BACKGROUNDInflammatory bowel diseases (IBD) have been associated with a low quality of life (QoL) and a negative impact on work productivity compared to the general population. Information about disease control, patient-reported outcomes (PROs), treatment patterns and use of healthcare resources is relevant to optimizing IBD management.AIMTo describe QoL and work productivity and activity impairment (WPAI), treatment patterns and use of healthcare resources among IBD patients in Brazil.METHODSA multicenter cross-sectional study included adult outpatients who were previously diagnosed with moderate to severe Crohn’s disease (CD) or ulcerative colitis (UC). At enrolment, active CD and UC were defined as having a Harvey Bradshaw Index ≥ 8 or a CD Activity Index ≥ 220 or calprotectin > 200 µg/g or previous colonoscopy results suggestive of inadequate control (per investigator criteria) and a 9-point partial Mayo score ≥ 5, respectively. The PRO assessment included the QoL questionnaires SF-36 and EQ-5D-5L, the Inflammatory Bowel Disease Questionnaire (IBDQ), and the WPAI questionnaire. Information about healthcare resources and treatment during the previous 3 years was collected from medical records. Chi-square, Fisher’s exact and Student’s t-/Mann-Whitney U tests were used to compare PROs, treatment patterns and the use of healthcare resources by disease activity (α = 0.05).RESULTSOf the 407 patients in this study (CD/UC: 64.9%/35.1%, mean age 42.9/45.9 years, 54.2%/56.6% female, 38.3%/37.1% employed), 44.7%/25.2% presented moderate-to-severe CD/UC activity, respectively, at baseline. Expressed in median values for CD/UC, respectively, the SF-36 physical component was 46.6/44.7 and the mental component was 45.2/44.2, the EQ-visual analog scale score was 80.0/70.0, and the IBDQ overall score was 164.0/165.0. Moderate to severe activity, female gender, being unemployed, a lower educational level and lower income were associated with lower QoL (P < 0.05). Median work productivity impairment was 20% and 5% for CD and UC patients, respectively, and activity impairment was 30%, the latter being higher among patients with moderate to severe disease activity compared to patients with mild or no disease activity (75.0% vs 10.0%, P < 0.001). For CD/UC patients, respectively, 25.4%/2.8% had at least one surgery, 38.3%/19.6% were hospitalized, and 70.7%/77.6% changed IBD treatment at least once during the last 3 years. The most common treatments at baseline were biologics (75.3%) and immunosuppressants (70.9%) for CD patients and 5-ASA compounds (77.5%) for UC patients.CONCLUSIONModerate to severe IBD activity, especially among CD patients, is associated with a substantial impact on QoL, work productivity impairment and an increased number of IBD surgeries and hospitalizations in Brazil.

The results of serum IgG and IgA tests for H pylori detection when used simultaneously, are more efficient in accuracy, sensitivity and negative predictive value, than those when used alone. The concentration of IgA antibodies in duodenal fluid is not useful in identifying patients with or without H pylori.

CONTEXT AND OBJECTIVE: Giardiasis is common in Brazil. For laboratory diagnosis, the method most utilized is microscopic examination of fecal samples, but the immunoenzymatic method is also available. The aim of this work was to verify the advantages and drawbacks of immunoassaying versus microscopy for diagnosing Giardia lamblia, when a single fecal sample is analyzed. DESIGN AND SETTING: Prospective, double-blind study at the parasitology laboratory of Faculdade de Medicina da Fundação ABC. METHODS: Samples were prepared according to the traditional sedimentation (Hoffman, Pons and Janer) and Faust methods. Results were deemed positive when Giardia lamblia was found by one or both methods. The Prospect ELISA kit was used for detecting Giardia lamblia-specific antigen, in accordance with the manufacturer's instructions. Results were expressed on a visual scale as negative or positive (+, ++, +++ or ++++). RESULTS: The ELISA test was positive even when a significant proportion of corresponding samples examined by microscopy were negative. This trend was statistically significant (p < 0.001). The overall concordance of results between the ELISA test and microscopic examination of single samples was only moderate (0.50 by kappa test). CONCLUSION: The ELISA test is useful when just searching for Giardia lamblia, because of its high sensitivity. For daily practice, we recommend microscopy, which is much cheaper and can also detect other parasites. The low positivity of single samples in this method can be overcome by using three samples, as recommended by most authors.

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-Context -Gastroesophageal reflux disease is very prevalent in the world. Endoscopically it can be classified as nonerosive when there is no mucosal erosive lesion on endoscopy. The presence of endoscopic minimal lesions is included in the Los Angeles classification for reflux disease. Virtual chromoendoscopy Fuji Intelligent Color Enhancement (FICE) is an endoscopic technique that enhances detection of small lesions of the digestive tract. Objective -To evaluate whether the use of FICE improves the diagnosis of minimal lesions on endoscopy, and to assess the association of symptoms with minimal lesions in patients with nonerosive reflux disease. Methods -One hundred fiftyfive patients were enrolled, 62 with typical reflux symptoms and 93 without esophageal symptoms. The patients had normal esophageal endoscopy or minimal lesions. Each patient was examined initially by conventional video endoscopy and then using FICE. Results -Among 155 patients, 113 had a normal conventional endoscopy and 42 had minimal lesions. Sixty-two patients had typical reflux symptoms, and 93 other symptoms unrelated to reflux. In 104 patients, the esophageal mucosa was normal for both conventional endoscopy and FICE, in 42 patients both techniques showed minimal lesions, in 9 patients conventional endoscopy was normal and minimal lesions were shown by FICE. The height and circumference of minimal lesions were greater using FICE than that measured by conventional endoscopy. There was a significant association of the presence of minimal lesions with male gender, but not with alcoholism, smoking, anti-inflammatory drugs and age. The diagnosis of minimal lesions was observer-dependent, both in conventional endoscopy as using FICE. ConclusionsThe use of FICE improves the diagnosis of minimal lesions as compared to conventional videoendoscopy, although this diagnosis remains observer-dependent. There was no association between the presences of minimal lesions with reflux symptoms.