Colitis eosinofílica asociada a enfermedad inflamatoria intestinal / Eosinophilic colitis associated with inflammatory bowel disease

INTRODUCCIÓN: La colitis eosinofílica y la colitis de la enfermedad inflamatoria intestinal, son dos entidades que pueden compartir similares características clínicas, endoscópicas y terapéuticas pero diferentes criterios diagnósticos. OBJETIVOS: Describir el caso clínico de un niño preescolar con antecedente de alergia alimentaria, de hospitalizaciones y uso de antibióticos por varias ocasiones, que evoluciona con diarrea crónica intermitente. CASO CLÍNICO: Se trata de un paciente masculino, de 3 años 5 meses, con antecedente de alergia alimentaria con cuadro crónico de dolor abdominal, diarrea y retraso en el crecimiento. Se realiza abordaje de diarrea crónica. RESULTADOS: Con hallazgos clínicos de enfermedad inflamatoria intestinal y descripción histopatológica de colitis eosinofílica, se considera la asociación entre estas dos patologías sin dejar la posibilidad de que esta última se trate de una fase inicial de enfermedad inflamatoria intestinal. CONCLUSIONES: El tratamiento de pacientes con colitis eosinofílica complicada es similar a la enfermedad inflamatoria intestinal, se requiere seguimiento clínico, endoscópico e histopatológico de pacientes con colitis eosinofílica a largo plazo.

INTRODUCTION: Eosinophilic colitis and inflammatory bowel disease colitis are two entities that may share similar clinical, endoscopic and therapeutic features but different diagnostic criteria. OBJECTIVES: To describe the clinical case of a preschool child with a history of food allergy, hospitalizations and use of antibiotics for several occasions, who evolves with chronic intermittent diarrhea. CLINICAL CASE: This is a male patient, 3 years 5 months old, with a history of food allergy with chronic abdominal pain, diarrhea and growth retardation. Chronic diarrhea was approached. RESULTS: With clinical findings of inflammatory bowel disease and histopathological description of eosinophilic colitis, the association between these two pathologies is considered without leaving the possibility that the latter is an initial phase of inflammatory bowel disease. CONCLUSIONS: The treatment of patients with complicated eosinophilic colitis is similar to inflammatory bowel disease, clinical, endoscopic and histopathological follow-up of patients with eosinophilic colitis is required in the long term.

Microscopic colitis: Case series and literature review / Colitis microscópica, serie de casos y revisión de la literatura

Abstract Introduction: Microscopic colitis is a benign and multifactorial disease characterized by watery diarrhea and histological alterations in the colonic mucosa. The incidence of this disease is increasing, being diagnosed more frequently. Materials and methods: In this retrospective study, patients were examined employing colonoscopy and biopsy due to a diagnosis of chronic diarrhea in a gastroenterology unit throughout 22 months. Their diagnosis of colitis was confirmed by clinical picture and microscopic analysis. Results: In the study period, a total of 2849 colonoscopies were performed, 116 in patients with chronic diarrhea. We identified 15 patients with microscopic colitis, 12 were men (80 %), and only three were older than 60 (20 %). Conclusion: Unlike the world literature, this study found that microscopic colitis in our patients affects the male sex primarily (male/female ratio: 4/1) and occurs in young people, with an average age of 47.5 years (range: 21-82 years).

Resumen Introducción: la colitis microscópica es una enfermedad benigna y multifactorial caracterizada por la presencia de diarrea acuosa y alteraciones histológicas en la mucosa colónica. La incidencia de esta enfermedad viene en aumento y su diagnóstico se realiza cada vez con mayor frecuencia. Métodos: estudio retrospectivo en el que se revisaron los pacientes por medio de colonoscopia y biopsias por diagnóstico de diarrea crónica en un período de 22 meses en una unidad de gastroenterología, y en quienes mediante la clínica y el análisis histológico se confirmó el diagnóstico de colitis microscópica. Resultados: en el período de estudio se realizó un total de 2849 colonoscopias, 116 en pacientes con diarrea crónica. Se identificaron 15 pacientes con colitis microscópica, 12 fueron hombres (80 %) y solo hubo 3 mayores de 60 años (20 %). Conclusión: a diferencia de lo informado en la literatura mundial, en este estudio se encontró que la colitis microscópica en nuestros pacientes compromete especialmente al sexo masculino (relación hombre/mujer: 4/1) y se presenta en personas jóvenes, con un promedio de edad de 47,5 años (rango de 21 a 82 años).

Therapeutics in radiation-induced proctopathy: a systematic review

Malignant neoplasms are increasingly prevalent in the daily clinical practice. Up to 61% of patients with pelvic malignancies undergo pelvic radiotherapy in different doses, which may cause intestinal damage, and the rectum is the segment most frequently affected due to its fixed position in the pelvis. Currently, there are several strategies to minimize the effects of radiation on the tissues surrounding the neoplastic site; despite those strategies, radiotherapy can still result in serious damage to organs and structures, and these injuries accompany patients throughout their lives. One of the most common damages resulting from pelvic radiotherapy is acute proctitis.The diagnosis is confirmed by visualizing the rectal mucosa through rigid or flexible rectosigmoidoscopy and colonoscopy. The objective of the present study was to review the forms of radiation-induced proctopathytherapy, and to evaluate the results of each method to propose a standardization for the treatment of this pathology. Despite the prevalence of radiation-induced proctopathy, there is no definitive standardized treatment strategy so far. The first approach can be tried with local agents, such as mesalazine and formalin. For refractory cases, control can usually be achieved with argon plasma coagulation, hyperbaric oxygen, and radiofrequency ablation therapies. Regarding the study of radiation-induced proctopathy, there is a lack of robust studies with large samples and standardized therapies to be compared. There is a lack of double-blinded, randomized controlled studies to determine a definitive standard treatment algorithm. (AU)

Characteristics of Inflammatory Bowel Disease Compared to Other National Centers in Colombia / Características de la enfermedad inflamatoria intestinal con respecto a otros centros nacionales de Colombia

Abstract Introduction: Inflammatory bowel disease (IBD) is an immune-mediated disease whose incidence in Latin America has increased in recent years. Aim: To analyze the demographic and clinical characteristics of patients with IBD treated in a university hospital and present the epidemiological data compared to other centers in Colombia. Patients and methods: Descriptive study of patients with IBD (1996-2019) at the Hospital Universitario Fundación Santa Fe de Bogotá. Analysis of data from centers in Medellín, Cali, Bogotá, and Cartagena. Results: Of 386 patients, 277 presented with ulcerative colitis (UC), 102 with Crohn's disease (CD), and seven with unclassifiable colitis. IBD was more frequent in women (53 %). Mortality was less than 1 %. The involvement of UC was mainly pancolitis (42.6 %). The greater the extent of the disease, the higher the hospitalization and surgery rates (OR 3.70, P < 0.01). Thirteen percent of patients with UC received biologics. Compromise due to CD was mainly ileocolonic (43.6 %) and ileal (43.6 %). The predominant clinical pattern of CD was structuring (50%). Forty-five percent received biologicals and 56 % surgery. Primary sclerosing cholangitis (PSC) was found in 4 % of patients (n = 15). Two patients with PSC developed colorectal cancer (OR 4.18; p 0.008), while 13 patients with UC developed colon cancer and seven dysplastic changes. Three patients with CD developed colon cancer. Conclusions: The results were compared to other reference centers. We found similar trends in the clinical behavior and treatment of IBD, with higher hospitalization and surgery rates in our cases.

Resumen Introducción: la enfermedad inflamatoria intestinal (EII) es una enfermedad inmunomediada, cuya incidencia en Latinoamérica ha aumentado en los últimos años. Objetivo: analizar las características demográficas y clínicas de los pacientes con EII tratados en un hospital universitario y presentar los datos epidemiológicos con respecto a otros centros en Colombia. Pacientes y métodos: estudio descriptivo de pacientes con EII (1996-2019) en el Hospital Universitario Fundación Santa Fe de Bogotá. Análisis de datos de centros de Medellín, Cali, Bogotá y Cartagena. Resultados: de 386 pacientes, 277 presentaron colitis ulcerativa (CU), 102 enfermedad de Crohn (EC) y 7 colitis no clasificable. La EII fue más frecuente en mujeres (53 %). La mortalidad fue menor de 1 %. El compromiso de la CU fue principalmente la pancolitis (42,6 %). Entre mayor la extensión de la enfermedad, más alta fue la tasa de hospitalización y cirugías (OR 3,70; p < 0,01). El 13 % de los pacientes con CU recibió biológicos. El compromiso por la EC fue principalmente ileocolónico (43,6 %) e ileal (43,6 %). El patrón clínico predominante de la EC fue estenosante (50%). El 45 % recibió biológicos y 56% cirugía. La colangitis esclerosante primaria (CEP) se encontró en 4 % de los pacientes (n = 15). Dos pacientes con CEP desarrollaron cáncer colorrectal (OR 4,18; p 0,008), mientras que 13 pacientes con CU desarrollaron cáncer de colon y 7 cambios displásicos. 3 pacientes con EC desarrollaron cáncer de colon. Conclusiones: se compararon los resultados en relación con otros centros de referencia. Encontramos tendencias similares en el comportamiento clínico y en el tratamiento de la EII, con mayores tazas de hospitalizaciones y cirugías en nuestros casos.

Mesenchymal stem cells have ameliorative effect on the colitis model via Nrf2/HO-1 pathway

Purpose: To evaluate the ameliorative effect of mesenchymal stem cells (MSCs) on acetic acid colitis model via Nrf2/HO-1 pathway in rats. Methods: In this study, 30 rats were divided into three groups. Acute colitis was induced by rectal administration of 4% solution of acetic acid. MSCs were injected intraperitoneally in the treatment group. Results: Increased levels of tumor necrosis factor-α (TNF-α), pentraxin-3, and malondialdehyde (MDA) in colitis group were revealed biochemically. Increased level of TNF-α and decreased levels of Nrf2 and interleukin-10 (IL-10) were observed in rectum tissues. Increased fibrous tissue proliferation, vascularization and inflammatory cell infiltration were described in the colitis group. Significant improvement was observed in MSCs treated group histopathologically. Increased immunopositivity of TNF-α, vascular endothelial growth factor (VEGF) and CD68 markers was observed in the colitis group cells, and decreased level of this positivity was observed in MSCs treated group. Conclusions: Biochemical, histopathological and immunohistochemical results strongly support the ameliorative effect of MSCs against acetic induced colitis model via Nrf2/HO-1 pathway in rats.

Pólipo con displasia de alto grado en muñón rectal posterior a procedimiento de Hartmann. Reporte de caso / Polyp with high-grade dysplasia in a rectal stump after the Hartmann procedure. case report

El procedimiento de Hartmann es una intervención quirúrgica resectiva de colon sigmoides, que de manera protocolaria se realiza en patología abdominal aguda en situaciones como la Diverticulitis Complicada. La derivación de la continuidad del tránsito intestinal (colostomía) y el cierre del remanente colorrectal (muñon rectal) forma parte a la descripción de tal procedimiento quirúrgico. La reconstrucción electiva del tránsito intestinal posterior a 6 meses de la derivación colónica, por medio de anastomosis colorrectal, corresponde al seguimiento y parte del tratamiento de la resolución del cuadro de peritonitis diverticular inicial complicado. Al seguimiento rutinario de un paciente en la consulta externa de coloproctología; durante la evaluación en la proctoscopia del muñon rectal, se evidencia como hallazgo incidental la presencia de un pólipo pediculado con característica histológica displasica de alto grado en su estudio anatomopatológico; en la cual esta descrita ampliamente como neoplasia con progresión a malignidad. Además de múltiples pólipos inflamatorios con cambios crónicos de su mucosa rectal. Ante los factores de riesgo y antecedentes personales de paciente, se decide realizar la escicion del remanente rectal. Existen poca literatura que reporte lesiones adenomatosas en muñones de recto, por enfermedad diverticular. Las hay descritas comúnmente en colitis crónicas de origen inespecífico, en enfermedad de Chron o pacientes con antecedentes de poliposis de origen familiar. Este paciente describe la inusual presentación de un adenoma con cambios histológicos importantes, así como también cambios crónicos inflamatorios de su mucosa rectal posterior a patología Diverticular complicada, en un tiempo de 12 meses.

The Hartmann procedure is a resective surgical intervention of the sigmoid colon, which is performed by protocol in acute abdominal pathology in situations such as Complicated Diverticulitis. Derivation of continuity of intestinal transit (colostomy) and closure of the colorectal remnant (rectal stump) is part of the description of such a surgical procedure. The elective reconstruction of the intestinal transit after 6 months of the colonic bypass, by means of colorectal anastomosis, corresponds to the follow-up and part of the treatment of the resolution of the initial complicated picture.To the routine follow-up of a patient in an outpatient coloproctology consultation; During the proctoscopy evaluation of the rectal stump, the presence of a pedunculated polyp with a high-grade dysplastic histological characteristic was evidenced as an incidental finding in its anatomopathological study; in which it is widely described as a neoplasm with progression to malignancy. In addition to multiple inflammatory polyps with chronic changes of its rectal mucosa. Given the risk factors and personal history of the patient, it was decided to perform the excision of the rectal remnant. There is little literature that reports adenomatous lesions in rectal stumps due to diverticular disease. They are commonly described in chronic colitis of non-specific origin, in Chron's disease or patients with a history of polyposis of family origin. This patient describes the unusual presentation of an adenoma with important histological changes, as well as chronic inflammatory changes of his rectal mucosa after complicated Diverticular pathology, in a period of 12 months.

Tumor neuroendocrino de colon derecho en un paciente con colitis ulcerativa: a propósito de un caso / Right colon neuroendocrine tumor in a patient with ulcerative colitis: A case study

Resumen Los tumores neuroendocrinos del colon son relativamente raros en comparación con el carcinoma colorrectal esporádico; su incidencia es muy baja y la localización más frecuente es en el ciego, colon sigmoideo y recto. Se describe con poca frecuencia la asociación de tumor neuroendocrino con la colitis ulcerativa debido a la inflamación crónica que conduce a la diferenciación de células neuroendocrinas a partir de células multipotenciales en el epitelio displásico, que puede ser responsable del desarrollo de carcinomas neuroendocrinos colorrectales. La presentación del caso se trata de un paciente de 57 años de edad con colitis ulcerativa con cuadro de dolor abdominal, pérdida de peso y diarreas líquidas con moco. En el examen físico presentó una lesión endurecida en el marco colónico derecho con tomografía de lesión neoplásica en el colon ascendente y en su hospitalización presentó un cuadro de oclusión intestinal, por lo que se le realizó una hemicolectomía más ileostomía, cuyo resultado en la biopsia fue un tumor neuroendocrino G3 de células grandes en el colon ascendente. En este artículo se revisan de forma práctica los aspectos relacionados con la fisiopatología, diagnóstico y tratamiento de la asociación de estas dos patologías.

Abstract Neuroendocrine colon tumors are relatively unknown compared with sporadic colorectal cancer; its incidence is low, and it is generally located in the cecum, sigmoid colon, and rectum. The existing relation between neuroendocrine tumors and ulcerative colitis is not frequently described due to the chronic inflammation that leads to neuroendocrine cell differentiation from multipotential cells in the dysplastic epithelium, which can be responsible for colorectal neuroendocrine carcinomas development. The study refers to the case of a patient of 57 years old with ulcerative colitis, abdominal pain, weight loss, and liquid diarrhea with mucus. Physical examination revealed a hardened lesion in the right colonic framework with the tomography of a neoplastic lesion in the ascending colon. When the patient was hospitalized, he developed an intestinal obstruction. A hemicolectomy plus ileostomy procedure was performed resulting in a large cell G3 neuroendocrine tumor in the ascending colon revealed in the biopsy. In this article, the aspects related to the pathophysiology, diagnosis, and treatment of the association of these two pathologies are reviewed in a practical way.

Manifestaciones cutáneas de la enfermedad inflamatoria intestinal / Cutaneous manifestations of Inflammatory Bowel Disease / Manifestações Cutâneas De Doença Inflamatória Intestinal

En los últimos años se ha evidenciado un aumento en la incidencia y prevalencia de la enfermedad inflamatoria intestinal, que comprende dos entidades: la enfermedad de Crohn y la colitis ulcerativa. Ambas, y paradójicamente su tratamiento, pueden desencadenar manifestaciones cutáneas con una amplia variedad de manifestaciones clínicas en piel, que son un reto diagnóstico para el médico. Solo el conocimiento de estos fenotipos clínicos permitirá el diagnóstico temprano, con el objetivo de lograr el abordaje diagnóstico y el tratamiento oportunos y de evitar secuelas a largo plazo.

In recent years, there is evidence of an increase in the incidence and prevalence of inflammatory bowel disease, in which two entities are involved: Chron disease and ul-cerative colitis. Both of these diseases and, paradoxically, their treatment with anti-TNF may trigger skin manifestations, whose variety of clinical presentations on the skin can represent a diagnostic challenge for the clinician. Only the knowledge of these clinical phenotypes will allow an early diagnosis to be carried out, in order to achieve a timely diagnostic approach and treatment, and to avoid long-term sequelae.

Nos últimos anos, tem havido um aumento na incidência e prevalência da doença infla-matória intestinal, que compreende duas entidades: doença de Crohn e colite ulcerosa. Ambos, e paradoxalmente o seu tratamento, podem desencadear manifestações cutâ-neas com uma grande variedade de manifestações clínicas na pele, o que constitui um desafio diagnóstico para o médico. Somente o conhecimento desses fenótipos clínicos permitirá o diagnóstico precoce, com o objetivo de alcançar uma abordagem diagnóstica e terapêutica oportuna e evitar sequelas a longo prazo.

Antioxidant evaluation of the aqueous extract of hulls of Campsiandra laurifolia in colitis induced by acetic acid in Wistar rats / Avaliação antioxidante do extrato aquoso de cascas de Campsiandra laurifolia na colite induzida por ácido acético em ratos Wistar

Abstract Due to the ethnopharmacological use of Campsiandra laurifolia (Fabaceae), popularly known as Acapurana, to treat wounds and ulcers, associated with the lack of alternative treatments for intestinal inflammations such as ulcerative colitis (UC), the present work sought to characterize its phytochemical and antioxidant activities, and to evaluate remedial action in experimental colitis with acetic acid. Phytochemical analyzes were performed through qualitative and quantitative colorimetric tests of the main secondary metabolites. In the colitismodel, 24male Wistar rats aged±60 days oldwere used, divided into 4 groups: Control (CO) control+aqueous extract of C. laurifolia 50mg/kg (CO+A50); Colitis (CL); and Colitis+aqueous extract of C. laurifolia 50 mg/kg (CL+ A50).Measurement of sphincter anal pressure and histological tests of the large intestine, lipoperoxidation (LPO), enzymeactivity of superoxide dismutase (SOD), and levels of glutathione (GSH)were performed. For statistical analysis, the oxidative stress (OS) results were expressed as means±standard error, adopting a significance level of p < 0.05. The screening indicated the presence of flavonoids, saponins and tannins in the extract, with high levels of phenolic

Resumo Devido ao uso etnofarmacológico de Campsiandra laurifolia (Fabaceae), popularmente conhecida comoAcapurana, para tratar feridas e úlceras, associado à falta dealternativas de tratamentos para as inflamações intestinais como a retocolite ulcerativa (RCU), o presente trabalho buscou caracterizar sua constituição fitoquímica, sua atividade antioxidante, e avaliar sua ação reparadora na colite experimental com ácido acético. As análises fitoquímicas foram realizadas por meio de ensaios colorimétricos qualitativos e quantitativos dos principaismetabólitos secundários.Nomodelo de colite, foramutilizados 24 ratos machos Wistar de±60 dias de idade, divididos em 4 grupos: Controle (CO), controle+ extrato aquoso de C. laurifolia 50mg/kg (CO+A50); Colite (CL); e Colite+extrato aquoso de C. laurifolia (CL+ A50). Foram realizadas aferições da pressão anal esfincteriana e avaliações histológicas do intestino grosso, lipoperoxidação (LPO), atividade da enzima superóxido dismutase (SOD) e níveis da glutationa (GSH). Para a análise estatística, resultados do estresse oxidativo (EO) foram expressos em médias±erro padrão, adotando um nível de significância de p < 0,05. O screening indicou no extrato a presença de flavonoides, saponinas e taninos com altos teores de compostos fenólicos e taninos, relacionando-os a uma elevada capacidade antioxidante. Na análise histológica, o grupo CL apresentou perda das criptas, do edema e do infiltrado inflamatório. O uso do extrato de C. laurifolia reestruturou as criptas, diminuiu o edema e aumentou a pressão anal esfincteriana, com diminuição da LPO, da SOD, e aumento da GSH. Sugere-se que o uso do extrato de C. laurifolia diminui o EO por seu poder antioxidante, conferido pelos compostos fenólicos presentes no extrato.

Enema de sulcralfato pode prevenir colite em segmentos colônicos sem trânsito fecal? / Can sucralfate enema prevent colitis in colonic segments without fecal transit?

RESUMO - RACIONAL: O estresse oxidativo é um dos principais mecanismos associados à ruptura dos mecanismos de defesa que formam a barreira epitelial cólica e reduz o conteúdo tecidual das proteínas claudina-3 e ocludina principais constituintes das junções de oclusão intercelulares. O sucralfato, possui atividade antioxidante e tem sido usado para tratar diferentes formas de colite. OBJETIVO: Mensurar o conteúdo tecidual de claudina-3 e ocludina da mucosa do cólon sem trânsito fecal, submetido à intervenção com sucralfato. MÉTODO: Trinta e seis ratos foram submetidos à colostomia do cólon esquerdo e fístula mucosa distal. Os animais foram divididos em dois grupos de acordo com a eutanásia ser realizada duas ou quatro semanas após a intervenção. Cada grupo foi dividido em três subgrupos de acordo com o tipo de intervenção realizada diariamente: solução salina isolada; sucralfato a 1 g/kg/dia ou sucralfato a 2g/kg/dia. A colite foi diagnosticada por análise histológica adotando escala de validação prévia. A expressão tecidual de ambas as proteínas foi identificada por imunoistoquímica. O conteúdo das proteínas foi quantificado por análise de imagem assistida por computador. RESULTADOS: O escore inflamatório foi maior nos segmentos cólicos sem trânsito fecal e os enemas com sucralfato reduziram o escore inflamatório nesses segmentos, principalmente nos animais submetidos à intervenção com sucralfato em maior concentração e por período mais longo de intervenção. Houve aumento no conteúdo tecidual das proteínas claudina-3 e ocludina, relacionado com a concentração de sucralfato. O conteúdo tecidual de ambas as proteínas não se modificou com a duração da intervenção. CONCLUSÃO: Enemas com sucralfato reduzem a inflamação e aumentam o conteúdo tecidual de claudina-3 e ocludina na mucosa cólica sem trânsito intestinal.

ABSTRACT - BACKGROUND: Oxidative stress is one of the main mechanisms associated with the rupture of the defense mechanisms of the colonic epithelial barrier; it reduces the tissue content of the claudin-3 and occludin proteins, which are the main constituents of intercellular tight junctions. Sucralfate (SCF) has antioxidant activity and has been used to treat different forms of colitis. AIM: This study aimed to measure the tissue claudin-3 and occludin content of the colon mucosa without fecal transit, subjected to intervention with SCF. METHODS: Thirty-six rats were subjected to left colon colostomy and distal mucous fistula. They were divided into two groups according to euthanasia that was performed 2 or 4 weeks after the intervention. Each group was divided into three subgroups according to the enema applied daily: saline alone, SCF at 1 g/kg/day, or SCF at 2 g/kg/day. Colitis was diagnosed by the histological analysis adopting the previous validate scale. The tissue expression of both proteins was identified by immunohistochemical technique. The content of proteins was quantified by computer-assisted image analysis. RESULTS: The inflammatory score was high in colonic segments without fecal transit, and enemas with SCF reduced the inflammatory score in these segments, mainly in those animals submitted to intervention with SCF in greater concentration and for a longer period of intervention. There was an increase in tissue content of claudin-3 and occludin, related to SCF concentration. The tissue content of both proteins was not related to the intervention time. CONCLUSION: Enemas with SCF reduced the inflammation and increased the tissue content of claudin-3 and occludin in colonic mucosa without fecal stream.

Expressão de e-caderina e claudina-3 no epitélio cólico após terapia com infliximabe: modelo experimental de colite de exclusão / Expression of e-cadherin and claudin-3 in the colonic epithelium after the infliximab therapy: experimental model of disuse colitis

RESUMO - RACIONAL: A etiopatogenia da colite por desuso (DC) ainda não foi totalmente elucidada. As principais teorias consideram que a doença pode estar relacionada ao aumento de bactérias anaeróbias, falta de suprimento de ácidos graxos de cadeia curta (AGCC) e distúrbios imunológicos que se desenvolvem em segmentos colorretais desprovidos de trânsito fecal. OBJETIVO: Verificar se a aplicação de infliximabe modifica o conteúdo tecidual das proteínas E-caderina e claudina-3 no epitélio cólico de ratos sem trânsito intestinal. MÉTODOS: Vinte dois ratos foram submetidos a derivação do trânsito intestinal pelo procedimento de Hartmann. Eles permaneceram com o ostoma por 12 semanas para permitir o desenvolvimento da colite de exclusão. Em seguida, foram divididos em três grupos experimentais: seis animais receberam 2,0 ml de solução salina/semana, oito infliximabe na dose de 5 mg/Kg/semana e, os demais, infliximabe na dose de 10 mg/Kg/semana por 5 semanas consecutivas. Em seguida, os animais foram eutanasiados e os segmentos cólicos com e sem trânsito intestinal foram removidos. A colite por desuso foi diagnosticada pelas alterações histológicas definidas por uma escala previamente validada. Expressão tecidual de E-caderina e claudina-3 foi avaliada por imuno-histoquímica, e o conteúdo tecidual de ambas as proteínas foi quantificado por análise de imagem assistida por computador. RESULTADOS: Segmentos cólicos exclusos de trânsito fecal apresentaram maior grau de inflamação do que os expostos ao trânsito fecal. Inflamação foi menor nos animais tratados com infliximabe, independente da dose utilizada. Níveis de E-caderina e claudina-3 estavam reduzidos no cólon excluso. O tratamento com infliximabe aumentou os níveis das proteínas em segmentos do cólon sem trânsito intestinal, principalmente nos animais que receberam a dose de 10mg/kg/semana. CONCLUSÃO: Infliximabe reduz inflamação nos segmentos do cólon excluso e aumenta o conteúdo tecidual de E-caderina e claudina-3, especialmente na concentração de 10mg/kg/semana.

ABSTRACT - BACKGROUND: The etiopathogenesis of disuse colitis (DC) has not yet been fully elucidated. The main theories consider that the disease may be related to an increase in anaerobic bacteria, the lack of short-chain fatty acid (SCFA) supply, and immunological disorders that develop in the colorectal segments devoid of fecal transit. AIM: The aim of this study was to verify whether the application of infliximab modifies the tissue content of E-cadherin and claudin-3 proteins in colonic epithelium of rats devoid of intestinal transit. METHODS: A total of 22 rats underwent intestinal transit bypass using Hartmann's procedure. They remained with the shunt for 12 weeks to allow the development of DC. Later, they were divided into three experimental groups: six animals received 2.0 mL saline solution/week, eight received infliximab at a dose of 5 mg/kg/week, and eight received infliximab at a dose of 10 mg/kg/week for 5 consecutive weeks. At the end of this period, the animals were euthanized, and the colonic segments with and without intestinal transit were removed. DC was diagnosed based on the histological changes defined by a previously validated scale. The tissue expression of E-cadherin and claudin-3 was assessed by immunohistochemistry, and the tissue content of both proteins was quantified by computer-aided image analysis. RESULTS: The colonic segments excluded from fecal transit showed a higher degree of inflammation than those exposed to fecal transit. The degree of inflammation was lower in animals treated with infliximab, regardless of the dose used. The levels of E-cadherin and claudin-3 were reduced in the excluded colon. Treating animals with infliximab increased the levels of both proteins in the colonic segments without intestinal transit, especially in animals receiving a dose of 10 mg/kg/week. CONCLUSION: Infliximab therapy reduces inflammation in the colonic segments excluded from intestinal transit and increases the tissue content of E-cadherin and claudin-3 proteins, especially when used at a concentration of 10 mg/kg/week.

Colitis amebiana necrosante, presentación de un caso / Necrotizing amebian colitis, case report

Resumen Introducción: La Organización Mundial de la Salud (OMS) y la Organización Panamericana de la Salud (OPS) han definido la amebiasis como la infección por Entamoeba histolytica, independientemente de los síntomas. La colitis amebiana necrosante es una forma rara de amebiasis que se asocia con una alta morbilidad y mortalidad. Caso clínico: Presentamos a un paciente femenino de 68 años, con antecedentes de diabetes mellitus tipo 2, con colitis amebiana necrosante con múltiples perforaciones, que fue sometida a una hemicolectomía derecha con íleo-transverso anastomosis. Conclusiones: Se necesitan intervenciones efectivas para prevenir la colitis amebiana y terapias adicionales para tratar la colitis amebiana fulminante y mejorar los resultados.

Abstract Background: Amebiasis has been defined by World Health Organization (WHO) and Pan American Health Organization (PAHO) as the infection with Entamoeba histolytica regardless of symptoms. Necrotizing amoebic colitis is a rare clinical form of amebosis that is associated with high morbidity and mortality. Case Report: We present a 68-years-old-female patient with necrotizing amoebic colitis with multiple perforations who survived after right hemicolectomy with ileus-transverse anastomosis. Conclusions: Effective interventions to prevent amebic colitis, and additional therapies to treat fulminant amebic colitis are needed to improve outcomes.

Enteritis eosinofílica. Presentación de un caso y revisión de la literatura / Eosinophilic enteritis. Case presentation and literature review

RESUMEN La enteritis eosinofílica consiste en la presencia de infiltrados eosinofílicos en el tracto digestivo. Constituye en la actualidad una entidad rara que puede localizarse en cualquier región del tubo digestivo. Su etiopatogenia se desconoce y en muchas ocasiones se relaciona con antecedentes de atopia. Las manifestaciones clínicas varían en función de las capas afectadas. Se presentó el caso de un paciente de 26 años de edad, con antecedentes de haber sido operado de apendicitis aguda, en el año 2011. Llegó al Cuerpo de Guardia refiriendo dolor intenso, fijo; en fosa iliaca derecha, acompañado de fiebre de 39°C, con escalofríos y síntomas dispéptico. Se orientó ingreso y se le realizó una videoendoscopia, se observó gastritis antral eritematosa exudativa con test para Helicobacter pylori positivo. Además, una videolaparoscopia arrojando presencia de asas delgadas apelotonadas y adherencias no recientes en fosa iliaca derecha. A pesar del tratamiento empleado el paciente continuó con dolor y fiebre, por lo que se decidió indicarle una enteroscopia de doble balón con biopsia de íleon. Se informó que a nivel del colon presentaba una colitis crónica inespecífica y en el íleon una hiperplasia linfoide. El estudio histopatológico confirmó la colitis inespecífica y una eosinofilia moderada en íleon. Se indicó tratamiento con prednisona y mesalazina con mejoría notable del cuadro clínico, fue dado de alta con el diagnóstico de una enteritis eosinofílica, con seguimiento por consulta externa de gastroenterología. En la actualidad se mantiene asintomático (AU).

ABSTRACT Eosinophilic enteritis is the presence of eosinophilic infiltrates in the digestive tract. Currently it is a rare entity than could be located in any region of the digestive tract. Its etiopathogenesis is unknown and is related, in many cases, to antecedents of atopy, Clinical manifestations may vary according to the affected layer. The authors present the case of a patient aged 26 years, with antecedents of having undergone an acute appendicitis surgery in 2011. He arrived to Emergency referring intense, steady pain in the right iliac fossa, accompanied by a 39o C fever, chills and dyspeptic symptoms. He was admitted and a video endoscopy was carried out. An exudative erythematous antral gastritis was observed with a positive test for Helicobacter pylori. In addition, video laparoscopy also showed the presence of thin, lumped loops and no-recent adherences in the right iliac fossa. In spite of the applied treatment, the patient continued with pain and fever, so the doctors indicated a double-balloon enteroscopy with ileum biopsy. It was informed an unspecific chronic colitis at the colon level and a lymphoid hyperplasia in the ileum. The histopathologic study confirmed the unspecific colitis and a moderate eosinophilia in the ileum. A prednisone and mesalazine treatment was indicated with a notable improvement of the clinical characteristics. The patient was discharged diagnosed with a eosinophilic enteritis and follow-up in out-patient consultation of Gastroenterology. Currently he keeps on asymptomatic (AU).

Colitis por cytomegalovirus en trasplante renal: Presentación de 2 casos / Cytomegalovirus colitis in kidney transplant recipients: presentation of two cases

Resumen La infección por citomegalovirus (CMV) es un riesgo latente en pacientes inmunocomprometidos por trasplante renal, asociándose con aumento del riesgo de rechazo del injerto y muerte. La infección por CMV puede manifestarse como infección activa o enfermedad por CMV (dividida en síndrome por CMV y enfermedad tisular invasiva por CMV). Presentamos dos casos de enfermedad tisular invasiva por CMV, la cual se presentó entre los primeros siete meses posteriores al trasplante. Ambos casos eran D+/R-; recibieron agentes depletores de linfocitos y micofenolato y profilaxis para CMV de acuerdo con las guías de práctica clínica. Los criterios para enfermedad por CMV incluyeron replicación viral detectable en sangre, hallazgos endoscópicos clásicos y confirmación histopatológica. Hacemos énfasis en la necesidad de identificar los factores de riesgo para la infección por CMV en pacientes con trasplante renal, especialmente el seroestatus donador/receptor y los medicamentos inmunosupresores. Aun cuando las guías de práctica clínica sugieren de uno a tres meses de profilaxis para CMV en casos de alto riesgo, debería considerarse la profilaxis extendida y el ajuste de los medicamentos inmunosupresores.

Abstract Cytomegalovirus infection is a latent risk among immunocompromised kidney transplant recipients and is associated with increased risk of allograft failure and death. CMV infection can manifest as active infection or as CMV disease (divided in CMV syndrome and CMV tissue-invasive disease). We present two cases of tissue invasive CMV disease, presenting within 7 months after kidney transplantation. Both cases were D+/R-, received lymphocyte-depleting agents and mycophenolate, and both received CMV prophylaxis according to General Practice Guidelines. CMV disease criteria included detectable viral replication in blood, classical endoscopic findings and histopathological confirmation. We emphasize the need of categorical identification of CMV infection risk factors among kidney transplantation recipients, specially CMV donor/recipient serostatus and immunosuppressive medication. Although clinical practice guidelines suggest 1 to 3 months CMV prophylaxis in high-risk cases, extended prophylaxis and immunosuppressive medication adjustment should be considered.

Colitis actínica de localización cecal. Serie de casos / Actinic colitis of cecal location. Number of cases

Resumen Por definición, la colitis actínica incluye cambios inflamatorios de la mucosa colorrectal secundarios a radioterapia en cercanía a la región tratada. La localización más frecuente es el recto y la indicación más común de radioterapia corresponde a neoplasias de la región pélvica incluidos el recto, la próstata y el cérvix. Se estima que hasta la mitad de los pacientes que reciben radiación pélvica llega a desarrollar síntomas gastrointestinales asociados. Se presentan dos pacientes con metástasis óseas sacroilíacas y pélvicas secundarias a adenocarcinoma de próstata que recibieron radiación en la región lumbosacra y pélvica, ambos pacientes presentaron episodios de deposiciones con sangre que iniciaron tempranamente posterior a la radioterapia. La colonoscopia mostró eritema y ulceración. En el estudio histopatológico se observó un patrón de colitis isquémica, con núcleo y citomegalia, estroma fibroso con cambios reactivos y abundante infiltrado inflamatorio neutrofílico. Estos hallazgos son característicos de la colitis actínica aguda; sin embargo, la localización cecal no ha sido frecuentemente reportada. Aunque al ser el ciego y el íleon terminal móviles de localización pélvica, se convierten en un factor de riesgo para que estos segmentos anatómicos sean susceptibles al impacto directo de la radioterapia. Esta condición, en la fase aguda, es autolimitada y se suele resolver con medidas de soporte. Es indispensable que el personal involucrado en el manejo de estos pacientes conozca esta entidad y los posibles diagnósticos diferenciales.

Abstract By definition, actinic colitis includes inflammatory changes of the colorectal mucosa secondary to radiation therapy of nearby tissue. The most frequent location is the rectum, and the most common indication for radiation therapy is a pelvic region neoplasm in the rectum, prostate or cervix. It is estimated that up to half of patients receiving pelvic radiation go on to develop associated gastrointestinal symptoms. We present two patients with sacroiliac and pelvic bone metastases secondary to prostate adenocarcinoma who received radiation in the lumbosacral and pelvic region. Both patients developed bloody stools soon after radiation therapy. Colonoscopy showed erythema and ulceration, and histopathology found a pattern of ischemic colitis with nucleus and cytomegalovirus infection, fibrous stroma with reactive changes and abundant inflammatory infiltration of neutrophils. These findings are characteristic of acute actinic colitis, but the cecal location has not been reported frequently. Nevertheless, the pelvic location of the cecum and the terminal ileum puts these anatomical segments at risk from the direct impact of radiation therapy. In the acute phase, this condition, is self-limiting and usually resolves with support measures. It is essential that the personnel involved in the management of these patients be aware of this entity and its possible differential diagnoses.

Obesity and helicobacter pylori infection in adults with non specific colitis / Obesidade e infecção por Helicobacter pylori em adultos com colite inespecífica

ABSTRACT Background Non specific colitis is defined as inflammatory condition of the colon that when examined microscopically lacks any characteristic features of any specific form of colitis and is commonly seen in reports of colonoscopy biopsies. There are many factors that cause it like obesity and H pylori. Aim of the study To determine the association of obesity and H pylori as contributory factors to this disease. Patients and methods This is a case-controlled study was carried out in Al-Kindy College of Medicine from January 2017 to June 2018. Sixty individuals were included; forty of them had non specific colitis. The rest were healthy control group. Demographic information's were taken like age and sex. Anthropometric measurement like weight in kilograms (kg), height in meters (m), waist circumference in centimeters (cm), and body mass index was done. H pylori IgG was done to both groups. Results Study results indicated that this disease was more common with increasing age, there is a significant difference (p = 0.002) between patients (48.12 ± 1.50) and control group (41.00 ± 1.10) regarding age. BMI of the patients is significantly higher in patients group (29.21 ± 0.41; p = 0.000) than the control (22.23 ± 0.41). Patients with non specific colitis showed significant (p = 0.000) increased in H pylori infection 33 (82.5%) compared with control group 2 (10%). Conclusions Obesity and infection withH pylori may predispose to non specific colitis.

RESUMO Introdução Colite inespecífica é uma condição inflamatória do cólon que microscopicamente não apresenta características de qualquer forma específica de colite; é comumente observada em relatórios patológicos de biópsias de colonoscopia. Vários fatores podem causar colite inespecífica, dentre os quais obesidade e infecção por H. pylori. Objetivo do estudo Determinar o possível papel da obesidade e H. pylori como fatores contribuintes para esta doença. Pacientes e Métodos Este foi um estudo caso-controle, realizado na Al-Kindy College of Medicine entre janeiro de 2017 e junho de 2018. Um total de 60 indivíduos foram incluídos, 40 dos quais apresentavam colite inespecífica. Os demais foram incluídos no grupo de controles saudáveis. Foram coletadas informações demográficas, como idade e sexo. Medidas antropométricas, como peso (kg), altura (m), circunferência da cintura (cm) e índice de massa corporal, também foram coletadas. Nos dois grupos, foi feita serologia para H. pylori (IgG) Resultados Os presentes resultados indicaram que esta doença era mais comum entre pacientes de idade mais avançada; observou-se uma diferença significativa p = 0,002 entre os pacientes 48,12 ± 1,50 e o grupo controle 41,00 ± 1,10 quanto à idade. O IMC foi significativamente maior no grupo de pacientes 29,21 ± 0,41; p = 0,000 do que no grupo controle 22,23 ± 0,41. A infecção por H. pylori foi significamente mais frequentemente observada no grupo de pacientes (33; 82,5%) em comparação ao grupo controle (2; 10%; p = 0,000. Conclusões A obesidade e a infecção por H. pylori podem predispor à colite inespecífica.

Efficacy of Baccharis dracunculifolia in the treatment of diversion colitis in rats / Eficácia da Baccharis dracunculifolia no tratamento da colite de desuso em ratos

Abstract Rationale: Disuse colitis is frequent in our country and the most effective treatment is high cost and there is a need for effective and low cost therapy. Objective: To evaluate the efficacy of Baccharis dracunculifolia (field rosemary) in the treatment of exclusion colitis in rats. Method: Eighteen Wistar rats were anesthetized and submitted to colostomy; they were then distributed into two groups: Control Group, receiving intrarectal saline infusion (n = 8) and Group BD receiving intrarectal infusion ofBaccharis dracunculifolia extract (n = 10); after 21 days of treatment they were euthanized, the intestinal segment excluded from intestinal transit was resected and submitted to histopathological study, classifying the degree of inflammation and degree of vascular congestion from 0 to 3. Results: Mean inflammation was 2.7 in Control Group versus 2.1 in BD Group (p = 0.049), while mean vascular congestion was 2.3 and 2, respectively, in Control and BD groups (p = 0.1642). Conclusion: Intra-rectal infusion ofBaccharis dracunculifolia extract significantly minimized the inflammatory process in the exclusion colitis of rats submitted to colostomy, without altering the degree of vascular congestion.

Resumo Racional A colite de desuso é frequente em nosso meio e o tratamento de maior eficácia é de alto custo, havendo necessidade de se encontrar uma terapêutica eficaz e de baixo custo. Objetivo Avaliar a eficácia da Baccharis dracunculifolia (alecrim-do-campo) no tratamento da colite de exclusão em ratos. Método Utilizou-se 18 ratos Wistar, os quais foram anestesiados e submetidos à colostomia; em seguida distribuídos em 2 grupos: Grupo Controle, recebendo infusão intrarretal de solução salina (n = 8) e Grupo BD, recebendo infusão intrarretal de extrato de Baccharis dracunculifolia (n = 10); após 21 dias de tratamento foram submetidos a eutanásia, o segmento intesinal excluso de trânsito intestinal foi ressecado e submetido a estudo histopatológico classificando-se o grau de inflamação e grau de congestão vascular de 0 a 3. Resultados Verificou-se média de inflamação 2,7 no Grupo Controle vs. 2,1 no Grupo BD (p = 0,049), enquanto as médias de congestão vascular foram 2,3 e 2, respectivamente, nos grupos controle e BD (p = 0,1642). Conclusão A infusão intrarretal do extrato de Baccharis dracunculifolia minimizou significantemente o processo inflamatório na colite de exclusão de ratos submetidos à colostomia, sem alterar o grau de congestão vascular.

Factores de riesgo asociados a la enfermedad inflamatoria intestinal en ancianos / Risk factors associated with the intestinal inflammatory disease in elderly

Introducción: Las enfermedades inflamatorias intestinales representan un importante problema de salud pública por el aumento en su prevalencia e incidencia a nivel mundial. Objetivo: Identificar los principales factores de riesgo asociados a la enfermedad inflamatoria intestinal en ancianos. Métodos: Se realizó una investigación analítica, de casos y controles, de pacientes de 60 y más años, con diagnóstico y confirmación histológica de alguna enfermedad inflamatoria intestinal, ingresados en el Servicio de Medicina del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, durante el 2015. El grupo de estudio estuvo conformado por 61 pacientes y el de control por 122 integrantes (2 por cada caso), seleccionados de los consultorios de procedencia de los afectados. En el análisis estadístico se calculó el porcentaje para las variables cualitativas y, a fin de comprobar la existencia de asociación, se aplicó la prueba de independencia de la Χ2, con 95 % de confiabilidad. Cada variable se analizó calculando la oportunidad relativa, con intervalos límite de confianza superior e inferior. Resultados: Se obtuvo una asociación causal de 5,4 veces más posibilidades de padecer alguna enfermedad inflamatoria intestinal si estaba presente el antecedente familiar de colitis. Asimismo, existió una asociación significativa (p<0,05) entre el antecedente familiar de enfermedad de Crohn y la enfermedad inflamatoria intestinal (9,8 %), y fue 9,7 veces más posible que apareciera algún trastorno inflamatorio de los intestinos si se consumían alimentos inadecuados. Conclusiones: Los factores de riesgo mayormente relacionados con la enfermedad inflamatoria intestinal fueron los antecedentes familiares de colitis y de enfermedad de Crohn, así como el consumo inadecuado de alimentos, el uso prolongado de antibióticos y el tabaquismo.

Introduction: The intestinal inflammatory diseases represent an important problem of public health due to the increase in their prevalence and incidence worldwide. Objective: To identify the main risk factors associated with the intestinal inflammatory disease in elderly. Methods: An analytic cases and controls investigation of 60 years and over patients, with diagnosis and histological confirmation of some intestinal inflammatory disease was carried out. They were admitted to the Medicine Service of Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba, during 2015. The study group was conformed by 61 patients and the control group by 122 members (2 for each case), belonging to the family doctor´s office of the affected patients. In the statistical analysis the percentage for the qualitative variables was calculated and, in order to check the existence of any association, the chi-square test was implemented, with 95 % of confidence. Each variable was analyzed calculating the relative opportunity, with upper and lower limit intervals of confidence. Results: There was a causal association of 5.4 times more possibilities of suffering some intestinal inflammatory disease if the family history of colitis was present. Also, a significant association existed (p <0.05) between the family history of Crohn disease and the intestinal inflammatory disease (9.8 %), and it was 9.7 times more possible that some inflammatory disorder of the bowels appeared if inadequate foods were eaten. Conclusions: The risk factors mostly related to the intestinal inflammatory disease were the family history of colitis and Crohn disease, as well as the inadequate consumption of foods, the long use of antibiotics and nicotine addiction.

Avaliação da fadiga em pessoas com doença inflamatória intestinal atendidas em um ambulatório especializado / Fatigue assessment in people with inflammatory bowel disease attended in a specialized outpatient clinic

Introdução: a fadiga é um dos sintomas da doença inflamatória intestinal (DII), presente tanto nas fases ativa quanto de remissão da doença. Objetivos: avaliar a fadiga em pessoas com DII atendidas em um ambulatório especializado; descrever o perfil sociodemográfico e clínico; identificar a gravidade, frequência e impacto da fadiga nas atividades diárias (AD) e verificar possíveis associações e correlações. Métodos: estudo observacional, transversal, com abordagem quantitativa realizado no ambulatório de atendimento à pacientes com DII em um hospital público de São Paulo, em setembro e outubro de 2019, aprovado por Comitê de Ética. A amostra foi constituída por 137 pacientes. Foram utilizados 4 instrumentos: Mini Exame do Estado Mental, Dados Sociodemográficos e Clínicos, Inventário de Depressão de Beck e Inflammatory Bowel Disease Fatigue Scale (IBD-F), validado e adaptado para o Brasil. A análise dos dados foi realizada através de estatística descritiva, testes de hipótese Mann-Whitey, Brunner- Munzel, Kruskal-Wallis, test t, qui-quadrado, Exato de Fisher e ANOVA, teste de correlação de Pearson e Kendalls, considerando o nível de significância de 5%. A consistência interna do instrumento IBD-F foi obtida através do Alpha de Cronbach. Resultados: Dos 137 pacientes, a maioria era do sexo feminino 82 (59,9%), idade média de 46,1 (DP=14,1) anos, 92 (67,2%) tinham Doença de Crohn (DC) e 45 (32,9%) tinham Retocolite Ulcerativa (RCU). A maioria (109/79,6%) informou sentir fadiga, com média de tempo de 24 meses (DP=66,1). A gravidade e frequência da fadiga apresentaram média de 7 pontos (0-20) e o impacto da fadiga nas AD, 15 (0-120). As mulheres apresentaram maiores médias de fadiga tanto para a gravidade e frequência (p = 0,002), quanto para o impacto da fadiga nas AD (p < 0,001). Pacientes com DC em atividade apresentaram maiores médias de gravidade, frequência e impacto nas AD (p < 0,001). Pacientes com RCU Moderada e Grave, também apresentaram maiores médias de gravidade, frequência e impacto da fadiga nas AD (p= 0,003; p= 0,001 respectivamente). Pacientes em uso de imunossupressor apresentaram menores médias de gravidade e frequência da fadiga (p = 0,05). A gravidade e frequência da fadiga são maiores quando a DII se manifesta na pele (p=0,008), visão (p=0,046) e sistema ósseo (p= 0,015), assim como o impacto da fadiga nas AD é maior quando a DII se manifesta na pele (p= 0,006), visão (p= 0,009) e vias urinárias (p= 0,036). Houve correlação moderada, forte e positiva entre a depressão e a gravidade, frequência e impacto da fadiga nas AD (r = 0,59, p < 0,001; r=0,45, p < 0,001; r = 0,73, p < 0,001 respectivamente). Conclusão: a gravidade, frequência e impacto da fadiga mostram-se relacionadas com o sexo feminino, com a DC em atividade e a RCU em condição Moderada a Grave; quando manifestada na pele e visão, e quando a depressão está presente nos pacientes com DII. Implicações para a prática e a pesquisa: a avaliação e tratamento da fadiga e da depressão são essenciais na assistência integral de pacientes com DII, especialmente em mulheres com doença ativa e com as manifestações descritas. A exploração da correlação entre depressão e fadiga é importante para o estudo de intervenções que diminuam globalmente o sofrimento do paciente.

Introduction: fatigue is one of the symptoms of inflammatory bowel disease (IBD), present both in the active phases and in remission of the disease. Objectives: assess fatigue in people with IBD treated in a specialized outpatient clinic; describe the sociodemographic and clinical profile; identify the severity, frequency and impact of fatigue on daily activities (DA) and verify possible associations and correlations. Methods: an observational, cross-sectional study with a quantitative approach was performed at the outpatient clinic for IBD patients in a public hospital located in São Paulo on September and October 2019. The study was approved by the Research Ethics Committee. The sample consisted of 137 patients. Four instruments were used: Mini Mental State Examination, Sociodemographic and Clinical Data, Beck Depression Inventory and Inflammatory Bowel Disease Fatigue Scale, validated and adapted for Brazil. Data analysis was performed through descriptive statistics, Mann-Whitey hypothesis tests, Brunner-Munzel, Kruskal-Wallis, test t, chi square, Fisher exact test, ANOVA and Pearson and Kendall\'s correlation test, considering the level of significance 5%. The internal consistency of the IBD-F was obtained using Cronbach\'s Alpha. Results: Of the 137 patients, the majority were female 82 (59.9%), mean age of 46.1 (SD=14.1) years, 92 (67.2%) had Crohn\'s disease (CD) and 45 (32.9%) ulcerative colitis (UC). The majority (109/79.6%) reported feeling fatigue, with an average time of 24 months (SD=66.1). The severity and frequency of fatigue showed an average of 7 points (0-20) and the impact of fatigue on DA, 15 (0-120). Women had higher means of fatigue for both severity and frequency (p = 0.002), and for the impact of fatigue on DA (p < 0.001). Patients with working CD had higher means of severity, frequency and impact in DA (p < 0.001). In patients with UC \"Moderate\" and \"Serious\", severity, frequency and impact in DA were higher (p= 0.003; p= 0.001 respectively). Patients using immunosuppressive had lower means of severity and frequency of fatigue (p = 0.05). The frequency and severity of fatigue is higher when IBD manifests itself on the skin (p=0.008), vision (p=0.046) and bone system (p= 0.015), as well as the impact of fatigue on DA is greater when IBD manifests itself on the skin (p= 0.006), vision (p= 0.009) and urinary tracts (p= 0.036). There was a moderate, strong and positive correlation between depression and the severity, frequency and impact of fatigue in DA (r = 0.59, p < 0.001; r=0.45, p < 0.001; r = 0.73, p < 0.001 respectively). Conclusion: the severity, frequency and impact of fatigue are related to female gender, activity CD and UC in moderate to serious condition; when manifested in the skin and vision, and when depression is present in patients with IBD. Implications for practice and research: the evaluation and treatment of fatigue and depression are specific in the comprehensive care of patients with IBD, especially in women with active disease and with the manifestations described. The exploration of the correlation between depression and fatigue is important for the study of interventions that reduce overall the patient's suffering.