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BACKGROUND: Inflammatory Bowel Disease is known for its extra intestinal manifestations, the oral cavity is no exception. OBJECTIVES: The aim of this study was to evaluate the association between Inflammatory Bowel Disease and oral mucosa lesions and symptoms, and complementary to evaluate their possible relation with oral hygiene, smoking habits, drug therapy, duration and activity of the disease. METHODS: Patients were selected from the Gastroenterology Clinic of a Portuguese tertiary referral hospital. This sample consisted of 113 patients previously diagnosed with ulcerative colitis or Crohn's disease along with a control group of 58 healthy individuals that were accompanying the study group patients to their appointments. Clinical interviews and clinical examinations were performed for data collection. RESULTS: The patients in the study group were more affected by oral symptoms (P=0.011), and showed a trend towards a higher incidence of oral mucosal lesions, even though statistical significance was not reached (8.8% versus 3.4% in the control group; P=0.159). Patients in active phase were the most affected. No differences were detected between Crohn's disease and ulcerative colitis, or concerning smoking habits. The corticosteroid and immunosuppressant therapy seemed to increase the incidence of oral symptoms (P=0.052). The oral mucosa lesions increased and the oral symptoms decreased over the course of the disease, however without statistical significance. CONCLUSION: Oral mucosa's lesions and oral symptoms were positively associated with Inflammatory Bowel Disease, mainly during disease activity periods and conceivably, associated with corticosteroid and immunosuppressant therapy.

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Background Inflammatory Bowel Disease is known for its extra intestinal manifestations, the oral cavity is no exception. Objectives The aim of this study was to evaluate the association between Inflammatory Bowel Disease and oral mucosa lesions and symptoms, and complementary to evaluate their possible relation with oral hygiene, smoking habits, drug therapy, duration and activity of the disease. Methods Patients were selected from the Gastroenterology Clinic of a Portuguese tertiary referral hospital. This sample consisted of 113 patients previously diagnosed with ulcerative colitis or Crohn’s disease along with a control group of 58 healthy individuals that were accompanying the study group patients to their appointments. Clinical interviews and clinical examinations were performed for data collection. Results The patients in the study group were more affected by oral symptoms (P=0.011), and showed a trend towards a higher incidence of oral mucosal lesions, even though statistical significance was not reached (8.8% versus 3.4% in the control group; P=0.159). Patients in active phase were the most affected. No differences were detected between Crohn’s disease and ulcerative colitis, or concerning smoking habits. The corticosteroid and immunosuppressant therapy seemed to increase the incidence of oral symptoms (P=0.052). The oral mucosa lesions increased and the oral symptoms decreased over the course of the disease, however without statistical significance. Conclusion Oral mucosa’s lesions and oral symptoms were positively associated with Inflammatory Bowel Disease, mainly during disease activity periods and conceivably, associated with corticosteroid and immunosuppressant therapy. .

Contexto A doença inflamatória intestinal é conhecida por suas manifestações extraintestinais, a cavidade oral não é exceção. Objetivos O objetivo deste estudo foi o de avaliar a associação da doença inflamatória intestinal com lesões da mucosa oral e sintomatologia oral, e complementarmente, avaliar a sua possível relação com a higiene oral, tabagismo, terapêutica farmacológica, duração e atividade da doença. Métodos Os pacientes foram selecionados no serviço de Gastroenterologia de um hospital de referência terciária Português (Hospital Garcia de Horta). Esta amostra foi composta por 113 pacientes previamente diagnosticados com colite ulcerosa ou doença de Crohn, juntamente com um grupo controle de 58 indivíduos saudáveis que acompanhavam os pacientes do grupo nas suas consultas de controle. Entrevistas clínicas e exames clínicos foram realizados para a coleta de dados. Resultados Os pacientes do grupo de estudo foram mais afetados por sintomas orais (P=0,011), e houve também uma tendência para uma maior incidência de lesões da mucosa oral, embora a significância estatística não tenha sido alcançada (8,8% versus 3,4% no grupo de controle; P=0,159). Pacientes em fase ativa foram os mais afetados. Não foram detetadas diferenças entre a doença de Crohn e a colite ulcerosa, ou relativas a hábitos tabágicos. O tratamento com corticosteroides e imunossupressores pareceu aumentar a incidência de sintomas orais (P=0,052). Os dados são ainda compatíveis com aumento das lesões da mucosa oral e diminuição dos sintomas ao longo do curso da doença, no entanto, sem significância estatística. Conclusão As lesões de mucosa oral e sintomas orais foram associados positivamente com a doença inflamatória intestinal, principalmente durante os períodos de atividade da doença e possivelmente, associado a terapêutica com corticosteroides e imunossupressores. .

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CONTEXT: Early refeeding after nonvariceal upper gastrointestinal bleeding is safe and reduces hospital stay/costs. OBJECTIVES: The aim of this study was obtaining objective data on refeeding after nonvariceal upper gastrointestinal bleeding. METHODS: From 1 year span records of nonvariceal upper gastrointestinal bleeding patients that underwent urgent endoscopy: clinical features; rockall score; endoscopic data, including severity of lesions and therapy; feeding related records of seven days: liquid diet prescription, first liquid intake, soft/solid diet prescription, first soft/solid intake. RESULTS: From 133 patients (84 men) Rockall classification was possible in 126: 76 score ≥5, 50 score <5. One persistent bleeding, eight rebled, two underwent surgery, 13 died. Ulcer was the major bleeding cause, 63 patients underwent endoscopic therapy. There was 142/532 possible refeeding records, no record 37% patients. Only 16% were fed during the first day and half were only fed on third day or later. Rockall <5 patients started oral diet sooner than Rockall ≥5. Patients that underwent endoscopic therapy were refed earlier than those without endotherapy. CONCLUSIONS: Most feeding records are missing. Data reveals delayed refeeding, especially in patients with low-risk lesions who should have been fed immediately. Nonvariceal upper gastrointestinal bleeding patients must be refed earlier, according to guidelines.

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CONTEXT: Colonoscopy is essential for synchronous and metachronous cancer detection. Carcinoembryonic antigen is a colorectal cancer tumor marker, important as a follow-up tool in patients with previous colorectal cancer. False-positive carcinoembryonic antigen elevation results in multiples exams and in patient anxiety. In literature, there is reference to transient carcinoembryonic antigen increase with colonoscopy. OBJECTIVE: To evaluate the influence of bowel preparation and colonoscopy in carcinoembryonic antigen blood levels. METHODS: We prospectively studied subjects that underwent routine colonoscopy in our institution. Blood samples were collected (1) before bowel cleaning, (2) before colonoscopy and (3) immediately after colonoscopy. Blood carcinoembryonic antigen levels were determined by "Sandwich" immunoassay. The statistical methods used were the paired t-test and ANOVA. RESULTS: Thirty-seven patients (22M/15F) were included; age range 28-84 (mean 56 years). Mean carcinoembryonic antigen values were 1.9, 2 and 1.8 for (1), (2) and (3), respectively. An increase in value (2) compared with (1) was observed in 20/37 patients (P = 0.018), mainly in younger patients and in patients requiring more endoluminal interventions. In 29/37 patients, the CEA value decreased from (2) to (3) (P = 1.3x10-7). CONCLUSIONS: A trend for carcinoembryonic antigen increase after bowel cleaning was observed, especially in younger patients and in patients with more endoluminal interventions, but without clinical meaning.

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Context Early refeeding after nonvariceal upper gastrointestinal bleeding is safe and reduces hospital stay/costs. Objectives The aim of this study was obtaining objective data on refeeding after nonvariceal upper gastrointestinal bleeding. Methods From 1 year span records of nonvariceal upper gastrointestinal bleeding patients that underwent urgent endoscopy: clinical features; rockall score; endoscopic data, including severity of lesions and therapy; feeding related records of seven days: liquid diet prescription, first liquid intake, soft/solid diet prescription, first soft/solid intake. Results From 133 patients (84 men) Rockall classification was possible in 126: 76 score ≥5, 50 score <5. One persistent bleeding, eight rebled, two underwent surgery, 13 died. Ulcer was the major bleeding cause, 63 patients underwent endoscopic therapy. There was 142/532 possible refeeding records, no record 37% patients. Only 16% were fed during the first day and half were only fed on third day or later. Rockall <5 patients started oral diet sooner than Rockall ≥5. Patients that underwent endoscopic therapy were refed earlier than those without endotherapy. Conclusions Most feeding records are missing. Data reveals delayed refeeding, especially in patients with low-risk lesions who should have been fed immediately. Nonvariceal upper gastrointestinal bleeding patients must be refed earlier, according to guidelines. .

Contexto A reintrodução alimentar precoce após hemorragia digestiva alta de causa não varicosa é segura, reduz internamento/custos hospitalares. Objetivos O objetivo deste estudo retrospectivo foi avaliar a realimentação após hemorragia digestiva alta de causa não varicosa. Métodos Dos processos dos doentes submetidos a endoscopia urgente por hemorragia digestiva alta de causa não varicosa, durante 1 ano, recolhemos: dados clínicos; classificação de Rockall; dados endoscópicos; registos nutricionais de 7 dias: prescrição de líquidos, primeira ingestão líquida, prescrição de dieta mole/sólida, primeira ingestão de dieta mole/sólida. Resultados Em 133 doentes (84 homens), a classificação Rockall foi possível em 126: 76 score ≥5, 50 score <5. Uma hemorragia inicial persistente, 8 recidivas hemorrágicas, dois doentes submetidos a cirurgia, 13 falecidos. A úlcera foi a lesão predominante, 63 doentes submetidos à terapêutica endoscópica. Encontraram-se 142/532 registos nutricionais possíveis, 37% sem qualquer registo. Só 16% foram realimentados no 1.° dia, metade foram realimentados no 3.° dia ou posteriormente. Doentes com Rockall <5 foram realimentados mais cedo que com Rockall ≥5. Doentes com terapêutica endoscópica foram realimentados mais cedo que sem terapêutica. Conclusões Falta a maioria dos registos. Os dados mostram realimentação tardia, sobretudo nos doentes com lesões de baixo risco que deveriam alimentar-se imediatamente. Doentes com hemorragia digestiva alta de causa não varicosa devem iniciar precocemente a alimentação, de acordo com as recomendações. .

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