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1.
Epidemiol Psychiatr Sci ; 29: e84, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31915099

RESUMO

AIMS: Although immune-mediated inflammatory diseases (IMID) are associated with multiple mental health conditions, there is a paucity of literature assessing personality disorders (PDs) in these populations. We aimed to estimate and compare the incidence of any PD in IMID and matched cohorts over time, and identify sociodemographic characteristics associated with the incidence of PD. METHODS: We used population-based administrative data from Manitoba, Canada to identify persons with incident inflammatory bowel disease (IBD), multiple sclerosis (MS) and rheumatoid arthritis (RA) using validated case definitions. Unaffected controls were matched 5:1 on sex, age and region of residence. PDs were identified using hospitalisation or physician claims. We used unadjusted and covariate-adjusted negative binomial regression to compare the incidence of PDs between the IMID and matched cohorts. RESULTS: We identified 19 572 incident cases of IMID (IBD n = 6,119, MS n = 3,514, RA n = 10 206) and 97 727 matches overall. After covariate adjustment, the IMID cohort had an increased incidence of PDs (incidence rate ratio [IRR] 1.72; 95%CI: 1.47-2.01) as compared to the matched cohort, which remained consistent over time. The incidence of PDs was similarly elevated in IBD (IRR 2.19; 95%CI: 1.69-2.84), MS (IRR 1.79; 95%CI: 1.29-2.50) and RA (IRR 1.61; 95%CI: 1.29-1.99). Lower socioeconomic status and urban residence were associated with an increased incidence of PDs, whereas mid to older adulthood (age 45-64) was associated with overall decreased incidence. In a restricted sample with 5 years of data before and after IMID diagnosis, the incidence of PDs was also elevated before IMID diagnosis among all IMID groups relative to matched controls. CONCLUSIONS: IMID are associated with an increased incidence of PDs both before and after an IMID diagnosis. These results support the relevance of shared risk factors in the co-occurrence of PDs and IMID conditions.


Assuntos
Artrite Reumatoide/epidemiologia , Doenças do Sistema Imunitário/complicações , Inflamação/complicações , Doenças Inflamatórias Intestinais/epidemiologia , Esclerose Múltipla/epidemiologia , Transtornos da Personalidade/epidemiologia , Adolescente , Adulto , Canadá/epidemiologia , Estudos de Coortes , Comorbidade/tendências , Feminino , Humanos , Doenças do Sistema Imunitário/epidemiologia , Incidência , Inflamação/epidemiologia , Masculino , Manitoba/epidemiologia , Pessoa de Meia-Idade , Transtornos da Personalidade/psicologia , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
2.
Gut ; 69(2): 274-282, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31196874

RESUMO

OBJECTIVES: To better understand the real-world impact of biologic therapy in persons with Crohn's disease (CD) and ulcerative colitis (UC), we evaluated the effect of marketplace introduction of infliximab on the population rates of hospitalisations and surgeries and public payer drug costs. DESIGN: We used health administrative data to study adult persons with CD and UC living in Ontario, Canada between 1995 and 2012. We used an interrupted time series design with segmented regression analysis to evaluate the impact of infliximab introduction on the rates of IBD-related hospitalisations, intestinal resections and public payer drug costs over 10 years among patients with CD and 5 years among patients with UC, allowing for a 1-year transition. RESULTS: Relative to what would have been expected in the absence of infliximab, marketplace introduction of infliximab did not produce significant declines in the rates of CD-related hospitalisations (OR at the last observation quarter 1.06, 95% CI 0.811 to 1.39) or intestinal resections (OR 1.10, 95% CI 0.810 to 1.50), or in the rates of UC-related hospitalisations (OR 1.22, 95% CI 1.07 to 1.39) or colectomies (OR 0.933, 95% CI 0.54 to 1.61). The findings were similar among infliximab users, except that hospitalisation rates declined substantially among UC patients following marketplace introduction of infliximab (OR 0.515, 95% CI 0.342 to 0.777). There was a threefold rise over expected trends in public payer drug cost among patients with CD following infliximab introduction (OR 2.98,95% CI 2.29 to 3.86), suggesting robust market penetration in this group, but no significant change among patients with UC (OR 1.06, 95% CI 0.955 to 1.18). CONCLUSIONS: Marketplace introduction of infliximab has not yielded anticipated reductions in the population rates of IBD-related hospitalisations or intestinal resections, despite robust market penetration among patients with CD. Misguided use of infliximab in CD patients and underuse of infliximab in UC patients may largely explain our study findings.


Assuntos
Fármacos Gastrointestinais/uso terapêutico , Hospitalização/estatística & dados numéricos , Doenças Inflamatórias Intestinais/tratamento farmacológico , /uso terapêutico , Adulto , Colectomia/estatística & dados numéricos , Colectomia/tendências , Colite Ulcerativa/tratamento farmacológico , Colite Ulcerativa/epidemiologia , Colite Ulcerativa/cirurgia , Doença de Crohn/tratamento farmacológico , Doença de Crohn/epidemiologia , Doença de Crohn/cirurgia , Custos de Medicamentos/estatística & dados numéricos , Custos de Medicamentos/tendências , Feminino , Hospitalização/tendências , Humanos , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/cirurgia , Análise de Séries Temporais Interrompida , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Fatores Socioeconômicos
3.
Surg Clin North Am ; 99(6): 1051-1062, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31676047

RESUMO

A full understanding of the presentation and work-up of inflammatory bowel disease is necessary to ensure appropriate treatment of this complex disease. Crohn's disease and ulcerative colitis share many common clinical features but are treated very differently. This article covers the factors which contribute to IBD pathogenesis and presentation as well as the methods of diagnosis and work-up to ensure that the appropriate diagnosis is reached. This article also serves as a basis of understanding for the more complex aspects of the disease to be discussed in subsequent articles.


Assuntos
Colite Ulcerativa/diagnóstico por imagem , Colite Ulcerativa/fisiopatologia , Doença de Crohn/diagnóstico por imagem , Doenças Inflamatórias Intestinais/fisiopatologia , Colite Ulcerativa/epidemiologia , Colonoscopia/métodos , Doença de Crohn/epidemiologia , Doença de Crohn/fisiopatologia , Feminino , Humanos , Doenças Inflamatórias Intestinais/diagnóstico por imagem , Doenças Inflamatórias Intestinais/epidemiologia , Imagem por Ressonância Magnética/métodos , Masculino , Prevalência , Prognóstico , Medição de Risco , Índice de Gravidade de Doença
4.
Surg Clin North Am ; 99(6): 1111-1121, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31676051

RESUMO

Patients with inflammatory bowel disease are at an increased risk of cancer secondary to long-standing intestinal inflammation. Surgical options must take into account the significant risk of synchronous disease at other colonic sites. Ileal pouch anal anastomosis is a viable option for patients with ulcerative colitis, but this should be restricted to early cancers that are unlikely to require preoperative or postoperative radiation treatment.


Assuntos
Transformação Celular Neoplásica/patologia , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/cirurgia , Lesões Pré-Cancerosas/patologia , Anastomose Cirúrgica , Colectomia/métodos , Colite Ulcerativa/epidemiologia , Colite Ulcerativa/patologia , Colite Ulcerativa/cirurgia , Neoplasias Colorretais/cirurgia , Comorbidade , Doença de Crohn/epidemiologia , Doença de Crohn/patologia , Doença de Crohn/cirurgia , Feminino , Humanos , Incidência , Doenças Inflamatórias Intestinais/patologia , Masculino , Lesões Pré-Cancerosas/epidemiologia , Prognóstico , Medição de Risco , Estomas Cirúrgicos , Análise de Sobrevida
5.
Isr Med Assoc J ; 21(10): 662-665, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31599507

RESUMO

BACKGROUND: Crohn's disease and ulcerative colitis are the two major classic presentations of inflammatory bowel diseases (IBD). Studies have shown a wide variation in the incidence and prevalence attributed to different geographic and ethnic populations. OBJECTIVES: To assess the clinical characteristics of IBD among Arabs in Israel and to compare them to characteristics of IBD among Ashkenazi Jews. METHODS: This retrospective, comparative study compared the clinical characteristics of IBD among 150 Arabs from the Holy Family Hospital and the Nazareth Hospital EMMS, both located in Nazareth, Israel, to those of 97 age- and sex-matched Ashkenazi Jewish patients from Shaare Zedek Medical Center, Jerusalem, Israel. RESULTS: The Arab cohort, which included 106 patients (70%) with Crohn's disease and 44 (29%) with ulcerative colitis, was compared to 97 Ashkenazi patients (81% with Crohn's disease and 17% with ulcerative colitis) (P < 0.05). Alcohol consumption was found in both groups, but Arabs smoked more (46% vs. 12%, respectively, P < 0.05). Obstructive phenotype was lower in Arabs (10% vs. 32%, P < 0.05). 5-aminosalicylic acid and anti-tumor necrosis factor alpha were prescribed for the Arab and Ashkenazi groups (89% and 21%, respectively). The need for surgical intervention due to disease severity and/or complications was not significant (22% vs. 24%). CONCLUSIONS: Despite similar reports of NOD2/CARD15 mutations, Crohn's disease is more common than ulcerative colitis within the Arab-Israeli population. Increased smoking rates may explain milder disease severities in Arabs, as reflected by lower obstructive pattern and frequent use of milder therapeutic modalities.


Assuntos
Árabes/estatística & dados numéricos , Doenças Inflamatórias Intestinais/epidemiologia , Judeus/estatística & dados numéricos , Adulto , Estudos de Coortes , Comorbidade , Feminino , Humanos , Israel/epidemiologia , Masculino , Estudos Retrospectivos , Fumar/epidemiologia , Adulto Jovem
6.
Zhonghua Er Ke Za Zhi ; 57(9): 694-699, 2019 Sep 02.
Artigo em Chinês | MEDLINE | ID: mdl-31530355

RESUMO

Objective: To investigate the incidence and risk factors of extraintestinal manifestations (EIMs) in children with inflammatory bowel disease (IBD). Methods: The clinical data of 161 children with IBD was collected from the electronic medical records in the Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine from January 2012 to December 2017. These patients were divided into Crohn's disease (CD) group and ulcerative colitis (UC) group, accounting for 82.0% (132 cases) and 18.0%(29 cases), respectively. The incidence of EIMs in each group was analyzed. The potential risk factors of EIMs including the IBD phenotype, gender, age, location of the CD lesion, disease activity of CD, and the presence of perianal lesion were analyzed with logistic regression model. Results: Eighty-eight patients (54.7%) had EIMs. The main EIMs were immune-mediated EIMs and growth retardation, accounting for 41.0% (66/161) and 24.2% (39/161), respectively. Aphthous ulcer (39/161, 23.0%) was the most common symptom among immune-mediated EIMs, followed by arthropathy (20/161, 12.4%) and skin lesions (19/161, 11.8%). Forty-three patients (26.7%) had EIMs before being diagnosed as IBD. Fifty-eight (65.9%) patients had only one EIM during the whole course of IBD. By logistic regression analysis, CD (OR=5.536, 95%CI:1.825-16.788) and perianal disease (OR=1.969, 95%CI:1.035-3.746) were the risk factors of immune-mediated EIMs. Meanwhile, CD (OR=11.319, 95%CI: 1.487-86.179), younger than six-year-old at diagnosis (OR=8.556, 95%CI: 3.109-23.545), moderate to severe activity of CD (OR=3.447, 95%CI: 1.196-9.934) and perianal disease (OR=3.361, 95%CI: 1.720-7.793) increased the risk of growth retardation. Conclusions: The children with IBD have a high incidence of EIMs, which were more common in CD than in UC. The risk factors of developing EIMs include CD, perianal diseases, younger than six-year-old at diagnosis and moderate to severe activity of CD.


Assuntos
Colite Ulcerativa/epidemiologia , Doença de Crohn/epidemiologia , Doenças Inflamatórias Intestinais/epidemiologia , Criança , China/epidemiologia , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/patologia , Doença de Crohn/diagnóstico , Doença de Crohn/patologia , Humanos , Incidência , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/patologia , Fatores de Risco
7.
J Med Life ; 12(2): 113-122, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31406511

RESUMO

Ulcerative colitis (UC) and Crohn's disease (CD) are classified as chronic inflammatory bowel diseases (IBD) which have similar symptoms and lead to digestive disorders and inflammation in the digestive system. The reason why they occur is still a mystery. A number of factors can be attributed to the prevalence of CD and UC, some of which include geographical location, inappropriate diet, genetics, and inappropriate immune response. Both diseases are more often diagnosed in urban areas compared to rural areas and both have their own challenges and side effects, but the patients can still have a good quality of life. Given the fact that the prevalence of this disease is higher at younger ages and that it disrupts half the life of the patient, it will, most likely, become a major health problem in the near future, even in developing countries. By reviewing valid scientific resources and evaluating new methods of addressing this disease, the present study aims to provide researchers and patients with new insights into this field and facilitate access to new treatments.


Assuntos
Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/prevenção & controle , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/epidemiologia , Colite Ulcerativa/prevenção & controle , Colite Ulcerativa/terapia , Doença de Crohn/diagnóstico , Doença de Crohn/epidemiologia , Doença de Crohn/prevenção & controle , Doença de Crohn/terapia , Dieta , Humanos , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/terapia , Prevalência , Qualidade de Vida
8.
Curr Gastroenterol Rep ; 21(8): 40, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31338613

RESUMO

PURPOSE OF REVIEW: Once thought a disease of Western civilizations, the inflammatory bowel diseases (IBD) impose a global burden, now penetrating populations in Asia, Africa, and South America. We summarize similarities and differences in the epidemiology of IBD globally, highlighting gaps in knowledge where future study is needed. RECENT FINDINGS: While incidence of IBD is stabilizing (or even decreasing) in many westernized regions, prevalence continues to grow due to a young age of onset and low mortality. In newly westernized regions, IBD is beginning to penetrate populations comparable to the rapid increases seen in North America, Europe, and Oceania in the last century. IBD imposes a significant fiscal and resource burden on healthcare systems. As global prevalence of these diseases continues to increase, we desperately need to anticipate the future burden to proactively prepare our healthcare systems for the challenges of increased patient load and aging populations with comorbid conditions and longer disease course.


Assuntos
Doenças Inflamatórias Intestinais/epidemiologia , Ásia/epidemiologia , Europa (Continente)/epidemiologia , Saúde Global/estatística & dados numéricos , Humanos , Incidência , Doenças Inflamatórias Intestinais/etiologia , América do Norte/epidemiologia , Prevalência , Fatores de Risco
9.
BMC Gastroenterol ; 19(1): 128, 2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31324228

RESUMO

BACKGROUND: We aimed to evaluate the long-term clinical and socioeconomic outcome of structured transition care in adolescents with inflammatory bowel disease (IBD). METHODS: We compared the clinical long-term course of 24 patients with and 11 patients without structured transition care within 24 months before and 24 months after transfer from paediatric to adult health care. Socio-economic parameters and quality of life were assessed by IBD Questionnaire (IBDQ-32) and additional items. Treatment costs were calculated for medication, surgery and hospitalisation. RESULTS: The percentage of transfer group patients with an IBD-related intestinal complication was higher compared to the transition group (64% vs. 21%, p = 0.022). We also found a tendency towards a higher number of IBD-related surgery in the transfer group compared to the transition group (46% vs. 13%, p = 0.077). Transfer group patients received higher mean cumulated doses of radiation compared with the transition group (4.2 ± 5.3 mSv vs. 0.01 ± 0.01 mSv, p = 0.036). Delayed puberty was only noted in the transfer group (27%, p = 0.025). Mean expenditures for surgeries and hospitalisation tended to be lower in the transition group compared to transfer group patients (744 ± 630€ vs. 2,691 ± 4,150€, p = 0.050). Sexual life satisfaction was significantly higher (p = 0.023) and rates of loose bowel movements tended to be lower (p = 0.053) in the transition group. CONCLUSIONS: Structured transition of adolescents with IBD from paediatric into adult health care can lead to important clinical and economic benefits.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Hospitalização/estatística & dados numéricos , Doenças Inflamatórias Intestinais , Puberdade Tardia/epidemiologia , Qualidade de Vida , Transição para Assistência do Adulto , Adolescente , Adulto , Procedimentos Cirúrgicos do Sistema Digestório/economia , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Alemanha/epidemiologia , Gastos em Saúde/estatística & dados numéricos , Humanos , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/psicologia , Doenças Inflamatórias Intestinais/terapia , Masculino , Fatores Socioeconômicos , Tempo , Transição para Assistência do Adulto/economia , Transição para Assistência do Adulto/organização & administração
10.
Gut ; 68(11): 1953-1960, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31300515

RESUMO

OBJECTIVE: IBD prevalence is estimated to be rising, but no detailed, recent UK data are available. The last reported prevalence estimate in the UK was 0.40% in 2003. We aimed to establish the current, and project future, prevalence in Lothian, Scotland. DESIGN: We conducted an all-age multiparameter search strategy using inpatient IBD international classification of disease (ICD-10) coding (K50/51)(1997-2018), IBD pathology coding (1990-2018), primary and secondary care prescribing data (2009-2018) and a paediatric registry, (1997-2018) to identify 'possible' IBD cases up to 31/08/2018. Diagnoses were manually confirmed through electronic health record review as per Lennard-Jones/Porto criteria. Autoregressive integrated moving average (ARIMA) regression was applied to forecast prevalence to 01/08/2028. RESULTS: In total, 24 601 possible IBD cases were identified of which 10 499 were true positives. The point prevalence for IBD in Lothian on 31/08/2018 was 784/100 000 (UC 432/100 000, Crohn's disease 284/100 000 and IBD unclassified (IBDU) 68/100 000). Capture-recapture methods identified an additional 427 'missed' cases (95% CI 383 to 477) resulting in a 'true' prevalence of 832/100 000 (95% CI 827 to 837).Prevalence increased by 4.3% per year between 2008 and 2018 (95% CI +3.7 to +4.9%, p<0.0001). ARIMA modelling projected a point prevalence on 01/08/2028 of 1.02% (95% CI 0.97% to 1.07%) that will affect an estimated 1.53% (95% CI 1.37% to 1.69%) of those >80 years of age. CONCLUSIONS: We report a rigorously validated IBD cohort with all-age point prevalence on 31/08/2018 of 1 in 125, one of the highest worldwide.


Assuntos
Doenças Inflamatórias Intestinais/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Doenças Inflamatórias Intestinais/diagnóstico , Masculino , Pessoa de Meia-Idade , Prevalência , Sistema de Registros , Escócia , Distribuição por Sexo , Adulto Jovem
11.
Medicine (Baltimore) ; 98(27): e16291, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277162

RESUMO

Despite the worldwide increasing incidence and prevalence of Inflammatory Bowel Disease (IBD), our knowledge about it in Mexico is still limited. The aim of this study is to describe the incidence and prevalence of IBD as well as its clinical and socio-demographical characteristics in Mexico from a nation-wide perspective.Multicenter nation-wide cohort study that included 42 IBD clinics from all over the country that participated with electronically register of the new cases over 17 years as well as all known existing cases together with their clinical and socio-demographical characteristics from patients with IBD (ulcerative colitis [UC], Crohn disease [CD], and inflammatory bowel disease unclassified [IBDU]). The data collection was conducted between January and October 2017. Incidence, prevalence, and mean incidence over 2 decades were then calculated. Data base was analyzed using SPSS v24 program SPSS (version 24, IBM Corp., Armonk, NY, USA).A total of 2645 patients with IBD were registered. The crude incidence rates of IBD, UC, and CD, respectively, were 0.21, 0.16, and 0.04 cases per 100,000-person year. The highest incidence was registered in the year 2015, compared with to the previous years. The mean incidence of IBD has increased steadily from 0.05 to 0.21 per 100,000 person-years over the past 15 years (P = .06). The incidence of IBD new cases have increased significantly throughout the last 16 years, 5.9-fold for IBD, 5.3-fold for UC, and 9.5-fold for CD. The prevalence rates of IBD, UC, and CD, respectively, were 1.83, 1.45, and 0.34 cases per 100,000-person-year.This is the first study from a nation-wide perspective that demonstrated a significant increase of prevalence and incidence of IBD in Mexico in the last 15 years.


Assuntos
Previsões , Doenças Inflamatórias Intestinais/epidemiologia , Vigilância da População , Adolescente , Adulto , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Incidência , Masculino , México/epidemiologia , Prevalência , Estudos Retrospectivos , Adulto Jovem
12.
Nutrients ; 11(7)2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31284450

RESUMO

This review discusses the personalised dietary approach with respect to inflammatory bowel disease (IBD). It identifies gene-nutrient interactions associated with the nutritional deficiencies that people with IBD commonly experience, and the role of the Western diet in influencing these. It also discusses food intolerances and how particular genotypes can affect these. It is well established that with respect to food there is no "one size fits all" diet for those with IBD. Gene-nutrient interactions may help explain this variability in response to food that is associated with IBD. Nutrigenomic research, which examines the effects of food and its constituents on gene expression, shows that-like a number of pharmaceutical products-food can have beneficial effects or have adverse (side) effects depending on a person's genotype. Pharmacogenetic research is identifying gene variants with adverse reactions to drugs, and this is modifying clinical practice and allowing individualised treatment. Nutrigenomic research could enable individualised treatment in persons with IBD and enable more accurate tailoring of food intake, to avoid exacerbating malnutrition and to counter some of the adverse effects of the Western diet. It may also help to establish the dietary pattern that is most protective against IBD.


Assuntos
Deficiências Nutricionais/dietoterapia , Dieta Ocidental/efeitos adversos , Hipersensibilidade Alimentar/dietoterapia , Doenças Inflamatórias Intestinais/dietoterapia , Nutrigenômica/métodos , Estado Nutricional , Medicina de Precisão/métodos , Adolescente , Fenômenos Fisiológicos da Nutrição do Adolescente , Adulto , Animais , Criança , Fenômenos Fisiológicos da Nutrição Infantil , Deficiências Nutricionais/epidemiologia , Deficiências Nutricionais/genética , Deficiências Nutricionais/fisiopatologia , Comportamento Alimentar , Feminino , Hipersensibilidade Alimentar/epidemiologia , Hipersensibilidade Alimentar/genética , Hipersensibilidade Alimentar/fisiopatologia , Interação Gene-Ambiente , Humanos , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/genética , Doenças Inflamatórias Intestinais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estado Nutricional/genética , Valor Nutritivo , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
13.
Nutrients ; 11(8)2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31357648

RESUMO

The incidence and prevalence of Inflammatory Bowel Disease (IBD) has rapidly increased worldwide and now is a global disease with some of the highest rates observed in North America [...].


Assuntos
Doenças Inflamatórias Intestinais/dietoterapia , Comportamento de Redução do Risco , Animais , Humanos , Incidência , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/fisiopatologia , Estado Nutricional , Valor Nutritivo , Prevalência , Fatores de Proteção , Medição de Risco , Fatores de Risco , Resultado do Tratamento
14.
Clin Exp Rheumatol ; 37(5): 723-730, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31172920

RESUMO

OBJECTIVES: The aim of this 2-year prospective study was to assess the diagnostic and therapeutic effect of a combined gastro-rheumatological approach in enteropathic spondyloarthritis (eSpA) patients. METHODS: Inflammatory bowel disease (IBD) patients with joint pain were referred by IBD-dedicated gastroenterologists to a dedicated rheumatologist. At baseline and at 3, 6, 12, 24 months, the following parameters were recorded: clinical and biochemical variables, SpA and IBD activity scores, treatment (conventional synthetic; csDMARDs, biologics; bDMARDs). Associations between treatment and patient characteristics were evaluated by logistic regression (AOR [95% CI]). RESULTS: Overall, 229 IBD patients were referred to rheumatologists. eSpA was diagnosed in 147 (64.2%) patients: 96 (65.3%) showing peripheral and 51 (34.7%) axial involvement. IBD included Crohn's disease (CD) in 141 (61.6%) and ulcerative colitis (UC) in 88 (38.4%). bDMARD treatment increased over the follow-up (baseline-24 months: 32.7-60%; AOR 3.45 [1.93-6.2], p<0.001). bDMARD use was less frequent in elderly patients (AOR 0.73 [0.56-0.96], p=0.023), in UC (AOR 0.43 [0.2-0.94], p=0.034) and in patients with peripheral involvement (AOR 0.53 [0.3-1.04], p=0.067). csDMARD use was increased in patients with peripheral involvement (AOR 4.65 [2.09-10.33], p<0.001) and in UC (AOR 2.30 [1.13-4.67], p=0.021). CRP, ESR, ASDAS-ESR levels and BASFI significantly decreased over the follow-up, whereas the pMayo score, BASDAI and HAQ-S were unchanged. CONCLUSIONS: In this prospective study in eSpA patients, a multidisciplinary approach was shown to optimise the therapeutic management and outcome (e.g. disease activity scores). bDMARD use paralleled an improvement in disease activity scores and confirmed a good safety profile.


Assuntos
Antirreumáticos , Doenças Inflamatórias Intestinais , Espondilartrite , Idoso , Antirreumáticos/uso terapêutico , Produtos Biológicos , Colite Ulcerativa , Comorbidade , Humanos , Doenças Inflamatórias Intestinais/tratamento farmacológico , Doenças Inflamatórias Intestinais/epidemiologia , Estudos Prospectivos , Doenças Reumáticas , Espondilartrite/tratamento farmacológico , Espondilartrite/epidemiologia
15.
Nutrients ; 11(6)2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31238597

RESUMO

Ageing of the human population has become a big challenge for health care systems worldwide. On the other hand, the number of elderly patients with inflammatory bowel disease (IBD) is also increasing. Considering the unique clinical characteristics of this subpopulation, including many comorbidities and polypharmacy, the current therapeutic guidelines for the management of IBD should be individualized and applied with caution. This is why the role of non-pharmacological treatments is of special significance. Since both IBD and older age are independent risk factors of nutritional deficiencies, appropriate dietary support should be an important part of the therapeutic approach. In this review paper we discuss the interrelations between IBD, older age, and malnutrition. We also present the current knowledge on the utility of different diets in the management of IBD. Considering the limited data on how to support IBD therapy by nutritional intervention, we focus on the Mediterranean and Dietary Approaches to Stop Hypertension diets, which seem to be the most beneficial in this patient group. We also discuss some new findings on their hypothetical anti-inflammatory influence on the course of IBD.


Assuntos
Dieta Mediterrânea , Abordagens Dietéticas para Conter a Hipertensão , Doenças Inflamatórias Intestinais/dietoterapia , Desnutrição/dietoterapia , Estado Nutricional , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/fisiopatologia , Masculino , Desnutrição/epidemiologia , Desnutrição/fisiopatologia , Pessoa de Meia-Idade , Valor Nutritivo , Recomendações Nutricionais , Fatores de Risco , Resultado do Tratamento
16.
BMC Public Health ; 19(Suppl 4): 550, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196184

RESUMO

BACKGROUND: Inflammatory bowel disease (IBD) was once considered as a Western disease. However, recent epidemiological data showed an emerging trend of IBD cases in the Eastern Asia countries. Clinico-epidemiological data of IBD in Malaysia is scarce. This study aimed to address this issue. METHODS: Retrospective analysis of ulcerative colitis (UC) and Crohn's disease (CD), diagnosed from January 1980 till June 2018 was conducted at our centre. RESULTS: A total of 413 IBD patients (281 UC, 132 CD) were identified. Mean crude incidence of IBD has increased steadily over the first three decades: 0.36 (1980-1989), 0.48 (1990-1999) and 0.63 per 100,000 person-years (2000-2009). In the 2010 to 2018 period, the mean crude incidence has doubled to 1.46 per 100,000 person-years. There was a significant rise in the incidence of CD, as depicted by reducing UC:CD ratio: 5:1 (1980-1989), 5:1 (1990-1999), 1.9:1 (2000-2009) and 1.7:1 (2010-2018). The prevalence rate of IBD, UC and CD, respectively were 23.0, 15.67 and 7.36 per 100,000 persons. Of all IBD patients, 61.5% (n = 254) were males. When stratified according to ethnic group, the highest prevalence of IBD was among the Indians: 73.4 per 100,000 persons, followed by Malays: 24.8 per 100,000 persons and Chinese: 14.6 per 100,000 persons. The mean age of diagnosis was 41.2 years for UC and 27.4 years for CD. Majority were non-smokers (UC: 76.9%, CD: 70.5%). The diseases were classified as follows: UC; proctitis (9.2%), left-sided colitis (50.2%) and extensive colitis (40.6%), CD; isolated ileal (22.7%), colonic (28.8%), ileocolonic (47.7%) and upper gastrointestinal (0.8%). 12.9% of CD patients had concurrent perianal disease. Extra intestinal manifestations were observed more in CD (53.8%) as compared to UC (12%). Dysplasia and malignancy, on the other hand, occurred more in UC (4.3%, n = 12) than in CD (0.8%, n = 1). Over one quarter (27.3%) of CD patients and 3.6% of UC patients received biologic therapy. CONCLUSION: The incidence of IBD is rising in Malaysia, especially in the last one decade. This might be associated with the urbanization and changing diets. Public and clinicians' awareness of this emerging disease in Malaysia is important for the timely detection and management.


Assuntos
Colite Ulcerativa/epidemiologia , Doença de Crohn/epidemiologia , Doenças Inflamatórias Intestinais/epidemiologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Incidência , Malásia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Urbanização , Adulto Jovem
17.
J Coll Physicians Surg Pak ; 29(5): 435-439, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31036113

RESUMO

OBJECTIVE: To compare the frequency of asthma and allergic diseases in patients with inflammatory bowel disease and Celiac disease using international study of asthma and allergies in childhood questionnaire. STUDY DESIGN: Cross-sectional, descriptive study. PLACE AND DURATION OF STUDY: Pediatric gastroenterology outpatient clinics and pediatric pulmonology outpatient clinics, from May 2015 to August 2015. METHODOLOGY: Patients aged between 6 and 18 years with the diagnoses of celiac and inflammatory bowel disease were included in the study. After recording the socio-demographic characteristics of all patients, the International study of asthma and allergies in childhood questionnaire was applied and required information collected. RESULTS: Eighty-three patients (31 males, 52 females) diagnosed with celiac, 42 patients (24 males, 18 females) diagnosed with ulcerative colitis, and 28 patients (11 females, 17 males) diagnosed with Crohn's disease were included. No significant difference was found between the groups in terms of the frequency of wheezing, wheezing in the last year, lifelong allergic rhinitis, long-term use of nasal steroids, and history of eczema (p >0.05). The frequency of atopic dermatitis was significantly higher in the celiac disease group than the other groups. CONCLUSION: The frequencies of asthma and atopy are similar in patients with celiac disease and inflammatory bowel disease.


Assuntos
Asma/epidemiologia , Doença Celíaca/diagnóstico , Dermatite Atópica/epidemiologia , Hipersensibilidade/epidemiologia , Doenças Inflamatórias Intestinais/diagnóstico , Adolescente , Doença Celíaca/epidemiologia , Criança , Estudos Transversais , Feminino , Humanos , Doenças Inflamatórias Intestinais/epidemiologia , Masculino , Paquistão/epidemiologia , Prevalência , Sons Respiratórios , Distribuição por Sexo , Inquéritos e Questionários
18.
Adv Clin Exp Med ; 28(7): 899-905, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31066244

RESUMO

BACKGROUND: The relationship of diffusely adherent Escherichia coli (DAEC) with pediatric inflammatory bowel disease (IBD) has not been previously studied. Diffusely adherent E. coli are a common cause of long-lasting childhood diarrhea and we postulated that they may induce inflammation of the intestinal mucosa, contributing to the development of IBD in susceptible children. OBJECTIVES: The aim of the study was to investigate the relationship between DAEC and pediatric IBD, including Crohn's disease (CD) and ulcerative colitis (UC). Diffusely adherent E. coli isolates were also assessed regarding their pathogenicity. MATERIAL AND METHODS: Diffusely adherent E. coli were screened among 130 E. coli strains isolated from intestinal biopsy specimens from 26 children with IBD using polymerase chain reaction (PCR) with primers specific to the pathotype and adherence assays to HEp-2 cells. Diffusely adherent E. coli were further analyzed for their ability to adhere to and invade polarized Caco-2 cells. The immunomodulatory effect of DAEC on the secretion of tumor necrosis factor α (TNF-α) by human monocyte-derived macrophages (MDM) was assessed using an immunoenzymatic assay. RESULTS: Diffusely adherent E. coli were recovered from 18 (69.2%) of the 26 intestinal biopsy specimens from both CD and UC patients. Most DAEC isolates carried AfaE3 adhesin, adhered to and were internalized by Caco-2 cells, and induced secretion of elevated levels of TNF-α. CONCLUSIONS: The study demonstrated the internalization of DAEC by intestinal epithelial cells and their ability to induce secretion of increased level of TNF-α in a Caco-2/macrophage compartmentalized culture. This indicated that the pathovar should be considered a pathobiont inducing inflammation of the intestinal mucosa in pediatric patients with IBD.


Assuntos
Aderência Bacteriana , Moléculas de Adesão Celular/metabolismo , Colite Ulcerativa/microbiologia , Doença de Crohn/microbiologia , Infecções por Escherichia coli/epidemiologia , Escherichia coli/isolamento & purificação , Doenças Inflamatórias Intestinais/microbiologia , Mucosa Intestinal/microbiologia , Adesinas de Escherichia coli , Células CACO-2 , Moléculas de Adesão Celular/genética , Criança , Colite Ulcerativa/epidemiologia , Colite Ulcerativa/imunologia , Doença de Crohn/epidemiologia , Doença de Crohn/imunologia , Escherichia coli/genética , Infecções por Escherichia coli/imunologia , Infecções por Escherichia coli/microbiologia , Humanos , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/imunologia , Mucosa Intestinal/imunologia , Polônia/epidemiologia , Prevalência
19.
Rev Med Chil ; 147(2): 212-220, 2019 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-31095170

RESUMO

Environmental factors may influence the development of Inflammatory Bowel Disease and modify its natural history. The objective of this review is to evaluate current evidence about environmental factors associated with the disease. A better knowledge about the pathogenesis of the disease can lead to better treatment strategies and suggestions to prevent the disease.


Assuntos
Exposição Ambiental/efeitos adversos , Doenças Inflamatórias Intestinais/etiologia , Dieta/efeitos adversos , Humanos , Doenças Inflamatórias Intestinais/epidemiologia , Obesidade/complicações , Probióticos , Fatores de Proteção , Fatores de Risco , Tabaco/efeitos adversos
20.
Curr Gastroenterol Rep ; 21(7): 31, 2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31098819

RESUMO

PURPOSE OF REVIEW: Extraintestinal manifestations (EIMs) of inflammatory bowel disease (IBD) represent a complex array of disease processes with variable epidemiologic penetrance, genetic antecedents, and phenotypic presentations. The purpose of this review is to provide an overview of primary and secondary EIMs as well as salient treatment strategies utilized. RECENT FINDINGS: While the genetic antecedents remain incompletely understood, the treatment armamentarium for EIMs has expanded with new pharmaceutical drug classes that effectively treat IBD. EIMs are an increasingly recognized complication of IBD that require prompt recognition, multidisciplinary management, and a multifaceted therapeutic approach. This review highlights the complexities and ramifications of EIM management and offers therapeutic guidance.


Assuntos
Doenças Inflamatórias Intestinais/complicações , Oftalmopatias/diagnóstico , Oftalmopatias/etiologia , Oftalmopatias/terapia , Humanos , Doenças Inflamatórias Intestinais/epidemiologia , Doenças da Boca/diagnóstico , Doenças da Boca/etiologia , Doenças da Boca/terapia , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/etiologia , Doenças Musculoesqueléticas/terapia , Dermatopatias/diagnóstico , Dermatopatias/etiologia , Dermatopatias/terapia
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