foram acompanhadas para avaliar o resultado cirúrgico. Resultados: A taxa de complicações precoces pós-operatória foi de 47,6%; incluíram elas perfuração intestinal em 4,8%, peritonite em 4,8%, infecção de ferida em 23,8%, abscessos pélvicos em 14,3%, trombose venosa profunda em 4,8%, obstrução intestinal em 9,5%, pancreatite em 9,5% e fissura anal em 4,8%. O tempo médio de seguimento dos pacientes foi de 6,79±4,24 anos. A taxa de complicações tardias durante o acompanhamento foi de 28,6%. Consequentemente, a sobrevida livre de complicações em longo prazo, durante 5 a 10 anos após o procedimento, foi de 92,3% e 56,4%, respectivamente. Entre as características iniciais, falta de tratamento medicamentoso prévio e sangramento como indicação para cirurgia, foram dois preditores de complicações cirúrgicas em longo prazo. Conclusão: O tratamento cirúrgico no tratamento da DII em crianças está associado a resultado favorável, embora complicações cirúrgicas de curto e longo prazo também sejam previsíveis.

Postoperative mortality in inflammatory bowel disease patients / Mortalidade em portadores de doença inflamatória intestinal submetidos a tratamento cirúrgico

ABSTRACT Introduction: Since the 1960s, mortality in Crohn's disease and Ulcerative Colitis patients had a significant decrease due to advances in medical and surgical therapy. An important proportion of these patients are submitted to surgical procedures during their disease course, with postoperative mortality between 4 and 10%. Methods: 157 inflammatory bowel disease patients submitted to surgical therapy were retrospectively identified and allocated in 2 groups (Crohn's and colitis). Deaths were individually discriminated in detail. Results: 281 surgical procedures were performed. In the colitis group, 43 operations were performed in 24 patients; in the abdominal Crohn's subgroup, 127 procedures in 90 patients and in the perineal Crohn's subgroup, 115 in 64 patients, respectively. Nine postoperative deaths were observed (3 in the colitis and 6 in the Crohn's groups). Overall postoperative mortality was 5.7% (4.5% for Crohn's; 6.6% in abdominal Crohn's and 12.5% for Colitis). Most of deaths were related to emergency procedures and previous use of corticosteroids. The cause of death in all patients was sepsis. Conclusions: Overall postoperative mortality in inflammatory bowel disease was 5.7%, and it was attributed to the severity of the cases referred.

RESUMO Introdução: A partir da década de 60, a mortalidade dos portadores de doença de Crohn (DC) e a Retocolite Ulcerativa Inespecífica (RCUI) teve declínio devido a novas terapêuticas clínicas e cirúrgicas. Importante proporção destes pacientes é submetida a procedimentos cirúrgicos no decorrer das suas vidas, com taxas de mortalidade variando entre 4 e 10%. Método: Foram identificados retrospectivamente 157 pacientes portadores de doenças inflamatórias intestinais (DII), submetidos a operações abdominais ou perineais, divididos em dois grupos (DC e RCUI). Os casos de óbitos foram discriminados e avaliados individualmente, de forma descritiva. Resultados: 281 operações foram realizadas. No grupo RCUI foram realizadas 43 operações em 24 pacientes, no subgrupo DC abdominal, 127 operações em 90 pacientes e no subgrupo DC perineal, 115 em 64 pacientes, respectivamente. Do total de 9 óbitos, 3 ocorreram no grupo RCUI e 6 no DC. A mortalidade geral nas DII foi de 5,7%. Para a DC, 4,5%. No subgrupo de operações abdominais foi de 6,6% e para a RCUI 12,5%. A maior parte dos óbitos estavam relacionados a procedimentos de urgência/emergência, com uso prévio de corticoterapia. A causa mortis em todos os pacientes foi sepse. Conclusões: A taxa de mortalidade cirúrgica nas DII foi de 5,7%, atribuidas pela severidade dos casos.

Mortalidad en enfermedad inflamatoria intestinal / Mortality in inflammatory bowel disease

Inflammatory bowel disease (IBD) is a chronic disease of unknown cause. It has been attributed to an inflammation of the intestinal mucosa due to loss of immunotolerance to commensal intestinal flora in genetically predisposed individuals. It presents short- and long-term complications, impacting the quality of life and increasing patient mortality, although this risk is slightly increased with respect to the general population. Causes of mortality may be due to complications of the disease, secondary to drugs or surgical complications. Mortality associated with the disease, it occurs mainly in the first 5 years of diagnosis, due to the increased risk of acute complications such as severe ulcerative colitis, toxic megacolon and massive digestive hemorrhage. In addition, patients with IBD are at increased risk of digestive tract and extraintestinal neoplasias. Colorectal cancer occurs as a consequence of chronic inflammation of the colonic mucosa. Extraintestinal neoplasms include lung cancer, hematologic malignancies such as lymphoma, cholangiocarcinoma, cervical cancer, and skin cancer. They also present an increased risk of cardiovascular and thromboembolic diseases, associated with the prothrombotic state of these patients. This review aims to describe the main causes of mortality in IBD patients, in order to be able to prevent the disease and provide opportune diagnosis

La enfermedad inflamatoria intestinal (EII) es una enfermedad crónica de causa desconocida. Su etiología se ha atribuido a una inflamación de la mucosa intestinal debido a una pérdida de la inmunotolerancia a la flora intestinal comensal en individuos genéticamente predispuestos. La EII puede presentar complicaciones a corto y largo plazo, lo que puede afectar la calidad de vida y mortalidad de los pacientes, siendo este riesgo levemente mayor con respecto a la población general. Las causas de mortalidad pueden ser consecuencia de las complicaciones propias de la enfermedad, secundaria a fármacos o por complicaciones quirúrgicas. En cuanto a la mortalidad asociada a la enfermedad, se presenta principalmente en los primeros 5 años de diagnóstico, por mayor riesgo de complicaciones agudas como colitis ulcerosa grave, megacolon tóxico y hemorragia digestiva masiva. Además, los pacientes con EII presentan mayor riesgo de neoplasias tanto del tubo digestivo como extraintestinales. El cáncer colorrectal se presenta como consecuencia de la inflamación crónica de la mucosa colónica. Dentro de las neoplasias extraintestinales se encuentran el cáncer de pulmón, neoplasias hematológicas como el linfoma, colangiocarcinoma, cáncer cervicouterino y cáncer de piel. También presentan mayor riesgo de enfermedades cardiovasculares y tromboembólicas, asociadas al estado protrombótico de estos pacientes. Esta revisión tiene como objetivo describir las principales causas de mortalidad en los pacientes con EII, con el fin de poder prevenirlas y diagnosticarlas oportunamente.

Manifestaciones extraintestinales en rectocolitis úlcerativa: a propósito de un caso / Extraintestinal manifestations in ulcerative proctocolitis: a case report

La colitis ulcerativa (CU) forma más común de la enfermedad inflamatoria intestinal (EII),¹ es una enfermedad crónica que cursa con inflamación recurrente no controlada del colon,² caracterizada por ulceración de la mucosa, sangrado rectal, diarrea y dolor abdominal.³ Un tercio de los pacientes pueden desarrollar una manifestación extraintestinal.4,5 En la CU estas manifestaciones suelen estar relacionadas con la actividad de la enfermedad.5,6 Presentamos un caso clínico de una paciente con CU quien presenta manifestaciones extraintestinales cutáneas, oculares y en mucosa bucal, con resolución de las mismas posterior a tratamiento médico

Ulcerative colitis (UC) the most common form of inflammatory bowel disease (IBD),¹ is a chronic disease that causes uncontrolled recurrent inflammation of the colon,² characterized by mucosal ulceration, rectal bleeding, diarrhea and abdominal pain.³ A third of patients may develop extraintestinal manifestation.4,5 In UC these manifestations are often associated with disease activity.5,6 We present a case of a patient with UC who presented extraintestinal cutaneous, ocular and oral mucosa, with resolution of the same post-treatment

Synchronous pyoderma gangrenosum and inflammatory bowel disease, healing after total proctocolectomy / Pioderma gangrenoso associado a doença inflamatória intestinal, com resolução após proctocolectomia total

We present a female patient observed with painful violaceous plaques with central bullae and pustules on the lower limbs, rapidly transformed into ulcers, associated with bloody diarrhea, recurrent oral erosions and hyperthermia in the previous 3 months. Cutaneous biopsy was consistent with pyoderma gangrenosum, and intestinal diagnostic procedures revealed a non-classifiable inflammatory bowel disease with high x-ANCA titers. Soon after admission the patient was submitted to total proctocolectomy following colonic perforation. Complete ulcer healing occurred three months after surgery, without recurrence. Pyoderma gangrenosum is a rare dermatosis frequently associated with inflammatory bowel disease. This case is particularly interesting for the synchronic clinical presentation of cutaneous and intestinal diseases, but also for the prompt regression of the former after total proctocolectomy.

Apresentamos uma paciente do sexo feminino observada com múltiplas placas violáceas dolorosas dos membros inferiores, com bolhas e pústulas evoluindo rapidamente para lesões ulceradas, surgindo no contexto de diarreia sanguinolenta, erosões orais recorrentes e febre com três meses de evolução. A biópsia cutânea foi compatível com pioderma gangrenoso; o estudo complementar revelou doença inflamatória intestinal inclassificável com títulos elevados de x-ANCA. Após perfuração cólica, a doente foi submetida a proctocolectomia total, com rápida cicatrização das lesões cutâneas ulceradas em três meses, sem recorrência. O pioderma gangrenoso é uma dermatose rara frequentemente associada a doença inflamatória intestinal. É interessante verificar neste caso a apresentação clínica sincrónica das doenças cutânea e intestinal, bem como a rápida resolução da primeira após proctocolectomia total.

Comparison of Standardized Peristomal Skin Care and Crusting Technique in Prevention of Peristomal Skin Problems in Ostomy Patients

PURPOSE: This study was performed to compare the effects of standardized peristomal skin care (SPSC) and crusting technique (CT) on the peristomal skin of ostomates. SPSC was developed by a consensus among the expert group based on a comprehensive review of the relevant literature and hospital protocols. METHODS: A randomized controlled pilot trial with 2 parallel arms was used. A total of 81 ostomates, who were recruited from a tertiary hospital, completed the baseline, 1-month, 2-month, and 3-month follow-up (SPSC group, n=45; CT group, n=36). SPSC consisted of water cleansing and direct application of ostomy appliances. CT involved crusting hydrocolloid powder and patting with water sponge or protective barrier liquid film. The outcomes of the study were assessed by skin problems, such as discoloration, erosion and tissue overgrowth; the domains of the evaluation tool used in examining the peristomal skin. A generalized estimating equation model was used to examine the effects according to time and group. RESULTS: In both SPSC and CT groups, the likelihood of occurrence of discoloration (OR, 1.99; 95% CI, 1.61-2.46), erosion (OR, 1.87; 95% CI, 1.55-2.25) and tissue enlargement (OR, 1.94; 95% CI, 1.36-2.77) increased with time. There was no significant difference in discoloration between the groups, whereas the probability of erosion (OR, 0.38; 95% CI, 0.16-0.89) and tissue overgrowth (OR, 0.09; 95% CI, 0.02-0.55) was lower in the SPSC group than in CT group. CONCLUSION: SPSC was sufficient in preventing peristomal skin problems of ostomates compared to the CT.

Actinomicose intestinal: relato de caso / Intestinal actinomycosis: case report

Relatamos o caso de paciente do sexo masculino, 48 anos, branco, trabalhador da zona rural, com queixa de dor abdominal tipo cólica associada a náuseas e vômitos havia 48 horas, desenvolvendo obstrução intestinal. A cavidade abdominal foi acessada por laparotomia, revelando duas áreas de estenose inflamatória no jejuno distal. Exame anatomopatológico revelou actinomicose abdominal, uma forma rara dessa doença.

We present a case of a 48-year-old Caucasian male farmer who was admitted to the hospital with cramping abdominal pain associated with nausea and vomiting for 48 hours, which developed large bowel obstruction. The abdominal cavity was accessed by laparotomy, showing two areas of inflammatory stenosis in distal jejunum. Anatomopathological examination showed abdominal actinomycosis, a rare presentation of this disease.

Enfermedad inflamatoria intestinal y su asociación con cáncer colorectal: experiencia en un hospital universitario / Inflammatory bowel disease and its relationship with colorectal cancer: experience from the university hospital

The risk of colorectal cancer (CCR) in inflammatory bowel disease (IBD) patients is increased. The risk is associated mainly with longer duration and greater extent of disease and the presence of primary sclerosing cholangitis. Aim: to report our experience with a large group of IBD patients from the University Hospital of the University of Chile and to characterize the clinical features of patients with IBD who developed CCR during the course of disease. Patients and Methods: Retrospective review of 318 patients with IBD (age range of 30-57 years, 120 women) treated between January 1987 and December 2006. Results: Two hundred forty one patients had ulcerative colitis (UC) and 77 had Crohn's disease (CD). Five patients (1.6 percent), three UC and two CD, developed CCR during this period. The average time between the diagnosis of IBD and CCR was 12.5 years (range 10-12). All patients had pancolitis. Two patients, one UC and one CD, had primary sclerosing cholangitis. Conclusion: Chilean patients with IBD have a risk develop CCR during the course of the disease. The longer duration, greater anatomic extent of colitis and the presence of primary sclerosing cholangitis are risk factors of this complication. Chemoprevention and surveillance guidelines with new endoscopic techniques might be best approach to decrease the incidence of CCR in patients with IBD.

El riesgo de cáncer colorectal (CCR) en pacientes con enfermedad inflamatoria intestinal (EII) está aumentando. Este riesgo está asociado principalmente con la duración prolongada de la enfermedad, extensión del área comprometida y la presencia de colangitis esclerosante primaria. Objetivo: Analizar nuestra experiencia en pacientes con EII controlados en el Hospital Clínico de la Universidad de Chile y describir las características clínicas de los pacientes con EII que desarrollaron CCR durante su evolución. Pacientes y Métodos: Estudio retrospectivo con 318 pacientes con EII (rango de edad de 30-57 años, 120 mujeres) tratadas entre Enero de 1987 y Diciembre de 2006. Resultados: Doscientos cuarenta y un pacientes con colitis ulcerosa (CU) y 77 con Enfermedad de Crohn (EC). Cinco pacientes (1,6 por ciento), tres CU y dos EC, desarrollaron CCR durante ese período. El tiempo promedio entre el diagnóstico de EII y el de CCR fue de 12,5 años (rango: 10-12 años). Todos los pacientes tenían una pancolitis. Dos pacientes, uno con CU y otro con EC, presentaron una colangitis esclerosante primaria. Conclusión: Los pacientes chilenos con EII tienen un riesgo de desarrollar CCR durante su evolución: Larga duración de la enfermedad, extensión del área comprometida y la presencia de colangitis esclerosante primaria son factores de riego de esta complicación. La quimioprevención y programas de vigilancia con nuevas técnicas endoscópicas podrían ser las principales estrategias para disminuir la incidencia de CCR en pacientes con EII.

Inflammatory bowel disease: diagnostic and therapeutic modalities

Inflammatory bowel disease [IBD] is chronic conditions of unknown origin that result from continuous or intermittent inflammation of a part of the intestinal wall. The main classic types of IBD are ulcerative colitis [UC], Crohn's disease [CD] and indeterminate colitis that cannot be classified accurately as UC or CD with pure colonic involvement. The aim of this study is to highlight this rare disease in our locality including; clinical feature, investigations, indication of surgical interference, operative procedures, histopathological examination, and postoperative complications. Twenty nine patients were included in this study from January 2000 to May 2006. Histopathological examination proved to be UC in 18 patients and CD of the intestinal tract in 11 patients. Patients were subjected to history, tarnsclinical examination, and routine laboratory investigation, abdominal X-ray in an erect position, barium enema, intravenous urography, sigmoidoscopy and colonoscopy. Biopsy was taken, and CT and MRI were done in selected cases. All patients subjected to medical and/or surgical treatment according to their finding. Their mean age was 49.4 +/- 2.1 years [range 12 -65 ys]. Female to male ratio was 2:1. The main clinical manifestations were abdominal pain in 27 patients [93.1%], bleeding per rectum in 14 patients [48.3%], mucus discharge in 10 patients [34.5%], and chronic diarrhea in 6 patients. Palpable abdominal mass was found in 3 patients. Extra-abdominal manifestations were loss of weight in 15 patients [51.7%], pallor in 11 patients [37.9%], lower limb edema in 7 patients and skin changes 4 patients. Twenty three patients [79.3%] were received medical treatment; 18 patients [62.1%] UC and 5 CD but the remaining 6 patients [20.7%] admitted to emergency department. Successful treatment with complete cure was achieved in 12 patients [41.4%]; 10 patients had UC and 2 CD while surgery was done in 17 patients [58.6%]; 9 patients had CD and 8 UC. Right hemicolectomy was done for 7 of them and limited resection anastomosis was performed in the other 2 patients. Total colectomy with terminal ileostomy was carried out in one patient and subtotal colectomy with ileorectal anastomsis in 7 patients. Postoperative intestinal fistula detected in one patient and right hemicolectomy was done. Wound infection occurred in 3 patients and one of them developed burst abdomen. IBD is not rare in our locality and its treatment still remains the challenge despite growing knowledge about the disease, advances in medical treatment and surgical techniques. Proper assessment of IBD requires cooperation of gastroenterologists, radiologists, histopathologists and surgeons

Colitis following fecal diversion: still a challenge

After fecal diversion, nonspecific colitis may be seen in the defunctionalized colon. The purpose of this prospective study is to identify specific findings that could help in the differential diagnosis between diversion colitis and other inflammatory bowel diseases in order to avoid inappropriate diagnosis and therapy. It was studied, prospectively, thirteen consecutive patients from two public hospitals of Rio de Janeiro who had undergone temporary colostomy for indications other than inflammatory bowel disease. They were submitted to endoscopy with biopsy of both proximal and distal colorectal segments, and prospectively evaluated before and after restoration of intestinal continuity. Endoscopy with biopsy of both proximal and distal excluded colorectal segments showed a nonspecific mucosal and submucosal inflammation, resembling ulcerative colitis ( p < 0.01). There was endoscopic resolution in all patients once restoration of intestinal continuity was established (p < 0.01) and also histologic improvement after the stoma closure. In conclusion there are no specific findings that make possible an unequivocal distinction between diversion colitis and other nonspecific inflammatory diseases. Diagnosis should be achieved if after stoma closure occur remission of endoscopic large bowel inflammatory signs with improvement in mucosal histologic appearance and prompt relief of clinical complaints.

Ileostomia continente: relato de quatro casos / Continent ileostomy: report of four cases

Os autores relatam três casos de ileostomia continente definitiva, realizadas em dois pacientes portadores de doença inflamatória intestinal e em doente com polipose adenomatosa familiar e pólipo degenerado no reto. Um caso de ileostomia continente temporária foi feito em paciente com doença inflamatória intestinal. A técnica utilizada de ileostomia continente preserva o esfincter íleo-cecal e uma pequena borda circular de parede cecal exteriorizados. O débito ileal, na primeira semana de pós-operatório, näo ultrapassou 410 ml/ dia. Concluem que a ileostomia continente, seja definitiva ou temporária, é um procedimento de utilidade, em casos selecionados, quando se deseja manter um controle eficaz do efluente intestinal

Qualidade de vida dos doentes com doença inflamatória intestinal antes e após tratamento cirúrgico / Quality of life in inflammatory bowel disease patients before and after surgical treatment

Foram entrevistados 44 doentes com doença inflamatória intestinal previamente submetidos a tratamento cirúrgico. Quarenta e dois doentes acharam que a operaçäo foi benéfica e realizada em data oportuna em 54,5 por cento dos doentes, tardia em 38,6 por cento e precoce em 6,8 por cento. A capacidade de trabalho permaneceu inalterada apesar da doença em 61,4 por cento e prejudicada em 20,4 por cento. Oito doentes näo trabalhavam por ocasiäo do início da doença. Após a operaçäo, 11,4 por cento permaneceram inalterados, 34,1 por cento consideraram-se melhorados quanto a capacidade laborativa. Cinqüenta por cento dos doentes permaneceram desempregados, em virtude do diagnóstico. Quanto a alteraçäo no aproveitamento escolar, 13,6 por cento consideraram que a doença näo interferiu, 15,9 por cento consideraram-se prejudicados e 70,5 por cento näo estudavam por ocasiäo do início da sintomatologia. Após a operaçäo, todos os que estudavam consideraram que seu proveitamento escolar melhorou. A doença melhorou o relacionamento familiar em 20,5 por cento dos casos e prejudicou em 13,6 por cento. O relacionamento sexual permaneceu inalterado em 63,6 por cento e prejudicado em 36,4 por cento. A operaçäo melhorou o desempenho sexual em 20,5 por cento e prejudicou em 29,5 por cento. O lazer foi prejudicado em 81,8 por cento dos doentes pela doença, caindo para 22,7 por cento após a operaçäo. Dos 44 doentes, 43 concordariam em serem operados novamente. Conclusöes: A doença inflamatória intestinal é responsável por piora da qualidade de vida representada pelo desempenho escolar, laborativo, sexual e atividades de lazer. O único aspecto que melhorou foi o relacionamento familiar. A operaçäo melhorou a qualidade de vida em todos os aspectos da maioria dos doentes. Apesar da melhora da capacidade laborativa, estes doentes foram discriminados em relaçäo a obtençäo de emprego