BACKGROUND: Inflammatory bowel diseases (IBD) are chronic inflammatory affections of recurrent nature whose incidence and prevalence rates have increased, including in Brazil. In long term, they are responsible for structural damage that impacts quality of life, morbidity and mortality of patients. OBJECTIVE: To describe the profile of physicians who treat IBD patients as well as the characteristics of IBD care, unmet demands and difficulties. METHODS: A questionnaire containing 17 items was prepared and sent to 286 physicians from 101 Brazilian cities across 21 states and the Federal District, selected from the register of the State Commission of the “Study Group of Inflammatory Bowel Disease of Brazil” (GEDIIB). RESULTS: The majority of the physicians who answered the questionnaire were gastroenterologists and colorectal surgeons. More than 60% had up to 20 years of experience in the specialty and 53.14% worked at three or more locations. Difficulties in accessing or releasing medicines were evident in this questionnaire, as was referrals to allied healthy professionals working in IBD-related fields. More than 75% of physicians reported difficulties in performing double-balloon enteroscopy and capsule endoscopy, and 67.8% reported difficulties in measuring calprotectin. With regard to the number of patients seen by each physician, it was shown that patients do not concentrate under the responsibility of few doctors. Infliximab and adalimumab were the most commonly used biological medicines and there was a higher prescription of 5-ASA derivatives for ulcerative colitis than for Crohn’s disease. Steroids were prescribed to a smaller proportion of patients in both diseases. The topics “biological therapy failure” and “new drugs” were reported as those with higher priority for discussion in medical congresses. In relation to possible differences among the country’s regions, physicians from the North region reported greater difficulty in accessing complementary exams while those from the Northeast region indicated greater difficulty in accessing or releasing medicines. CONCLUSION: The data obtained through this study demonstrate the profile of specialized medical care in IBD and are a useful tool for the implementation of government policies and for the Brazilian society as a whole.

These results demonstrate that pretreatment with glutamine prevents mucosal injury and improves gut and lung recovery after I/R injury in rats.

Intestinal ischemia and reperfusion (I/R) causes cellular and tissue damage to the intestine and remote organs such as the liver. Increased production of ROS and nitric oxide and dysregulation of cytoprotective enzymes may be involved in intestinal I/R. The aim was to evaluate the protective effects of glutamine on the intestine and liver of rats with intestinal I/R injury. Twenty male Wistar rats (300 g) were divided into four groups: sham-operated (SO), glutamine + SO (G + SO), I/R, and glutamine + I/R (G + I/R). Occlusion of the SMA for 30 min was followed by 15-min reperfusion. Glutamine (25 mg/kg/day) was administered once daily 24 and 48 h before I/R induction. Blood and tissue of were collected for aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, histopathological analysis, immunohistochemistry of IL-1β and TNF-α, thiobarbituric acid reactive substance (TBARS) and nitric oxide, Nrf2/keap1, superoxide dismutase (SOD), NADPH quinone oxidoreductase1 (NQO1), inducible nitric oxide synthase (iNOS), heat shock protein (HSP70), glucose-regulated protein 78 (GRP78), and activating transcription factor 6 (ATF-6) by western blot. Statistic analysis by ANOVA-Student-Newman-Keuls test (mean ± SE) significantly was p < 0.05. Tissue damage, AST, ALT, IL-1β, TNF-α, TBARS, NO, Keap1, iNOS, GRP78, and ATF-6 expression were significantly lower in the G + I/R group as compared to the I/R group. Expression of Nrf2, SOD, NQO1, and HSP70, was significantly higher in the G + I/R group as compared to I/R group. Pre-treatment with glutamine provided protection against oxidative damage in the intestine and liver in an experimental model of intestinal I/R.

Pretreatment with Gln reduced oxidative, tissue damage and showed a decrease expression of inflammatory mediators.

AIMTo evaluate the protective effects of glutamine in a model of portal hypertension (PH) induced by partial portal vein ligation (PPVL).METHODSMale Wistar rats were housed in a controlled environment and were allowed access to food and water ad libitum. Twenty-four male Wistar rats were divided into four experimental groups: (1) control group (SO) - rats underwent exploratory laparotomy; (2) control + glutamine group (SO + G) - rats were subjected to laparotomy and were treated intraperitoneally with glutamine; (3) portal hypertension group (PPVL) - rats were subjected to PPVL; and (4) PPVL + glutamine group (PPVL + G) - rats were treated intraperitoneally with glutamine for seven days. Local injuries were determined by evaluating intestinal segments for oxidative stress using lipid peroxidation and the activities of glutathione peroxidase (GPx), endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS) after PPVL.RESULTSLipid peroxidation of the membrane was increased in the animals subjected to PH (P < 0.01). However, the group that received glutamine for seven days after the PPVL procedure showed levels of lipid peroxidation similar to those of the control groups (P > 0.05). The activity of the antioxidant enzyme GTx was decreased in the gut of animals subjected to PH compared with that in the control group of animals not subjected to PH (P < 0.01). However, the group that received glutamine for seven days after the PPVL showed similar GTx activity to both the control groups not subjected to PH (P > 0.05). At least 10 random, non-overlapping images of each histological slide with 200 × magnification (44 pixel = 1 μm) were captured. The sum means of all areas, of each group were calculated. The mean areas of eNOS staining for both of the control groups were similar. The PPVL group showed the largest area of staining for eNOS. The PPVL + G group had the second highest amount of staining, but the mean value was much lower than that of the PPVL group (P < 0.01). For iNOS, the control (SO) and control + G (SO + G) groups showed similar areas of staining. The PPVL group contained the largest area of iNOS staining, followed by the PPVL + G group; however, this area was significantly smaller than that of the group that underwent PH without glutamine (P < 0.01).CONCLUSIONTreatment with glutamine prevents gut mucosal injury after PH in rats.

Objective The present study describes the epidemiological profile of patients with colorectal cancer (CRC) from the Hospital de Clínicas de Passo Fundo, Passo Fundo, RS, Brazil, between January 1, 2007 and December 31, 2016. Method Retrospective analysis of secondary data of 1,001 patients from the Hospital Cancer Registry. Results Most subjects were Caucasian males, with a mean age of 63.68 years old. The majority of patients had incomplete elementary education and were married. In addition, 44.5% of the patients had a family history of cancer. Most subjects with a positive past or current history of alcohol intake or smoking were male. The diagnosis was mostly based on anatomopathological findings, with a predominance of adenocarcinomas and upper rectum and distal colon localization. Most lesions were in advanced stages, and the liver was the most common site for metastasis. The predominant treatment was surgery with neoadjuvant/adjuvant therapy. After the first treatment, 49.0% of the patients reported complete remission. The survival rate was 78.8% in 10 months. Conclusion The present research analyzed the profile of CRC patients.

One of the most challenging phenotypes of Crohn’s disease is perianal fistulizing disease (PFCD). It occurs in up to 50% of the patients who also have symptoms in other parts of the gastrointestinal tract, and in 5% of the cases it occurs as the first manifestation. It is associated with severe symptoms, such as pain, fecal incontinence, and a significant reduction in quality of life. The presence of perianal disease in conjunction with Crohn’s disease portends a significantly worse disease course. These patients require close monitoring to identify those at risk of worsening disease, suboptimal biological drug levels, and signs of developing neoplasm. The last 2 decades have seen significant advancements in the management of PFCD. More recently, newer biologics, cell-based therapies, and novel surgical techniques have been introduced in the hope of improved outcomes. However, in refractory cases, many patients face the decision of having a stoma made and/or a proctectomy performed. In this review, we describe modern surgical management and the most recent advances in the management of complex PFCD, which will likely impact clinical practice.

BACKGROUND This is the first study on the epidemiology of inflammatory bowel diseases (IBDs) in Rio Grande do Sul (RS), the southernmost state of Brazil with the country’s fifth largest population. Crohn’s disease (CD) and ulcerative colitis (UC) are collectively termed IBDs. They have high incidence and prevalence rates in high-income countries, although in recent years there has been a change in the classic geographical distribution of IBDs, with growing rates in traditionally low-incidence regions. AIM To estimate the incidence and prevalence of IBDs in the RS state, Brazil, between 2014 and 2019. METHODS This is a cross-sectional descriptive observational study. Patients with IBD who had initiated treatment and met the inclusion criteria of the RS state free drug distribution program were included. Data were obtained from registration or renewal records of the RS state specialty pharmacy. The male, female, and total populations were estimated according to mid-year data from the Brazilian Institute of Geography and Statistics, which served as a reference for calculating the incidence and prevalence rates of IBDs during the study period. Results were described using mean, standard deviation, and range. RESULTS We included 1082 patients with IBD, of whom 57.5% were female and 42.5% were male. Patients with CD accounted for 72.45% of the sample, and those with UC accounted for 27.54%. IBD prevalence during the study period was 9.51 per 100000 population, of which 6.89 corresponded to people with CD and 2.62, to people with UC. Incidence rates per 100000 population/year were 2.54 in 2014, 2.61 in 2015, 1.91 in 2016, 0.80 in 2017, 0.83 in 2018, and 0.96 in 2019. The mean IBD incidence rate per 100000 population was 1.61, of which 1.17 corresponded to CD and 0.44, to UC. The mean age was 41 years, and patients were mostly aged 30-40 years. Prevalence by region was higher in the state capital metropolitan area: 12.69 per 100000 population. CONCLUSION Our results demonstrated an IBD prevalence of 9.51% and incidence of 1.61 per 100000 population. The patients were predominantly female, and CD was more prevalent than UC.