Progression of Inflammatory Bowel Diseases Throughout Latin America and the Caribbean: A Systematic Review.

BACKGROUND & AIMS: The incidence of inflammatory bowel diseases (IBD) is increasing in Latin America. We performed a systematic review to identify clinical and epidemiologic features of IBD in Latin America (including Mexico, Central America, and South America) and the Caribbean. METHODS: We searched MEDLINE, EMBASE, and SciELO databases for clinical or epidemiologic studies of Crohn's disease (CD) or ulcerative colitis (UC) from Latin American and Caribbean countries and territories that reported incidence, prevalence, ratio of UC:CD, IBD phenotype, and treatment, through September 12, 2018. Data were extracted from 61 articles for analysis. RESULTS: The incidence and prevalence of IBD have been steadily increasing in Latin America and the Caribbean. The incidence of CD in Brazil increased from 0.08 per 100,000 person-years in 1988 to 0.68 per 100,000 person-years in 1991-1995 to 5.5 per 100,000 person-years in 2015. The highest reported prevalence of IBD was in Argentina, in 2007, at 15 and 82 per 100,000 person-years for CD and UC, respectively. The ratio of UC:CD exceeded 1 in all regions throughout Latin America and the Caribbean with the exception of Brazil. Treatment with tumor necrosis factor antagonists increased steadily for patients with CD (43.4% of all patients in Brazil were treated in 2014) but less so for patients with UC (4.5% of all patients were treated in 2014). Surgery for IBD decreased with time. In Chile, surgeries were performed on 57.0% of patients with CD and 18.0% of patients with UC during the period of 1990-2002; these values decreased to 38.0% and 5.0%, respectively, during the period of 2012-2015. In Peru, 6.9% of patients with UC received colectomies in the period of 2001-2003 and 6.2% in 2004-2014. CONCLUSIONS: In a systematic review, we found the incidence of IBD to be increasing throughout Latin America and the Caribbean. Population-based epidemiology studies are needed to evaluate the increase in IBD in these regions, which differ from other global regions in climate, culture, demographics, diet, healthcare delivery and infrastructure, and socioeconomic status.

Desarrollo de infección tuberculosa latente y efectos adversos de la isoniazida durante tratamiento con biológico por enfermedad de Crohn / Development of latent tuberculosis and adverse effects with isoniazid during biologist therapy´s in Crohn´s disease / Desenvolvimento de tuberculose latente durante e efeitos adversos da isoniazida o tratamento com biológicos para a doença de Crohn

Los fármacos anti factor de necrosis tumoral alfa (TNF-α) bloquean una de las citoquinas implicadas en la patogénesis de la Enfermedad Inflamatoria intestinal (EII). Su uso se relaciona con aumento de tuberculosis (TB), por lo que el despistaje previo es obligatorio. En la infección tuberculosa latente (ITBL) se utiliza isoniazida como quimioprofilaxis, fármaco que no se encuentra libre de reacciones adversas. Se presenta y discute el caso de una paciente con reacción adversa en piel secundaria al uso de isoniazida.

Anti-tumor necrosis factor alfa drugs are responsible for blocking one of the cytoquines implicated on inflammatory bowel disease pathogenesis. Its use has been linked to an increase in tuberculosis cases which is why screening before starting treatment is mandatory. Latent tuberculosis is treated with isoniazid as chemoprophylaxis although its use may provoke adverse effects. A case is presented of a patient with skin adverse reaction due to the use of isoniazid.

Os medicamentos anti factor de necrose tumoral alfa (TNF-α ) bloqueiam uma das citocinas envolvidas na patogénese da doença inflamatória intestinal (DII). A sua utilização está associada com um aumento da tuberculose (TB), de modo que a despistagem anterior dessa doença é necessária. Na TB latente, frequentemente se utiliza a isoniazida é usado como quimioprofilaxia, uma droga que não está livre de reações adversas. Apresentamos e discutimos o caso de uma paciente com reação adversa na pele secundária ao uso da isoniazida.

Manejo del paciente con constipación / Managing the constipated patient

El estreñimiento es un problema común. La mayoría de las personas resolverá el problema por si mismo, sin embargo hay un porcentaje que no lo logran y requieren de ayuda médica. Sigue siendo un reto para el médico seleccionar quienes se beneficiarán de estudios para excluir enfermedad orgánica, de estudios específicos para evaluar el mecanismo fisiopatológico implicado, y cuál es el mejor tratamiento para cada paciente. En este capítulo se revisan los aspectos más relevantes para el manejo de pacientes con estreñimiento funcional.

Constipation is a common problem. Most people solve the problem by itself, but there is a percentage who do not succeed and require medical help. It remains a challenge for the physician to select those who will benefit from studies to exclude organic disease, specific studies to evaluate the physiological mechanism involved, and what is the best treatment for each patient. In this chapter we review the most relevant aspects for the management of patients with functional constipation.

Incidence of inflammatory bowel disease in five geographical areas of Uruguay in the biennial 2007-2008.

INTRODUCTION: The incidence of inflammatory bowel disease (IBD) is different according to the geographical areas. No data on the incidence of IBD in Uruguay are available. OBJECTIVE: To determine the incidence of IBD, ulcerative colitis (UC) and Crohn's disease (CD), in five areas of Uruguay and to compare the results with those from other geographical regions. MATERIAL AND METHOD: A prospective study was performed in five areas of Uruguay during 2007-2008. The study population included 645,695 inhabitants. Multiple independent sources were used for the uptake of cases. Patients older than 14 years and living in the selected areas were included only after reviewing their medical history. Confirmed IBD was defined by a standard protocol after one year of follow up. RESULTS: A total of 34 cases were diagnosed in the study period, 29 UC and 5 CD. Crude incidence rate for IBD was 2.63 per 100,000 inhabitants/year, 2.25 and 0.39 for UC and CD, respectively. Adjusted rates were 4.26 per 100,000 inhabitants/year for UC and 0.74 per 100,000 inhabitants/year for CD. The UC/CD ratio was 5.8. The average age for IBD was 40.7 years. No statistically significant differences were found between UC and CD by age (P = 0.267) or gender (P = 0.489). CONCLUSIONS: Incidence rates of IBD place Uruguay in the regions of low incidence. As it has been described in low-incidence countries, UC is more common than CD. This study establishes a precedent to follow the evolution of IBD epidemiology in Uruguay.

[Clinical characteristics of patients with inflammatory bowel disease and thromboembolic events]. / Caracteristicas clinicas de pacientes con enfermedad inflamatoria intestinal y enventos tromboembólicos.

OBJECTIVE: To determine the clinical characteristics of patients with thromboembolic events (TEE) included in the National Register of Inflammatory Bowel Diseases of Uruguay (RNEII). MATERIAL AND METHODS: From the RNEII database of 515 patients, an analysis of case series was made. Medical records of 23 patients with diagnosis of ETE were reviewed Image studies were required for diagnosis of deep thrombosis, while superficial thromboflebitis diagnosis was clinical. RESULTS: Eight patients who did not meet the inclusion criteria were excluded. Of the remaining fifteen patients (2.9%), 11 had ulcerative colitis (CUC) and 4 Crohn's disease (CD). The mean age was 42.1 years (range 12 to 64 years). 40% presented this complication before the 40 years old and the mortality caused by TEE was 6.7%. 53.3 of cases had active disease when the TEE presented. 63.6% of CUC patients developed an extensive colitis, while 100% of patients with CD had colonic involvement. Another extraintestinal manifestation was seen in 46.7% of patients, specially in the CUC group. Deep vein thrombosis was the most frequent TEE (66.7%). 40% of patients repeated more than one TEE episode. CONCLUSIONS: TEE in inflammatory bowel disease are an important morbimortality factor because they can occur in young people, be recurrent and affect unusual vascular sites. TEE may be observed in both active and quiescent disease. They have been more frequently found in patients with extensive disease, colonic involvement and other extraintestinal manifestations.

[The Latin-American Consensus on Chronic Constipation]. / Consenso Latinoamericano de Estreñimiento Crónico.

The Latin-American Consensus on Chronic Constipation aimed to establish guidelines to improve the identification, diagnosis and treatment of this disorder in the region. Two coordinators and an honorary coordinator established the process and the topics to be discussed, based on a systematic review of the literature published in the previous 10 years, since 1995. Seventeen members participated with the support of their local gastroenterology societies. The members reviewed the different subjects based on the levels of evidence and grades of recommendation; the topics were then discussed in a plenary session. A written report was drafted and the coordinators prepared the final declarations to be submitted to a vote by all the members in October 2006. The consensus concluded that chronic constipation has an estimated prevalence of 5-21% in the region, with a female-to-male ratio of 3:1. Among individuals with constipation, 75% use some type of medication, with more than 50% using home remedies. A diagnosis based on Rome Criteria was recommended and diagnostic testing only in persons older than 50 years or with alarm symptoms. The use of barium enema as an initial investigation was recommended only in countries with a high prevalence of idiopathic megacolon or Chagas' disease. Recommendations on treatment included an increase in dietary fiber of up to 25-30 g/day (grade C). No evidence was found to recommend measures such as exercise, increased water intake, or frequent visits to the toilet. Fiber supplements such as Psyllium received a grade B and pharmacological treatments such as tegaserod and polyethylene glycol, both grade A. There was insufficient evidence to recommend lactulose, but the consensus did not disadvise its use when necessary. Complementary investigations such as colonic transit followed by anorectal manometry and defecography were only recommended to rule out colonic inertia and/or obstructive defecation in patients not responding to treatment. Biofeedback was recommended (grade B) for those with pelvic dyssynergia.

Características clínicas de presentación y seguimiento de una cohorte de 121 pacientes con colitis ulcerosa crónica en Uruguay / Presentation and follow up characteristics of 121 patients with chronic ulcerative colitis in Uruguay

Objetivo: describir las características clínicas y evolutivas de una cohorte de pacientes con colitis ulcerosa crónica (CUC). Material y método: se analizó en forma retrospectiva y prospectiva una cohorte de 121 pacientes con diagnóstico de CUC que iniciaron su enfermedad entre 1951 y 2003, procedentes de la asistencia pública y privada, de Montevideo y del interior, asistidos por los autores en al menos una oportunidad al 30 de junio de 2003. Con los datos de las historias clínicas se confeccionó un registro que incluyó: edad de inicio, topografía, severidad, manifestaciones extraintestinales, requerimiento de cirugía y mortalidad. Resultados: 53,7 por ciento fueron mujeres y 46,3 por ciento hombres. La edad mínima al inicio fue de 3 años y la máxima de 76, con una mediana de 32. El compromiso fue: 18,8 por ciento recto, 22,2 por ciento rectosigmoide, 19,8 por ciento colitis izquierda y 38,5 por ciento pancolitis. El debut fue leve en 47,1 por ciento, moderado en 31,4 por ciento y severo en 18,2 por ciento (p=0,0001). Presentaron manifestaciones extraintestinales 7,4 por ciento y antecedentes familiares de CUC 4,1 por ciento. Requirieron cirugía diez pacientes (8,3por ciento), con una mediana entre el inicio de la enfermedad y ésta de 5,5 años, siendo en 70 por ciento por severidad del empuje. El tiempo medio de seguimiento fue 10,5 años. Desarrollaron cáncer de colon tres pacientes (2,5 por ciento). Conclusiones: esta cohorte presentó bajo requerimiento de cirugía, la que se asoció a severidad del empuje y ocurrió fundamentalmente en el primer año de enfermedad, y baja ocurrencia de cáncer y mortalidad.

Características clínicas de presentación y evolutivas de una cohorte de 48 pacientes con enfermedad de Crohn en Uruguay / Presentation and progression characteristics in a cohort of 48 patients with Crohn disease in Uruguay

Objetivo: describir las características clínicas y evolutivas de una cohorte de pacientes con enfermedad de Crohn (EC). Material y método: se analizó en forma retrospectiva y prospectiva una cohorte de 48 pacientes con EC, que iniciaron su enfermedad entre 1951 y 2003, procedentes de la asistencia pública y privada, de Montevideo y del interior, asistidos por los autores en al menos una oportunidad al 30 de junio de 2003. Con los datos de las historias clínicas se confeccionó un registro con las variables: sexo, edad de inicio, antecedentes familiares de enfermedad inflamatoria intestinal (EII), topografía, enfermedad perianal, manifestaciones extraintestinales, resección intestinal y mortalidad. Resultados: 50 por ciento fueron mujeres y 50 por ciento hombres. La edad mínima fue de 4 años y la máxima de 89, con una mediana de 25; 43,7 por ciento tuvo compromiso de colon, 23 por ciento de íleon, 16,7 por ciento de íleon-colon y 16,7 por ciento proximal al íleon; 52,2 por ciento presentó enfermedad perianal. Tenían antecedentes familiares de EII cinco pacientes (10,4 por ciento), y presentaron manifestaciones extraintestinales siete (14,6 por ciento), siendo más de 70 por ciento articulares. La media de seguimiento fue de 12,3 años. Requirieron resección intestinal 31,2 por ciento de los pacientes (20 por ciento requirió más de una), con una mediana entre el inicio de la EC y la cirugía de cuatro años, no habiendo diferencia estadísticamente significativa respecto a la topografía. Fallecieron tres pacientes. Conclusiones: en esta cohorte, la afectación de colon y perianal fue mayor a lo esperado, en cambio el requerimiento de resección intestinal y la morbimortalidad menor, aunque no despreciable considerando el grupo etario afectado.