The surgical treatment of patients with ulcerative colitis from an university hospital at Natal, Brazil

Alencar, Suelene Suassuna Silvestre de; Corrêa, Romualdo da Silva; Bezerra, Cátia de França; Menezes, Emanuela Simone Cunha de; Nascimento, Antonio Luiz do; Costa, Davi Aragão Alves da; Alencar, Marcelo José Carlos

doi:10.1590/s2237-93632012000300010

Cited by 2 publications

(3 citation statements)

References 15 publications

(28 reference statements)

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“…Late pouch-related complications following proctocolectomy and IPAA include pouchitis (in about a third of patients), pouch-vaginal fistula, and later pouch dysfunction due to pouch sepsis and pouchitis. 11,22,25 Late complications were present in 16% of the patients in this series. Three per cent of our patients with UC developed colorectal cancer, which falls within the 2-27% reported in international studies.…”

Section: Discussionmentioning

confidence: 72%

“…20 The EIMs were seen in 17% of CD patients in this series compared to the 40% reported in the literature 20 and in 16% of UC patients, which is higher than the 4.5-8% seen in certain Asian studies, 21 but lower than the 30-45% reported in the Western literature. 1,21,22 We concede that this is a select group of patients and this observation cannot be generalised to all patients with IBD.…”

Section: Discussionmentioning

confidence: 96%

“…The literature, however, shows no consistency of disease extent in the literature, with pancolitis reported to occur in 20-77% of patients in the general UC population, 11,21,22 followed by left-sided colitis at 17-20% and proctitis in 3-4.5%. 1,11 Indications for surgery include cancer risk, intractability, acute severe colitis, fulminant colitis and perforation.…”

Section: Discussionmentioning

confidence: 99%

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A fourteen-year audit of surgery for inflammatory bowel disease at a tertiary colorectal unit

et al. 2021

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BACKGROUND: In South Africa, inflammatory bowel disease (IBD) is increasing in frequency. The purpose of the study was to document our experience with the surgical management of patients with IBD and describe the cohort undergoing surgical management of IBD in a KwaZulu-Natal province tertiary state sector hospital METHODS: Retrospective analysis of a database of patients undergoing surgery for IBD. Demographics, site and disease duration, surgical indications, management and outcome were analysed RESULTS: Of 397 patients with IBD, 136 had Crohn's disease (Cd) (African 13, Indian 78, Coloured 10 and White 35) and 261 had ulcerative colitis (UC) (African 67, Indian 158, Coloured 9 and White 27). Eighty-six of 136 patients with CD required surgical referral. Ileo-colonic CD was most common and non-stricturing/non-penetrating disease behaviour predominated. Seventy-four patients with CD underwent 76 abdominal surgical procedures with in-hospital mortality of 3.5% and a morbidity of 20.9%. Twenty patients required anorectal fistula procedures. Recurrence occurred in nine patients (10.5%) and malignant transformation was seen in three patients (2.2%). One hundred and sixty-three of the 261 patients with UC had pancolitis. Failed medical management was the most common indication for surgical referral. Fifty-one patients with UC had surgery, (age 44.5 [IQR 27-56] years). Forty-five patients underwent 63 abdominal surgical procedures with an overall mortality of 17.7% and a morbidity of 39.2%. Colorectal cancer was seen in 10 patients (3.8%). Laparoscopic procedures were undertaken in eight CD patients (10.8%) and 29 UC patients (39%). The median hospital stay was 7 days for both open and laparoscopic resection CONCLUSION: IBD is not uncommon in African patients, with UC being more frequent than CD. Postoperative mortality and potential for malignant transformation are higher for UC Keywords: inflammatory bowel disease, Crohn's disease, ulcerative colitis, surgical management

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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A fourteen-year audit of surgery for inflammatory bowel disease at a tertiary colorectal unit

et al. 2021

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Quality of life, work productivity impairment and healthcare resources in inflammatory bowel diseases in Brazil

Parra

Chebli

Amarante

et al. 2019

WJG

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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.

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The surgical treatment of patients with ulcerative colitis from an university hospital at Natal, Brazil

Cited by 2 publications

References 15 publications

A fourteen-year audit of surgery for inflammatory bowel disease at a tertiary colorectal unit

A fourteen-year audit of surgery for inflammatory bowel disease at a tertiary colorectal unit

Quality of life, work productivity impairment and healthcare resources in inflammatory bowel diseases in Brazil

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