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Martins CDA, de Azevedo MFC, Carlos AS, Damião AOMC, Sobrado Junior CW, Nahas SC, Queiroz NSF. Predictive factors of response to infliximab therapy in Brazilian inflammatory bowel disease patients. Therap Adv Gastroenterol 2023; 16:17562848231210053. [PMID: 38026104 PMCID: PMC10652804 DOI: 10.1177/17562848231210053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Background Biological therapies have revolutionized the treatment of patients with inflammatory bowel disease (IBD). Infliximab (IFX) has been shown to be effective in inducing and maintaining remission in patients with Crohn's disease and ulcerative colitis. However, about one-third of the patients are primary non-responders, and up to half can lose response over time. Hence, it is important to assess which factors are related to treatment failure. Objectives We aimed to identify factors predicting clinical and endoscopic remission with IFX treatment during maintenance therapy in a Brazilian IBD referral center. Design We conducted a cross-sectional study to describe demographic, clinical, and IBD therapy-related characteristics of IBD patients treated with IFX for at least 6 months in a Brazilian referral center. Subsequently, we evaluated factors associated with clinical and endoscopic remission (primary and secondary outcomes, respectively). Methods We used descriptive statistics to summarize the essential demographic and clinical characteristics of the population. The association of sociodemographic and clinical variables with outcomes was analyzed using multivariable logistic regression. Results A total of 131 IBD patients (the mean age 41.7 years) were enrolled in this study. Clinical and endoscopic remission were observed in 79.4% and 58.2% of the patients, respectively. In the multivariable analysis, IFX therapy duration and higher albumin levels increased the likelihood of clinical remission, while previous surgery decreased its chance. Prior use of adalimumab and higher C-reactive protein levels reduced the likelihood of endoscopic remission. Conclusion In summary, this study has enhanced our understanding of the predictive factors of treatment response to IFX in a well-characterized Brazilian IBD population. Trial registration 4.254.501 and 2.903.748.
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Affiliation(s)
- Camilla de Almeida Martins
- Department of Gastroenterology and Division of Colorectal Surgery, University of Sao Paulo School of Medicine, São Paulo, Brazil
| | | | - Alexandre Sousa Carlos
- Department of Gastroenterology and Division of Colorectal Surgery, University of Sao Paulo School of Medicine, São Paulo, Brazil
| | | | - Carlos Walter Sobrado Junior
- Department of Gastroenterology and Division of Colorectal Surgery, University of Sao Paulo School of Medicine, São Paulo, Brazil
| | - Sergio Carlos Nahas
- Department of Gastroenterology and Division of Colorectal Surgery, University of Sao Paulo School of Medicine, São Paulo, Brazil
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2
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Garcia KS, de Azevedo MFC, Carlos ADS, Barros LL, Oba J, Sobrado Junior CW, Sipahi AM, Alves ODDC, Navarro-Rodriguez T, Parra RS, Chebli JMF, Chebli LA, Flores C, Vieira A, do Ceará CDA, Queiroz NSF, Damião AOMC. Efficacy of Early Optimization of Infliximab Guided by Therapeutic Drug Monitoring during Induction-A Prospective Trial. Biomedicines 2023; 11:1757. [PMID: 37371853 DOI: 10.3390/biomedicines11061757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Therapeutic drug monitoring (TDM) during induction therapy with anti-tumor necrosis factor drugs has emerged as a strategy to optimize response to these biologics and avoid undesired outcomes related to inadequate drug exposure. This study aimed to describe clinical, biological, and endoscopic remission rates at six months in Brazilian inflammatory bowel disease (IBD) patients following a proactive TDM algorithm guided by IFX trough levels (ITL) and antibodies to IFX (ATI) levels during induction, at week six. A total of 111 IBD patients were prospectively enrolled, excluding those previously exposed to the drug. ITL ≥ 10 μg/mL was considered optimal. Patients with suboptimal ITL (<10 µg/mL) were guided according to ATI levels. Those who presented ATI ≤ 200 ng/mL underwent dose intensification in the maintenance phase, and patients with ATI > 200 ng/mL discontinued IFX. In our study, proactive TDM was associated with persistence in the IFX rate at six months of 82.9%. At that time, rates of clinical, biological, and endoscopic remission in patients under IFX treatment were 80.2%, 73.9%, and 48.1%, respectively. Applying a simplified TDM-guided algorithm during induction seems feasible and can help improve patients' outcomes in clinical practice.
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Affiliation(s)
- Karoline Soares Garcia
- Department of Gastroenterology, University of São Paulo, School of Medicine, São Paulo 05403-000, Brazil
| | | | - Alexandre de Sousa Carlos
- Department of Gastroenterology, University of São Paulo, School of Medicine, São Paulo 05403-000, Brazil
| | - Luísa Leite Barros
- Department of Gastroenterology, University of São Paulo, School of Medicine, São Paulo 05403-000, Brazil
| | - Jane Oba
- Department of Gastroenterology, University of São Paulo, School of Medicine, São Paulo 05403-000, Brazil
| | | | - Aytan Miranda Sipahi
- Department of Gastroenterology, University of São Paulo, School of Medicine, São Paulo 05403-000, Brazil
| | | | - Tomás Navarro-Rodriguez
- Department of Gastroenterology, University of São Paulo, School of Medicine, São Paulo 05403-000, Brazil
| | - Rogério Serafim Parra
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil
| | | | - Liliana Andrade Chebli
- University Hospital of the Federal University of Juiz de Fora, Juiz de Fora 36038-330, Brazil
| | - Cristina Flores
- Crohn's and Colitis Reference Center, Rio Grande do Sul 90560-002, Brazil
| | - Andrea Vieira
- Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo 01221-010, Brazil
| | | | - Natália Sousa Freitas Queiroz
- Health Sciences Graduate Program, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba 80215-901, Brazil
- IBD Center, Santa Cruz Hospital, Curitiba 80420-090, Brazil
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3
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Baima JP, Imbrizi M, Andrade AR, Chebli LA, Argollo MC, Queiroz NSF, Azevedo MFCD, Vieira A, Costa MHDM, Fróes RDSB, Penna FGCE, Quaresma AB, Damião AOMC, Moraes ACDS, Santos CHMD, Flores C, Zaltman C, Vilela EG, Morsoletto E, Gonçalves Filho FDA, Santana GO, Zabot GP, Parente JML, Sassaki LY, Zerôncio MA, Machado MB, Cassol OS, Kotze PG, Parra RS, Miszputen SJ, Coy CSR, Ambrogini Junior O, Chebli JMF, Saad-Hossne R. SECOND BRAZILIAN CONSENSUS ON THE MANAGEMENT OF ULCERATIVE COLITIS IN ADULTS: A CONSENSUS OF THE BRAZILIAN ORGANIZATION FOR CROHN'S DISEASE AND COLITIS (GEDIIB). Arq Gastroenterol 2023; 59:51-84. [PMID: 36995889 DOI: 10.1590/s0004-2803.2022005s1-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/05/2022] [Indexed: 03/31/2023]
Abstract
BACKGROUND Inflammatory bowel diseases are immune-mediated disorders that include Crohn's disease (CD) and ulcerative colitis (UC). UC is a progressive disease that affects the colorectal mucosa causing debilitating symptoms leading to high morbidity and work disability. As a consequence of chronic colonic inflammation, UC is also associated with an increased risk of colorectal cancer. OBJECTIVE This consensus aims to provide guidance on the most effective medical management of adult patients with UC. METHODS A consensus statement was developed by stakeholders representing Brazilian gastroenterologists and colorectal surgeons (Brazilian Organization for Crohn's Disease and Colitis [GEDIIB]). A systematic review including the most recent evidence was conducted to support the recommendations and statements. All recommendations/statements were endorsed using a modified Delphi Panel by the stakeholders/experts in inflammatory bowel disease with at least 80% or greater consensus. RESULTS AND CONCLUSION The medical recommendations (pharmacological and non-pharmacological) were mapped according to the stage of treatment and severity of the disease onto three domains: management and treatment (drug and surgical interventions), criteria for evaluating the effectiveness of medical treatment, and follow-up/patient monitoring after initial treatment. The consensus targeted general practitioners, gastroenterologists and surgeons who manage patients with UC, and supports decision-making processes by health insurance companies, regulatory agencies, health institutional leaders, and administrators.
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Affiliation(s)
- Júlio Pinheiro Baima
- Universidade Nove de Julho, Bauru, SP, Brasil
- Hospital das Clínicas da Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil
| | | | | | | | | | | | | | - Andrea Vieira
- Irmandade Santa Casa de Misericórdia de São Paulo, SP, Brasil
| | | | | | | | | | | | | | | | - Cristina Flores
- Centro de Referência em Crohn e Colite do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Cyrla Zaltman
- Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Eduardo Garcia Vilela
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | | | | | | | - Gilmara Pandolfo Zabot
- Hospital Moinhos de Vento e Coloprocto Clínica do Aparelho Digestivo, Porto Alegre, RS, Brasil
| | | | | | | | | | | | - Paulo Gustavo Kotze
- Pontifícia Universidade Católica do Paraná, Programa de Pós-Graduação em Ciências da Saúde, Curitiba, PR, Brasil
| | - Rogerio Serafim Parra
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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4
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Damião AOMC, Queiroz NSF. Medical Therapy in Chronic Refractory Ulcerative Colitis: When Enough Is Enough. Clin Colon Rectal Surg 2022; 35:32-43. [PMID: 35069028 PMCID: PMC8763462 DOI: 10.1055/s-0041-1740036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Despite significant improvements in the management of ulcerative colitis (UC) in parallel with the evolution of therapeutic targets and novel biologics and small molecules, a subset of medically refractory patients still requires colectomy. Recent population-based studies demonstrate a trend toward a decrease in the rates of surgery for UC patients in the biological era, although the potential of disease modification with these agents is still debated. As the concept of irreversible bowel damage is underexplored in UC, refractory patients can be exposed to multiple treatments losing optimal timing for surgery and further developing complications such as dysplasia/cancer, dysmotility, microcolon, and other functional abnormalities. This review aims to discuss the concept of disease progression in UC, explore the limitations of medical treatment in refractory UC patients, and propose the application of a three-step algorithm that allows timely indication for surgery in clinical practice.
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Affiliation(s)
| | - Natália Sousa Freitas Queiroz
- Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil,Address for correspondence Natália Sousa Freitas Queiroz, MD, PhD Department of Gastroenterology, University of São Paulo School of MedicineSão Paulo 05403-000Brazil
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5
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Romero RK, Magro DO, Queiroz NSF, Damião AOMC, Teixeira FV, Nones RB, Sassaki LY, Saad-Hossne R, Kotze PG. Perception and clinical decisions from inflammatory bowel diseases' specialists towards positioning of new therapies in Crohn's disease and ulcerative colitis: A national web-based survey from the Brazilian IBD study group (GEDIIB). Gastroenterol Hepatol 2021; 45:499-506. [PMID: 34634427 DOI: 10.1016/j.gastrohep.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND In the last decade, new therapies with different mechanisms of action have been approved for the treatment of moderate to severe Crohn's disease (CD) and ulcerative colitis (UC). Due to the lack of comparative head-to-head trials, the ideal positioning of agents as the most appropriate first- or second-line therapies remains to be defined. OBJECTIVE This survey aimed to evaluate the perception and decisions of Brazilian Inflammatory Bowel Diseases (IBD) specialists in positioning of new therapies (vedolizumab [VEDO], ustekinumab [UST] and tofacitinib [TOFA]) in the management of IBD in different clinical scenarios. METHODOLOGY An anonymous national web-based questionnaire was used to determine the positioning of treatment options in different clinical scenarios (using Google Forms platform), which involved different age ranges, phenotypes, clinical situations and previous exposure to anti-TNF agents (14 scenarios for CD and 10 scenarios for UC). In CD, physicians could choose between UST or VEDO, whilst in UC, between UST, VEDO or TOFA. Six reasons for the specific choice were proposed, such as mechanism of action, safety, method of administration or onset of action. Statistical analysis was carried out with chi-square and t-tests. RESULTS A total of 150 out of 672 GEDIIB IBD specialists (22.32%) responded to the survey. In CD scenarios, UST was the most dominant choice (11/14 scenarios), with VEDO dominating only 3 clinical situations. In UC scenarios, VEDO was the dominant choice (8/10), with UST being chosen for scenarios that included extraintestinal manifestations. Among the reasons for specific choices, the most commonly chosen were the higher efficacy due to the intrinsic mechanism of action and safety profile. CONCLUSIONS UST was the dominant choice as compared to VEDO in CD in most scenarios, especially due to its mechanism of action and safety. VEDO was the dominant choice as compared to UST and TOFA in UC scenarios, mainly for reasons also related to its mechanism of action and safety profile. Comparative studies including patient outcomes are needed to better define the positioning of new IBD therapeutic options in our country.
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7
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Garcia KS, Moutinho BD, de Azevedo MFC, Queiroz NSF, Milani LR, Sanches LN, Barros LL, Oba J, Carlos ADS, Damião AOMC, Sipahi AM. Recovery from COVID-19 Pneumonia in a Patient with Acute Severe Colitis. Inflamm Intest Dis 2020; 5:93-97. [PMID: 32984404 PMCID: PMC7493790 DOI: 10.1159/000508161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/23/2020] [Indexed: 12/26/2022] Open
Abstract
Introduction The coronavirus disease 2019 (COVID-19) pandemic has increased concern regarding SARS-CoV-2 infection in inflammatory bowel disease (IBD) patients, especially those on immunosuppressive therapies or with active disease. There are limited reports describing the clinical features of COVID-19 in an IBD population, and the impact of immunosuppression on the severity of the infection remains unclear. Case Report A 33-year-old female patient with a long history of ulcerative colitis, poorly controlled, was admitted with COVID-19 a few days after being discharged from the hospital for treatment of acute severe ulcerative colitis. High-risk factors for COVID-19 complications, i.e., high-dose steroids (40 mg prednisone) and severe active disease, were present at admission. Despite the development of extensive pulmonary involvement, the patient had a favorable outcome. Discussion Management of IBD patients during the COVID-19 pandemic has been challenging. Measures to minimize the potential risk of SARS-CoV-2 infection, including strict social distancing and self-isolation, in the IBD population have been recommended, especially for high-risk patients. Although steroid tapering and persistence of biologics are advised by professional groups, the best treatment strategy for IBD patients presenting a flare during the outbreak has yet to be defined.
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Affiliation(s)
- Karoline Soares Garcia
- Division of Gastroenterology and Hepatology, Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Bruna Damásio Moutinho
- Division of Gastroenterology and Hepatology, Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Matheus Freitas Cardoso de Azevedo
- Division of Gastroenterology and Hepatology, Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Natalia Sousa Freitas Queiroz
- Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Luciane Reis Milani
- Division of Gastroenterology and Hepatology, Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Lucas Navarro Sanches
- Division of Gastroenterology and Hepatology, Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Luisa Leite Barros
- Division of Gastroenterology and Hepatology, Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Jane Oba
- Division of Gastroenterology and Hepatology, Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil.,Instituto da Criança e do Adolescente, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Alexandre de Sousa Carlos
- Division of Gastroenterology and Hepatology, Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Aderson Omar Mourão Cintra Damião
- Division of Gastroenterology and Hepatology, Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Aytan Miranda Sipahi
- Division of Gastroenterology and Hepatology, Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil.,Laboratory of Clinical and Experimental Gastroenterology (LIM-07), Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
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8
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Kotze PG, Underwood FE, Damião AOMC, Ferraz JGP, Saad-Hossne R, Toro M, Iade B, Bosques-Padilla F, Teixeira FV, Juliao-Banos F, Simian D, Ghosh S, Panaccione R, Ng SC, Kaplan GG. Progression of Inflammatory Bowel Diseases Throughout Latin America and the Caribbean: A Systematic Review. Clin Gastroenterol Hepatol 2020; 18:304-312. [PMID: 31252191 DOI: 10.1016/j.cgh.2019.06.030] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/10/2019] [Accepted: 06/16/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The incidence of inflammatory bowel diseases (IBD) is increasing in Latin America. We performed a systematic review to identify clinical and epidemiologic features of IBD in Latin America (including Mexico, Central America, and South America) and the Caribbean. METHODS We searched MEDLINE, EMBASE, and SciELO databases for clinical or epidemiologic studies of Crohn's disease (CD) or ulcerative colitis (UC) from Latin American and Caribbean countries and territories that reported incidence, prevalence, ratio of UC:CD, IBD phenotype, and treatment, through September 12, 2018. Data were extracted from 61 articles for analysis. RESULTS The incidence and prevalence of IBD have been steadily increasing in Latin America and the Caribbean. The incidence of CD in Brazil increased from 0.08 per 100,000 person-years in 1988 to 0.68 per 100,000 person-years in 1991-1995 to 5.5 per 100,000 person-years in 2015. The highest reported prevalence of IBD was in Argentina, in 2007, at 15 and 82 per 100,000 person-years for CD and UC, respectively. The ratio of UC:CD exceeded 1 in all regions throughout Latin America and the Caribbean with the exception of Brazil. Treatment with tumor necrosis factor antagonists increased steadily for patients with CD (43.4% of all patients in Brazil were treated in 2014) but less so for patients with UC (4.5% of all patients were treated in 2014). Surgery for IBD decreased with time. In Chile, surgeries were performed on 57.0% of patients with CD and 18.0% of patients with UC during the period of 1990-2002; these values decreased to 38.0% and 5.0%, respectively, during the period of 2012-2015. In Peru, 6.9% of patients with UC received colectomies in the period of 2001-2003 and 6.2% in 2004-2014. CONCLUSIONS In a systematic review, we found the incidence of IBD to be increasing throughout Latin America and the Caribbean. Population-based epidemiology studies are needed to evaluate the increase in IBD in these regions, which differ from other global regions in climate, culture, demographics, diet, healthcare delivery and infrastructure, and socioeconomic status.
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Affiliation(s)
- Paulo Gustavo Kotze
- IBD Outpatient Clinics, Colorectal Surgery Unit, Catholic University of Paraná, Curitiba, Brazil.
| | - Fox E Underwood
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Jose Geraldo P Ferraz
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | | | - Martin Toro
- Hospital Universitario de la Universidad Nacional de Cuyo, Mendoza, Argentina
| | | | | | | | | | | | - Subrata Ghosh
- Institute of Translational Medicine, NIHR Biomedical Research Centre, University of Birmingham and Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Remo Panaccione
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Siew C Ng
- Department of Medicine and Therapeutics, Institute of Digestive Disease, LKS Institute of Health Science, State Key Laboratory of Digestive Disease, Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Gilaad G Kaplan
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
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9
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Queiroz NSF, Barros LL, de Azevedo MFC, Oba J, Sobrado CW, de Sousa Carlos A, Milani LR, Sipahi AM, Damião AOMC. Management of inflammatory bowel disease patients in the COVID-19 pandemic era: a Brazilian tertiary referral center guidance. Clinics (Sao Paulo) 2020; 75:e1909. [PMID: 32321117 PMCID: PMC7153358 DOI: 10.6061/clinics/2020/e1909] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 12/15/2022] Open
Abstract
The world is fighting the COVID-19 outbreak and health workers, including inflammatory bowel diseases specialists, have been challenged to address the specific clinical issues of their patients. We hereby summarize the current literature in the management of inflammatory bowel disease (IBD) patients during the COVID-19 pandemic era that support the rearrangement of our IBD unit and the clinical advice provided to our patients.
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Affiliation(s)
- Natália Sousa Freitas Queiroz
- Departamento de Gastroenterologia, Hospital das Clinicas
HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author.E-mail:
/
| | - Luísa Leite Barros
- Divisao de Gastroenterologia e Hepatologia Clinica,
Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina,
Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Matheus Freitas Cardoso de Azevedo
- Divisao de Gastroenterologia e Hepatologia Clinica,
Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina,
Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Jane Oba
- Divisao de Gastroenterologia e Hepatologia Clinica,
Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina,
Universidade de Sao Paulo, Sao Paulo, SP, BR
- Instituto da Crianca e do Adolescente (ICr), Hospital das
Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP,
BR
- Corresponding author.E-mail:
/
| | - Carlos Walter Sobrado
- Departamento de Gastroenterologia, Hospital das Clinicas
HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Alexandre de Sousa Carlos
- Divisao de Gastroenterologia e Hepatologia Clinica,
Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina,
Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luciane Reis Milani
- Divisao de Gastroenterologia e Hepatologia Clinica,
Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina,
Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Aytan Miranda Sipahi
- Departamento de Gastroenterologia, Hospital das Clinicas
HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Laboratorio de Gastroenterologia Clinica e Experimental
(LIM07), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo,
Sao Paulo, SP, BR
| | - Aderson Omar Mourão Cintra Damião
- Divisao de Gastroenterologia e Hepatologia Clinica,
Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina,
Universidade de Sao Paulo, Sao Paulo, SP, BR
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10
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Teixeira FV, Vilela EG, Damião AOMC, Vieira A, Albuquerque ICD, Parente JML, Chebli JMF, Ambrogini Junior O, Hossne RS, Miszputen SJ. Ulcerative colitis - treatment with biologicals. ACTA ACUST UNITED AC 2019; 65:547-553. [PMID: 31066808 DOI: 10.1590/1806-9282.65.4.547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2018] [Indexed: 02/08/2023]
Abstract
The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.
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Affiliation(s)
- Fabio Vieira Teixeira
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Coloproctology Society, Avenida Marechal Câmara, 160 sala 916 - Centro, Rio de Janeiro - RJ, Brasil.,Study Group of Intestinal Inflammatory Disease of Brasil
| | - Eduardo Garcia Vilela
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Gastroenterology Federation, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Study Group of Intestinal Inflammatory Disease of Brasil
| | - Aderson Omar Mourão Cintra Damião
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Gastroenterology Federation, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Study Group of Intestinal Inflammatory Disease of Brasil
| | - Andrea Vieira
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Gastroenterology Federation, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Study Group of Intestinal Inflammatory Disease of Brasil
| | - Idblan Carvalho De Albuquerque
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Coloproctology Society, Avenida Marechal Câmara, 160 sala 916 - Centro, Rio de Janeiro - RJ, Brasil.,Study Group of Intestinal Inflammatory Disease of Brasil
| | - José Miguel Luz Parente
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Gastroenterology Federation, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Study Group of Intestinal Inflammatory Disease of Brasil
| | - Júlio Maria Fonseca Chebli
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Gastroenterology Federation, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Study Group of Intestinal Inflammatory Disease of Brasil
| | - Orlando Ambrogini Junior
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Gastroenterology Federation, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Study Group of Intestinal Inflammatory Disease of Brasil
| | - Rogerio Saad Hossne
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Coloproctology Society, Avenida Marechal Câmara, 160 sala 916 - Centro, Rio de Janeiro - RJ, Brasil.,Study Group of Intestinal Inflammatory Disease of Brasil
| | - Sender Jankiel Miszputen
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Gastroenterology Federation, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Study Group of Intestinal Inflammatory Disease of Brasil
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11
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Zacharias P, Damião AOMC, Moraes AC, Teixeira FV, Ludvig JC, Nones RB, Saad-Hossne R, Sassaki LY, Silva RPLD, Facchin L, Olandoski M, Kotze PG. ADALIMUMAB FOR ULCERATIVE COLITIS: RESULTS OF A BRAZILIAN MULTICENTER OBSERVATIONAL STUDY. Arq Gastroenterol 2017; 54:321-327. [PMID: 28977114 DOI: 10.1590/s0004-2803.201700000-51] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 06/29/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Adalimumab is a monoclonal antibody, tumor necrosis factor-alpha (TNFα) inhibitor that has efficacy for inducing and maintaining remission in moderate-to-severe ulcerative colitis. Real world studies with adalimumab in Latin American ulcerative colitis patients are scarce. OBJECTIVE To assess the clinical remission rates in induction and maintenance with adalimumab therapy in ulcerative colitis. METHODS Observational, multicenter and retrospective study on a case series of patients with moderate-to-severe ulcerative colitis under adalimumab therapy. The variables analyzed were: demographic data, previous infliximab status, concomitant drugs, the Montreal Classification, disease activity (Mayo score) at weeks 0, 8, 26 and 52, or until the last follow-up. Clinical remission was defined as a partial Mayo score ≤2 and Last observation carried forward (LOCF) and Non responder imputation (NRI) analysis were used. RESULTS Thirty-six patients were included in the study. With LOCF analysis, remission rates at weeks 8, 26 e 52 were of 41.7%, 47.2% and 47.2%, respectively. With NRI analysis, remission rates at weeks 8, 26 and 52 were of 41.7%, 41.7% and 27.8%, respectively. CONCLUSION Adalimumab was effective in the treatment of moderate-to-severe ulcerative colitis. Clinical remission was observed in approximately 40% of the patients at weeks 8 and 26, and in almost a quarter of the patients after 1 year of follow up.
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Affiliation(s)
- Patrícia Zacharias
- Unidade de Cirurgia Colorretal, Hospital Universitário Cajuru, PUCPR, Curitiba, PR, Brazil
| | | | - Antonio Carlos Moraes
- Serviço de Gastroenterologia, Hospital Clementino Fraga Filho, UFRJ, Rio de Janeiro, RJ, Brazil
| | | | | | - Rodrigo Bremer Nones
- Serviço de Gastroenterologia, Hospital Nossa Senhora das Graças, Curitiba, PR, Brasil
| | | | | | | | - Luiza Facchin
- Unidade de Cirurgia Colorretal, Hospital Universitário Cajuru, PUCPR, Curitiba, PR, Brazil
| | | | - Paulo Gustavo Kotze
- Unidade de Cirurgia Colorretal, Hospital Universitário Cajuru, PUCPR, Curitiba, PR, Brazil
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12
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Kotze PG, Damião AOMC, Moraes AC. THE APPROVAL OF VEDOLIZUMAB FOR THE MANAGEMENT OF INFLAMMATORY BOWEL DISEASES IN BRAZIL: the beginning of a new biological era. Arq Gastroenterol 2016; 53:3-4. [PMID: 27276096 DOI: 10.1590/s0004-28032016000100002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 10/09/2015] [Indexed: 06/06/2023]
Affiliation(s)
- Paulo Gustavo Kotze
- Serviço de Coloproctologia do Hospital Universitário Cajuru, PUCPR, Curitiba, PR, Brasil, Pontifícia Universidade Católica do Paraná, Serviço de Coloproctologia, Hospital Universitário Cajuru, PUCPR, Curitiba PR , Brazil
| | - Aderson Omar Mourão Cintra Damião
- Serviço de Gastroenterologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil, Universidade de São Paulo, Serviço de Gastroenterologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo SP , Brazil
| | - Antonio Carlos Moraes
- Serviço de Gastroenterologia do Hospital Clementino Fraga Filho, UFRJ, Rio de Janeiro, RJ, Brasil., Universidade Federal do Rio de Janeiro, Serviço de Gastroenterologia, Hospital Clementino Fraga Filho, UFRJ, Rio de Janeiro RJ , Brazil
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13
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Rodrigues M, D’Amico MFM, Patiño FRA, Barbieri D, Damião AOMC, Sipahi AM. Clinical manifestations, treatment, and outcomes of children and adolescents with eosinophilic esophagitis. Jornal de Pediatria (Versão em Português) 2013. [DOI: 10.1016/j.jpedp.2012.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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14
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Rodrigues M, D'Amico MFM, Patiño FRA, Barbieri D, Damião AOMC, Sipahi AM, Sipahy AM. Clinical manifestations, treatment, and outcomes of children and adolescents with eosinophilic esophagitis. J Pediatr (Rio J) 2013; 89:197-203. [PMID: 23642431 DOI: 10.1016/j.jped.2013.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 09/28/2012] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE This study aimed to describe the clinical, endoscopic, and histologic characteristics, as well as the response to conventional treatment of pediatric patients with the classical form of eosinophilic esophagitis (EoE). METHODS Study of clinical, laboratory, endoscopic, and histologic data and response to conventional treatment of 43 previously followed pediatric patients with the classical form of EoE. RESULTS A total of 43 patients diagnosed with EoE were included in the study, of which 37 were males (86%), with a mean age of 8.4 years. The most common symptoms were: nausea, vomiting, and abdominal pain (100%) in children younger than 7 years, and loss of appetite (60%), heartburn (52%), and food impaction (48%) in children older than 7 years and adolescents. Regarding the endoscopic findings, 12 (28%) patients had whitish plaques on the esophageal lining, 8 (18.5%) had longitudinal grooves, 2 (4.5%) had concentric rings, 3 (7%) had longitudinal grooves and whitish plaques, and the remaining 18 (42%) had esophageal mucosa with normal appearance. Despite the initial favorable response, 76.7% of patients required more than one course of corticosteroid therapy (systemic or aerosol) and diet (exclusion or elimination of food or elementary allergens). Persistence of eosinophil infiltration was found in some patients despite favorable clinical response. CONCLUSIONS The classic form of EoE typically shows different symptoms according age range. A significant number of patients required more than one treatment cycle to show clinical remission. Endoscopic and histologic improvement was observed; however, eosinophilic infiltration persisted in some patients.
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Affiliation(s)
- Maraci Rodrigues
- Departamento de Gastroenterologia e Hepatologia, Hospital das Clínicas, Universidade de São Paulo USP, São Paulo, SP, Brazil.
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15
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Werneck-Silva AL, Alvares EP, Gama P, Damião AOMC, Osaki LH, Ogias D, Sipahi AM. Intestinal damage in strongyloidiasis: the imbalance between cell death and proliferation. Dig Dis Sci 2006; 51:1063-9. [PMID: 16865572 DOI: 10.1007/s10620-006-8010-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2005] [Accepted: 07/14/2005] [Indexed: 12/25/2022]
Abstract
Strongyloidiasis is an endemic tropical parasitosis caused by Strongyloides stercoralis that also affects immigrants in nontropical countries. The nematode colonizes the duodenum and upper jejunum, inducing mucosal alterations. Because integrity is essential for a functional barrier, we aimed to study apoptosis and proliferation in the small bowel epithelium infected with S. stercoralis. We evaluated 23 patients and 17 controls. Apoptotic cells were detected by TUNEL and M30 immunolabelling, whereas proliferation was scored by Ki67 immunostaining and mitotic counting. Infection increased apoptotic indices in duodenum and jejunum (P < 0.001). Conversely, it decreased cell proliferation in both segments (P < 0.001). Our results showed that intestinal strongyloidiasis promotes an imbalance between cell death and proliferation. This is the first evidence of disruption of the epithelial kinetics with S. stercoralis infection, though the mechanisms remain unclear. Furthermore, our results support the idea that strongyloidiasis disturbs the mucosal integrity and can compromise the intestinal barrier.
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Affiliation(s)
- Ana Luiza Werneck-Silva
- Department of Gastroenterology, School of Medicine, Laboratory of Investigation (LIM 07), University of São Paulo, São Paulo, Brazil
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Leite AZA, Sipahi AM, Damião AOMC, Garcez AT, Buchpiguel CA, Lopasso FP, Lordello MLL, Agostinho CLO, Laudanna AA. Effect of a selective nonsteroidal anti-inflammatory inhibitor of cyclooxygenase-2 on the small bowel of rats. Braz J Med Biol Res 2004; 37:333-6. [PMID: 15060699 DOI: 10.1590/s0100-879x2004000300007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The pathogenesis of nonsteroidal anti-inflammatory drug (NSAID) enteropathy is a complex process involving the uncoupling of mitochondrial oxidative phosphorylation and inhibition of cyclooxygenase (COX). Rofecoxib, a selective inhibitor of COX-2, has shown less gastric damage, but the same beneficial effect is not clear in the case of the small bowel. Fifty-seven male Wistar rats (250-350 g) were divided into three groups (N=19 each) to evaluate the effect of this NSAID on the rat intestine. The groups received 2.5 mg/kg rofecoxib, 7.5 mg/kg indomethacin or water with 5% DMSO (control) given as a single dose by gavage 24 h before the beginning of the experiment. A macroscopic score was used to quantify intestinal lesions and intestinal permeability was measured using [51Cr]-ethylenediaminetetraacetic acid ([51Cr]-EDTA). The extent of intestinal lesion, indicated by a macroscopic score, was significantly lower when rofecoxib was administered compared to indomethacin (rofecoxib=0.0 vs indomethacin=63.6 +/- 25.9; P<0.05) and did not differ from control. The intestinal permeability to [51Cr]-EDTA was significantly increased after indomethacin (control=1.82 +/- 0.4 vs indomethacin=9.12 +/- 0.8%; P<0.0001), but not after rofecoxib, whose effect did not differ significantly from control (control=1.82 +/- 0.4 vs rofecoxib=2.17 +/- 0.4%; ns), but was significantly different from indomethacin (indomethacin=9.12 +/- 0.8 vs rofecoxib=2.17 +/- 0.4%; P<0.001). In conclusion, the present data show that rofecoxib is safer than indomethacin in rats because it does not induce macroscopic intestinal damage or increased intestinal permeability.
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Affiliation(s)
- A Z A Leite
- Laboratório de Investigação Médica, Departamento de Gastroenterologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
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