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.

INFLAMMATORY BOWEL DISEASE CARE IN BRAZIL: HOW IT IS PERFORMED, OBSTACLES AND DEMANDS FROM THE PHYSICIANS' PERSPECTIVE.

BACKGROUND: Inflammatory bowel diseases (IBD) are chronic inflammatory affections of recurrent nature whose incidence and prevalence rates have increased, including in Brazil. In long term, they are responsible for structural damage that impacts quality of life, morbidity and mortality of patients. OBJECTIVE: To describe the profile of physicians who treat IBD patients as well as the characteristics of IBD care, unmet demands and difficulties. METHODS: A questionnaire containing 17 items was prepared and sent to 286 physicians from 101 Brazilian cities across 21 states and the Federal District, selected from the register of the State Commission of the "Study Group of Inflammatory Bowel Disease of Brazil" (GEDIIB). RESULTS: The majority of the physicians who answered the questionnaire were gastroenterologists and colorectal surgeons. More than 60% had up to 20 years of experience in the specialty and 53.14% worked at three or more locations. Difficulties in accessing or releasing medicines were evident in this questionnaire, as was referrals to allied healthy professionals working in IBD-related fields. More than 75% of physicians reported difficulties in performing double-balloon enteroscopy and capsule endoscopy, and 67.8% reported difficulties in measuring calprotectin. With regard to the number of patients seen by each physician, it was shown that patients do not concentrate under the responsibility of few doctors. Infliximab and adalimumab were the most commonly used biological medicines and there was a higher prescription of 5-ASA derivatives for ulcerative colitis than for Crohn's disease. Steroids were prescribed to a smaller proportion of patients in both diseases. The topics "biological therapy failure" and "new drugs" were reported as those with higher priority for discussion in medical congresses. In relation to possible differences among the country's regions, physicians from the North region reported greater difficulty in accessing complementary exams while those from the Northeast region indicated greater difficulty in accessing or releasing medicines. CONCLUSION: The data obtained through this study demonstrate the profile of specialized medical care in IBD and are a useful tool for the implementation of government policies and for the Brazilian society as a whole.

Atendimento da doença inflamatória intestinal no Brasil: como é feito, os entraves e as demandas sob a ótica dos médicos / Inflammatory bowel disease care in brazil: how it is performed, obstacles and demands from the physicians' perspective

ABSTRACT BACKGROUND: Inflammatory bowel diseases (IBD) are chronic inflammatory affections of recurrent nature whose incidence and prevalence rates have increased, including in Brazil. In long term, they are responsible for structural damage that impacts quality of life, morbidity and mortality of patients. OBJECTIVE: To describe the profile of physicians who treat IBD patients as well as the characteristics of IBD care, unmet demands and difficulties. METHODS: A questionnaire containing 17 items was prepared and sent to 286 physicians from 101 Brazilian cities across 21 states and the Federal District, selected from the register of the State Commission of the "Study Group of Inflammatory Bowel Disease of Brazil" (GEDIIB). RESULTS: The majority of the physicians who answered the questionnaire were gastroenterologists and colorectal surgeons. More than 60% had up to 20 years of experience in the specialty and 53.14% worked at three or more locations. Difficulties in accessing or releasing medicines were evident in this questionnaire, as was referrals to allied healthy professionals working in IBD-related fields. More than 75% of physicians reported difficulties in performing double-balloon enteroscopy and capsule endoscopy, and 67.8% reported difficulties in measuring calprotectin. With regard to the number of patients seen by each physician, it was shown that patients do not concentrate under the responsibility of few doctors. Infliximab and adalimumab were the most commonly used biological medicines and there was a higher prescription of 5-ASA derivatives for ulcerative colitis than for Crohn's disease. Steroids were prescribed to a smaller proportion of patients in both diseases. The topics "biological therapy failure" and "new drugs" were reported as those with higher priority for discussion in medical congresses. In relation to possible differences among the country's regions, physicians from the North region reported greater difficulty in accessing complementary exams while those from the Northeast region indicated greater difficulty in accessing or releasing medicines. CONCLUSION: The data obtained through this study demonstrate the profile of specialized medical care in IBD and are a useful tool for the implementation of government policies and for the Brazilian society as a whole.

RESUMO CONTEXTO: As doenças inflamatórias intestinais (DII) são afecções inflamatórias crônicas de caráter recorrente, cujas taxas de incidência e prevalência têm aumentado, inclusive no Brasil. A longo prazo, são responsáveis por danos estruturais que impactam na qualidade de vida, morbidade e mortalidade dos pacientes. OBJETIVO: Avaliar o perfil dos médicos que atendem pacientes com DII, assim como as características deste atendimento, demandas não atendidas e dificuldades. MÉTODOS: Um questionário contendo 17 variáveis foi elaborado e enviado para médicos, selecionados a partir do cadastro da Comissão das Estaduais do Grupo de Estudos da Doença Inflamatória Intestinal do Brasil (GEDIIB), totalizando 286 médicos de 101 cidades brasileiras distribuídas por 21 estados e Distrito Federal. RESULTADOS: A maioria dos médicos que respondeu o questionário foram Gastroenterologistas e Coloproctologistas. Mais de 60% tinham até 20 anos de atuação na especialidade e 53,14% trabalhavam em três locais ou mais. A dificuldade no acesso ou liberação de medicamentos ficou evidenciada neste questionário, assim como a dificuldade no encaminhamento para profissionais não médicos que atuam em DII. Mais de 75% dos médicos relataram dificuldades para realização de enteroscopia por duplo balão e cápsula endoscópica, e 67,8% para realização da calprotectina. Em relação ao número de pacientes atendidos por cada médico, foi evidenciado que não há uma concentração de pacientes sob a responsabilidade de poucos médicos. O infliximabe e o adalimumabe foram os biológicos mais utilizados e ficou evidenciada prescrição maior de derivados de 5-ASA para retocolite ulcerativa quando comparada à doença de Crohn. Os corticoides foram prescritos para uma parcela menor de pacientes em ambas doenças. Os temas "falha a terapia biológica" e "novas drogas" foram referidos como aqueles com maior prioridade para discussão em eventos científicos. Em relação às possíveis diferenças entre cada região e o restante do país, os médicos da região Norte relataram maior dificuldade no acesso a exames complementares e os médicos da região Nordeste, maior dificuldade no acesso ou liberação de medicamentos. CONCLUSÃO: Os dados obtidos por meio deste estudo mostram o perfil do atendimento médico especializado em DII e podem se constituir em ferramenta útil para para elaboração de políticas governamentais e para sociedade brasileira como um todo.

Biological therapy for pyoderma gangrenosum / Terapia biológica no tratamento do pioderma gangrenoso

INTRODUCTION: pyoderma gangrenosum (PG) is a rare and severe neutrophilic dermatosis associated with inflammatory bowel disease (IBD) and other systemic diseases such as rheumatoid arthritis and hematological malignancies. Diagnosis is based on clinical criteria and exclusion of other skin disorders. There is no gold standard for the treatment of PG; traditionally intravenous corticosteroids are used, but recently the use of drugs that inhibit tumor necrosis factor alpha (TNF-alpha) has changed the management of PG, showing great effectiveness. CASE REPORT: female patient, 23 years old, diagnosed with severe nonspecific ulcerative colitis (UC) three years ago, undergoing treatment with oral mesalamine and azathioprine. She developed PG fourteen days after hospital discharge; hospitalization was due to worsening of intestinal disease symptoms. She was successfully treated using biological therapy after unfavorable evolution with corticosteroid therapy. CONCLUSION: PG, a rare extraintestinal manifestation of IBD of difficult resolution that has significant impact on patient quality of life. The use of biological therapy for PG has higher efficacy in the treatment of patients decreasing wound healing time and return to daily activities. (AU)

INTRODUÇÃO: pioderma gangrenoso (PG) é uma rara e grave dermatose neutrofílica associada a doença inflamatória intestinal (DII) e a outras doenças sistêmicas como a artrite reumatoide e neoplasias hematológicas. O diagnóstico é baseado em critérios clínicos e exclusão de outras desordens da pele. Ainda não há padrão ouro para o tratamento do PG, tradicionalmente usa-se corticoides endovenosos, porém recentemente o uso de fármacos inibidores do fator de necrose tumoral alfa (TNF-alfa) tem mudado o manejo do PG mostrando grande efetividade. RELATO DO CASO: paciente feminina, 23 anos, com diagnóstico de retocolite ulcerativa inespecífica (RCUI) severa há três anos, em tratamento com mesalazina oral e azatioprina. Evoluiu apresentando PG quatorze dias após alta hospitalar, por internamento devido agudização dos sintomas intestinais da doença. Foi tratada com sucesso usando terapia biológica após evolução desfavorável com corticoide. CONCLUSÃO: PG, uma rara manifestação extraintestinal das DII, é de difícil resolução e com significante interferência na qualidade de vida dos pacientes. O uso de terapia biológica no PG vem mostrando melhor eficácia no tratamento desses doentes com diminuição do tempo de cicatrização das feridas e retorno às atividades diárias. (AU)

Qualidade de vida de pacientes portadores de doença inflamatória intestinal / Calidad de vida de pacientes portadores de enfermedad inflamatoria intestinal / Quality of life of patients with inflammatory bowel disease

OBJETIVOS: Avaliar a qualidade de vida (QV) de portadores de doenças inflamatórias intestinais (DII) e relacionar dados sociodemográficos e mórbidos à QV. MÉTODOS: Estudo transversal, realizado com 103 portadores de DII, cadastrados na farmácia de alto custo de Cuiabá - Mato Grosso que responderam ao Prontuário-Padrão, ao questionário de QV geral SF36 e ao específico IBDQ. RESULTADOS: Dentre os 103 pacientes com DII, 62 tinham retocolite ulcerativa idiopática e 41 doença de Crohn; 62 por cento eram mulheres; 69,9 por cento, casados; 48,5 por cento, pardos; 49,5 por cento, fumantes, 37,9 por cento necessitaram de cirurgia e 40,8 por cento apresentavam doença em atividade. Foi observada alteração significativa da QV em homens, fumantes e entre aqueles com doença em atividade. CONCLUSÃO: DII afetam a QV em diversos aspectos. Medidas para manutenção da QV, suporte psicológico, social e educacional devem ser considerados para portadores de DII.

OBJECTIVES: To assess the quality of life (QV) in patients with inflammatory bowel disease (DII), and relate it to demographic data and morbidity. METHODS: Cross-sectional study with 103 patients with DII, registered in the high cost pharmacy of Cuiabá - Mato Grosso, who responded to the Standard Medical Record, the general QV questionnaire SF-36 and the specific IBDQ. RESULTS: Among 103 patients with DII, 62 had ulcerative colitis and 41 had Crohn's disease; 62 percent were women; 69.9 percent were married; 48.5 percent were of mixed race; 49.5 percent were smokers; 37.9 percent required surgery; and, 40.8 percent had active disease. We observed significant changes in QV in men, smokers and those with active disease. CONCLUSION: DII affect QV in several respects. Measures for maintenance of QV, psychological, social and education support should be considered for patients with DII.

OBJETIVOS: Evaluar la calidad de vida (CV) de portadores de enfermedades inflamatorias intestinales (EII) y relacionar datos sociodemográficos y mórbidos a la CV. MÉTODOS: Se trata de un estudio transversal, realizado con 103 portadores de EII, registrados en la farmacia de alto costo de Cuiabá - Mato Grosso que respondieron a la Historia Clínica-Patrón, al cuestionario de CV general SF36 y al específico IBDQ. RESULTADOS: De los 103 pacientes con EII, 62 tenían rectocolitis ulcerosa idiopática y 41 enfermedad de Crohn; 62 por ciento eran mujeres; 69,9 por ciento, casados; 48,5 por ciento, pardos; 49,5 por ciento, fumadores, 37,9 por ciento necesitaron de cirugía y 40,8 por ciento presentaban la enfermedad en actividad. Fue observada una alteración significativa de la CV en hombres, fumadores y en aquellos con la enfermedad en actividad. CONCLUSIÓN: Las EII afectan la CV en diversos aspectos. Para la manutención de la CV, deben ser considerados el soporte psicológico, social y educacional de los portadores de EII.

Perfil epidemiológico dos pacientes portadores de doença inflamatória intestinal do estado de Mato Grosso / The epidemiological profile of patients with inflammatory Bowel disease in the State of Mato Grosso

Estudos epidemiológicos recentes sugerem que a incidência da doença de Crohn (DC) e da retocolite ulcerativa (RCUI) está aumentando no Brasil, apesar de desconhecermos sua taxa real. OBJETIVO: Descrever o perfil epidemiológico dos pacientes com doença inflamatória intestinal (DII) que residem no estado de Mato Grosso. RESULTADOS: Foram avaliados 220 pacientes com doença inflamatória intestinal, 125 eram do sexo feminino e 95 do sexo masculino. Do total de casos, 117 tinham RCUI, 86 doença de Crohn e 17 colite indeterminada. A doença foi mais freqüente em casados (66,0 por cento), em pacientes de cor parda (48,0 por cento) e em não fumantes (61,8 por cento). A média da idade foi de 39 anos, variando de 6 a 80 anos. Em algum momento da evolução da doença, 77 (35 por cento) pacientes necessitaram de tratamento cirúrgico. A média de anos dos pacientes estudados foi de 9,17 anos, variando de 0 a 20 anos estudados. CONCLUSÃO: Apesar da pouca literatura sobre a doença, os dados deste estudo revelam que os portadores de DII, no estado de Mato Grosso, apresentam características epidemiológicas semelhantes aos portadores de outros estados do Brasil.

Recent epidemiological studies suggest that the incidence of Crohn's disease (CD) and Ulcerative Colitis (UC) is increasing in Brazil despite the fact that we do not know what the actual rate is. OBJECTIVE: To describe the epidemiological profile of patients with inflammatory bowel disease in people resident in the state of Mato Grosso. RESULTS: 220 patients with inflammatory bowel disease were assessed. 125 were female and 95 were male. Of the total number of cases, 117 had UC, 86 had Crohn's disease and 17 had non-specific colitis. The disease was most common amongst married patients (66 percent), dark-skinned patients (48 percent) and non-smokers (61.8 percent). The average age was 39, and the age range was from 6 to 80. At some stage in the treatment 77 (35 percent) patients required surgical treatment. The average number of years studied was 9.17 with a variation from 0 to 20 years. CONCLUSION: Despite the lack of literature on the disease, the data from this study reveal that patients with IBD in the state of Mato Grosso show the same epidemiological features as those from other Brazilian states.

Effects of budesonide and probiotics enemas on the systemic inflammatory response of rats with experimental colitis.

PURPOSE: The aim of this study was to investigate the effect of enemas containing probiotics and budesonide on the systemic inflammatory response in experimental colitis. METHODS: Fifty male Wistar rats with experimental colitis induced by 10% acetic acid enema were randomized to five groups (10 rats each) according to the treatment: group 1--saline solution, group 2--budesonide (0.75 mg/kg/day), group 3--probiotics (1mg/day), group 4--probiotics plus budesonide, and group 5--control, with not-treated rats. The following variables were studied: body weight, serum levels of albumin, C-reactive protein and interleucine-6 (IL-6). RESULTS: All animals lost weight between the beginning and the end of the experiment (280+ 16 mg versus 249+21 mg, p< 0.001). There was a significant decrease in the serum albumin between the normal pre-induction level (3.45 + 0.49 mg/dL) and the 1st day after colitis induction (1.61+051 mg/dL, p< 0.001) in all treated groups when compared to the control group. C- reactive protein increased after induction and diminished on the 7th day in all groups. In the control group there was an increase in the IL-6 after colitis induction. None of the treated groups significantly differed from IL-6 pre-colitis status (p>0.05). Only probiotic rats presented a significant decrease of IL-6 than controls (0,30+/-0,08 mg/dL vs. 0,19+/-0,03 mg/dL; p<0.01). CONCLUSION: Probiotics are effective to diminished inflammatory status mediated by IL-6 in experimental colitis.

Effects of budesonide and probiotics enemas on the colonic mucosa of rats with experimental colitis.

PURPOSE: To investigate the effect of enemas containing probiotics and budesonide on the colonic mucosa in experimental colitis. METHODS: Fifty male Wistar rats with experimental colitis induced by 10% acetic acid enema were randomized to five groups (10 rats each) according to the treatment: group 1--saline solution, group 2--budesonide (0.75 mg/kg/day), group 3--probiotics (1mg/day), group 4--probiotics plus budesonide, and group 5--control, with not-treated rats. The following variables were studied: body weight, macroscopic and microscopic score of the colonic mucosa, and DNA content of the mucosa. RESULTS: All animals lost weight between the beginning and the end of the experiment (280+ 16 mg versus 249+21 mg, p< 0.001). There was no significant difference among the groups in relation to both the macroscopic and histological score. The budesonide + probiotic group showed higher DNA content than control group (1.24+ 0.15 versus 0.92+ 0.30 mg/100 mg of tissue, p=0.01). CONCLUSION: Budesonide in addition to probiotics enhances the mucosal trophism in experimental colitis.

Effects of budesonide and probiotics enemas on the colonic mucosa of rats with experimental colitis

PURPOSE: To investigate the effect of enemas containing probiotics and budesonide on the colonic mucosa in experimental colitis. METHODS: Fifty male Wistar rats with experimental colitis induced by 10 percent acetic acid enema were randomized to five groups (10 rats each) according to the treatment: group 1 - saline solution, group 2 - budesonide (0.75 mg/kg/day), group 3 - probiotics (1mg/day), group 4 - probiotics plus budesonide, and group 5 - control, with not-treated rats. The following variables were studied: body weight, macroscopic and microscopic score of the colonic mucosa, and DNA content of the mucosa. RESULTS: All animals lost weight between the beginning and the end of the experiment (280+ 16 mg versus 249+21 mg, p< 0.001). There was no significant difference among the groups in relation to both the macroscopic and histological score. The budesonide + probiotic group showed higher DNA content than control group (1.24+ 0.15 versus 0.92+ 0.30 mg/100mg of tissue, p=0.01). CONCLUSION: Budesonide in addition to probiotics enhance the mucosal trophism in experimental colitis.

OBJETIVO: Investigar o efeito da administração retal de probióticos e budesonida na mucosa colônica de ratos com colite experimental. MÉTODOS: Cinquenta ratos Wistar com colite experimental induzida pelo ácido acético à 10 por cento foram randomizados em 5 grupos (n=10 por grupo) para diferentes tratamentos: grupo 1 - solução fisiológica; grupo 2 - budesonida (0,75mg/kg/dia); grupo 3 - probióticos (1 g/dia); grupo 4 - probióticos associados a budesonida; e finalmente grupo 5 - controle, composto por ratos sem tratamento. As seguintes variáveis foram estudadas: peso corporal, aspecto macroscópico e microscópico da mucosa e conteúdo de DNA da mucosa colônica. RESULTADOS: Todos os animais perderam peso entre o início e o fim do experimento (280±16 vs 249±21g; p<0.001). Não houve diferença estatística significativa entre os grupos em relação a macroscopia e histologia. O grupo budesonida + probiótico apresentou conteúdo de DNA maior que o grupo controle (1,24±0,15 versus 0,92±0,30 g/100g de tecido; p=0,01). CONCLUSÃO: A associação de budesonida com probióticos acelera o trofismo mucoso na colite experimental.

Effects of budesonide and probiotics enemas on the systemic inflammatory response of rats with experimental colitis

PURPOSE: The aim of this study was to investigate the effect of enemas containing probiotics and budesonide on the systemic inflammatory response in experimental colitis. METHODS: Fifty male Wistar rats with experimental colitis induced by 10 percent acetic acid enema were randomized to five groups (10 rats each) according to the treatment: group 1 - saline solution, group 2 - budesonide (0.75 mg/kg/day), group 3 - probiotics (1mg/day), group 4 - probiotics plus budesonide, and group 5 - control, with not-treated rats. The following variables were studied: body weight, serum levels of albumin, C-reactive protein and interleucine-6 (IL-6). RESULTS: All animals lost weight between the beginning and the end of the experiment (280+ 16 mg versus 249+21 mg, p< 0.001). There was a significant decrease in the serum albumin between the normal pre-induction level (3.45 + 0.49mg/dL) and the 1st day after colitis induction (1.61+051mg/dL, p< 0.001) in all treated groups when compared to the control group. C- reactive protein increased after induction and diminished on the 7th day in all groups. In the control group there was an increase in the IL-6 after colitis induction. None of the treated groups significantly differed from IL-6 pre-colitis status (p>0.05). Only probiotic rats presented a significant decrease of IL-6 than controls (0,30±0,08 mg/dL vs. 0,19±0,03 mg/dL; p<0.01). CONCLUSION: Probiotic associated with budesonida Probiotics are effective to diminished inflammatory status mediated by IL-6 in experimental colitis.

OBJETIVO: Investigar o efeito da administração retal de probióticos e budesonida na resposta inflamatória de ratos com colite experimental. MÉTODOS: Cinqüenta ratos Wistar com colite experimental induzida pelo acido acético à 10 por cento foram randomizados em 5 grupos (n=10 por grupo) para diferentes tratamentos: grupo 1 - solução fisiológica; grupo 2 budesonida (0,75mg/kg/dia); grupo 3 - probióticos (1 g/dia); grupo 4 - probióticos associados a budesonida; e finalmente grupo 5 - controle, composto por ratos sem tratamento. As seguintes variáveis foram estudadas: peso corporal, dosagens séricas de albumina, proteína C reativa (PCR) e interleucina-6 (IL-6). RESULTADOS: Todos os animais perderam peso entre o inicio e o fim do experimento (280±16 vs 249±21g; p<0.001). Ocorreu uma queda significativa da albumina sérica entre o normal (3,45±0,49g/dL) e o 1° dia de colite (grupo 5 = 1,61±0,51 g/dL; p <0.001) em todos grupos com tratamento em relação ao grupo controle. A PCR aumentou após a indução da colite, diminuindo no sétimo dia de colite em todos os grupos. No grupo controle houve um aumento da IL-6 após a indução da colite. Nenhum dos grupos de tratamento diferiu significantemente dos valores de IL-6 antes da indução a colite (p>0.05). As comparações entre o grupo controle (0,30±0,08 mg/dL) e outros mostraram que houve uma queda significante nos níveis de IL-6 apenas no grupo probiótico (0,19±0,03 mg/dL; p<0.01). CONCLUSÃO: Probióticos são efetivos na diminuição do estado inflamatório mediado pela IL-6 na colite experimental.