RESUMO: Estudos epidemiológicos recentes sugerem que a incidência da doença de Crohn (DC) e da retocolite ulcerativa (RCUI) está aumentando no

Objectives:To assess the quality of life (QV) in patients with inflammatory bowel disease (DII), and relate it to demographic data and morbidity. Methods: Cross-sectional study with 103 patients with DII, registered in the high cost pharmacy of Cuiabá -Mato Grosso, who responded to the Standard Medical Record, the general QV questionnaire SF-36 and the specific IBDQ. Results: Among 103 patients with DII, 62 had ulcerative colitis and 41 had Crohn's disease; 62% were women; 69.9% were married; 48.5% were of mixed race; 49.5% were smokers; 37.9% required surgery; and, 40.8% had active disease. We observed significant changes in QV in men, smokers and those with active disease. Conclusion: DII affect QV in several respects. Measures for maintenance of QV, psychological, social and education support should be considered for patients with DII. Keywords: Inflammatory bowel disease; Crohn's disease; Ulcerative colitis; Colitis; Quality of life RESUMOObjetivos: Avaliar a qualidade de vida (QV) de portadores de doenças inflamatórias intestinais (DII) e relacionar dados sociodemográficos e mórbidos à QV. Métodos: Estudo transversal, realizado com 103 portadores de DII, cadastrados na farmácia de alto custo de Cuiabá -Mato Grosso que responderam ao Prontuário-Padrão, ao questionário de QV geral SF36 e ao específico IBDQ. Resultados: Dentre os 103 pacientes com DII, 62 tinham retocolite ulcerativa idiopática e 41 doença de Crohn; 62% eram mulheres; 69,9%, casados; 48,5%, pardos; 49,5%, fumantes, 37,9% necessitaram de cirurgia e 40,8% apresentavam doença em atividade. Foi observada alteração significativa da QV em homens, fumantes e entre aqueles com doença em atividade. Conclusão: DII afetam a QV em diversos aspectos. Medidas para manutenção da QV, suporte psicológico, social e educacional devem ser considerados para portadores de DII. Descritores: Doença inflamatória intestinal; Doença de Crohn; Retocolite ulcerativa; Colite; Qualidade de vida RESUMEN Objetivos: Evaluar la calidad de vida (CV) de portadores de enfermedades inflamatorias intestinales (EII) y relacionar datos sociodemográficos y mórbidos a la CV. Métodos: Se trata de un estudio transversal, realizado con 103 portadores de EII, registrados en la farmacia de alto costo de Cuiabá -Mato Grosso que respondieron a la Historia Clínica-Patrón, al cuestionario de CV general SF36 y al específico IBDQ. Resultados: De los 103 pacientes con EII, 62 tenían rectocolitis ulcerosa idiopática y 41 enfermedad de Crohn; 62% eran mujeres; 69,9%, casados; 48,5%, pardos; 49,5%, fumadores, 37,9% necesitaron de cirugía y 40,8% presentaban la enfermedad en actividad. Fue observada una alteración significativa de la CV en hombres, fumadores y en aquellos con la enfermedad en actividad. Conclusión: Las EII afectan la CV en diversos aspectos. Para la manutención de la CV, deben ser considerados el soporte psicológico, social y educacional de los portadores de EII. Descriptores: Enfermedad inflamatoria intestinal; Enfermedad de Crohn; Colite ulcerosa; Colite; Calidad de vida

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.

Probiotics are effective to diminished inflammatory status mediated by IL-6 in experimental colitis.

Introduction: pyoderma gangrenosum (PG) is a rare and severe neutrophilic dermatosis associated with inflammatory bowel disease (IBD) and other systemic diseases such as rheumatoid arthritis and hematological malignancies. Diagnosis is based on clinical criteria and exclusion of other skin disorders. There is no gold standard for the treatment of PG; traditionally intravenous corticosteroids are used, but recently the use of drugs that inhibit tumor necrosis factor alpha (TNF-alpha) has changed the management of PG, showing great effectiveness. Case report: female patient, 23 years old, diagnosed with severe nonspecific ulcerative colitis (UC) three years ago, undergoing treatment with oral mesalamine and azathioprine. She developed PG fourteen days after hospital discharge; hospitalization was due to worsening of intestinal disease symptoms. She was successfully treated using biological therapy after unfavorable evolution with corticosteroid therapy. Conclusion: PG, a rare extraintestinal manifestation of IBD of difficult resolution that has significant impact on patient quality of life. The use of biological therapy for PG has higher efficacy in the treatment of patients decreasing wound healing time and return to daily activities.

PURPOSE: To investigate the effect of enemas containing probiotics and budesonide on the colonic mucosa in experimental colitis. METHODS: Fifty male Wistar rats with experimental colitis induced by 10% acetic acid enema were randomized to five groups (10 rats each) according to the treatment: group 1 - saline solution, group 2 - budesonide (0.75 mg/kg/day), group 3 - probiotics (1mg/day), group 4 - probiotics plus budesonide, and group 5 - control, with not-treated rats. The following variables were studied: body weight, macroscopic and microscopic score of the colonic mucosa, and DNA content of the mucosa. RESULTS: All animals lost weight between the beginning and the end of the experiment (280+ 16 mg versus 249+21 mg, p< 0.001). There was no significant difference among the groups in relation to both the macroscopic and histological score. The budesonide + probiotic group showed higher DNA content than control group (1.24+ 0.15 versus 0.92+ 0.30 mg/100mg of tissue, p=0.01). CONCLUSION: Budesonide in addition to probiotics enhance the mucosal trophism in experimental colitis.

Background There are few data on the quality-of-care for inflammatory bowel disease (IBD) in public, private or mixed hospitals, especially in Latin America. The aim of the study was to evaluated clinic and quality parameters and their association with need for ICU and death in Brazilian hospitals. Methods This was a multicentre study carried out in 26 hospitals. Four hundred eighty-eight admissions of patients with IBD were analysed between June 2021 and October 2022. Results The median stay length was 6 days (0–121). The median age was 38 years (16–87), and 265 (54.6%) were female. Three hundred and thirty-nine patients (69.5%) had Crohn's disease (CD) and 149 (30.5%) ulcerative colitis (UC). The median time between symptoms onset and hospital admission was 72 months (1-504) in CD and 49 months (1-300) in UC. In the CD group, there was structural damage in 248 cases (73.2%). UC in pancolitis form was seen in 97 (66%). The Charlson Comorbidity Index (CCI) was scored at least at one point in 182 records (37.3%), and the median was 2 (1-17). Three hundred-seven admissions (62.9%) were urgent, and 208 cases (42.6%) remained in the emergency room (ER) for 2 days (1-22). Disease activity and structural damage accounted for 58.6% of admissions. One-hundred and eighty-three surgeries were performed (37.5%), and 35 (18.1%) postoperative complications were reported. The most prescribed drugs were biologicals (52.8%) before admission and corticosteroids during hospitalization (37.3%). Red days were verified in 45.3%. Intensive care unit (ICU) admission was required in 55 cases (11.3%). One hundred and nine (22.3%) bacterial infections were registered. There were 16 deaths (3.3%), and the main cause was sepsis (37.5%). Surgery, infection, duration of CD symptoms, and CCI were associated with the need for ICU (p= 0.000; 0.000; 0.043; 0.014, respectively). The CCI of 1 best predicted the need for ICU (AUROC 0.588; S 52.7%, E 64.7%). Infection, age, days in the ER, ICU, and CCI were associated with death (p= 0.004; 0.022; 0.006; 0.000; 0.000, respectively). The CCI of 1 is also the best predicted death (AUROC 0.782; S 81.3%, E 64.2%). The need to stay in ER and red days were lower in private and mixed hospitals (p= 0.000). Infection and death rates were similar (p= 0.323). Conclusion A sample with complications associated with IBD but with low CCI due to their younger age was characterized. The majority had CD, and more than 60% of admissions were urgent. The CCI accuracy in predicting ICU and death was obtained. A system deficiency was more evidenced in public hospitals in the rate of individuals who remained in ER. From the red days, greater problem-solving agility was found in private and mixed hospitals.

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