RESUMO
BACKGROUND: Inflammatory 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. AIM: To describe QoL and work productivity and activity impairment (WPAI), treatment patterns and use of healthcare resources among IBD patients in Brazil. METHODS: A 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). RESULTS: Of 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. CONCLUSION: Moderate 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.
Assuntos
Colite Ulcerativa/epidemiologia , Doença de Crohn/epidemiologia , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Adulto , Brasil/epidemiologia , Colite Ulcerativa/complicações , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/cirurgia , Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Doença de Crohn/cirurgia , Estudos Transversais , Emprego/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Estudos Prospectivos , Índice de Gravidade de DoençaRESUMO
GOALS: We studied the prevalence and predictors of small-intestinal bacterial overgrowth (SIBO) in Crohn's disease (CD) outpatients and the relationship between SIBO and intestinal and/or systemic inflammation. BACKGROUND: The relationship of SIBO with systemic and intestinal inflammation in CD patients is unclear. STUDY: In this cross-sectional study, conducted between June, 2013 and January, 2015, 92 CD patients and 97 controls with nonchronic gastrointestinal complaints were assessed for the presence of SIBO using the H2/CH4 glucose breath test. Multivariate logistic regression was performed to investigate the potential association between SIBO and demographic, disease-related data, systemic markers of inflammation (C-reactive protein, and erythrocyte sedimentation rate), and biomarker of intestinal inflammation [fecal calprotectin concentration (FCC)]. RESULTS: The SIBO rate was significantly higher in CD patients than in controls (32.6% vs. 12.4%, respectively, P=0.0008). Patients with and without SIBO were comparable with regard to demographics, systemic inflammatory biomarkers, and disease characteristics, except for the stricturing phenotype being more common in SIBO-positive CD patients (43.3% vs. 19.3%, P=0.015). Notably, FCC was significantly higher in SIBO-positive patients (median of 485.8 vs.132.7 µg/g; P=0.004). Patients presenting increased FCC and stricturing disease had an odds of 9.43 (95% confidence interval, 3.04-11.31; P<0.0001) and 3.83 (95% confidence interval, 1.54-6.75; P=0.025) respectively, for SIBO diagnosis. CONCLUSIONS: In CD patients, SIBO is a highly prevalent condition. Stricturing phenotype and increased FCC were strongly and independently associated with the presence of SIBO. SIBO diagnostic work-up followed by directed treatment is recommended in CD patients who present stricturing disease, especially in those with concurrent intestinal inflammation.
Assuntos
Síndrome da Alça Cega/epidemiologia , Doença de Crohn/sangue , Doença de Crohn/epidemiologia , Microbioma Gastrointestinal , Intestino Delgado/microbiologia , Adulto , Biomarcadores/sangue , Síndrome da Alça Cega/sangue , Síndrome da Alça Cega/diagnóstico , Síndrome da Alça Cega/microbiologia , Sedimentação Sanguínea , Brasil/epidemiologia , Proteína C-Reativa/análise , Estudos de Casos e Controles , Doença de Crohn/diagnóstico , Doença de Crohn/microbiologia , Estudos Transversais , Fezes/química , Feminino , Humanos , Mediadores da Inflamação/sangue , Complexo Antígeno L1 Leucocitário/análise , Masculino , Pessoa de Meia-Idade , Fenótipo , Prevalência , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Adulto JovemRESUMO
Pancreatite aguda letal desenvolveu-se em uma paciente jovem, com diagnóstico de lúpus eritematoso sistêmico. Nessa ocasiao, ela estava em uso de prednisoma, medicaçao esta eventualmente relacionada à pancreatite. Na laparotomia, estavam presentes sinais evidentes de pancreatite necro-hemorrágica. Este relato, apoiado por revisao da literatura, ilustra o dilema da patogênese e terapia da pancreatite no lúpus, ressaltando a potencial gravidade desta associaçao e a necessidade de estudos adicionais.