Clinical aspects and prognosis of patients with inflammatory bowel disease associated with autoimmune liver diseases / Aspectos clínicos y pronósticos de pacientes con enfermedad inflamatoria intestinal asociada a enfermedades hepáticas autoinmunes

Background and aims: Inflammatory bowel diseases (IBD) are chronic conditions that may be accompanied by autoimmune liver disease (AILD), most commonly primary sclerosing cholangitis (PSC). The objective of this study was to evaluate the behaviour of patients with IBD associated with AILD and compare a PSC group with a non-PSC group.Methods: Medical records of patients with IBD associated with PSC, autoimmune cholangitis, primary biliary cholangitis, small-duct PSC, autoimmune hepatitis (AIH) and overlapping syndromes were assessed.Results: Fifty-four patients were included: 48 (88.9%) had ulcerative colitis and six (11.1%) had Crohn's disease; 35 (64.8%) had PSC and 19 (35.2%) did not have PSC. There was no difference in outcomes (surgical treatment for IBD, liver transplantation or death) between the groups. Time since the diagnosis of IBD was associated with surgical treatment of IBD (p=0.041; OR: 1.139, 95% CI: 1.006–1.255). Time since the diagnosis of AILD (p=0.003; OR: 1.259, 95% CI: 1.1–1.396), as well as portal hypertension at diagnosis (p=0.014; OR: 18.22, 95% CI: 1.815–182.96), were associated with liver transplantation. In addition, previous diagnosis of AIH was associated with de novo IBD (p=0.012; OR: 7.1, 95% CI: 1.215–42.43).Conclusion: Both groups had similar disease behaviour. A longer time since the diagnosis of IBD increased the risk for surgical treatment (13.9%/year). A 25.9%/year increase in liver transplantation was observed after the diagnosis of AILD, which was increased 18.22 times by the presence of portal hypertension. In addition, the diagnosis of AIH was associated with an increase in the number of diagnoses of de novo IBD (7.1).

Antecedentes y objetivos: Las enfermedades inflamatorias intestinales (EII) son afecciones crónicas que pueden ir acompañadas de enfermedad hepática autoinmune (EHA) o colangitis esclerosante primaria (CEP). El objetivo del estudio fue evaluar el comportamiento de pacientes con EII asociada a EHA y comparar un grupo con CEP con un grupo sin CEP.Métodos: Se evaluaron las historias clínicas de pacientes con EII asociadas con CEP, colangitis autoinmune, colangitis biliar primaria, CEP de conductos pequeños, hepatitis autoinmune (HAI) y síndromes superpuestos.Resultados: Se incluyeron 54 pacientes. De ellos, 48 (88,9%) tenían colitis ulcerosa y seis (11,1%) tenían enfermedad de Crohn; 35 (64,8%) tenían CEP y 19 (35,2%) no tenían CEP. No hubo diferencias en los resultados (tratamiento quirúrgico para la EII, trasplante de hígado o muerte) entre los grupos. El tiempo transcurrido desde el diagnóstico de EII se asoció con el tratamiento quirúrgico de la EII (p=0,041). El tiempo desde el diagnóstico de EHA (p=0,003), así como la hipertensión portal en el momento del diagnóstico (p=0,014), fueron asociado con el trasplante de hígado. Además, el diagnóstico previo de HAI se asoció con EII de novo (p=0,012).Conclusión: Ambos grupos tuvieron un comportamiento de enfermedad similar. Un mayor tiempo desde el diagnóstico de EII aumentó el riesgo de tratamiento quirúrgico (13,9%/año). Se observó un aumento del 25,9%/año en el trasplante de hígado después de diagnóstico de EIA, que se incrementó 18,22 veces por la presencia de hipertensión portal. Además, el diagnóstico de HAI se asoció con un aumento en el número de diagnósticos de EII de novo (7,1).

Clinical aspects and prognosis of patients with inflammatory bowel disease associated with autoimmune liver diseases.

BACKGROUND AND AIMS: Inflammatory bowel diseases (IBD) are chronic conditions that may be accompanied by autoimmune liver disease (AILD), most commonly primary sclerosing cholangitis (PSC). The objective of this study was to evaluate the behaviour of patients with IBD associated with AILD and compare a PSC group with a non-PSC group. METHODS: Medical records of patients with IBD associated with PSC, autoimmune cholangitis, primary biliary cholangitis, small-duct PSC, autoimmune hepatitis (AIH) and overlapping syndromes were assessed. RESULTS: Fifty-four patients were included: 48 (88.9%) had ulcerative colitis and six (11.1%) had Crohn's disease; 35 (64.8%) had PSC and 19 (35.2%) did not have PSC. There was no difference in outcomes (surgical treatment for IBD, liver transplantation or death) between the groups. Time since the diagnosis of IBD was associated with surgical treatment of IBD (p=0.041; OR: 1.139, 95% CI: 1.006-1.255). Time since the diagnosis of AILD (p=0.003; OR: 1.259, 95% CI: 1.1-1.396), as well as portal hypertension at diagnosis (p=0.014; OR: 18.22, 95% CI: 1.815-182.96), were associated with liver transplantation. In addition, previous diagnosis of AIH was associated with de novo IBD (p=0.012; OR: 7.1, 95% CI: 1.215-42.43). CONCLUSION: Both groups had similar disease behaviour. A longer time since the diagnosis of IBD increased the risk for surgical treatment (13.9%/year). A 25.9%/year increase in liver transplantation was observed after the diagnosis of AILD, which was increased 18.22 times by the presence of portal hypertension. In addition, the diagnosis of AIH was associated with an increase in the number of diagnoses of de novo IBD (7.1).

Knowledge and Practices of Pediatricians Regarding Functional Constipation in the State of Minas Gerais, Brazil.

OBJECTIVES: The aim of the study was to analyze the knowledge, approaches, and practices of pediatricians participating in a regional pediatric conference regarding functional constipation (FC) to identify knowledge gaps. METHODS: Cross-sectional regional study based on a semistructured questionnaire related to the Rome III criteria and the participant profiles. RESULTS: Of 400 questionnaires distributed, 264 (66.0%) were completed. Most pediatricians (76.7%) did not recognize the Rome III criteria, but the majority did recognize the following risk factors for FC: low-fiber diet (97.8%), family history (86.6%), onset of toilet training (76.4%), and weaning (62.4%). Foods considered high in fiber were oats (95.7%), leafy vegetables (95.3%), and wheat bran (93.2%). Digital rectal examination was not performed by 57.7% of nongastroenterologists. Complementary examinations were ordered in 27.5% and 72.5% of patients by general pediatricians and pediatric gastroenterologists, respectively, although the sample of gastroenterologists was not representative. The most prescribed drugs by nongastroenterologists were mineral oil (72.6%), magnesium hydroxide (52.1%), lactulose (41.0%), and polyethylene glycol (25.2%). Pediatric gastroenterologists prescribed magnesium hydroxide (91.7%), polyethylene glycol (91.7%), and mineral oil (58.3%). Most pediatricians (70.0%) considered the average treatment duration to be less than 1 year, although gastroenterologists considered it to be more than 1 year (54.6%). CONCLUSIONS: The knowledge of pediatricians regarding FC is inadequate. Constipation may not receive the public health attention it deserves within pediatric residency programs. The authors suggest that better education regarding FC should be included in medical school and residency program curricula to improve patient care.