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Huber MK, Valim V, Serrano ÉV, Mendonça JA, Lourenço RB, Espírito Santo TMR, Nordal H, de Fátima Bissoli M, de Oliveira Gavi MBR. Prevalence of spondyloarthritis in inflammatory bowel disease according ASAS and ultrassonography and its correlation with plasma calprotectin. Adv Rheumatol 2024; 64:27. [PMID: 38622711 DOI: 10.1186/s42358-023-00348-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/24/2023] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Enteropathic spondyloarthritis is underdiagnosed and inflammatory biomarkers and ultrasonography (US) could be useful for screening inflammatory bowel disease (IBD) patients. The objective of this study was to evaluate the prevalence of spondyloarthritis (SpA) in IBD patients, according to the Assessment of SpondyloArthritis International Society (ASAS) criteria and the correlation of results of US of entheses and joints with plasma calprotectin levels. METHODS This was an observational cross-sectional study. Patients from the IBD outpatient clinic of a reference center were evaluated according to ASAS criteria classification, results of US of entheses and joints, and inflammatory biomarker measurements (erythrocyte sedimentation rates, C-reactive protein levels, fecal and plasma calprotectin levels). A p value lower than 0.05 was considered significant. RESULTS A total of 30.5% of the studied sample (n = 118) of patients with IBD presented at least one inflammatory musculoskeletal manifestation. The overall prevalence of enteropathic SpA was 13.55%, with 10.16% axial SpA and 4.23% peripheral SpA according to the ASAS criteria. A total of 42.1% of patients had an MASEI score greater than 18, 35.2% had synovitis, and 14.7% had tenosynovitis on US, increasing the frequency of diagnosis of enteropathic SpA to 22.8%. Plasma calprotectin levels were similar to those in healthy controls, and correlated only with the fecal calprotectin level (p 0.041). CONCLUSIONS A total of 13.5% of patients met the criteria in accordance with the ASAS criteria for enteropathic SpA, which increased to 22.8% with the addition of US. The prevalence of enthesitis, synovitis and tenosynovitis by US of symptomatic joints and entheses were 42%, 35% and 14.7% respectively. Plasma calprotectin was correlated with fecal calprotectin but not with inflammatory biomarkers or US or ASAS criteria.
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Affiliation(s)
- Míriam Küster Huber
- Program in Public Health of Health Science Center of Federal University of Espírito Santo (PPGSC-UFES), Vitoria, Espírito Santo, Brazil
| | - Valeria Valim
- Program in Public Health of Health Science Center of Federal University of Espírito Santo (PPGSC-UFES), Vitoria, Espírito Santo, Brazil.
- Medicine Department of Federal University of Espírito Santo (UFES), University Hospital of the Federal University of Espírito Santo (Hucam-Ufes/Ebserh), Vitoria, Espírito Santo, Brazil.
| | - Érica Vieira Serrano
- University Hospital of the Federal University of Espírito Santo (Hucam-Ufes/Ebserh), Vitoria, Espírito Santo, Brazil
| | | | - Rafael Burgomeister Lourenço
- University Hospital of the Federal University of Espírito Santo (Hucam-Ufes/Ebserh), Vitoria, Espírito Santo, Brazil
| | | | - Hilde Nordal
- Haukeland Hospital, University of Bergen, Bergen, Norway
| | - Maria de Fátima Bissoli
- University Hospital of the Federal University of Espírito Santo (Hucam-Ufes/Ebserh), Vitoria, Espírito Santo, Brazil
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Michopoulos S, Paspatis G, Triantafyllou K, Potamianos S, Nikolopoulou V, Akriviadis E, Karagiannis JA, Ladas S, Tampaki M, Tzathas C. A multicenter, prospective, observational study of the long-term outcomes of Crohn's disease patients under routine care management in Greece. Ann Gastroenterol 2018; 31:583-592. [PMID: 30174395 PMCID: PMC6102459 DOI: 10.20524/aog.2018.0295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 06/12/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Real-world data on management patterns and long-term outcomes of patients with inadequately controlled Crohn's disease (CD) in Greece are scarce. METHODS This was a multicenter, prospective observational study of 18-65-year-old CD patients whose physicians judged that their current therapy was inadequate to control their condition and therefore decided to switch treatment. Data were collected at enrollment (time of switch), and 30, 54 and 104 weeks post-enrollment. RESULTS Sixty-six eligible patients (median age: 35.8 years; 56.1% males; median CD diagnosis duration: 2.3 years) were enrolled by nine hospital sites. At the time of treatment switch, 66.7% had "mild" (CD activity index [CDAI] <220) and 30.3% "moderate-to-severe" (220≤CDAI≤450) disease activity. Ileocolonic involvement, extraintestinal manifestations, prior CD-related surgeries and prior corticosteroid use were reported in 65.2%, 51.5%, 24.2% and 78.8% of patients, respectively. Throughout the study, most patients were managed with anti-tumor necrosis factor (TNF) medications (74.2%/74.1% infliximab; 10.6%/13.8% adalimumab at enrollment/end of study, respectively). At 54 and 104 weeks post-enrollment, the baseline CDAI score (median 174.5) decreased to 145.5 and 146.0 points (P<0.001) and the baseline C-reactive protein level (median: 13.6 mg/L) decreased to 3.5 and 3.0 mg/L (P<0.001), respectively, not differing statistically between patients with "mild" and "moderate-to-severe" disease activity. In this patient population, 56.1% were corticosteroid-free throughout observation, while for the remaining 43.9%, the mean percentage corticosteroid-free period was 80.2%. CD-related surgeries and hospitalizations were reported in 8.1% and 19.4%, respectively. CONCLUSION Under routine care in Greece, inadequately controlled CD patients were mainly switched to anti-TNFs, which lowered disease activity and reduced corticosteroid use.
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Affiliation(s)
- Spyridon Michopoulos
- Gastroenterology Department, “Alexandra” General Hospital of Athens (Spyridon Michopoulos), Greece
| | - Gregorios Paspatis
- Gastroenterology Department, “Venizeleio Pananeio” General Hospital of Heraklion, Crete (Gregorios Paspatis), Greece
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine – Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, “Attikon” University General Hospital, Athens (Konstantinos Triantafyllou), Greece
| | - Spyridon Potamianos
- Gastroenterology Department, University General Hospital of Larissa (Spyridon Potamianos), Greece
| | - Vassiliki Nikolopoulou
- Gastroenterology Department, University General Hospital of Patras, Rio (Vassiliki Nikolopoulou), Greece
| | - Evangelos Akriviadis
- 3 Internal Medicine Department, “Diavalkaniko” Medical Center of Thessaloniki, Thessaloniki (Evangelos Akriviadis), Greece
| | - John A. Karagiannis
- Gastroenterology Department, “Konstantopouleio–Agia Olga” General Hospital of Nea Ionia, Athens (John A. Karagiannis†), Greece
| | - Spyridon Ladas
- First Propaedeutic Clinic of Internal Medicine, “Laiko” General Hospital of Athens (Spyridon Ladas), Greece
| | - Maria Tampaki
- Merck Sharp & Dohme Pharmaceutical, Industrial and Commercial S.A., Athens (Maria Tampaki), Greece
| | - Charalambos Tzathas
- Gastroenterology Department, “Tzaneio” General Hospital of Piraeus, Piraeus (Charalambos Tzathas), Greece
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Mak WY, Segal JP, Hart A. Twenty years of biological therapy in an patient with IBD. BMJ Case Rep 2018; 2018:bcr-2017-221994. [PMID: 29367361 DOI: 10.1136/bcr-2017-221994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This interesting case is the first to our knowledge to report outcomes of a patient with Crohn's disease (CD) treated with the biological drug, infliximab, for around 20 years. The case highlights the positive effect of long-term use of infliximab in achieving and maintaining remission in a patient with CD.In this case, loss of response to infliximab was not dependent on length of exposure to the drug. It also appeared that infliximab was still efficacious after drug holidays, which can be especially important around times of pregnancy. Of interest, 'loss of response' to infliximab occurred at one particular time point. The drug was then reintroduced at a later date, which gave the patient clinical benefit. This case suggests that in some situations infliximab can be reintroduced in patients with previous 'loss of response'.Importantly, in this case, Infliximab had no major adverse effects during the 20 years follow-up.
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Affiliation(s)
| | | | - Ailsa Hart
- IBD Unit, St. Mark's Hospital, Harrow, UK
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Vagianos C, Malgarinos G, Spyropoulos C, Triantafillidis JK. Entero-vesical fistulas in CROHN'S disease: A case series report and review of the literature. Int J Surg Case Rep 2017; 41:477-480. [PMID: 29546021 PMCID: PMC5705824 DOI: 10.1016/j.ijscr.2017.11.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/16/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Entero-vesical fistula (EVF) is an abnormal link between the enteric lumen and the urinary bladder. Crohn's disease (CD) represents, nowadays, the most common cause in the formation of this fistula. MATERIALS AND METHODS The aim of this study was to describe the diagnostic and treating modalities applied in nine patients with CD and EVFs, the clinical/epidemiological features of this clinical entity and to perform a systemic review of the literature, concerning the diagnosis and treatment of this complication. RESULTS The medical records of eight men and one woman (mean age 42 ± 12 years) with EVFs were analyzed. The terminal ileum and the ileocecal region were affected in three and six cases, respectively. The most common symptoms were pneumaturia, fecaluria, fever, urinary urgency and abdominal pain. The diagnosis was suspected by abdominal CT scan and by indirect findings of bladder infection in cystoscopy. MRI with concurrent cystography set the diagnosis in three patients. Colonoscopy was not helpful. Conservative treatment, including administration of antibiotics and immunosuppressive agents in all patients and anti-TNF-a agent (infliximab) in six patients, was ineffective. Surgical treatment was applied in seven cases (77.8%), including fistula repair in all patients, drainage of coexistent intraabdominal abscess in two, small bowel resection in four and ileocecectomy in two cases. CONCLUSION EFVs are uncommon but potentially dangerous complications of CD. Abdominal CT scan and cystoscopy are the most commonly used diagnostic modalities. Surgical treatment seems to be unavoidable in most cases, although medical treatment could also benefit a small cohort of patients.
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Affiliation(s)
- Costantine Vagianos
- Second Propaedeutic Department of Surgery, Laikon Hospital, University of Athens, Athens, Greece
| | - George Malgarinos
- Inflammatory Bowel Disease Unit, IASO General Hospital, Holargos, Greece
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Charpentier C, Salleron J, Savoye G, Fumery M, Merle V, Laberenne JE, Vasseur F, Dupas JL, Cortot A, Dauchet L, Peyrin-Biroulet L, Lerebours E, Colombel JF, Gower-Rousseau C. Natural history of elderly-onset inflammatory bowel disease: a population-based cohort study. Gut 2014; 63:423-32. [PMID: 23408350 DOI: 10.1136/gutjnl-2012-303864] [Citation(s) in RCA: 256] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
UNLABELLED Data on the natural history of elderly-onset inflammatory bowel disease (IBD) are scarce. METHODS In a French population-based cohort we identified 841 IBD patients >60 years of age at diagnosis from 1988 to 2006, including 367 Crohn's disease (CD) and 472 ulcerative colitis (UC). RESULTS Median age at diagnosis was similar for CD (70 years (IQR: 65-76)) and UC (69 years (64-74)). Median follow-up was 6 years (2-11) for both diseases. At diagnosis, in CD, pure colonic disease (65%) and inflammatory behaviour (78%) were the most frequent phenotype. At maximal follow-up digestive extension and complicated behaviour occurred in 8% and 9%, respectively. In UC, 29% of patients had proctitis, 45% left-sided and 26% extensive colitis without extension during follow-up in 84%. In CD cumulative probabilities of receiving corticosteroids (CSs), immunosuppressants (ISs) and anti tumor necrosis factor therapy were respectively 47%, 27% and 9% at 10 years. In UC cumulative probabilities of receiving CS and IS were 40% and 15%, respectively at 10 years. Cumulative probabilities of surgery at 1 year and 10 years were 18% and 32%, respectively in CD and 4% and 8%, respectively in UC. In CD complicated behaviour at diagnosis (HR: 2.6; 95% CI 1.5 to 4.6) was associated with an increased risk for surgery while CS was associated with a decreased risk (HR: 0.5; 0.3 to 0.8). In UC CS was associated with an increased risk (HR: 2.2; 1.1 to 4.6) for colectomy. CONCLUSIONS Clinical course is mild in elderly-onset IBD patients. This information would need to be taken into account by physicians when therapeutic strategies are established.
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Affiliation(s)
- Cloé Charpentier
- Gastroenterology Unit, EPIMAD Registry, Rouen University and Hospital, , Rouen, France
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Abstract
Arthritis is the most common extraintestinal manifestation of inflammatory bowel disease (IBD) and can have a significant impact on morbidity and quality of life. IBD-associated arthropathy is considered a subtype of seronegative spondyloarthropathy, with axial, peripheral, or a combination of both joint manifestations. Peripheral arthritis is generally non-erosive and the oligoarticular variant particularly may correlate with intestinal disease activity. Axial arthritis may include inflammatory back pain, sacroiliitis, or ankylosing spondylitis, and is less likely to correlate with gastrointestinal symptoms. While there have been advances in identifying predisposing genetic factors and in elucidating pathophysiology of inflammatory bowel disease, the mechanisms surrounding the development of arthritis in IBD remain unclear. Treatment of inflammatory bowel disease is not always sufficient for control of arthritis. While treatment with biologic agents is promising, there remains a great need for larger, randomized studies to address optimal therapy of IBD associated arthropathy.
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Affiliation(s)
- Sheila L. Arvikar
- Department of Medicine, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
| | - Mark C. Fisher
- Department of Medicine, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
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Kleinubing-Júnior H, Pinho MDSL, Ferreira LC, Bachtold GA, Merki A. Perfil dos pacientes ambulatoriais com doenças inflamatórias intestinais. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2011. [DOI: 10.1590/s0102-67202011000300004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUÇÃO: As doenças inflamatórias intestinais são enfermidades crônicas, que afetam significativamente a qualidade e expectativa de vida dos pacientes. Existe polimorfismo clínico e a abordagem terapêutica tem sido modificada nos últimos anos. OBJETIVO: Reavaliar o perfil dos pacientes em acompanhamento ambulatorial analisando o comportamento das doenças, sua prevalência e conduta terapêutica. MÉTODOS: Foi realizado um estudo transversal da última atualização da base de dados dos pacientes de ambulatório de doença inflamatória intestinal em 2010. Os itens analisados foram sexo e idade dos pacientes, tipo da doença (retocolite ulcerativa ou doença de Crohn), localização da doença, tipo de medicação em uso, e se os pacientes estavam sintomáticos ou assintomáticos na última consulta. RESULTADOS: Foram estudados 171 pacientes. O sexo feminino mostrou-se predominante (60,8%) e a média de idade dos pacientes foi de 42,3, variando de 16 a 84 anos. Em relação ao tipo de doença inflamatória, a retocolite ulcerativa mostrou-se mais prevalente (58,5%). As localizações mais frequentes na retocolite ulcerativa foram pancolite e retite, ambas com 26% (n=26). Na doença de Crohn a localização ileocolônica foi a mais prevalente, com 47,9% (n=34), sendo seguida pela colônica com 25,4% (n=18). A monoterapia foi a mais utilizada, correspondendo a 54,4% dos pacientes, sendo que os imunossupressores foram as drogas de uso mais frequente (35,5%). A associação de medicamentos foi necessária em 36,3% dos casos, sendo a combinação mais frequente salicilato local com sistêmico em 33,9%. Nos portadores de retocolite ulcerativa 82% estavam em uso de salicilatos, seja local ou sistêmico. Na doença de Crohn 57,7% faziam uso de imunossupressores. Em relação à atividade da doença na última consulta, 71,3% dos pacientes apresentavam-se assintomáticos. CONCLUSÃO: A retocolite ulcerativa foi pouco mais prevalente que a doença de Crohn, sendo pancolite e retite as localizações mais frequentes. Na doença de Crohn a localização ileocolônica foi a mais encontrada seguida pela colônica. A monoterapia com imunossupressores foi o esquema terapêutico mais utilizado. A maioria dos pacientes apresentava-se assintomático na última consulta.
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A family report of Crohn's disease in three children immigrating from Albania to Greece and review of the literature. J Crohns Colitis 2010; 4:582-5. [PMID: 21122563 DOI: 10.1016/j.crohns.2010.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 03/29/2010] [Accepted: 03/30/2010] [Indexed: 02/07/2023]
Abstract
Cases of immigrant families affected by IBD have rarely been reported and seem to be of exceptional interest towards a better understanding of disease aetiopathogenesis. The first case of Crohn's disease in a family of immigrants from Albania to Greece with three offspring is described herein. A family with three children, one 22 year-old male and two 18-year-old twin females immigrated from southern Albania to northwest Greece ten years ago. The whole family lived in the same house and had no previous history of bowel or other chronic diseases. Two years ago the boy complained of diarrhoea, perianal pain and loss of weight. Subsequent investigation revealed ileal and perianal Crohn's disease. One year after Crohn's disease was diagnosed in the boy, one of the twins was diagnosed with ileal Crohn's disease. Six months afterwards, the second twin underwent emergency appendectomy due to acute appendicitis; four months later she was diagnosed with ileal Crohn's disease. Genetically predisposed individuals seem to be vulnerable to a continuous pressure of a still unknown environmental factor(s). In addition, lifestyle modification seems to represent a predisposing factor toward inflammatory bowel disease in immigrants.
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9
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Abstract
OBJECTIVES The aim of this study was to evaluate any potential influence of a family history of inflammatory bowel disease (IBD) on the clinical phenotypes and the course of IBD in children. METHODS In this retrospective study, the notes of 411 children with the diagnosis of IBD, 244 (59.4%) with ulcerative colitis, 129 (31.4%) with Crohn's disease and 38 (9.2%) with IBD unclassified, who were admitted to our department between 1 January 1981 and 31 December 2007 were reviewed. The aim was to assess the prevalence of familial IBD and its impact on the age of disease onset, clinical phenotypes according to the Montreal classification, course and outcome of disease. The control group consisted of IBD children without a family history of IBD, who were admitted to the hospital during the same time period. RESULTS Thirty five (8.5%) children had a family history of IBD, (ulcerative colitis 6.6%, Crohn's disease 10.9% and IBD unclassified 13.2%). Sixty-eight percent of the 22 pairs of first-degree relatives were concordant for the clinical phenotype of disease. Significantly, more children with familial IBD had symptom onset and/or disease diagnosis before 5 years of age compared with sporadic IBD (P = 0.01 and P = 0.014, respectively); however, no differences were seen in sex, clinical phenotypes, need for aggressive treatment and/or surgery. CONCLUSION Children with familial IBD had earlier onset of disease compared with those with sporadic IBD. However, this had no significant impact on the clinical phenotypes, the course and/or the outcome of disease.
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Salvarani C, Fries W. Clinical features and epidemiology of spondyloarthritides associated with inflammatory bowel disease. World J Gastroenterol 2009. [PMID: 19468993 DOI: 10.3748/wjg.15.2449.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2022] Open
Abstract
Inflammation of axial and/or peripheral joints is one of the most frequent extra-intestinal manifestations complicating the clinical course and therapeutic approach in inflammatory bowel diseases (IBD). The frequency of these complications seems to be similar for both diseases, Crohn's disease and ulcerative colitis. Arthritis associated with IBD belongs to the category of spondyloarthropathies. Axial involvement ranges from isolated inflammatory back pain to ankylosing spondylitis, whereas peripheral arthritis is noted in pauciarticular and in polyarticular disease. Asymptomatic radiological involvement of the sacroiliac joints is reported to occur in up to 50% of patients. Other musculoskeletal manifestations such as buttock pain, dactylitis, calcaneal enthesitis, and thoracic pain are frequently underdiagnosed and, consequently, are not treated appropriately. Several diagnostic approaches and criteria have been proposed over the past 40 years in an attempt to correctly classify and diagnose such manifestations. The correct recognition of spondylarthropathies needs an integrated multidisciplinary approach in order to identify common therapeutic strategies, especially in the era of the new biologic therapies.
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Affiliation(s)
- Carlo Salvarani
- Department of Internal Medicine, Rheumatology Unit, University of Messina, Reggio Emilia, Italy
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Salvarani C, Fries W. Clinical features and epidemiology of spondyloarthritides associated with inflammatory bowel disease. World J Gastroenterol 2009; 15:2449-2455. [PMID: 19468993 PMCID: PMC2686901 DOI: 10.3748/wjg.15.2449] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Revised: 03/13/2009] [Accepted: 03/20/2009] [Indexed: 02/06/2023] Open
Abstract
Inflammation of axial and/or peripheral joints is one of the most frequent extra-intestinal manifestations complicating the clinical course and therapeutic approach in inflammatory bowel diseases (IBD). The frequency of these complications seems to be similar for both diseases, Crohn's disease and ulcerative colitis. Arthritis associated with IBD belongs to the category of spondyloarthropathies. Axial involvement ranges from isolated inflammatory back pain to ankylosing spondylitis, whereas peripheral arthritis is noted in pauciarticular and in polyarticular disease. Asymptomatic radiological involvement of the sacroiliac joints is reported to occur in up to 50% of patients. Other musculoskeletal manifestations such as buttock pain, dactylitis, calcaneal enthesitis, and thoracic pain are frequently underdiagnosed and, consequently, are not treated appropriately. Several diagnostic approaches and criteria have been proposed over the past 40 years in an attempt to correctly classify and diagnose such manifestations. The correct recognition of spondylarthropathies needs an integrated multidisciplinary approach in order to identify common therapeutic strategies, especially in the era of the new biologic therapies.
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12
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Salviano FN, Burgos MGPDA, Santos EC. [Socioeconomic and nutritional profile of patients with inflammatory bowel disease at a university hospital]. ARQUIVOS DE GASTROENTEROLOGIA 2008; 44:99-106. [PMID: 17962852 DOI: 10.1590/s0004-28032007000200003] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2006] [Accepted: 02/01/2007] [Indexed: 01/10/2023]
Abstract
BACKGROUND Inflammatory bowel diseases include chronic and relapsing inflammatory disorders, represented by ulcerative proctocolitis and Crohns disease, commonly associated with malnutrition. AIM Characterize the nutritional and socioeconomic profile of patients hospitalized at the Pernambuco "Hospital das Clínicas", Recife, PE, Brazil. METHODS Cross-sectional study carried out at the gastroenterology clinic, which was previously approved by the Ethics Commission for studies involving human beings. The methods included clinical history data, socioeconomic conditions and nutritional assessment. Data were subject to statistical analysis (Students t test for equal and unequal variables). RESULTS The sample consisted of 24 male and female patients, with a mean age of 43.83 +/- 16.13 years, mostly married, coming from Recife, with low income, who lived in their own house with relatives. We found a higher prevalence of ulcerative proctocolitis (62.5%), with diagnosis time of more than 5 years, symptoms of abdominal pain, bloody-mucous diarrhea with 6-9 evacuations/day, with the distal colon being the most affected part. Osteoporosis was present in 26.7% of cases. Nutritional status was assessed through the body mass index. The weight loss percentage corresponded to 41.7% and 70.8%, respectively, classified as malnourished, associated or not with high prevalence levels of anemia, hypoalbuminemia and hypocalcemia. Gender correlation evidenced higher triceps fold and arm circumference values in men. CONCLUSIONS Despite the study limitations, data suggest relevant information about the occurrence of these diseases in the northeast of Brazil, as well as about its frequent association with important nutritional deficiencies.
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Affiliation(s)
- Flávia Nunes Salviano
- Serviço de Nutrição, Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, PE.
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A cross-sectional study of 130 Brazilian patients with Crohn's disease and ulcerative colitis: analysis of articular and ophthalmologic manifestations. Clin Rheumatol 2007; 27:503-9. [PMID: 18097711 DOI: 10.1007/s10067-007-0797-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Revised: 11/07/2007] [Accepted: 11/09/2007] [Indexed: 12/18/2022]
Abstract
This is a cross-sectional study that analyzed the pattern and frequency of articular and ophthalmologic manifestations in patients with Crohn's disease (CD) and ulcerative colitis (UC), with or without signs of active bowel inflammation. One hundred and thirty consecutive patients with CD (n = 71) and UC (n = 59) were examined. Simple X-rays of lumbar spine, sacroiliac joints, and calcaneal bone were performed and human leukocyte antigen (HLA)-B27 was typed. Joint manifestations occurred in 41 (31.5%) patients, 27 (38%) with CD and 14 (23.7%) with UC. Peripheral involvement occurred in 22 patients, axial involvement in five, and mixed involvement in 14. The most frequently involved joints were knees (56.1%), ankles (29.3%), and hips (29.3%), while the predominant pattern was oligoarticular (84.6%) and asymmetrical (65.6%). Enthesitis was identified in seven (5.4%) patients and inflammatory lumbar pain in 13 (10%). Eight of these patients fulfilled the diagnostic criteria for ankylosing spondylitis (6.2%). Radiographic sacroiliitis occurred in 12 patients (9.2%). Ocular abnormalities were present in six patients (6.2%), and HLA-B27 was positive in five (5.8%). In conclusion, the articular manifestations in the present study were predominantly oligoarticular and asymmetric, with a low frequency of ophthalmologic involvement and positive HLA-B27.
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Abstract
Inflammatory bowel disease (IBD) is very common in developed countries, while it is relatively uncommon in Asian countries. However, the incidence of IBD has been increasing in some Asian countries in recent years. Most cases of ulcerative colitis (UC) in Asia are of the chronic relapsing type, run a milder course, and the fulminant type is rarely seen. There is no difference in clinical manifestations between Asian and developed countries. The incidence of Crohn's Disease (CD) is mainly in males in Asia, while it is mainly in females in developed countries. The clinical manifestations of CD are similar between both sets of countries. In China there are less fistulae and perianal diseases, and extraintestinal manifestations of CD are uncommon. In China, 5.6% of patients with UC have a family history, which is lower than 10-20% in developed countries. NOD2/CARD15 variants in the locus of 16q112 (IBD1) are significantly associated with the susceptibility of CD in developed countries, but NOD2/CARD15 variants have not been found in Asian CD patients.
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Affiliation(s)
- Yu Fang Wang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
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von Roon AC, Reese G, Teare J, Constantinides V, Darzi AW, Tekkis PP. The risk of cancer in patients with Crohn's disease. Dis Colon Rectum 2007; 50:839-55. [PMID: 17308939 DOI: 10.1007/s10350-006-0848-z] [Citation(s) in RCA: 209] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The risk of cancer in patients with Crohn's disease is not well defined. Using meta-analytical techniques, the present study was designed to quantify the risk of intestinal, extraintestinal, and hemopoietic malignancies in such patients. METHODS A literature search identified 34 studies of 60,122 patients with Crohn's disease. The incidence and relative risk of cancer were calculated for patients with Crohn's disease and compared with the baseline population of patients without Crohn's disease. Overall pooled estimates, with 95 percent confidence intervals, were obtained, using a random-effects model. RESULTS The relative risk of small bowel, colorectal, extraintestinal cancer, and lymphoma compared with the baseline population was 28.4 (95 percent confidence interval, 14.46-55.66), 2.4 (95 percent confidence interval, 1.56-4.36), 1.27 (95 percent confidence interval, 1.1-1.47), and 1.42 (95 percent confidence interval, 1.16-1.73), respectively. On subgroup analysis, patients with Crohn's disease had an increased risk of colon cancer (relative risk, 2.59; 95 percent confidence interval, 1.54-4.36) but not of rectal cancer (relative risk, 1.46; 95 percent confidence interval, 0.8-2.55). There was significant association between the anatomic location of the diseased bowel and the risk of cancer in that segment. The risk of small bowel cancer and colorectal cancer was found to be higher in North America and the United Kingdom than in Scandinavian countries with no evidence of temporal changes in the cancer incidence. CONCLUSIONS The present meta-analysis demonstrated an increased risk of small bowel, colon, extraintestinal cancers, and lymphoma in patients with Crohn's disease. Patients with extensive colonic disease that has been present from a young age should be candidates for endoscopic surveillance; however, further data are required to evaluate the risk of neoplasia over time.
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Affiliation(s)
- Alexander C von Roon
- Department of Biosurgery and Surgical Technology, Imperial College, St. Mary's Hospital, London, W2 1NY, UK
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Kaliora AC, Stathopoulou MG, Triantafillidis JK, Dedoussis GVZ, Andrikopoulos NK. Chios mastic treatment of patients with active Crohn's disease. World J Gastroenterol 2007; 13:748-753. [PMID: 17278198 PMCID: PMC4066008 DOI: 10.3748/wjg.v13.i5.748] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Revised: 11/12/2006] [Accepted: 12/21/2006] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the effectiveness of mastic administration on the clinical course and plasma inflammatory mediators of patients with active Crohn's disease (CD). METHODS This pilot study was conducted in patients with established mild to moderately active CD, attending the outpatient clinics of the hospital, and in healthy controls. Ten patients and 8 controls were recruited for a 4-wk treatment with mastic caps (6 caps/d, 0.37 g/cap). All patients successfully completed the protocol. CD Activity Index (CDAI), Nutritional Risk Index (NRI), C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), monocyte chemotactic protein-1 (MCP-1), and total antioxidant potential (TAP) were evaluated in the plasma at baseline and at the end of the treatment period. Results were expressed as mean values +/- SE and P < 0.05 was considered to indicate statistical significance. RESULTS Patients exhibited significant reduction of CDAI (222.9 +/- 18.7 vs 136.3 +/- 12.3, P = 0.05) as compared to pretreament values. Plasma IL-6 was significantly decreased (21.2 +/- 9.3 pg/mL vs 7.2 +/- 2.8 pg/ mL, P = 0.027), and so did CRP (40.3 +/- 13.1 mg/mL vs 19.7 +/- 5.5, P = 0.028). TAP was significantly increased (0.15 +/- 0.09 vs 0.57 +/- 0.15 mmol/L uric acid, P = 0.036). No patient or control exhibited any kind of side effects. CONCLUSION The results suggest that mastic significantly decreased the activity index and the plasma levels of IL-6 and CRP in patients with mildly to moderately active CD. Further double-blind, placebo-controlled studies in a larger number of patients are required to clarify the role of this natural product in the treatment of patients with CD.
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Affiliation(s)
- Andriana C Kaliora
- Department of Science of Dietetics-Nutrition, Harokopio University of Athens, 70 El. Venizelou ave., Kallithea 17671, Athens, Greece.
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Meier C, Thönneßen C, Rothe U, Henker J, Quietzsch J, Prager J, Bürk G, Kiess W, Richter T. Chronisch entzündliche Darmerkrankungen bei Kindern und Jugendlichen. Monatsschr Kinderheilkd 2006. [DOI: 10.1007/s00112-005-1226-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chatzicostas C, Roussomoustakaki M, Potamianos S, Paspatis G, Mouzas I, Romanos J, Mavrogeni H, Kouroumalis E. Factors associated with disease evolution in Greek patients with inflammatory bowel disease. BMC Gastroenterol 2006; 6:21. [PMID: 16869971 PMCID: PMC1557858 DOI: 10.1186/1471-230x-6-21] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Accepted: 07/25/2006] [Indexed: 12/18/2022] Open
Abstract
Background The majority of Crohn's disease patients with B1 phenotype at diagnosis (i.e. non-stricturing non-penetrating disease) will develop over time a stricturing or a penetrating pattern. Conflicting data exist on the rate of proximal disease extension in ulcerative colitis patients with proctitis or left-sided colitis at diagnosis. We aimed to study disease evolution in Crohn's disease B1 patients and ulcerative colitis patients with proctitis and left-sided colitis at diagnosis. Methods 116 Crohn's disease and 256 ulcerative colitis patients were followed-up for at least 5 years after diagnosis. Crohn's disease patients were classified according to the Vienna criteria. Data were analysed actuarially. Results B1 phenotype accounted for 68.9% of Crohn's disease patients at diagnosis. The cumulative probability of change in disease behaviour in B1 patients was 43.6% at 10 years after diagnosis. Active smoking (Hazard Ratio: 3.01) and non-colonic disease (non-L2) (Hazard Ratio: 3.01) were associated with behavioural change in B1 patients. Proctitis and left-sided colitis accounted for 24.2%, and 48.4% of ulcerative colitis patients at diagnosis. The 10 year cumulative probability of proximal disease extension in patients with proctitis and left-sided colitis was 36.8%, and 17.1%, respectively (p: 0.003). Among proctitis patients, proximal extension was more common in non-smokers (Hazard Ratio: 4.39). Conclusion Classification of Crohn's disease patients in B1 phenotype should be considered as temporary. Smoking and non-colonic disease are risk factors for behavioural change in B1 Crohn's disease patients. Proximal extension is more common in ulcerative colitis patients with proctitis than in those with left-sided colitis. Among proctitis patients, proximal extension is more common in non-smokers.
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Affiliation(s)
| | - Maria Roussomoustakaki
- Department of Gastroenterology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Spiros Potamianos
- Department of Gastroenterology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Gregorios Paspatis
- Department of Gastroenterology, Venizelion General Hospital, Heraklion, Crete, Greece
| | - Ioannis Mouzas
- Department of Gastroenterology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - John Romanos
- Department of Surgical Oncology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Helen Mavrogeni
- Department of Internal Medicine, General Hospital of Rethymnon, Crete, Greece
| | - Elias Kouroumalis
- Department of Gastroenterology, University Hospital of Heraklion, Heraklion, Crete, Greece
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Abstract
BACKGROUND Inflammatory bowel disease is uncommon in Southeast Asia but is increasing in incidence. The epidemiology and phenotype of Crohn disease (CD) in the Chinese population is not well-known. The purpose of this study was to determine the incidence, temporal trend, clinical features, risk factors, extraintestinal manifestations, and the treatment of CD in the Chinese population of Hong Kong. METHODS We performed a single-center study of consecutive definite CD cases based on internationally accepted criteria, with strict exclusion of infective enterocolitis. RESULTS Eighty Chinese CD patients were recruited, characterized by male gender predominance (male:female ratio 2.5:1), no association with ever smoking (OR 1.02, 95% CI: 0.54-1.92), absence of familial clustering (0%), high proportion of upper gastrointestinal tract disease proximal to the terminal ileum (19%), and a low proportion of isolated terminal ileal disease (4%). The mean age at diagnosis was 33 years. Forty-five percent of patients had penetrating disease, 18% stricturing disease, and 37% had nonstricturing, nonpenetrating disease. Twenty-five percent of patients had at least 1 extraintestinal manifestation, and there was a high rate of ankylosing spondylitis (9%). The incidence of CD was 1.0 per 100,000 and has increased by 3 fold during the past decade. The age-adjusted incidence was 3.0 per 100,000 (95% CI: 2.3-3.7 per 100,000). CONCLUSIONS The incidence of CD in the Chinese is increasing. There are some notable epidemiological and phenotypic differences between Chinese CD with Caucasian CD including the lack of familial clustering, male predominance, and higher proportion of upper GIT involvement and lower frequency of isolated terminal ileal disease.
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Affiliation(s)
- Rupert W L Leong
- Department of Gastroenterology, The University of New South Wales, Bankstown-Lidcombe Hospital, Sydney, NSW, Australia.
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Triantafillidis JK, Hyphantis T, Cheracakis P, Antoniou A, Sklavaina M. Suicide as an outcome in patients with inflammatory bowel disease. Am J Gastroenterol 2002; 97:1066-1068. [PMID: 12003396 DOI: 10.1111/j.1572-0241.2002.05636.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Souza MHLP, Troncon LEDA, Rodrigues CM, Viana CFG, Onofre PHC, Monteiro RA, Passos ADC, Martinelli ALC, Meneghelli UG. [Trends in the occurrence (1980-1999) and clinical features of Crohn's disease and ulcerative colitis in a university hospital in southeastern Brazil]. ARQUIVOS DE GASTROENTEROLOGIA 2002; 39:98-105. [PMID: 12612713 DOI: 10.1590/s0004-28032002000200006] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Crohn's disease and ulcerative colitis are regarded as uncommon in developing countries, but studies on their occurrence in Brazil are scarce. Aims - To determine the occurrence of Crohn's disease and ulcerative colitis in a Brazilian university hospital throughout a 20-year period, and analyze the demographical, clinical and evolutive features of these cases. METHODS The frequencies of new cases of Crohn's disease and ulcerative colitis admitted from January 1980 up to December 1999 were calculated and a descriptive analysis of the features of all cases seen from January 1990 up to December 1999 was performed. RESULTS A total of 257 new cases (126 with Crohn's disease and 131 with ulcerative colitis) was recorded. The frequencies of admissions for both Crohn's disease and ulcerative colitis have increased progressively from 40 up to 61 cases/10.000 new admissions and Crohn's disease gradually became more common than ulcerative colitis. For both diseases, there was predominance of women, age at admission in the range of 30-40 years, Caucasian origin, married state and non-smokers. Digestive symptoms presented were similar to those already described for both diseases and there were no differences between Crohn's disease and ulcerative colitis regarding the frequencies of general complaints and extra-intestinal manifestations (29.5% vs 23.3%), including thromboembolism (5.9% vs 5.4%). Obstruction and/or perforation were seen in up to 59.2% of Crohn's disease cases, whereas 53.7% of all ulcerative colitis cases presented as severe forms. In Crohn's disease cases with obstruction, smoking was significantly more common than in non-complicated cases. In ulcerative colitis cases of increased severity, general complaints, extra-intestinal manifestations and pancolitis were significantly more frequent than in less severe forms. CONCLUSIONS For the last 20 years, there have been an increased frequency of admission of inflammatory bowel diseases, and Crohn's disease have become more prevalent than ulcerative colitis. Demographical, clinical and evolutive features of these diseases seems to be similar to those already described, but there seems to be a predominance of more severe forms of both diseases.
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