Crianças com DC apresentam essas complicações com maior frequência do que as com retocolite ulcerativa. Caso haja indicação de terapia anti-TNF. INTRODUÇÃO: Existe uma grande prevalência de manifestações extra- intestinais(MEI) em portadores de doença de Crohn(DC) e de retocolite ulcerativa(RCU). OBJETIVO: Verificar a adequação da ingestão alimentar de pacientes com doença de Crohn e retocolite ulcerativa inespecífica. MÉTODOS: Para avaliação da.
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PDF | Ulcerative colitis is an autoimmune disorder of unknown etiology. Os autores relatam um caso de retocolite ulcerativa associada à artrite reumatoide em. principais como a doença de Crohn (DC) e a colite ulcerativa (CU) que se caracterizam por apresentar rasgos clínico-patológicos que se superpõem e outros. Retocolite Ulcerativa (RCU): Perfil Evolutivo Clínico Endoscópico. Estudo Retrospectivo Ulcerative Colitis: Clinical and Endoscopic Profile. A Retrospective .
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Most cases, particularly in CD, are moderate to severe at diagnosis, with a tendency for disease activity to fluctuate over time[ 3 ].
CD can progress from pure inflammatory lesions to destructive complications such as intestinal perforation, strictures, abscesses and fistula formation, which may result in irreversible bowel damage leading to loss of gastrointestinal tract function and disability that may require hospitalizations and surgical treatment[ 4 , 5 ]. Symptoms of active UC or relapse include bloody diarrhea with or without mucus, abdominal pain and fecal urgency.
This disease presents a cyclical course, including phases of exacerbation and remission, with a variable degree of intensity. Patients with extensive or severe inflammation may experience acute complications, such as toxic megacolon and severe bleeding[ 6 , 7 ]. The main goal of treatment for IBD is to achieve and maintain disease remission, prevent complications, hospitalization and surgery, and improve health-related quality of life[ 1 , 10 ].
According to Lichtenstein et al[ 11 ], for moderate to severe CD, daily prednisone is indicated until resolution of symptoms and resumption of weight gain. Azathioprine AZA and 6-mercaptopurine 6-MP are recommended for the maintenance of steroid-induced remission, and parenteral methotrexate MTX is indicated for steroid-dependent and steroid-refractory disease.
Patients who are refractory to these agents can be treated with biological therapy, such as infliximab IFX , adalimumab, certolizumab pegol, ustekinumab and vedolizumab[ 11 ]. The conventional therapy for inpatients with severe active UC includes intravenous steroids and monotherapy with intravenous cyclosporin.
For patients with steroid-dependent disease or those who are refractory to steroids or immunomodulators, a biological therapy should be considered[ 2 ].
In addition to clinical remission, endoscopic remission, expressed as mucosal healing, has become an important endpoint in IBD[ 12 ]. This outcome has been correlated with a reduction in surgeries and hospitalizations[ 13 ]. Another endpoint recommended by current IBD guidelines is the level of fecal calprotectin, a noninvasive biomarker that has been used to evaluate disease activity in IBD[ 1 , 2 , 13 ].
The level of this biomarker can be correlated with macroscopic and histological inflammation, as detected by colonoscopy and biopsies[ 14 - 17 ]. Despite the emergence of biological therapy, conventional therapy continues to be prescribed in moderate to severe IBD MS-IBD , particularly in countries where biologics are not covered by insurance[ 18 , 19 ].
As a standard of treatment and the primary alternative to biologics, conventional therapy should present robust effectiveness results in IBD outcomes. Eligibility criteria Studies were considered eligible if they met the following criteria: 1 Meta-analysis, systematic reviews, randomized clinical trials RCTs , observational or case-control studies; 2 studied conventional therapy in adult patients with MS-IBD, including CD or UC; and 3 comparative or single arm studies. Conventional therapy included corticosteroids prednisone, hydrocortisone, budesonide, prednisolone, dexamethasone , 5-aminosalicylic acid 5-ASA derivatives mesalazine and sulfasalazine and immunosuppressants AZA, MTX, mycophenolate, cyclosporine, tacrolimus, 6-MP.
Studies evaluating the maintenance of remission in quiescent disease were considered eligible only if they presented information about the disease severity prior to the remission period. Exclusion criteria were as follows: sample size below 50, narrative review, specific subpopulations e.
No time limits were applied. The quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation criteria for each selected study[ 22 ]. Data extraction Two independent reviewers conducted the search in databases using the predefined strategy and selected the studies. In cases without a consensus, a third reviewer was consulted about the eligibility and was responsible for the final decision.
The following information was extracted from each selected study: first author name, journal and year of publication, place where the study was conducted, follow-up period, sample size, disease characteristics, study outcomes, and quality of evidence. Study outcomes The primary outcome measures were clinical remission induction or maintenance , clinical response and mucosal healing. As secondary outcomes, fecal calprotectin, hospitalization, death and surgeries were assessed.
All outcomes were classified by whatever definition was used in the individual study.World J Gastroenterol. Reversal of DNA hypomethylation by folic acid supplements: possible role in colorectal cancer prevention.
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The prevalence and phenotype in Brazilian patients with inflammatory bowel disease
The amount of butyrate available decreases toward the rectum. The quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation criteria for each selected study[ 22 ].
Genes, diet and inflammatory bowel disease.