Fecal calprotectin as a noninvasive test to predict deep remission in patients with ulcerative colitis.

ABSTRACT: Mucosal healing (MH) has become a major target in the management of ulcerative colitis (UC). Because repeat endoscopy is expensive and invasive, we aimed to evaluate fecal calprotectin (FC) as an alternative marker to predict MH in UC.Eighty patients with UC in clinical remission were consecutively included in a prospective observational study. FC was measured using a quantitative enzyme-linked immunosorbent assay. The colonic mucosa was assessed for endoscopic and histological measures of inflammatory status. Endoscopic and histological remission were defined according to the Mayo endoscopic subscore (MES) and Geboes score (GS), respectively. Deep remission was defined as a combination of the MES and GS. FC performance and cutoff values for identifying MH and deep remission were determined using contingency tables and receiver operator characteristic (ROC) and area under the curve (AUC) analysis.The median FC concentration in patients who met the criteria for deep remission (MES ≤1 and GS < 3.1) was 65.5 µg/g, while that in patients with disease activity was 389.6 µg/g (P = .025). A FC cutoff value of 100 µg/g, determined by the ROC analysis, resulted in sensitivity and specificity of 91.7% and 57.1%, respectively, for histological remission, and 82.4% and 60.9%, respectively, for deep mucosal remission. Positive correlations were detected between FC concentrations with the histologic (CC: 0.435; P < .001) and the combined endoscopic and histologic (CC: 0.413; P < .001) scores.FC can be used confidently as a noninvasive biomarker to predict deep remission in patients with UC in clinical remission when concentrations are below 100 µg/g.

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

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

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

INFLAMMATORY BOWEL DISEASE: OUTPATIENT TREATMENT PROFILE.

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