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Allin KH, Jensen CB, Jacobsen RK, Jess T. Metformin use is not associated with reduced risk of older onset inflammatory bowel disease: a Danish nationwide population-based study. J Gastroenterol 2022; 57:761-9. [PMID: 35780256 DOI: 10.1007/s00535-022-01896-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/13/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Metformin has pleiotropic effects including anti-inflammatory properties and effects on the gut microbiome. It is primarily used in the older population, where the occurrence of inflammatory bowel disease (IBD) is increasing. The aim of this study was to examine whether metformin protects against development of IBD. METHODS In the setting of a Danish nationwide population-based cohort, we conducted a nested case-control study using a new-user active comparator design. For each patient with IBD, we selected 10 IBD-free individuals matched on age, sex, and duration of follow-up. Conditional logistic regression was used to estimate odds ratios (ORs) of IBD. Adjustment included educational level, other immune-mediated inflammatory diseases, and use of dipeptidyl peptidase (DPP)-4 inhibitors and statins. RESULTS Among 302,863 IBD-free new users of oral glucose-lowering drugs, we identified 1271 patients who developed IBD and 12,676 matched IBD-free individuals. Mean age at IBD diagnosis was 66 (SD, 11) years. We found no association between ever use of metformin and risk of IBD, Crohn's disease or ulcerative colitis, adjusted OR 0.95 (95% CI 0.78-1.15), 0.87 (95% CI 0.60-1.26), and 1.04 (95% CI 0.83-1.31), respectively. Neither was the cumulative dose of metformin or the treatment duration with metformin associated with risk of IBD. CONCLUSIONS In this population-based study, we report that despite anti-inflammatory effects and a notable impact on the gut microbiome, metformin use is not associated with reduced risk of older onset IBD.
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Queiroz NSF, Teixeira FV, Motta MP, Chebli LA, Hino AAF, Martins CDA, Quaresma AB, Silva AADPD, Damião AOMC, Saad-Hossne R, Kotze PG. Risk stratification and geographical mapping of Brazilian inflammatory bowel disease patients during the COVID-19 outbreak: Results from a nationwide survey. World J Gastroenterol 2021; 27:1226-1239. [PMID: 33828396 PMCID: PMC8006093 DOI: 10.3748/wjg.v27.i12.1226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/17/2020] [Revised: 01/28/2021] [Accepted: 02/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) pandemic is still evolving globally, and Brazil is currently one of the most affected countries. It is still debated whether patients with inflammatory bowel disease (IBD) are at a higher risk for developing COVID-19 or its complications.
AIM To assess geographical distribution of IBD patients at the highest risk and correlate these data with COVID-19 mortality rates in Brazil.
METHODS The Brazilian IBD Study Group (Grupo de Estudos da Doença Inflamatória Intestinal do Brasil) developed a web-based survey adapted from the British Society of Gastroenterology guidelines. The included categories were demographic data and inquiries related to risk factors for complications from COVID-19. Patients were categorized as highest, moderate or lowest individual risk. The Spearman correlation test was used to identify any association between highest risk and mortality rates for each state of the country.
RESULTS A total of 3568 patients (65.3% females) were included. Most participants were from the southeastern and southern regions of Brazil, and 84.1% were using immunomodulators and/or biologics. Most patients (55.1%) were at moderate risk, 23.4% were at highest risk and 21.5% were at lowest risk of COVID-19 complications. No association between the proportion of IBD patients at highest risk for COVID-19 complications and higher mortality rates was identified in different Brazilian states (r = 0.146, P = 0.467).
CONCLUSION This study indicates a distinct geographical distribution of IBD patients at highest risk for COVID-19 complications in different states of the country, which may reflect contrasting socioeconomic, educational and healthcare aspects. No association between high risk of IBD and COVID-related mortality rates was identified.
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Affiliation(s)
| | - Fábio Vieira Teixeira
- IBD Unit, Gastroenterology Department, Gastrosaúde Clinic, Marilia 17509190, SP, Brazil
| | | | - Liliana Andrade Chebli
- IBD Outpatient Clinics, Universidade Federal de Juiz de Fora, Juiz de Fora 36010-010, MG, Brazil
| | - Adriano Akira Ferreira Hino
- Health Sciences Postgraduate Program, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba 80440-220, PR, Brazil
| | - Camilla de Almeida Martins
- Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo 05403-000, SP, Brazil
| | - Abel Botelho Quaresma
- Departamento de Ciências da Saúde, Universidade do Oeste de Santa Catarina (UNOESC), Joaçaba 89600-000, SC, Brazil
| | | | | | - Rogerio Saad-Hossne
- Botucatu Medical School, Paulista State University (UNESP), Botucatu 18600-050, SP, Brazil
| | - Paulo Gustavo Kotze
- Health Sciences Postgraduate Program, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba 80440-220, PR, Brazil
- IBD Outpatient Clinics, Pontificia Universidade Católica do Paraná (PUCPR), Curitiba 80440-220, PR, Brazil
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Choi YJ, Choi EK, Han KD, Park J, Moon I, Lee E, Choe WS, Lee SR, Cha MJ, Lim WH, Oh S. Increased risk of atrial fibrillation in patients with inflammatory bowel disease: A nationwide population-based study. World J Gastroenterol 2019; 25:2788-2798. [PMID: 31236001 PMCID: PMC6580358 DOI: 10.3748/wjg.v25.i22.2788] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 01/30/2019] [Revised: 04/22/2019] [Accepted: 04/29/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD), a chronic inflammatory disease of the gastrointestinal tract, could play a role in the pathophysiology of atrial fibrillation (AF).
AIM To investigate the association between IBD and AF development.
METHODS We performed a population-based cohort study using records in the Korean National Health Insurance Services database between 2010 and 2014. A total of 37696 patients with IBD (12349 with Crohn’s disease and 25397 with ulcerative colitis) were identified. The incidence rate of newly diagnosed AF in patients with IBD was compared with that in a 3 times larger cohort of 113088 age- and sex-matched controls without IBD.
RESULTS During 4.9 ± 1.3 years of follow-up, 1120 patients newly diagnosed with AF (348 in the IBD group and 772 in controls) were identified. After adjustments using multivariable Cox proportional hazards, patients with IBD were at a 36% [95% confidence interval (CI) 20%-54%] higher risk of AF than controls. The association between IBD and the development of AF was stronger in younger than in older patients. Patients without cardiovascular risk factors showed a higher risk of AF primarily. Additionally, patients receiving immun-omodulators [Hazard ration (HR) 1.46, 95%CI 1.31-1.89], systemic corticosteroids (HR 1.37, 95%CI 1.10-1.71), or biologics agents (HR 2.38, 95%CI 1.51-3.75) were at higher risk of AF than patients without them.
CONCLUSION IBD significantly increased the risk of AF, and the impact of IBD on developing AF was in patients with moderate to severe disease.
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Affiliation(s)
- You-Jung Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, South Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, South Korea
| | - Kyung-Do Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul 03083, South Korea
| | - Jiesuck Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, South Korea
| | - Inki Moon
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, South Korea
| | - Euijae Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, South Korea
| | - Won-Seok Choe
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, South Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, South Korea
| | - Myung-Jin Cha
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, South Korea
| | - Woo-Hyun Lim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul 07061, South Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, South Korea
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Sánchez-Morales A, Pérez-Ayala MF, Cruz-Martínez M, Arenas-Osuna J, Ramírez-Mendoza P, Ceniceros RA, Mora-Cañas EM, Cruz-Domínguez P, Saavedra-Salinas MÁ. [Probiotics’ effectiveness on symptoms, histological features and feeding tolerance in ulcerative colitis]. Rev Med Inst Mex Seguro Soc 2019; 57:9-14. [PMID: 31071249] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Probiotics have been used in the adjuvant treatment of Ulcerative Colitis (UC). OBJECTIVE To evaluate the role of a combination of probiotics on the clinical, histological changes and feeding tolerance in patients with UC. METHODS An open UC patients with mild to moderate activity and clinical trial was conducted. Patients were randomized to receive or a combination of 6 strains of probiotics for 3 months while continuing their drug treatment established. UC activity was assessed by Truelove and Witts scale and histological findings by Gupta index. Descriptive statistics, Chi square test and Student t test for comparison of the two groups was performed. RESULTS In each group 17 patients were included. An improvement was found in the disease activity (52.9% vs. 23.5%, p = 0.07) and in histologic index (82.3% vs. 41.1%, p = 0.03) in patients treated with probiotics compared to the control group. Improved food tolerance was also observed in patients treated with probiotics. CONCLUSION The study shows a beneficial short-term effect on symptoms, histological findings and feeding tolerance with the administration of a combination of 6 strains of probiotics in patients with UC.
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Affiliation(s)
| | - Mayte Fabiola Pérez-Ayala
- Instituto Mexicano del Seguro Social, Hospital de Especialidades “Dr. Antonio Fraga Mouret”, División de Educación en Salud. Ciudad de México, México
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Valejo Coelho MM, Fernandes C. [Pyoderma Gangrenosum in a Patient with Ulcerative Colitis]. ACTA MEDICA PORT 2018; 31:346. [PMID: 30020881 DOI: 10.20344/amp.10641] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 04/16/2018] [Indexed: 11/20/2022]
Affiliation(s)
| | - Cândida Fernandes
- Serviço de Dermatovenereologia. Centro Hospitalar de Lisboa Central. Lisboa. Portugal
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Sebastián Domingo JJ. Review of the role of probiotics in gastrointestinal diseases in adults. Gastroenterol Hepatol 2017; 40:417-429. [PMID: 28185664 DOI: 10.1016/j.gastrohep.2016.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 11/25/2016] [Accepted: 12/02/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Probiotics may act as biological agents that modify the intestinal microbiota and certain cytokine profiles, which can lead to an improvement in certain gastrointestinal diseases. OBJECTIVES To conduct a review of the evidence of the role of probiotics in certain gastrointestinal diseases in adults. SEARCH METHODS Review conducted using appropriate descriptors, filters and limits in the PubMed database (MEDLINE). SELECTION CRITERIA The MeSH terms used were Probiotics [in the title] AND Gastrointestinal Diseases, with the following limits or filters: Types of study: Systematic Reviews, Meta-Analysis, Guideline, Practice Guideline, Consensus Development Conference (and Consensus Development Conference NIH), Randomized Controlled Trial, Controlled Clinical Trial and Clinical Trial; age: adults (19 or older); language: English and Spanish; in humans, and with at least one abstract. DATA COLLECTION AND ANALYSIS Full texts of all the Systematic Reviews and meta-analyses directly related to the review's objective were obtained, as well as the Randomised Controlled Trials of the studies that were considered relevant and of sufficient quality for this review. MAIN RESULTS Certain probiotics, different for each process, have proven to be effective and beneficial in cases of acute infectious diarrhoea, antibiotic-associated diarrhoea, Clostridium difficile-associated diarrhoea, pouchitis and Helicobacter pylori infection eradication. AUTHORS' CONCLUSIONS Although some probiotics have not demonstrated any benefit, there are certain gastrointestinal diseases in which the use of probiotics, true biological agents, can be recommended.
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Krzesiek E, Zaleska-Dorobisz U, Iwańczak B, Dorobisz AT. Deep Vein Thrombosis of the Left Lower Limb in a 12 Year-Old Female Child with Ulcerative Colitis - Case Report. Pol J Radiol 2016; 81:65-8. [PMID: 26966473 PMCID: PMC4763799 DOI: 10.12659/pjr.894529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 07/15/2015] [Indexed: 12/26/2022] Open
Abstract
Background Inflammatory bowel disease includes ulcerative colitis and Crohn’s disease. Case Report This case report presents a patient with ulcerative colitis, with thrombotic complication of the left common iliac vein that occurred at the age of 11, two years after diagnosis. After a year of anticoagulation and compression therapy, although exacerbations of underlying disease occurred in the first 6 months of treatment, there was no recurrence of deep venous thrombosis, partial recanalization within affected venous system has been achieved and the patient is remission of ulcerative colitis for the last six months. Conclusions In children, thromboembolic complications occur about 7 times less often than in adults, but increases in the case of hospitalized children. In children with IBD this complication can occur independently og disease activity even in patients with any other risk factors.
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Affiliation(s)
- Elżbieta Krzesiek
- Department of Pediatrics, Gastroenterologu and Nutrition, Medical University, Wrocław, Poland
| | | | | | - Andrzej T Dorobisz
- Department of Vascular, General and Transplant Surggery, Medical University, Wrocław, Poland
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Abstract
With the incidence of inflammatory bowel disease (IBD) increasing rapidly in many Asian countries, including Hong Kong, it is important that patient characteristics are better understood. For example, are the phenotypes, behaviors, complications, and even treatment responses found in Asian patients similar to those of their Western counterparts? To formally address these questions, a properly designed local cohort study is needed. Whilst IBD is still relatively uncommon in Asia, the establishment of a local IBD registry will significantly contribute to the answering of these questions. The Hong Kong IBD registry was established to fill the gap in the understanding of IBD patients, and to foster research into IBD in Hong Kong. The Hong Kong IBD registry is a territory-wide registry that includes all public hospitals in Hong Kong. We included all IBD patients who were currently receiving medical care at these hospitals. With the help of the central computer medical record system of the Hospital Authority of Hong Kong, all clinical events, medications usage, endoscopy records, and laboratory results of patients in the registry were captured. Apart from data collection, the registry is also establishing a bio-specimen bank of blood and stool samples of IBD patients for future research. The IBD registry is a very useful platform for population-based studies on IBD in Asia.
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Affiliation(s)
- Wai K Leung
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
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9
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Abstract
Inflammatory bowel disease (IBD) is a chronic idiopathic inflammatory disease of the gastrointestinal (GI) tract. In the past decade a shift in the treatment paradigm of IBD has ensued. The availability of drugs capable of inducing mucosal healing, combined with the recognition that IBD is not an intermittent disease, but rather a progressive one causing bowel damage and disability, led us to a more stringent strategy. Tailored therapy with more aggressive treatment in high-risk patients, treating beyond symptoms, intervening early before damage occurs, optimizing therapeutic regimens, and actively pursuing sustained remission and sustained control of inflammation are strategies that are slowly being incorporated in our clinical practice. Furthermore, new drugs targeting different immunological pathways, such as vedolizumab, have recently been approved and therefore more therapeutic resources for patients failing anti-tumour necrosis factor alpha (anti-TNFα) agents will be available. The future years look promising for IBD. Hopefully the new trends in IBD management, combined with new drugs, will make possible to change the course of disease and provide better therapy and quality of life for patients suffering from this disabling disease.
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Affiliation(s)
| | | | - Marilia Cravo
- Gastroenterology Department, Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal
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Chun J, Lee C, Kwon JE, Hwang SW, Kim SG, Kim JS, Jung HC, Im JP. Usefulness of the cytomegalovirus antigenemia assay in patients with ulcerative colitis. Intest Res 2015; 13:50-9. [PMID: 25691843 PMCID: PMC4316222 DOI: 10.5217/ir.2015.13.1.50] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 03/06/2014] [Revised: 05/28/2014] [Accepted: 06/30/2014] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Patients with ulcerative colitis (UC) are at high risk for cytomegalovirus (CMV) reactivation. The usefulness of the CMV antigenemia assay in active UC patients has rarely been studied. We assessed whether the assay detects CMV colitis and predicts clinical outcomes in patients with UC. Methods We retrospectively reviewed the medical records of patients hospitalized for moderate-to-severe UC from 2003 to 2012. Positive CMV antigenemia was defined as ≥1 pp65-positive cell per 2×105 polymorphonuclear neutrophils. CMV colitis was defined as the presence of inclusion bodies and/or positive immunohistochemistry in the colonic mucosa. The primary outcome was steroid refractoriness, defined as the absence of clinical improvement after intravenous high-dose steroid administration. Results A total of 43 patients were enrolled. CMV antigenemia was detected in 12 (27.9%) patients. Positive CMV antigenemia was significantly associated with CMV colitis (P =0.001). The sensitivity and specificity of positive CMV antigenemia for diagnosing CMV colitis were 66.7% and 87.1%, respectively. Steroid refractoriness was found in 11 of 12 (91.7%) and 12 of 31 (38.7%) patients with positive and negative CMV antigenemia, respectively (P =0.002). The independent predictors for steroid refractoriness were positive CMV antigenemia (adjusted odds ratio [OR], 7.73; 95% confidence interval [CI], 1.22-49.19; P =0.030) and a shorter duration from the diagnosis of UC (adjusted OR, 0.99; 95% CI, 0.98-0.99; P =0.025). Conclusions The CMV antigenemia assay shows low sensitivity but high specificity for detecting CMV colitis and may predict steroid-refractory UC. Early rescue therapy might be considered in UC patients positive for CMV antigenemia.
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Affiliation(s)
- Jaeyoung Chun
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Changhyun Lee
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Ji-Eun Kwon
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Wook Hwang
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Gyun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Joo Sung Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Chae Jung
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Pil Im
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Magalhães J, Castro FDD, Carvalho PB, Machado JF, Leite S, Moreira MJ, Cotter J. Disability in Inflammatory Bowel Disease: Translation to Portuguese and Validation of the "Inflammatory Bowel Disease - Disability Score". GE Port J Gastroenterol 2015; 22:4-14. [PMID: 28868362 PMCID: PMC5580123 DOI: 10.1016/j.jpge.2014.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 10/06/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) has a physical, psychological and social impact, often compromising the patient's ability to perform daily activities. Recently a new measurement for disability in IBD was developed. The Inflammatory Bowel Disease-Disability Score (IBD-DS) comprises the following domains: mobility, self-care, major daily life activities, gastrointestinal-related problems, mental health and interaction with the environment. The aim of our study was to translate to Portuguese and to validate the IBD-DS. METHODS Eighty-five patients, 55 with Crohn's disease (CD) and 30 with ulcerative colitis (UC), completed the Portuguese version of the IBD-DS and the short inflammatory bowel disease questionnaire (SIBDQ-10 questions). Disease activity was assessed using the Harvey-Bradshaw (HB) for CD and partial Mayo score (pMayo) for UC. Pearson's correlation coefficient was used to assess the correlation between the IBD-DS and SIBDQ. The Student's t-test was used to compare the mean of IBD-DS between active and inactive disease. Statistical analysis was performed with SPSS 21.0 and the statistical level of significance (α) was established at 5%. RESULTS In our study, a significant negative correlation between the IBD-DS and the SIBDQ was observed (r = -0.858, p < 0.001 for CD and r = -0.933, p < 0.001 for UC). There was a statistically significant difference of the mean of IBD-DS between inactive vs. active disease (93.78 vs. 117.57, p = 0.016 for CD and 78.96 vs. 137.14, p < 0.001 for UC). CONCLUSION The Portuguese version of the inflammatory bowel disease-disability score has a strong correlation with patients' quality of life and clinical disease activity and was shown to be a valid tool to measure disability in patients with inflammatory bowel disease.
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Affiliation(s)
- Joana Magalhães
- Gastroenterology Department, Centro Hospitalar do Alto Ave, E.P.E., Guimarães, Portugal
| | | | - Pedro Boal Carvalho
- Gastroenterology Department, Centro Hospitalar do Alto Ave, E.P.E., Guimarães, Portugal
| | - João Firmino Machado
- Gastroenterology Department, Centro Hospitalar do Alto Ave, E.P.E., Guimarães, Portugal
| | - Sílvia Leite
- Gastroenterology Department, Centro Hospitalar do Alto Ave, E.P.E., Guimarães, Portugal
| | - Maria João Moreira
- Gastroenterology Department, Centro Hospitalar do Alto Ave, E.P.E., Guimarães, Portugal
| | - José Cotter
- Gastroenterology Department, Centro Hospitalar do Alto Ave, E.P.E., Guimarães, Portugal.,Instituto de Investigação em Ciências da Vida e da Saúde, University of Minho, Braga, Portugal.,ICVS/3B's Laboratório Associado, University of Minho, Braga, Portugal
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Xavier JCC, Coelho KIR, Sassaki LY, Yamashiro FDS, Oliveira KCL, Rodrigues MAM. Primary sclerosing cholangitis associated with severe ulcerative colitis in a young man. Autops Case Rep 2013; 3:37-41. [PMID: 28584805 PMCID: PMC5453659 DOI: 10.4322/acr.2013.037] [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] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 12/03/2013] [Indexed: 11/23/2022] Open
Abstract
Primary sclerosing cholangitis, a chronic progressive cholestatic liver disease, is the most serious hepatobiliary complication of ulcerative colitis (UC). The authors present the case of a severe and intractable form of UC associated with primary sclerosing cholangitis, in which the diagnosis of this hepatobiliary complication was made during the postmortem examination. A 19-year-old man, with an 8-month diagnosis of UC, was non-responsive to any therapeutic approach. He presented at the emergency care unit severely ill and with cachexia, and subsequently died of septic shock. The postmortem examination confirmed the clinical diagnosis of severe UC and disclosed the presence of primary sclerosing cholangitis. Although laboratory tests have shown a typical cholestatic profile with elevated alkaline phosphatase and gamma-glutamyl transferase levels, hepatic dysfunction was related to sepsis. This report highlights how challenging the diagnosis of primary sclerosing cholangitis can be and shows the value of the postmortem examination to add important information to a medical diagnosis.
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Affiliation(s)
| | | | - Ligia Yukie Sassaki
- Department of Internal Medicine - Faculdade de Medicina - Universidade Estadual Paulista, Botucatu/SP, Brazil
| | - Fabio da Silva Yamashiro
- Department of Internal Medicine - Faculdade de Medicina - Universidade Estadual Paulista, Botucatu/SP, Brazil
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Kang SM, Jang YR, Yoon HH, Kim S, Kim EY, Ha SY, Park JW. A Case of Balsalazide-Induced Limited Form of Granulomatosis with Polyangiitis with Bronchiolitis Obliterans Organizing Pneumonia-like Variant in Ulcerative Colitis. Tuberc Respir Dis (Seoul) 2012; 72:323-7. [PMID: 23227073 PMCID: PMC3510283 DOI: 10.4046/trd.2012.72.3.323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 01/27/2012] [Accepted: 01/12/2012] [Indexed: 11/24/2022] Open
Abstract
5-Aminosalicylate agents are the main therapeutic agents for ulcerative colitis. Balsalazide is a prodrug of 5-aminosalicylate and has fewer side effects than the other 5-aminosalicylate agents. Pulmonary complications resembling granulomatosis with polyangiitis in ulcerative colitis are extremely rare. Here, we report a patient with ulcerative colitis on balsalazide presenting respiratory symptoms and multiple pulmonary nodules from a chest radiography that was pathologically diagnosed with a limited form of granulomatosis with polyangiitis with bronchiolitis obliterans organizing pneumonia-like variant. To our knowledge, this is the first report of a balsalazide-induced limited form of granulomatosis with polyangiitis with bronchiolitis obliterans organizing pneumonia-like variant.
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Affiliation(s)
- Shin Myung Kang
- Department of Pulmonary and Critical Care Medicine, Gachon University Gil Hospital, Incheon, Korea
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