Development of the Nursing Assessment Tool for the Patient With Inflammatory Bowel Disease.

This study aims to develop and validate a nursing assessment tool for patients with inflammatory bowel disease. In this cross-sectional descriptive study using a quantitative approach, nurses were invited to participate. The Delphi technique was used to obtain a consensus among expert nurses. Descriptive analysis was used for each item on the nursing assessment tool. Overall, 345 nurses were identified; 32 were eligible as experts and 13 validated the consultation. Of the 13 expert nurses, most were female (11, 84.62%), their mean age was 46.36 ± 10.59 years, eight (61.54%) graduated from public institutions, and eight (61.54%) had a master's degree. The initial version had 106 items, which was reduced to 95 items. The content of four domains (identification, health-disease profile, psychobiological needs, and physical examination) was validated in two rounds about the content with more than 80% of agreement. Two domains (sociodemographic data and health conditions, and personal cares) were validated in the first round with more than 80% of agreement. All domains were validated for their appearance during the first round with more than 80% of agreement. The Nursing Assessment Tool for Patients with Inflammatory Bowel Disease (IBD) had a considerable level of agreement regarding content and appearance validation in all dimensions.

Clinical factors associated with severity in patients with inflammatory bowel disease in Brazil based on 2-year national registry data from GEDIIB.

The Brazilian Organization for Crohn's Disease and Colitis (GEDIIB) established a national registry of inflammatory bowel disease (IBD). The aim of the study was to identify clinical factors associated with disease severity in IBD patients in Brazil. A population-based risk model aimed at stratifying the severity of IBD based on previous hospitalization, use of biologics, and need for surgery for ulcerative colitis (UC) and Crohn's Disease (CD) and on previous complications for CD. A total of 1179 patients (34.4 ± 14.7y; females 59%) were included: 46.6% with UC, 44.2% with CD, and 0.9% with unclassified IBD (IBD-U). The time from the beginning of the symptoms to diagnosis was 3.85y. In CD, 41.2% of patients presented with ileocolic disease, 32% inflammatory behavior, and 15.5% perianal disease. In UC, 46.3% presented with extensive colitis. Regarding treatment, 68.1%, 67%, and 47.6% received biological therapy, salicylates and immunosuppressors, respectively. Severe disease was associated with the presence of extensive colitis, EIM, male, comorbidities, and familial history of colorectal cancer in patients with UC. The presence of Montreal B2 and B3 behaviors, colonic location, and EIM were associated with CD severity. In conclusion, disease severity was associated with younger age, greater disease extent, and the presence of rheumatic EIM.

Clinical and Psychological Factors Associated with Addiction and Compensatory Use of Facebook Among Patients with Inflammatory Bowel Disease: A Cross-Sectional Study.

BACKGROUND: Inflammatory bowel diseases are chronic conditions characterized by incapacitating symptoms, which can compromise patient's quality of life and social interaction. As social media use is continuously increasing and Facebook is one of the most accessed social media worldwide, this study aimed to evaluate the use of Facebook and identify clinical and psychological factors associated with addiction and compensatory use among patients. METHODS: This case-control study enrolled 100 outpatients and 100 healthy individuals, who were classified into the patient and control groups, respectively. Facebook use was evaluated using the questionnaire Psycho-Social Aspects of Facebook Use (PSAFU). The IBD Questionnaire and the 36-Item Short-Form Health Survey (SF-36) were used to measure Health-related quality of life. Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale; self-esteem, using the Rosenberg Self-Esteem scale. RESULTS: The patient group included 54 patients with Crohn's disease and 46 with ulcerative colitis. Facebook use was similar between the patient and control groups in all evaluated aspects (p=0.21). In the patient and the control groups, the compensatory use of Facebook was directly related to the symptoms of depression (patients: R = 0.22; p = 0.03; controls: R = 0.34; p = 0.0006) and inversely related to self-esteem scale (patients: R = -0.27; p = 0.006; controls: R = -0.37; p = 0.0001). Facebook addiction showed an inverse correlation with self-esteem (patients: R = -0.32; p = 0.001; controls: R = -0.24; p = 0.02) and quality of life (patients: IBDQ score, R = -0.30; p = 0.003; controls: SF-36 score, R = -0.29; p = 0.004). CONCLUSION: The use of Facebook was not different between study groups. Psychological aspects such as depression and low self-esteem were associated with the compensatory use of Facebook in both groups, which may be related to unsatisfactory personal aspects of social interaction.

Management of inflammatory bowel disease and serum level of infliximab in newborn exposed to anti-TNF therapy during pregnancy: Case report and literature review.

RATIONALE: Heightened inflammatory bowel disease (IBD) activity during pregnancy is associated with higher rates of preterm birth, miscarriage, and low birth weight. Therefore, its adequate treatment is essential, considering the risk-benefit of medication use. Although previous literature has described the management of IBD during pregnancy, few studies have assessed the pharmacokinetics of IBD drugs in the newborn. In this case report, we describe the management of ulcerative colitis during pregnancy and discuss the benefits of checking serum levels of infliximab in newborns exposed to the medication during pregnancy. PATIENT CONCERN: A 37-year-old patient with ulcerative colitis in clinical and endoscopic remission had been undergoing treated with infliximab since 2008. The patient became pregnant in 2018. DIAGNOSIS AND INTERVENTION: Infliximab medication was discontinued at the 29th week of pregnancy. OUTCOMES: The pregnancy was uneventful, and the levels of infliximab in the umbilical cord were >20 µg/dL. Live vaccinations were postponed until the baby was 6 months old, when a new serum drug level proved to be undetectable. LESSONS: Our case suggests that the use of infliximab is safe in pregnancy, and drug discontinuation could be considered from the 24th week of pregnancy onward to reduce placental transfer to the newborn in patients at low risk of relapse. Vaccines with live attenuated organisms should be delayed for at least 6 months or until the serum level of the medication is undetectable.

Small Intestinal Hemangioma: A Case Report.

BACKGROUND Hemangiomas are benign vascular neoplasms that originate from fast-growing embryonic mesodermal tissue and have a proliferation of endothelial cells, which manifest themselves in different forms, locations, and dimensions. Owing to its rarity and similarity of symptoms with other chronic bowel diseases, intestinal hemangioma is a differential diagnosis to be considered in patients presenting with symptoms such as abdominal pain and anemia. CASE REPORT A 46-year-old woman with a history of diffuse abdominal pain and abdominal distension for 20 years presented with a worsening of symptoms in the past year. She denied weight loss or changes in bowel habits or stool appearance. Laboratory investigations showed microcytic hypochromic anemia. Colonoscopy results were normal. A contrast-enhanced abdominal computed tomography scan showed focal and concentric thickening of the small intestine, measuring 8.3 cm, and associated with calcifications, intestinal dilation, mesenteric lymph node enlargement, and vascular dilatation and consistent with infectious granulomatous diseases such as intestinal tuberculosis, carcinoid tumor, Crohn's disease, and lymphoma. The tuberculin skin test resulted in a strong 25-mm reaction. We suspected intestinal tuberculosis or expansive injury, and the patient underwent exploratory laparotomy with visualization of a 4- to 5-cm bluish/blackish vegetating lesion located 220 cm from the Treitz angle. The anatomopathological study showed cavernous hemangioma of the small intestine, measuring 2.6×1.0 cm. The patient recovered well and remained asymptomatic. CONCLUSIONS Although rare, intestinal hemangioma should be on the list of differential diagnoses for chronic intestinal diseases, especially if there is anemia due to coexisting iron deficiency.

Risk factors for ulcerative colitis-associated colorectal cancer: A retrospective cohort study.

Inflammatory bowel disease is associated with an increased risk of colorectal cancer. The study aims to identify the risk factors for ulcerative colitis-colorectal cancer and to perform a survival curve analysis of the outcome.This retrospective cohort study included 254 patients from March 2016 to October 2017. Age, age at diagnosis, follow-up time, smoking status, and family history of colorectal cancer were analyzed as risk factors for colorectal cancer.The mean patient age was 46.6 ±â€Š16.9 years; 5.5% of the patients were smokers and 49.6% had pancolitis. Six patients (2.36%) had colorectal cancer, which was associated with age at diagnosis (odds/hazard ratio 1.059 [95% confidence interval: 1.001-1.121]; P = .04), family history of colorectal cancer (12.992 [1.611-104.7]; P = .02), and follow-up time (0.665 [0.513-0.864]; P = .002). Active smoking was the main identified risk factor, after both logistic (8.477 [1.350-53.232]; P = .02) and Cox proportional-hazards (32.484 [2.465-428.1]; P = .008) regression analysis. The risk of colorectal cancer was 3.17% at 10 years and 4.26% at 20 years of follow-up.Active smoking and family history were identified as risk factors for colorectal cancer. These findings should aid the early identification of patients who require vigorous surveillance, and prevent exposure to risk factors.

Immunosuppression and Malignant Neoplasms: Risk-Benefit Assessment in Patients with Inflammatory Bowel Disease.

BACKGROUND The treatment of inflammatory bowel disease aims to induce and maintain disease remission, avoid complications, and restore quality of life. The treatments include the use of immunosuppressants and biological therapy. Despite the effectiveness of these treatments in controlling disease activity and in limiting complications, there remains an increased risk of developing malignancies. CASE REPORT A 70-year-old male patient with ulcerative colitis who had pancolitis was initially treated with mesalazine. In 2010, the medication was changed to azathioprine due to clinical disease activity. The patient demonstrated clinical and endoscopic response to the medication, but presented recurrent facial lesions identified as non-melanoma skin cancer in 2014, 2015, and 2016. Azathioprine was discontinued and anti-TNF therapy was started, but no satisfactory clinical or endoscopic response was observed. The patient developed hematuria and a ureter tumor was found with subsequent ureteronephrectomy. Moreover, the patient underwent total colectomy with ileostomy as a treatment for refractory ulcerative colitis. CONCLUSIONS Immunosuppressive therapy can facilitate the development of malignant neoplasms, accelerate tumor growth, and favor the onset of metastases. The types of tumors most associated with its use are lymphoproliferative tumors and non-melanoma skin cancer. The benefits of adequate control of inflammatory bowel disease are clear and the use of immunosuppressants should not be limited by these potential adverse outcomes; however, the risk-benefit profile of immunosuppression should always be assessed on a case-by-case basis.

Anti-TNF Exposure during Pregnancy in Crohn's Disease Patients.

Inflammatory bowel disease (IBD) affects young people of reproductive age. Therefore, a broad discussion is needed about the possible disease effects in pregnancy, as well as the risks of fetal exposure to the medications used, especially biological therapy. This study aimed to describe the management of 4 Crohn's disease patients who received anti-TNF therapy during pregnancy and present a literature review. We reported 4 cases composed of young women who became pregnant while receiving anti-TNF agents. The patients presented a satisfactory response to the clinical treatment and the pregnancies progressed without complications. We did not observe maternal or embryonic toxicity, or unfavorable outcomes. The available data point to inflammatory activity as the main risk factor for unfavorable gestational evolution to date, and showed anti-TNF therapy to be safe during pregnancy and breastfeeding. However, the benefits and risks must be discussed with the patient and management decisions should be taken on an individual basis.