Doença inflamatória intestinal: qual a relevância da doença no Brasil?

Abstract

The term inflammatory bowel disease (IBD) encompasses such disorders as idiopathic ulcerative colitis (IUC) and Crohn's disease (CD), characterized as recurrent and immunemediated, with the intestine as the target organ and chronic inflammatory process as the principal event.The etiology remains unknown and is probably multi-factorial. It is believed that genetically predisposed individuals interact with environmental factors (probably triggers for the disease), sparking an uncontrolled immune response that gives rise to a chronic intestinal inflammatory process. Progression of the disease can involve perforations, obstructions, and even intestinal tumors. The limited modifications in the evolution of IBD with treatment, and its emergence in young individuals tend to cause a major impact on work capacity, quality of life, and socioeconomic issues for patients and families.IBD prevalence increased rapidly in the industrialized countries in the latter half of the 20 th century, tending to stabilize. CD incidence is 5 cases per 100 thousand inhabitants/ year in the United States and Europe, with a prevalence of 50/100 thousand, while IUC prevalence is 12/100 thousand inhabitants in the United States.In developing countries where Western lifestyle is spreading, the corresponding rates are increasing and indicate an environmental influence in the genesis of IBD. Prevalence, incidence, and mortality rates in Brazil are still unknown, although regional reports have described an increase in the number of new cases of CD as compared to IUC.The disease mainly affects individuals in their teens and twenties and presents a diverse range of symptoms, severity, and extra-intestinal manifestations. The most frequent clinical picture includes chronic diarrhea, abdominal pain, and rectal bleeding, which also occur in various other prevalent diseases in Brazil such as bacterial, parasitic, and viral intestinal infections. Diagnostic difficulties arise both in the formulation of the clinical hypothesis and in the investigative process. The lack of a single gold standard test requires the association of clinical data with serological, radiological, endoscopic, and histological tests to reach a diagnosis. Even this entire armamentarium may be insufficient to produce a diagnosis, and only the natural evolution of the disease can help the clinician.There is still no cure, but the emergence of new biological drugs points to a reduction in the morbidity of IBD by controlling the cells and immune mediators involved in the inflammation, thus preventing its perpetuation. However, the chronic and costly use of drugs has a major socioeconomic impact on Brazil's Unified National Health System, which currently releases medication for some 12 thousand patients.While aiming to analyze the public health impact of IBD in Brazil, we have observed a lack of the following: systematic data collection on patients in the principal referral centers, prevalence and incidence estimates for the country, long-term follow-up of patient cohorts, and economic a...

Crohn’s disease environmental factors in the developing world: A case-control study in a statewide catchment area in Brazil

“…Incidence and prevalence of CD in Brazil vary according to geographical differences[ 11 ]. In the Brazilian State of Rio de Janeiro, the presence of extreme income inequality and the existence of both urban and rural areas provide an interesting case study to further understand the role of environmental factors in CD development.…”

Measurement of psycho-emotional constructs and self-management in health of patients with inflammatory bowel diseases

“…The age range can vary between 15 to 30 years old and with a second peak between 60 to 80 years old. Regarding Brazilian data, the Zaltman study mentions that the rates of prevalence, incidence and mortality of IBDs in Brazil are still unknown, although regional reports have described an increase in the number of new cases of CD when compared to ulcerative colitis (UC) (ZALTMAN, 2007).…”

“…Concerning to the type of IBD, the majority of our participants presented Crohn's disease as a diagnosis. Studies have warned to the rapid increase of this disease in comparison to others IBDs (SOUZA et al, 2002;ZALTMAN, 2007;LIMA, 2012;MARANHÃO;VIEIRA;CAMPOS, 2015) The literature has mentioned that the rapid increase and prevalence of IBD in developing countries is due to the Western lifestyle linked to the environmental factor of the IBDs genesis (ZALTMAN, 2007). Besides, Shanahan, 2002, points out that in addition to family history and predisposing environmental factors, other factors such as antigens derived from the microbiota, degree of exposure to intestinal pathogens, smoking, and use of nonsteroidal anti-inflammatory drugs appear to be linked to the development of the IBDs (SHANAHAN, 2002).…”

Alterações Morfofuncionais Na Estrutura Intestinal Causadas Pela Retocolite Ulcerativa E Principais Formas De Tratamento Farmacológico E Imunobiológico

“…Na progressão da doença podem surgir perfurações, obstruções e até tumores intestinais (ZALTMAN, 2007); e, baseada na gravidade, sintomatologia e da extensão anatômica das lesões é classificada como leve, moderada e grave: (CARVALHO, 2012).…”

“…Após o diagnóstico são realizadas medidas terapêuticas, que dependem da forma, extensão e gravidade da doença (SOUZA; BELASCO;AGUIAR, 2008). Na progressão da doença podem surgir perfurações, obstruções e até tumores intestinais (ZALTMAN, 2007). Microscopicamente a inflamação atinge preferencialmente a mucosa e a submucosa, sendo comum a presença de agregados celulares epiteliais com características pré-cancerosas, e a vascularização é muito proeminente, principalmente se a doença estiver em atividade (HEAD, JURENKA, 2003).…”