Crohn’s disease with involvement of the esophagus, stomach and duodenum has a prevalence of 0.5% to 4% in symptomatic adult patients, but some studies have shown that these results may be underestimated, since upper gastrointestinal endoscopy is not performed routinely in the initial evaluation of the disease in adult patients, as it is in the pediatric population. In general, involvement of the upper gastrointestinal tract in Crohn’s disease occurs concomitantly with involvement of the lower gastrointestinal tract. The diagnosis depends on clinical, endoscopic, histological and radiological evaluation. The presence of aphthoid ulcers, longitudinal ulcers, bamboo-joint-like appearance, stenoses and fistulas are endoscopic findings suggestive of the disease, and it is important to exclude the presence of Helicobacter pylori infection. The primary histological findings, which facilitate the diagnosis, are the presence of a chronic inflammatory process with a predominance of lymphoplasmacytic cells and active focal gastritis. The presence of epithelioid granuloma, although less frequent, is highly suggestive of the disease in the absence of chronic granulomatous disease. Treatment should include the use of proton pump inhibitors associated with corticosteroids, immunomodulators and biological therapy according to the severity of the disease.

Background. In inflammatory bowel disease (IBD) patients there are reports of the occurrence of hepatobiliary manifestations, so the aim of this study was to evaluate the hepatobiliary manifestations in patients with Crohn’s disease (CD) and ulcerative colitis (UC) from an IBD reference center. Methods. Cross-sectional study in an IBD reference center, with interviews and review of medical charts, between July 2015 and August 2016. A questionnaire addressing epidemiological and clinical characteristics was used. Results. We interviewed 306 patients, and the majority had UC (53.9%) and were female (61.8%). Hepatobiliary manifestations were observed in 60 (19.6%) patients with IBD. In the greater part of the patients (56.7%) hepatobiliary disorders were detected after the diagnosis of IBD. In UC (18.2%) patients, the hepatobiliary disorders identified were 11 (6.7%) non-alcoholic fatty liver disease, 9 (5.5%) cholelithiasis, 6 (3.6%) primary sclerosing cholangitis (PSC), 3 (1.8%) hepatotoxicity associated with azathioprine, 1 (0.6%) hepatitis B, and 1 (0.6%) hepatic fibrosis. In CD (21.3%) patients, 11 (7.8%) had cholelithiasis, 11 (7.8%) non-alcoholic fatty liver disease, 4 (2.8%) PSC, 3 (2.1%) hepatotoxicity, 1 (0.7%) hepatitis B, (0.7%) hepatitis C, 1 (0.7%) alcoholic liver disease, and 1 (0.7%) autoimmune hepatitis (AIH). There was one case of PSC/AIH overlap syndrome. Conclusion. The frequency of hepatobiliary disorders was similar in both forms of IBD in patients evaluated. The most common nonspecific hepatobiliary manifestations in IBD patients were non-alcoholic liver disease and cholelithiasis. The most common specific hepatobiliary disorder was PSC in patients with extensive UC or ileocolonic CD involvement; this was seen more frequently in male patients.

BACKGROUND There has been an increase in cases of inflammatory bowel disease (IBD) in recent years. There is also greater access and availability of immunosuppressive and biological agents, which increase the risk of opportunistic infection despite improving the quality of life and promoting mucosal healing. Tuberculosis (TB) remains a public health problem, and it has a high incidence in several countries. Therefore, knowledge of the risk of developing TB in patients with IBD is important. AIM To evaluate the risk of active TB in patients with IBD under treatment from an endemic area in Latin America. METHODS A standard questionnaire included demographic variables, clinical aspects of IBD disease, history of active TB during treatment, active TB characteristics and evolution, initial screening and results and time from the start of anti-tumor necrosis factor alpha (TNFα) to TB development. RESULTS Azathioprine, anti-TNFα and the combination of these two drugs were associated with a higher risk of active TB incidence. The TNFα blockers increased the relative risk of developing active TB compared to other treatments. All four multivariable models showed that the use of TNFα blockers alone or in combination with azathioprine was an important risk factor for the incidence of active TB. After adjustment for sex, age, type of IBD and latent TB, anti-TNFα with azathioprine increased the relative risk to 17.8 times more than conventional treatment. Late TB, which was diagnosed 3 mo after the start of anti-TNFα, was the most frequent. CONCLUSION Treatment with anti-TNFα increased the risk of active TB in IBD patients from an endemic area in Latin America. This risk was increased when anti-TNFα was combined with azathioprine. The time from the beginning of the treatment to the active TB diagnosis suggests a new TB infection.

No abstract

Background/Aims. Identify the degree of adherence to drug therapy in patients with inflammatory bowel diseases followed up at a referral center in Bahia-Brazil. Methods. Observational, analytical, and cross-sectional studies carried out from June/2017 to July/2018, with questionnaire application and medical record review at a referral center in inflammatory bowel diseases in Salvador, Bahia. The Morisky Green Levine Scale was applied to assess adherence. Mean, standard deviation, and frequency analyses were performed using the statistical package SPSS, and chi-square was used to evaluate the association between categorical variables and adherence degree to treatment. Significant associations were considered with p<0.05. Results. 302 patients with inflammatory bowel diseases were included. Nonadherence was highlighted in the sample. Most part of the study population was female, declared themselves to be mixed race, claimed to be from urban areas, and married. Nonadherence was more frequent than adherence in most sociodemographic variables of the present study. Nonadherence also stood out among the clinical variables, such as disease activity, drug side effect, and use of more than two additional medications. The association between all studied variables and adherence degree to treatment, considering the general sample, did not show statistical significance. When Crohn’s disease and ulcerative colitis patients were evaluated separately, a statistically significant association between nonadherence and female patients with ulcerative colitis was observed. Conclusions. The high frequency of nonadherence was observed in the studied sample. Female gender was associated to nonadherence in the subpopulation with ulcerative colitis.

A doença de Crohn (DC) faz parte do grupo de doença inflamatória intestinal (DII). A DC pode ter comportamento desde mais leves (inflamatória), até as formas mais graves (estenosante e penetrante). O presente trabalho tem objetivo de caracterizar a DC de acordo com o comportamento da doença inflamatório, estenosante ou penetrante. Trata-se de um estudo transversal observacional, com entrevista dos pacientes e revisão dos prontuários após aplicação do TCLE. As variáveis foram analisadas pelo pacote estatístico SPSS versão 21.0. Foram incluídos 92 pacientes, 55,4% (51) eram do sexo feminino. A média de idade foi 44,4 anos (± 14,6) e a média de tempo de doença foi 114,6 meses. A idade de diagnóstico mais frequente nos três fenótipos foi entre 17 e 40 anos. Um total de 54,3% (50) apresentavam o comportamento não estenosante/não penetrante, 23,9% (22) estenosante e 22,2% (20) penetrante. Em todos os comportamentos da doença, a grande maioria se autodeclarou como pardo, seguido por negro. Os comportamentos estenosante e penetrante mantiveram predominância do sexo feminino, enquanto que na forma não estenosante/ não penetrante, do sexo masculino. Entre os pacientes com doença de comportamento não penetrante e não estenosante e com o comportamento penetrante, a principal localização foi a colônica, Entre os pacientes com doença estenosante, a maioria apresentou localização ileocônica. Os pacientes com a doença penetrante foram mais jovens no momento da entrevista, com localização mais frequente colônica e maior frequência de doença perianal associada.Nosso trabalho conclui que o comportamento não penetrante/não estenosante foi o mais observado na amostra estudada. Os pacientes com as formas complicadas, tiveram o diagnóstico mais tardio e apresentaram maior tempo de duração da doença. A forma penetrante apresentou mais frequente localização colônica e doença perianal associada. O comportamento estenosante teve predominante localização ileocolonica, enquanto na doença não penetrante/ não estenosante a localização colônica foi a mais frequente.

Background Inflammatory bowel diseases (IBD) are chronic diseases that may have a variety of extraintestinal manifestations(EIM), including pulmonary1. Although less frequent than other types of EIM, these alterations have been increasingly. Manifestations present with a wide variety of phenotypes, which can affect different parts of the respiratory system2. As most of these patients are asymptomatic, this type of manifestation is less diagnosed than the other extraintestinal manifestations3,4. Methods Cross-sectional, analytical, single-center study, carried out from April/2021 to October/2022, with the application of a questionnaire and review of medical records of patients from an outpatient clinic specialized in IBD in Salvador/BA, at Hospital Geral Roberto Santos(HGRS). Approved by the HGRS Research Ethics Committee. Inclusion criteria: patients ≥18 years old, diagnosed with IBD and signed the informed consent form. Dyspnea symptoms were evaluated using the Modified Medical Research Council Dyspnea Scale(mMRC), dry or productive cough, chest pain and hemoptysis. The clinical activity of the IBD was evaluated using the Harvey-Bradshaw Index in CD and the Lichtiger Index in UC. To test the association between the presence of respiratory manifestations and the clinical activity of the IBD, the chi-square test was used. Significant associations were considered at p &lt; 0.05. Results Total of 255 patients were included, 47.1% with CD and 52.9% with UC, 44 had respiratory symptoms. Table 1 shows the general and clinical characteristics. Current treatments: mesalazine suppository and oral(63,2%), azathioprine(29.8%), infliximab(17.3%), sulfasalazine(15.7%), adalimumab(8.6%), prednisone(7.5%), ustekinumab(1.6%), methotrexate(1.6%), vedolizumab(0.8%), tacrolimus or cyclosporine(0.4%), tofacitinib(0.4%). Most of these patients(70.6%) were in clinical remission of IBD at the time the questionnaire was collected, while a minority (29.5%) were in clinical activity. In the 44 patients with respiratory symptoms, the majority are female(77.3%). Patients in clinical remission had respiratory symptoms in 12.9%(22/171), while patients in active remission had respiratory symptoms in 26.2%(22/74). Dyspnea was the most frequent symptom. Statistically significant association was found between the presence of respiratory manifestations and clinical activity(p=0.008). No difference in relation to the type of IBD, nor for medication. Table 2 shows association between disease activity and the presence of respiratory symptoms. Conclusion The frequency of respiratory symptoms was high in patients with IBD, with a higher prevalence in patients with active disease. This finding draws attention to a possible mechanism associated with the IBD activity.

No abstract