A descriptive study of inflammatory bowel disease at an Egyptian tertiary care center.

INTRODUCTION AND AIMS: Inflammatory bowel disease (IBD) is a group of chronic intestinal disorders that trigger prolonged inflammation of the digestive tract. Its incidence and prevalence appear to be increasing in the African population and in Egypt. The present study aims to highlight the pattern and management of IBD in Egyptian patients. MATERIALS AND METHODS: Two hundred patients with IBD were assessed for ulcerative colitis (UC), through the Mayo score, and for Crohn's disease (CD), with the Crohn's disease activity index (CDAI). RESULTS: Median patient age was 35 years, with a predominance of females. UC was more common than CD (88% and 12%, respectively) and severity was moderate, in the majority of cases. Most UC patients had left-sided lesions, whereas ileitis was the most common finding (37.5%) in the CD patients. Proctitis was the least common finding in both diseases and Crohn's fistulizing disease was detected in 4.1% of the patients. Interestingly, peripheral arthropathy was the most common extraintestinal manifestation in the IBD patients (70%) and axial arthropathy was the least common (6%). Severe ocular or mucocutaneous involvement was very rare. Finally, biologic treatment was prescribed to 15.4% of the UC patients and 20.8% of the CD patients. CONCLUSIONS: Although the clinical presentation of IBD in Egypt is comparable to that reported worldwide, diagnoses were found to be delayed. There were fewer cases of CD than UC, but more mild-to-moderate disease severity. The surveillance of patients with IBD must continue and awareness of the disease in the Egyptian medical community needs to increase. A national registry must be established, multicenter studies need to be conducted, and molecular diagnostics is recommended.

C-reactive protein/albumin ratio (CAR) as a marker for detecting acute severe ulcerative colitis in Egyptian patients.

INTRODUCTION AND AIM: The C-reactive protein/albumin ratio (CAR) is an inflammatory marker that is considered to have prognostic value in many diseases. Our aim in the present study was to investigate the diagnostic performance of the CAR in determining the clinical severity of acute severe ulcerative colitis (ASUC). MATERIALS AND METHODS: A retrospective study on 200 UC patients that were admitted to the Gastroenterology unit of the Alexandria University, over an 8-year period from January 2012 to January 2020, was conducted. Patient demographic data, laboratory values, and clinical and endoscopic disease activity scores were evaluated. C-reactive protein (CRP) and albumin levels were recorded. The CAR was calculated to determine clinical severity. RESULTS: Of the 200 patients, 135 (67.5%) were men and 65 (32.5%) were women. Mean age was 43.5 ±â€¯9.8 years. Patients were divided into groups with mild, moderate, or severe disease activity and there were statistically significant differences in the CAR, the erythrocyte sedimentation rate (ESR), CRP levels, and albumin levels (p = 0.001; p < 0.05). With a cut-off value of 0.6, the CAR performed best in defining patients with severe disease, with an area under the curve (AUC) of 0.985, 98% sensitivity, 100% specificity, positive predictive value (PPV) of 100%, and negative predictive value (NPV) of 97%, p < 0.001. AUC values for the diagnosis of severe disease were 0.985, 0.88, 0.72, and 0.65 for the CAR, CRP, albumin, and the ESR, respectively. CONCLUSION: There was a statistically significant association between the CAR and clinical disease activity in patients with UC. The CAR is a reliable and practical tool for detecting ASUC.

Association of dietary fiber consumption with disease activity in ulcerative colitis: An exploratory study in the Mexican population.

INTRODUCTION: Dietary fiber intake helps in the remission of ulcerative colitis (UC). OBJECTIVE: To evaluate if there is an association between the amount of fiber in usual diet and disease activity in patients with UC. METHODS: Cross-sectional study of a cohort of patients with UC. Dietary fiber intake was calculated and compared with the recommended amount (14 g/1000 kcal) with Mann-Whitney's U-test. Using Spearman's correlation coefficient, the number of relapses and the amount of consumed fiber were analyzed, and the relationship of dietary fiber consumption with disease activity was established by logistic regression. RESULTS: The group without ongoing UC activity consumed a higher amount of dietary fiber (20 g, IQR = 18-26, p = 0.062), and 47% consumed more than the recommended amount; the logistic regression analysis showed that compliance with recommended fiber consumption was associated as a protective factor against UC current activity (OR = 0.227, p = 0.032). As for dietary fiber intake and the number of relapses within previous year, an inversely proportional correlation was observed (r = -0.399, p = 0.011). CONCLUSIONS: Consumption of the recommended dietary fiber amount in the general population had a protective effect against UC activity in Mexican patients.

INTRODUCCIÓN: La fibra dietética suplementada coadyuva en la remisión de la colitis ulcerosa crónica idiopática (CUCI). OBJETIVO: Evaluar la asociación entre la cantidad de fibra de la dieta habitual y la actividad de la enfermedad en pacientes con CUCI. MÉTODOS: Estudio transversal de una de cohorte de pacientes con CUCI. Se calculó el consumo de fibra dietética y con U de Mann-Whitney se comparó con la cantidad recomendada (14 g/1000 kcal). Con coeficiente de correlación de Spearman se analizaron el número de recaídas y la cantidad de fibra consumida, y la relación de esta con la actividad de la enfermedad mediante regresión logística. RESULTADOS: El grupo sin actividad actual de CUCI consumió más fibra dietética (RIC = 18-26, p = 0.062) y 47 % consumió más de la cantidad recomendada; el análisis de regresión logística mostró que cumplir con esta se asoció como factor protector en contra de la actividad actual de la CUCI (RM = 0.227, p = 0.032). En la fibra y el número de recaídas en el último año se observó una correlación inversamente proporcional (r = −0.399, p = 0.011). CONCLUSIONES: El consumo recomendado de fibra en la población general tuvo un efecto protector para la actividad actual de la CUCI en pacientes mexicanos.

Asociación del consumo de fibra dietética con la actividad de la colitis ulcerosa crónica idiopática. Estudio exploratorio en población mexicana / Association of dietary fiber consumption with disease activity in ulcerative colitis. An exploratory study in the Mexican population

Resumen Introducción: La fibra dietética suplementada coadyuva en la remisión de la colitis ulcerosa crónica idiopática (CUCI). Objetivo: Evaluar la asociación entre la cantidad de fibra de la dieta habitual y la actividad de la enfermedad en pacientes con CUCI. Métodos: Estudio transversal de una de cohorte de pacientes con CUCI. Se calculó el consumo de fibra dietética y con U de Mann-Whitney se comparó con la cantidad recomendada (14 g/1000 kcal). Con coeficiente de correlación de Spearman se analizaron el número de recaídas y la cantidad de fibra consumida, y la relación de esta con la actividad de la enfermedad mediante regresión logística. Resultados: El grupo sin actividad actual de CUCI consumió más fibra dietética (RIC = 18-26, p = 0.062) y 47 % consumió más de la cantidad recomendada; el análisis de regresión logística mostró que cumplir con esta se asoció como factor protector en contra de la actividad actual de la CUCI (RM = 0.227, p = 0.032). En la fibra y el número de recaídas en el último año se observó una correlación inversamente proporcional (r = −0.399, p = 0.011). Conclusiones: El consumo recomendado de fibra en la población general tuvo un efecto protector para la actividad actual de la CUCI en pacientes mexicanos.

Abstract Introduction: Dietary fiber intake helps in the remission of ulcerative colitis (UC). Objective: To evaluate if there is an association between the amount of fiber in usual diet and disease activity in patients with UC. Methods: Cross-sectional study of a cohort of patients with UC. Dietary fiber intake was calculated and compared with the recommended amount (14 g/1000 kcal) with Mann-Whitney's U-test. Using Spearman's correlation coefficient, the number of relapses and the amount of consumed fiber were analyzed, and the relationship of dietary fiber consumption with disease activity was established by logistic regression. Results: The group without ongoing UC activity consumed a higher amount of dietary fiber (20 g, IQR = 18-26, p = 0.062), and 47% consumed more than the recommended amount; the logistic regression analysis showed that compliance with recommended fiber consumption was associated as a protective factor against UC current activity (OR = 0.227, p = 0.032). As for dietary fiber intake and the number of relapses within previous year, an inversely proportional correlation was observed (r = −0.399, p = 0.011). Conclusions: Consumption of the recommended dietary fiber amount in the general population had a protective effect against UC activity in Mexican patients.

Real-world experience with MMX mesalazine use in Mexican patients with ulcerative colitis at two tertiary care centers.

INTRODUCTION AND AIMS: The 5-aminosalicylates, especially mesalazine, are the first option in the treatment of mild-to-moderate ulcerative colitis (UC). High rates of remission induction and maintenance have been observed with the new multimatrix (MMX) mesalazine formulation, mainly in patients with distal disease. Our aim was to describe the real-world experience with MMX mesalazine in patients with UC at two tertiary care centers. MATERIALS AND METHODS: A retrospective cohort study was conducted that included 142 patients with confirmed UC diagnosis, analyzed in three study groups: 1) oral MMX mesalazine as monotherapy for remission induction, 2) oral MMX mesalazine as monotherapy for remission maintenance, and 3) oral MMX mesalazine plus topical therapy for remission induction. RESULTS: The frequency of clinical remission induction in group 1 was 80.3%, with biochemical remission of 74.2%. Group 2 had 100% clinical and biochemical remission maintenance. The frequency of clinical remission induction in group 3 was 88.6%, biochemical remission was 85.7%, and topical therapy was suspended in 87.3% at the end of follow-up. No adverse events were documented. CONCLUSIONS: There were high percentages of clinical and biochemical remission in the two corresponding study groups and topical therapy was suspended in the majority of patients in ashort follow-up period.

Changes in chronic idiopathic ulcerative colitis epidemiological pattern in Mexico in a tertiary care hospital.

BACKGROUND: Chronic idiopathic ulcerative colitis (CIUC) is a disease with multifactorial chronic inflammation of the colonic mucosa. Its prevalence ranges from 37.5-250/100,000 in North America to 10-500/100,000 in Europe. In Mexico, there are studies that show an increase in the frequency of new cases. The purpose of this work was to identify possible changes in CIUC behavior in a referral hospital. METHODS: New ulcerative colitis (UC) cases confirmed by histopathology from January 2007 to December 2014 were included. Clinical and demographic data were collected through the review of medical records and direct interview in order to compare them with a previous study conducted at the same institution from January 1986 to December 2006. RESULTS: A total of 189 patients were included. Mean number of UC annual new cases was 23.6. The study included 95 male patients (50 %) and 94 female patients (50 %), with an average age of 44.6 years at diagnosis. The frequency of pancolitis was 77 %, in comparison with 59 % in the previous period. Extra-intestinal manifestations (EIM) were present in 55.8 % and colectomies in 5.2 %. CONCLUSION: There is a lower mean of annual new cases; however, some characteristics of the disease have changed over time: there is an increased frequency of pancolitis and EIM, as well as a decrease in the rate of colectomies.

ANTECEDENTES: La colitis ulcerosa crónica idiopática (CUCI) es una enfermedad con inflamación crónica de la mucosa del colon de origen multifactorial. El objetivo de este trabajo es identificar posibles cambios en el comportamiento de la CUCI en un hospital de referencia. MÉTODOS: Se incluyeron nuevos casos de CUCI confirmados por histopatología de enero del 2007 a diciembre del 2014. RESULTADOS: Se incluyeron un total de 189 pacientes. La media de nuevos casos anuales de CUCI fue de 23.6. Este estudio incorpora 95 pacientes de sexo masculino (50 %) y 94 de sexo femenino (50 %), con una edad promedio al diagnóstico de 44.6 años. La frecuencia de pancolitis fue del 77 %, en comparación con el 59 % en el periodo anterior. Las manifestaciones extraintestinales (MEI) estuvieron presentes en el 55.8 % y las colectomías en el 5.2 %. CONCLUSIÓN: Algunas características de la enfermedad han cambiado con el tiempo: aumento de la frecuencia de pancolitis y MEI, así como disminución de la tasa de colectomías.

Real-world experience with MMX mesalazine use in Mexican patients with ulcerative colitis at two tertiary care centers. / Experiencia de la vida real con el uso de mesalazina MMX en pacientes mexicanos con CUCI en dos centros de tercer nivel.

INTRODUCTION AND AIMS: The 5-aminosalicylates, especially mesalazine, are the first option in the treatment of mild-to-moderate ulcerative colitis (UC). High rates of remission induction and maintenance have been observed with the new multimatrix (MMX) mesalazine formulation, mainly in patients with distal disease. Our aim was to describe the real-world experience with MMX mesalazine in patients with UC at two tertiary care centers. MATERIALS AND METHODS: A retrospective cohort study was conducted that included 142 patients with confirmed UC diagnosis, analyzed in three study groups: 1) oral MMX mesalazine as monotherapy for remission induction, 2) oral MMX mesalazine as monotherapy for remission maintenance, and 3) oral MMX mesalazine plus topical therapy for remission induction. RESULTS: The frequency of clinical remission induction in group 1 was 80.3%, with biochemical remission of 74.2%. Group 2 had 100% clinical and biochemical remission maintenance. The frequency of clinical remission induction in group 3 was 88.6%, biochemical remission was 85.7%, and topical therapy was suspended in 87.3% at the end of follow-up. No adverse events were documented. CONCLUSIONS: There were high percentages of clinical and biochemical remission in the two corresponding study groups and topical therapy was suspended in the majority of patients in a short follow-up period.

Cambios en el patrón epidemiológico de la colitis ulcerosa crónica idiopática en México en un hospital de tercer nivel de atención / Changes in chronic idiopathic ulcerative colitis epidemiological pattern in Mexico in a tertiary care hospital

Resumen Antecedentes: La colitis ulcerosa crónica idiopática (CUCI) es una enfermedad con inflamación crónica de la mucosa del colon de origen multifactorial. El objetivo de este trabajo es identificar posibles cambios en el comportamiento de la CUCI en un hospital de referencia. Métodos: Se incluyeron nuevos casos de CUCI confirmados por histopatología de enero del 2007 a diciembre del 2014. Resultados: Se incluyeron un total de 189 pacientes. La media de nuevos casos anuales de CUCI fue de 23.6. Este estudio incorpora 95 pacientes de sexo masculino (50 %) y 94 de sexo femenino (50 %), con una edad promedio al diagnóstico de 44.6 años. La frecuencia de pancolitis fue del 77 %, en comparación con el 59 % en el periodo anterior. Las manifestaciones extraintestinales (MEI) estuvieron presentes en el 55.8 % y las colectomías en el 5.2 %. Conclusión: Algunas características de la enfermedad han cambiado con el tiempo: aumento de la frecuencia de pancolitis y MEI, así como disminución de la tasa de colectomías.

Abstract Background: Chronic idiopathic ulcerative colitis (CIUC) is a disease with multifactorial chronic inflammation of the colonic mucosa. In Mexico, there are studies that show an increase in the frequency of new cases. The purpose of this work was to identify possible changes in CIUC behavior in a referral hospital. Methods: New ulcerative colitis (UC) cases confirmed by histopathology from January 2007 to December 2014 were included. Results: A total of 189 patients were included. Mean number of UC annual new cases was 23.6. The study included 95 male patients (50 %) and 94 female patients (50 %), with an average age of 44.6 years at diagnosis. The frequency of pancolitis was 77 %, in comparison with 59 % in the previous period. Extra-intestinal manifestations (EIM) were present in 55.8 % and colectomies in 5.2 %. Conclusion: Some characteristics of the disease have changed over time: there is an increased frequency of pancolitis and EIM, as well as a decrease in the rate of colectomies.

The controlling nutritional status score: A promising tool for nutritional screening and predicting severity in ulcerative colitis patients. / La escala control nutricional (CONUT): una herramienta prometedora para el cribado nutricional y como predictor de severidad en la colitis ulcerosa crónica idiopática.

INTRODUCTION AND AIMS: The controlling nutritional status (CONUT) score has previously been shown to be useful for nutritional assessment and the prediction of several inflammatory and neoplastic diseases. The aim of the present study was to evaluate the potential use of the CONUT score as a method for nutritional screening and predicting severity in ulcerative colitis (UC). MATERIALS AND METHODS: The study was conducted on 60 patients diagnosed with UC. Demographic, clinical, and biochemical patient characteristics were collected from their clinical records, and disease severity was assessed using the Truelove and Witts scale (TWS). The risks for malnutrition were evaluated through the nutritional risk index and the CONUT score. RESULTS: More than 90% of the UC patients presented with malnutrition risk, according to the scores analyzed. Patients with a high (>6points) CONUT score presented with moderate-to-severe activity on the TWS. A higher CONUT score was also associated with an increase in C-reactive protein (CRP) (P=.002) and erythrocyte sedimentation rate (ESR) (P=.009). The data analysis was performed utilizing the SPSS version 19 program. CONCLUSIONS: The CONUT score could be a promising tool for evaluating nutritional status in UC patients and predicting UC severity.

Inflammatory bowel disease in Mexico: Epidemiology, burden of disease, and treatment trends. / Epidemiología, carga de la enfermedad y tendencias de tratamiento de la enfermedad inflamatoria intestinal en México.

INTRODUCTION AND AIMS: There is no systematized information for determining/monitoring the burden of inflammatory bowel disease in Mexico. The aim of the present study was to estimate the annual burden of inflammatory bowel disease on the Mexican National Healthcare System, by number of patients seen, hospitalizations, and specific deaths, stratified into age groups. MATERIALS AND METHODS: Utilizing specific databases of the Mexican National Healthcare System registries coded as ICD-10: K50 and K51, we retrieved and analyzed the data corresponding to the patients seen and hospitalized in 2015, stratified by age group, as well as the specific deaths. Treatment trends among physicians were also examined. RESULTS: In 2015, 5,009 women (8.1) and 4,944 men (8.4) with Crohn's disease received medical attention (prevalence of cases seen) and 35.1% of those patients were ≥50years of age. In that same period, 17,177 women (27.7) and 15,883 men (26.9) with ulcerative colitis were seen and 31.6% of those patients were ≥50years of age. The hospitalized cases (prevalence of hospitalized cases) were 1,097 patients (0.91) with Crohn's disease and 43.7% of those patients were ≥50years of age; and 5,345 patients (4.42) with ulcerative colitis and 47.6% of those patients were ≥50years of age. Deaths (specific mortality rate) were: 32 women (0.52) and 36 men (0.50) due to Crohn's disease, and 267 women (4.31) and 186 men (3.15) due to ulcerative colitis. CONCLUSIONS: Inflammatory bowel disease is a burden on the health of Mexican adults and the Mexican National Healthcare System, and it is expected to increase over the next 15years.