Inflammatory bowel diseases (IBDs) are chronic inflammatory conditions of a recurrent nature, whose incidence and prevalence rates have increased worldwide.
The aim of this study was to profile the doctors who treat patients with IBDs in Brazil and to understand and analyze the journey and importance of this care.
This is a cross-sectional study that descriptively and inferentially analyzed the pre-existing database of the Brazilian Inflammatory Bowel Disease Study Group and through this observed the reality of care for Crohn’s disease and ulcerative colitis, in the country.
In the descriptive analysis, we found results regarding the physicians’ profile such as specialty, number of patients treated with these diseases and their difficulties in accessing medications, complementary exams, and multidisciplinary team. In the statistical analysis regarding the Human Development Index of the states, the significant results were related to workplace, difficulty in accessing medications, and referral to other specialists. Regarding the association of variables with medical demographics, the results were significant in relation to workplace, difficulty in accessing medications, and complementary exams.
The study showed a profile of the doctors who treat patients with IBDs and who participated in this survey. In addition to analyzing and describing the doctor’s profile and their difficulties, we listed the main aspects that hinder both diagnosis and treatment, attributed to external factors, regardless of their reality and competence.
Inflammatory bowel diseases are chronic inflammatory conditions of a recurrent nature, whose incidence and prevalence rates have increased worldwide. It is known that early diagnosis and short start of the correct indicated treatment alter the natural history of the disease, preventing complications; hence, it is necessary to know the profile of the doctors who treat these patients in Brazil and especially to understand the difficulties in care and evaluate them in relation to other variables.
This study showed the profile of physicians who treat inflammatory bowel disease (IBD) patients, through their registration in the Brazilian Inflammatory Bowel Disease Study Group. In addition to analyzing the physician’s profile and their difficulties, the main aspects that hinder both the diagnosis and treatment of the disease, attributed to external factors, were listed. Therefore, more effective public health policies should be planned and expanded, aiming at growth and adaptation focused on IBDs
Patients undergoing Crohn’s disease (CD) surgery may develop a higher rate of postoperative complications (POC) than other patients.
The aim of this study was to investigate factors determining POC in patients with CD undergoing urgent laparotomy.
This is a retrospective cohort study conducted on adult patients undergoing urgent laparotomy for CD. Clinical and surgical variables, medication history, American Society of Anesthesiologists classification, and POC were investigated. Data collection and management were carried out using the REDCap software (REDCap electronic data capture tools) hosted at the hospital institution. For statistical analysis, the χ2 (or Fisher’s exact) test, Student’s t-test, Mann-Whitney test, and simple and multiple multilevel logistic regression analyses were used.
There was an association regarding the history of adalimumab use (p=0.04, OR 2.8, 95%CI 1.03-7.65), previous use of prednisone (p<0.01, OR 2.03, 95%CI 2.00-2.05), urgent surgery indications (p<0.01, OR=4.32, 95% CI=1.58-11.82), mechanical anastomosis (p=0.02, OR=0.22, 95%CI 0.06-0.80), unexpected intraoperative findings (p=0.02, OR 10.46, 95%CI 1.50-72.99), length of hospital stay greater than 10 days (p<0.01, OR 16.86, 95%CI 2.99-94.96), unplanned intensive care unit (ICU) admission (p=0.01, OR 15.06, 95%CI 1.96-115.70), and planned ICU admission (p<0.01, OR 18.46, 95%CI 3.60-94.51). On multivariate analysis, there was an association between the indication of urgent surgery (or emergency) (p=0.01, OR 4.38, 95%CI 1.43-13.37) and unexpected intraoperative findings (p=0.03, OR 8.11, 95%CI 1.21-54.50).
Unexpected changes and urgent surgical indications are considered risk factors for POC in patients with CD.
Endoscopic evaluation, particularly the macroscopic mucosal and histological results of ileocolic biopsies, is essential for the management of inflammatory bowel disease. Endoscopic appearance is not always sufficient to differentiate Crohn’s disease and ulcerative colitis, but there are some characteristics that favor one or another diagnosis. Both diseases have an increased incidence of colorectal carcinoma; so, surveillance colonoscopy is important for detecting early neoplastic lesions.
To update the importance of endoscopy in the evaluation, diagnosis and prognosis of inflammatory bowel disease.
Search was done in the scientific literature of the TRIP database, chosen from clinical questions (PICO) with the following descriptors: “inflammatory bowel disease”, “endoscopy/colonoscopy”, “Crohn’s disease”, “ulcerative colitis” and “diagnosis/treatment”.
Endoscopic investigation in patients with chronic colitis is quite accurate for the differential diagnosis between ulcerative colitis and Crohn’s disease. Endoscopy is indicated for ulcerative colitis during severe crisis due to its prognostic value. Another accepted indication for endoscopy in inflammatory bowel disease is its use in the screening for dysplastic lesion.
Ileocolonoscopy allows an accurate diagnosis of Crohn’s disease or ulcerative colitis in up to 90% of cases. The healing of the mucosa assessed by endoscopy after treatments despite not being consensus is still the gold-standard in the evaluation of remission of the disease. Colonoscopy is essential for long-term cancer surveillance and in the future the implementation of Confocal Laser Endomicroscopy seems to be very promising in assessing the initial dysplasia.
Desenvolvido por Surya MKT