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Objective: Vitamin D has been widely studied as a mediator of the immune response, becoming evident the prevalence of hypovitaminosis D in patients with Crohn's disease. This work aims at evaluating the serum levels of vitamin D in patients suffering from Crohn's disease in a southeast region of Brazil. Methods: It is a prospective study, with statistical analysis of the values of serum vitamin D measured between April 2014 and April 2015 in patients with Crohn's disease. Individuals with mild anal complaints, without any colorectal involvement, comprised the control group. Results: One hundred and four patients whose average age was 40.6 years were evaluated, being 56 (53.8%) female and 48 (46.2%) male. The average serum vitamin D level was 21.6 ng/mL, with standard deviation 13.85. The control group was comprised by 66 individuals, whose average age was 48.9 years. With 38 (57.6%) female and 28 (42.4%) male. In this group the average serum vitamin D level was 40.9 ng/mL. Statistical significance was demonstrated with p<0.0001. Conclusion: There was high prevalence of hypovitaminosis D in patients with Chron's disease, when compared to the control group. Hypovitaminosis D was not evidenced in patients in the latter group.

Objetivo: A vitamina D tem sido amplamente estudada como mediadora da resposta imune, tornando-se evidente a prevalência de hipovitaminose D em pacientes com doença de Crohn. Este trabalho objetiva avaliar os níveis séricos de vitamina D nos pacientes com portadores de doença de Crohn em uma região do sudeste do Brasil. Métodos: Trata-se de estudo prospectivo, com análise estatística dos valores da vitamina D sérica dosados entre Abril de 2014 e Abril de 2015 em pacientes com doença de Crohn. Indivíduos com queixas anais leves, sem qualquer acometimento colorretal, compuseram o grupo controle. Resultados: Foram avaliados 104 pacientes, cuja média de idade foi de 40,6 anos, sendo 56 (53,8%) mulheres e 48 (46,2%) homens. O nível sérico de vitamina D médio foi 21,6 ng/mL, com desvio-padrão de 13,85. O grupo controle foi composto por 66 indivíduos, cuja média de idade foi 48,9 anos, com 38 (57,6%) mulheres e 28 (42,4%) homens. Neste grupo o nível sérico médio de vitamina D foi 40,9 ng/mL. Foi demonstrada significância estatística com p<0,0001. Conclusão: Houve elevada prevalência de hipovitaminose D em pacientes com doença de Crohn, quando comparados ao grupo controle. Não foi evidenciada hipovitaminose D entre os pacientes deste último grupo.

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O íleo compreende cerca de 3/5 distais do intestino delgado, sendo responsável pela digestão e absorção de alimentos. O diagnóstico de doenças que afetam esse segmento pode ser feito por meio de avaliação clínica e exames complementares. A colonoscopia, além da possibilidade de análise macroscópica, permite realização de biópsias para avaliação histológica. Apenas três publicações sobre a descrição das características endoscópicas do íleo terminal foram encontradas na literatura. Ainda assim, não foram encontradas descrições ou classificação em publicações que mencionavam o aspecto endoscópico do íleo terminal, sendo reportados apenas como íleo normal. Isso reforça a idéia do desconhecimento ou não aceitação dessas pela comunidade científica. Os aspectos endoscópicos desse segmento, quando afetado por diversas doenças variam de íleo endoscopicamente normal a casos que o exame macroscópico demonstra características especificas dessas doenças. Nesse estudo, existem dúvidas quanto à necessidade de biópsias desse segmento em pacientes com ileoscopia normal. Além disso, foram encontrados poucos estudos com critérios para caracterização macro e microscópica do íleo.

The ileum is approximately the most distal three-fifths of the small intestine and is responsible for the digestion and the absorption of foods. The diagnosis of diseases that affects this segment can be achieved by clinical evaluation and complementary examinations. Not only does ileocolonoscopy allow macroscopical analysis, but also enables biopsies to be carried out for histological evaluation. Only three publications about the description of the endoscopic characteristics of the terminal ileum have been found in the literature. Even so, there have not been found descriptions or classifications in publications that mentioned endoscopic aspect of the terminal ileum, being reported only as normal ileum. Therefore, this strengthens the idea of the lack of knowledge or the non-acceptance of these descriptions and these classifications by the scientific community. Endoscopic aspects of this segment when affected by several diseases vary from normal endoscopically ileum to cases when the macroscopical examination demonstrate specific features of these illnesses. In the present investigation, there are doubts about the need of biopsy of this segment in patients with normal ileoscopy. Moreover, few studies with criteria for macroscopical and microscopical characterization of the ileum were found.

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CONTEXT: For the diagnosis of the diseases which affect the terminal ileum, the colonoscopy allows macroscopic evaluation and the performing of biopsies. Studies with criteria for the endoscopic and histological characterization of this segment are scarce and there are still some doubts about the need of biopsies in patients with normal ileoscopy. OBJECTIVE: Study the terminal ileum of patients who underwent colonoscopy considering: endoscopic and histological correlation; agreement between results of the initial histological evaluation and slides review, and the chance of subjects with normal ileoscopy with abdominal pain and/or chronic diarrhea to show histological alterations. METHODS: In a prospective study, 111 patients who presented smooth mucosa without enanthema in the endoscopic exam of the terminal ileum were selected. Biopsies of the ileal mucosa of such patients were performed, being the slides routinely examined and reviewed afterwards. RESULTS: The correlation between patients with normal ileoscopy and ileum with preserved histological architecture was of 99.1%. The agreement between initial histological evaluation and slides review calculated by the Kappa test was 0.21. In patients with abdominal pain and/or chronic diarrhea, the chance of showing histological alterations was 2.5 times higher than the others. CONCLUSIONS: The correlation between endoscopic and histological findings was high. The agreement between the initial histologic evaluation and slides review was not satisfactory. The chance of subjects with normal ileoscopy with abdominal pain and/or chronic diarrhea, showing histological alterations was higher in relation to the asymptomatic ones or with other symptoms, although the clinical importance of this datum was not evaluated.

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CONTEXT: For the diagnosis of the diseases which affect the terminal ileum, the colonoscopy allows macroscopic evaluation and the performing of biopsies. Studies with criteria for the endoscopic and histological characterization of this segment are scarce and there are still some doubts about the need of biopsies in patients with normal ileoscopy. OBJECTIVE: Study the terminal ileum of patients who underwent colonoscopy considering: endoscopic and histological correlation; agreement between results of the initial histological evaluation and slides review, and the chance of subjects with normal ileoscopy with abdominal pain and/or chronic diarrhea to show histological alterations. METHODS: In a prospective study, 111 patients who presented smooth mucosa without enanthema in the endoscopic exam of the terminal ileum were selected. Biopsies of the ileal mucosa of such patients were performed, being the slides routinely examined and reviewed afterwards. RESULTS: The correlation between patients with normal ileoscopy and ileum with preserved histological architecture was of 99.1 percent. The agreement between initial histological evaluation and slides review calculated by the Kappa test was 0.21. In patients with abdominal pain and/or chronic diarrhea, the chance of showing histological alterations was 2.5 times higher than the others. CONCLUSIONS: The correlation between endoscopic and histological findings was high. The agreement between the initial histologic evaluation and slides review was not satisfactory. The chance of subjects with normal ileoscopy with abdominal pain and/or chronic diarrhea, showing histological alterations was higher in relation to the asymptomatic ones or with other symptoms, although the clinical importance of this datum was not evaluated.

CONTEXTO: Para o diagnóstico de doenças que afetam o íleo terminal, a colonoscopia permite avaliação macroscópica e realização de biopsias. Estudos com critérios para caracterização endoscópica e histológica desse segmento são escassos e ainda persistem dúvidas quanto à necessidade de biopsias em pacientes com ileoscopia normal. OBJETIVO: Estudar o íleo terminal de pacientes submetidos a colonoscopia, considerando correlação endoscópica e histológica; concordância entre resultados da avaliação histológica inicial e revisão de lâminas e chance de indivíduos com ileoscopia normal, com dor abdominal e ou diarreia crônica apresentarem alterações histológicas. MÉTODOS: Estudo prospectivo, no qual foram selecionados 111 pacientes, que apresentaram ao exame endoscópico do íleo terminal mucosa lisa e sem enantema. Foram realizadas biopsias da mucosa ileal nesses indivíduos, sendo as lâminas examinadas rotineiramente e revisadas posteriormente. RESULTADOS: A correlação entre pacientes com ileoscopia normal e íleo com arquitetura histológica preservada foi de 99,1 por cento. A concordância entre avaliação histológica inicial e revisão de lâminas calculada pelo teste de Kappa, foi 0,21. Nos pacientes com ileoscopia normal, com dor abdominal e ou diarreia crônica, a chance de apresentarem alterações histológicas foi 2,5 vezes maior em relação aos demais. CONCLUSÃO: A correlação entre achados endoscópicos e histológicos foi elevada. A concordância entre avaliação histológica inicial e revisão de lâminas não foi satisfatória. A chance de indivíduos com ileoscopia normal, com dor abdominal e ou diarreia crônica, apresentarem alterações histológicas foi maior, porém a importância clínica desse dado não foi avaliada.

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BACKGROUND: Rectoanal inhibitory reflex is not always evident in patients with chagasic megacolon. This may be due to insufficient volumes of air used during insufflation for the manometric examination. AIMS: To identify the volume of air necessary to induce rectoanal inhibitory reflex in patients with chagasic megacolon and to observe its prevalence in these individuals. METHODS: Rectoanal inhibitory reflex in 39 patient with chagasic megacolon was studied by means of anorectal manometry using the balloon method. The balloon was insufflated using sequential volumes up to 300 mL to induce reflex. RESULTS: Rectoanal inhibitory reflex was identified in 43.6% of the patients using a mean volume of 196 mL of insufflated air (standard error = 13.5). CONCLUSION: Rectoanal inhibitory reflex can be induced in patients with chagasic megacolon when greater volumes of air are used.

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BACKGROUND: Rectoanal inhibitory reflex is not always evident in patients with chagasic megacolon. This may be due to insufficient volumes of air used during insufflation for the manometric examination. AIMS: To identify the volume of air necessary to induce rectoanal inhibitory reflex in patients with chagasic megacolon and to observe its prevalence in these individuals. METHODS: Rectoanal inhibitory reflex in 39 patient with chagasic megacolon was studied by means of anorectal manometry using the balloon method. The balloon was insufflated using sequential volumes up to 300 mL to induce reflex. RESULTS: Rectoanal inhibitory reflex was identified in 43.6 percent of the patients using a mean volume of 196 mL of insufflated air (standard error = 13.5). CONCLUSION: Rectoanal inhibitory reflex can be induced in patients with chagasic megacolon when greater volumes of air are used.

RACIONAL: O reflexo inibitório retoanal nem sempre é evidente nos pacientes com megacólon chagásico. Acredita-se que isso ocorra devido à utilização de volumes insuficientes de insuflação de ar, ao exame manométrico, para induzi-lo. OBJETIVO: Quantificar a média de volume de ar necessário para induzir o reflexo inibitório retoanal em pacientes com megacólon chagásico e verificar sua prevalência. MÉTODOS: Estudou-se o reflexo inibitório retoanal em 39 pacientes com megacólon chagásico por meio da manometria anorretal, utilizando-se o método do balão. Para indução do reflexo foram insuflados volumes seqüenciais de até 300 mL de ar. RESULTADOS: O reflexo inibitório retoanal foi encontrado em 43,6 por cento dos pacientes, com média de ar insuflado de 196 mL (erro padrão = 13,5). CONCLUSÃO: O reflexo inibitório retoanal pode ser induzido em pacientes com megacólon chagásico, quando utilizados maiores volumes de insuflação de ar.

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