[Follow-up study of fistula in Crohn's disease]

Experiência clínica com o uso de infliximab em 44 portadores de doença de Crohn

RACIONAL - OBJETIVO: Avaliar a eficácia do infliximab no tratamento de pacientes com doença de Crohn ativa ou com fístulas. MÉTODOS: Quarenta e quatro portadores de doença de Crohn, refratários ao tratamento convencional, foram tratados com infliximab, na dose de 5 mg/kg, através de infusão endovenosa. RESULTADOS: Trinta deles (68,2%) obtiveram melhora dos sintomas, com regressão importante nos níveis de atividade da doença, medidos pelo CDAI (Crohn's Disease Activity Index). Oito (57,1%) de 14 portadores de fístulas também obtiveram bons resultados, com fechamento ou importante diminuição do fluxo destas. A tolerância à droga foi boa em todos os casos. CONCLUSÃO: O uso de infliximab nestes casos parece ser boa opção terapêutica, com baixos índices de efeitos colaterais.

[Trends in the occurrence (1980-1999) and clinical features of Crohn's disease and ulcerative colitis in a university hospital in southeastern Brazil]

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.