SURGICAL MANAGEMENT OF ADULT CROHN'S DISEASE AND ULCERATIVE COLITIS PATIENTS: A CONSENSUS FROM THE BRAZILIAN ORGANIZATION OF CROHN'S DISEASE AND COLITIS (GEDIIB).

BACKGROUND: Despite optimized medical therapy, contemporary risk of surgery in inflammatory bowel diseases (IBD) after 10 years of diagnosis is 9.2% in patients with ulcerative colitis (UC) and 26.2% in Crohn's disease, (CD) in the biological era. OBJECTIVE: This consensus aims to detail guidance to the most appropriate surgical procedures in different IBD scenarios. In addition, it details surgical indications and perioperative management of adult patients with CD and UC. METHODS: Our consensus was developed by colorectal surgeons and gastroenterologists representing the Brazilian Study Group of Inflammatory Bowel Diseases (GEDIIB), with the Rapid Review methodology being conducted to support the recommendations/statements. Surgical recommendations were structured and mapped according to the disease phenotypes, surgical indications, and techniques. After structuring the recommendations/statements, the modified Delphi Panel methodology was used to conduct the voting by experts in IBD surgery and gastroenterology. This consisted of three rounds: two using a personalized and anonymous online voting platform and one face-to-face presential meeting. Whenever participants did not agree with specific statements or recommendations, an option to outline possible reasons was offered to enable free-text responses and provide the opportunity for the experts to elaborate or explain disagreement. The consensus of recommendations/statements in each round was considered to have been reached if there was ≥80% agreement. RESULTS AND CONCLUSION: This consensus addressed the most relevant information to guide the decision-making process for adequate surgical management of CD and UC. It synthesizes recommendations developed from evidence-based statements and state-of-art knowledge. Surgical recommendations were structured and mapped according to the different disease phenotypes, indications for surgery and perioperative management. Specific focus of our consensus was given to elective and emergency surgical procedures, determining when to indicate surgery and which procedures may be the more appropriate. The consensus is targeted to gastroenterologists and surgeons interested in the treatment and management of adult patients with CD or UC and supports decision-making of healthcare payors, institutional leaders, and/or administrators.

Tratamento cirúrgico de pacientes adultos com doença de Crohn e retocolite ulcerativa: um consenso da Organização Brasileira de Doença de Crohn e Colite (GEDIIB) / Surgical management of adult crohn's disease and ulcerative colitis patients: a consensus from the brazilian organization of crohn's disease and colitis (gediib)

ABSTRACT Background: Despite optimized medical therapy, contemporary risk of surgery in inflammatory bowel diseases (IBD) after 10 years of diagnosis is 9.2% in patients with ulcerative colitis (UC) and 26.2% in Crohn's disease, (CD) in the biological era. Objective: This consensus aims to detail guidance to the most appropriate surgical procedures in different IBD scenarios. In addition, it details surgical indications and perioperative management of adult patients with CD and UC. Methods: Our consensus was developed by colorectal surgeons and gastroenterologists representing the Brazilian Study Group of Inflammatory Bowel Diseases (GEDIIB), with the Rapid Review methodology being conducted to support the recommendations/statements. Surgical recommendations were structured and mapped according to the disease phenotypes, surgical indications, and techniques. After structuring the recommendations/statements, the modified Delphi Panel methodology was used to conduct the voting by experts in IBD surgery and gastroenterology. This consisted of three rounds: two using a personalized and anonymous online voting platform and one face-to-face presential meeting. Whenever participants did not agree with specific statements or recommendations, an option to outline possible reasons was offered to enable free-text responses and provide the opportunity for the experts to elaborate or explain disagreement. The consensus of recommendations/statements in each round was considered to have been reached if there was ≥80% agreement. Results and conclusion: This consensus addressed the most relevant information to guide the decision-making process for adequate surgical management of CD and UC. It synthesizes recommendations developed from evidence-based statements and state-of-art knowledge. Surgical recommendations were structured and mapped according to the different disease phenotypes, indications for surgery and perioperative management. Specific focus of our consensus was given to elective and emergency surgical procedures, determining when to indicate surgery and which procedures may be the more appropriate. The consensus is targeted to gastroenterologists and surgeons interested in the treatment and management of adult patients with CD or UC and supports decision-making of healthcare payors, institutional leaders, and/or administrators.

RESUMO Contexto: Apesar da terapia medicamentosa otimizada, o risco contemporâneo de cirurgia nas doenças inflamatórias intestinais (DII) após 10 anos do diagnóstico é de 9,2% em pacientes com retocolite ulcerativa (RCU) e de 26,2% na doença de Crohn (DC) na era biológica. Objetivo: Este consenso visa detalhar as orientações para os procedimentos cirúrgicos mais adequados em diferentes cenários da DII. Além disso, detalha as indicações cirúrgicas e o manejo perioperatório de pacientes adultos com DC e RCU. Métodos: Nosso consenso foi desenvolvido por cirurgiões colorretais e gastroenterologistas representantes da Organização Brasileira de Doença de Crohn e Colite (GEDIIB), com a metodologia de revisão rápida sendo conduzida para respaldar as recomendações. As recomendações cirúrgicas foram estruturadas e mapeadas de acordo com os fenótipos da doença, indicações cirúrgicas e técnicas. Após a estruturação das recomendações, a metodologia modificada do Painel Delphi foi utilizada para conduzir a votação por especialistas em cirurgia de DII e gastroenterologia. Esta consistiu em três rondas: duas com recurso a uma plataforma de votação online personalizada e anônima e uma reunião presencial. Sempre que os participantes não concordavam com afirmações ou recomendações específicas, era oferecida uma opção de delinear possíveis razões para permitir respostas em texto livre e dar a oportunidade para os especialistas elaborarem ou explicarem a discordância. O consenso de recomendações/declarações em cada rodada foi considerado alcançado se houve concordância ≥80%. Resultados e conclusão Este consenso abordou as informações mais relevantes para orientar o processo de tomada de decisão para o manejo cirúrgico adequado de DC e RCU. Ele sintetiza recomendações desenvolvidas a partir de evidências e conhecimento de alto nível. As recomendações cirúrgicas foram estruturadas e mapeadas de acordo com os diferentes fenótipos da doença, indicações para cirurgia e manejo perioperatório. O foco específico do nosso consenso foi dado aos procedimentos cirúrgicos eletivos e de emergência, determinando quando indicar a cirurgia e quais procedimentos podem ser os mais adequados. O consenso é direcionado a gastroenterologistas e cirurgiões interessados no tratamento e manejo de pacientes adultos com DC ou RCU e apoia a tomada de decisões de pagadores de saúde, líderes institucionais e/ou administradores.

Prevention of HIV infection among migrant population groups in Northeast Brazil

A infecção pelo HIV entre pobres, mulheres e populações migrantes do interior do Nordeste Brasileiro vem crescendo. As diferentes configurações, crenças e representações e formas de organização do comportamento, associadas à capacidade de seguir adequadamente medidas de prevenção, foram o foco desta investigação. Os participantes foram localizados em bairros com altas taxas de migração através do Programa Saúde da Família em Fortaleza e Teresina. Empregou-se a metodologia qualitativa nesta investigação. Vários sistemas de crenças, valores e organização social da sexualidade desta população representam obstáculos à prevenção da AIDS e inibem o uso do preservativo. Pobreza, falta de perspectiva e medo estão associados à situação de pobreza, exclusão social e preconceito e à total ausência de direitos humanos. Quando examinados conjuntamente, estes fatores definem diferentes configurações dos migrantes com uma elevada vulnerabilidade ao HIV/AIDS. A alta vulnerabilidade destes grupos, relacionada à complexidade sócio-econômica, deve ser considerada nos programas de prevenção e controle da AIDS.