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Hracs L, Windsor JW, Gorospe J, Cummings M, Coward S, Buie MJ, Quan J, Goddard Q, Caplan L, Markovinović A, Williamson T, Abbey Y, Abdullah M, Abreu MT, Ahuja V, Raja Ali RA, Altuwaijri M, Balderramo D, Banerjee R, Benchimol EI, Bernstein CN, Brunet-Mas E, Burisch J, Chong VH, Dotan I, Dutta U, El Ouali S, Forbes A, Forss A, Gearry R, Dao VH, Hartono JL, Hilmi I, Hodges P, Jones GR, Juliao-Baños F, Kaibullayeva J, Kelly P, Kobayashi T, Kotze PG, Lakatos PL, Lees CW, Limsrivilai J, Lo B, Loftus EV, Ludvigsson JF, Mak JWY, Miao Y, Ng KK, Okabayashi S, Olén O, Panaccione R, Paudel MS, Quaresma AB, Rubin DT, Simadibrata M, Sun Y, Suzuki H, Toro M, Turner D, Iade B, Wei SC, Yamamoto-Furusho JK, Yang SK, Ng SC, Kaplan GG. Global evolution of inflammatory bowel disease across epidemiologic stages. Nature 2025:10.1038/s41586-025-08940-0. [PMID: 40307548 DOI: 10.1038/s41586-025-08940-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/26/2025] [Indexed: 05/02/2025]
Abstract
During the twentieth century, inflammatory bowel disease (IBD) was considered a disease of early industrialized regions in North America, Europe and Oceania1. At the turn of the twenty-first century, IBD incidence increased in newly industrialized and emerging regions in Africa, Asia and Latin America, while the prevalence in early industrialized regions continued to grow steadily2-4. Changes in the incidence and prevalence denote the evolution of IBD across four epidemiologic stages: stage 1 (emergence), characterized by low incidence and prevalence; stage 2 (acceleration in incidence), marked by rapidly rising incidence and low prevalence; and stage 3 (compounding prevalence), where the incidence decelerates, plateaus or declines while the prevalence steadily increases. A fourth stage (prevalence equilibrium) has been proposed in which the prevalence slope plateaus due to demographic shifts in an ageing IBD population, but it has not yet been evidenced. To date, these stages have remained theoretical, lacking specific numerical indicators to define transition points. Here, using real-world data from 522 population-based studies encompassing 82 global regions and spanning more than a century (1920-2024), we show spatiotemporal transitions across stages 1-3 and model stage 4 progression. Understanding the evolution of IBD across epidemiologic stages enables healthcare systems to better anticipate the future worldwide burden of IBD.
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Affiliation(s)
- Lindsay Hracs
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joseph W Windsor
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Julia Gorospe
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael Cummings
- Centre for Health Informatics and Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Stephanie Coward
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael J Buie
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joshua Quan
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Quinn Goddard
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Léa Caplan
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ante Markovinović
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tyler Williamson
- Centre for Health Informatics and Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Yvonne Abbey
- Maidstone and Tunbridge Wells NHS Trust, Kent, UK
| | - Murdani Abdullah
- Division of Gastroenterology, Department of Internal Medicine, HCRC IMERI, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Maria T Abreu
- F. Widjaja Inflammatory Bowel Disease Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- International Organization for the study of Inflammatory Bowel Disease (IOIBD), Stockholm, Sweden
| | - Vineet Ahuja
- International Organization for the study of Inflammatory Bowel Disease (IOIBD), Stockholm, Sweden
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Raja Affendi Raja Ali
- Sir Jeffrey Cheah Sunway Medical School, Faculty of Medical and Life Sciences, Sunway University, Selangor, Malaysia
| | - Mansour Altuwaijri
- Division of Gastroenterology, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Domingo Balderramo
- IBD Unit, Gastroenterology Department, Hospital Privado Universitario de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
| | - Rupa Banerjee
- International Organization for the study of Inflammatory Bowel Disease (IOIBD), Stockholm, Sweden
- IBD Center, Asian Institute of Gastroenterology, Hyderabad, India
| | - Eric I Benchimol
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
- Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Charles N Bernstein
- International Organization for the study of Inflammatory Bowel Disease (IOIBD), Stockholm, Sweden
- Department of Medicine, and the University of Manitoba IBD Clinical and Research Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Eduard Brunet-Mas
- Gastroenterology Department, Parc Taulí Hospital Universitari, Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Johan Burisch
- International Organization for the study of Inflammatory Bowel Disease (IOIBD), Stockholm, Sweden
- Gastrounit, Medical Division, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vui Heng Chong
- Division of Gastroenterology and Hepatology, Department of Medicine, Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, Bandar Seri Begawan, Brunei Darussalam
| | - Iris Dotan
- International Organization for the study of Inflammatory Bowel Disease (IOIBD), Stockholm, Sweden
- Division of Gastroenterology, Rabin Medical Center, Petah-Tikva, Israel, Affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sara El Ouali
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Angela Forbes
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Anders Forss
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Richard Gearry
- International Organization for the study of Inflammatory Bowel Disease (IOIBD), Stockholm, Sweden
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Viet Hang Dao
- Internal Medicine Faculty, Hanoi Medical University, Hanoi, Vietnam
| | - Juanda Leo Hartono
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division Gastroenterology & Hepatology, National University Hospital, Singapore, Singapore
| | - Ida Hilmi
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Phoebe Hodges
- Blizard Institute, Barts & The London School of Medicine, Queen Mary University of London, London, UK
- Tropical Gastroenterology & Nutrition Group, University of Zambia School of Medicine, Lusaka, Zambia
| | - Gareth-Rhys Jones
- University of Edinburgh, Institute for Regeneration and Repair, Edinburgh, UK
| | - Fabián Juliao-Baños
- Department of Gastroenterology, Pablo Tobon Uribe Hospital, Medellín, Colombia
| | - Jamilya Kaibullayeva
- JSC Research Institute of Cardiology and Internal Diseases of the Ministry of Health of the Republic of Kazakhstan, Astana, Republic of Kazakhstan
- Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Paul Kelly
- Blizard Institute, Barts & The London School of Medicine, Queen Mary University of London, London, UK
- Tropical Gastroenterology & Nutrition Group, University of Zambia School of Medicine, Lusaka, Zambia
| | - Taku Kobayashi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Paulo Gustavo Kotze
- International Organization for the study of Inflammatory Bowel Disease (IOIBD), Stockholm, Sweden
- Health Sciences Postgraduate Program, Pontificia Universidade Católica do Paraná, Curitiba, Brazil
| | - Peter L Lakatos
- International Organization for the study of Inflammatory Bowel Disease (IOIBD), Stockholm, Sweden
- Division of Gastroenterology, McGill University, Montreal, Quebec, Canada
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Charlie W Lees
- Centre for Genomics and Experimental Medicine (CGEM), Institute of Genetics & Cancer, University of Edinburgh, Edinburgh, UK
- Edinburgh IBD Unit, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - Julajak Limsrivilai
- Division of Gastroenterology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Bobby Lo
- Gastrounit, Medical Division, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | - Edward V Loftus
- International Organization for the study of Inflammatory Bowel Disease (IOIBD), Stockholm, Sweden
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatrics, Örebro University Hospital, Stockholm, Sweden
| | - Joyce W Y Mak
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - YingLei Miao
- Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Province Clinical Research Center for Digestive Diseases, Kunming, China
| | - Ka Kei Ng
- Conde S. Januário Hospital, Macao SAR, China
| | - Shinji Okabayashi
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ola Olén
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Remo Panaccione
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- International Organization for the study of Inflammatory Bowel Disease (IOIBD), Stockholm, Sweden
| | - Mukesh Sharma Paudel
- Department of Gastroenterology, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Abel Botelho Quaresma
- UNOESC Curso de Medicina: Universidade do Oeste de Santa Catarina, Joaçaba, Brazil
- Health Sciences Postgraduate Program, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - David T Rubin
- International Organization for the study of Inflammatory Bowel Disease (IOIBD), Stockholm, Sweden
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA
| | - Marcellus Simadibrata
- Division of Gastroenterology, Department of Internal Medicine, HCRC IMERI, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Yang Sun
- Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
- Yunnan Province Clinical Research Center for Digestive Diseases, Kunming, China
| | - Hidekazu Suzuki
- Division of Gastroenteroloy and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Martin Toro
- Head of the Inflammatory Bowel Diseases Unit, HIGEA, Mendoza, Argentina
| | - Dan Turner
- International Organization for the study of Inflammatory Bowel Disease (IOIBD), Stockholm, Sweden
- The Juliet Keidan Institute of Pediatric Gastroenterology & Nutrition, The Hebrew University of Jerusalem, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Beatriz Iade
- Cooperativa de Servicios Médicos (COSEM), Montevideo, Uruguay
| | - Shu Chen Wei
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Jesus K Yamamoto-Furusho
- Inflammatory Bowel Disease Clinic, Department of Gastroenterology, National Institute of Medical Sciences and Nutrition and National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Suk-Kyun Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Siew C Ng
- International Organization for the study of Inflammatory Bowel Disease (IOIBD), Stockholm, Sweden.
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China.
- Microbiota I-Center (MagIC), Hong Kong, China.
- New Cornerstone Science Laboratory, The Chinese University of Hong Kong, Hong Kong, China.
| | - Gilaad G Kaplan
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
- International Organization for the study of Inflammatory Bowel Disease (IOIBD), Stockholm, Sweden.
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de Castro CT, Dos Santos Natividade M, Pereira M, Miranda SS, Aragão E, de Souza Teles Santos CA, Dos Santos DB. Geographic and Temporal Patterns in Biologic Prescriptions for Inflammatory Bowel Diseases in the Public Healthcare System in Brazil: An Ecological Study. Pharmacoepidemiol Drug Saf 2025; 34:e70114. [PMID: 39950239 DOI: 10.1002/pds.70114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 12/31/2024] [Accepted: 01/29/2025] [Indexed: 05/09/2025]
Abstract
PURPOSE To analyze the geographic and temporal patterns of biologic prescriptions for inflammatory bowel disease (IBD) in Brazil's public national unified health system (SUS). METHODS This ecological study used data from patients with IBD in the SUS Outpatient Information System between 2008 and 2022. Prais-Winsten regression was used to estimate the trends in prescription rate of biologics. For geographic analysis, average prescription rate of biologics was calculated by state for three periods: 2008-2012, 2013-2017, and 2018-2022. Global Moran's index (GMI) and local indicators of spatial autocorrelation (LISA) were used to assess spatial autocorrelation and identify spatial clusters of biologic prescriptions, respectively. RESULTS The prescription rate of biologics increased from 3.0% to 16.7%. Infliximab was the most prescribed drug from 2008 to 2012 (3.0%-4.2%), and adalimumab was the most widely prescribed drug from 2013 to 2022 (4.3%-9.1%). Higher prescription rates of biologics were observed in patients with Crohn's disease than in those with ulcerative colitis (40.5% vs. 3.2%). Biologics were primarily prescribed in the Southeast and South; however, the central-western and northern regions showed greater changes in prescription rates over time. There were increased clusters of high biologic prescriptions across the three evaluated periods. CONCLUSIONS The increase in biologic prescriptions over time may be attributed to their enhanced efficacy in inducing and maintaining IBD remission. Biologic prescriptions in Brazil are experiencing temporal and geographical changes, indicating that disparities in drug prescriptions may decrease with universal, equitable healthcare access, despite administrative challenges in obtaining these medications through SUS.
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Affiliation(s)
| | | | - Marcos Pereira
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | | | - Erika Aragão
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - Carlos Antonio de Souza Teles Santos
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
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dos Reis Guerra JA, Magro DO, Rodrigues Coy CS, Valverde DA, de Oliveira ES, Quaresma AB, Kotze PG. Temporal Trends in Surgery and Hospitalization Rates for Crohn's Disease in Brazil: A Population-Based Study. CROHN'S & COLITIS 360 2025; 7:otae082. [PMID: 40207073 PMCID: PMC11979744 DOI: 10.1093/crocol/otae082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Indexed: 04/11/2025] Open
Abstract
Introduction Biological therapy has transformed the natural course of inflammatory bowel disease, but there are still controversies regarding its potential to reduce surgical rates for Crohn's disease (CD). This study, conducted with the support of the Brazilian National Healthcare System, aimed to analyze temporal trends in surgery and hospitalization rates among patients with CD and to correlate these data with the dispensing of azathioprine (AZA), infliximab (IFX), and adalimumab (ADA). Methodology This retrospective observational study used data from the National Public Healthcare Department of Informatics through the TT Disease Explorer® platform from 2012 to 2022. Demographic data, medications used, and the prevalence of surgical procedures and hospitalizations associated with the International Classification of Diseases codes for CD were analyzed. Annual average percent changes (AAPCs) were calculated to assess temporal trends. Results Between 2012 and 2022, there was a significant increase of 288.07% in the diagnoses of CD, rising from 27 551 to 106 917 cases. Concurrently, there was an increase in the absolute number of patients treated with AZA, IFX, and ADA, with increasing rates of 65.79%, 251.09%, and 242.48%, respectively. However, the proportion of patients receiving AZA per CD patients decreased by 57.28%, from 44.79% to 19.13% (AAPC = -7.94%, 95% CI, -8.05 to -7.83; P < .001). The use of IFX remained relatively stable, with a slight change from 13.82% to 12.50% (AAPC = 0.01%, 95% CI, -0.20 to 0.22; P = .935), while the use of ADA decreased by 11.75%, from 11.65% to 10.28% (AAPC = -1.74%, 95% CI, -2.48 to -1.82; P < .001). The absolute number of hospitalizations related to CD increased by 57.71%. Despite the rise in the number of cases and the greater availability of biological treatments, the proportion of hospitalized patients decreased by 59.29%, from 6.19% to 2.52% (AAPC = -7.04%, 95% CI, -7.42 to -6.66; P < .001). Similarly, the proportion of surgical procedures relative to the total number of cases decreased by 55.08%, from 1.09% to 0.49% (AAPC = -5.73%, 95% CI, -6.68 to -4.77; P < .001). Conclusions Despite the cumulative increase in the prevalence of CD cases in the country and the absolute increase in the dispensing of biologics, the proportion of hospitalizations and surgical procedures among CD patients treated in the public health system in Brazil decreased.
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Affiliation(s)
| | | | | | | | | | - Abel Botelho Quaresma
- Health Sciences Postgraduate Program, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
- IBD Outpatient Clinic, Colorectal Surgery Unit, Universidade do Oeste de Santa Catarina, UNOESC, Brazil
| | - Paulo Gustavo Kotze
- Colorectal Surgery Unit, Catholic University of Paraná, IBD Outpatient Clinics, Curitiba, Brazil
- Health Sciences Postgraduate Program, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
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Sauer P, Luft VC, Dall'Alba V. Patients with Inflammatory Bowel Disease who regularly consume fruits and vegetables present lower prevalence of disease activation: A cross-sectional study. Clin Nutr ESPEN 2024; 61:420-426. [PMID: 38777464 DOI: 10.1016/j.clnesp.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Exclusion diets are common practices among individuals with Inflammatory Bowel Disease (IBD). Reports that certain foods trigger or worsen symptoms are recurrent but lack evidence. The aim of the study was to identify which foods were most frequently avoided by patients with Crohn's Disease (CD) and Ulcerative Colitis (UC) and whether the consumption of any food group was associated with disease activity. METHODS Cross-sectional study with adult patients seen at an outpatient clinic in a tertiary public hospital. Dietary intake and eating habits were accessed through questionnaires administered via telephone interview. Disease activity and symptoms were assessed using the Harvey-Bradshaw Index (IHB) for CD and the Lichtiger Index (LI) for UC. Poisson regression with a robust variance estimator was used to estimate prevalence ratios. Analyzes were performed using SPSS - Statistical Package for the Social Sciences. RESULTS The study included 145 patients. Of these, 69.7% avoided certain foods, with citrus fruits and raw vegetables among the most avoided (16.8% and 13.8%, respectively). Regular consumption of fruits (PR = 0.56; CI 95% 0.32-0.97; p = 0.042) and vegetables (PR = 0.56; CI 95% 0.32-0.98; p = 0.045) was associated with a 44% lower prevalence of the active phase of the disease, compared to those who do not consume these foods, adjusted for age, sex and type of disease. Other food items did not present significant associations in the adjusted model. CONCLUSIONS Fruit and vegetable intake appears to have a protective role in the recurrence of IBD. Excluding foods is a common practice, even among patients in remission, and this should be combated as it can lead to nutritional losses. It is important to reinforce with patients the benefits of a varied and less restrictive diet.
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Affiliation(s)
- Patrícia Sauer
- Graduate Program in Gastroenterology and Hepatology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Nutrition Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Vivian Cristine Luft
- Nutrition Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Graduate Program in Food, Nutrition and Health, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Graduate Program in Epidemiology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Valesca Dall'Alba
- Graduate Program in Gastroenterology and Hepatology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Nutrition Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Graduate Program in Food, Nutrition and Health, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
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Parra RS, Chebli JMF, de Azevedo MFC, Chebli LA, Zabot GP, Cassol OS, de Sá Brito Fróes R, Santana GO, Lubini M, Magro DO, Imbrizi M, Moraes ACDS, Teixeira FV, Alves Junior AJT, Gasparetti Junior NLT, da Costa Ferreira S, Queiroz NSF, Kotze PG, Féres O. Effectiveness and Safety of Ustekinumab for Ulcerative Colitis: A Brazilian Multicentric Observational Study. CROHN'S & COLITIS 360 2024; 6:otae023. [PMID: 38681979 PMCID: PMC11053358 DOI: 10.1093/crocol/otae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Real-world data on the effectiveness and safety of ustekinumab (UST) in ulcerative colitis (UC) are lacking in Latin America. In this study, we aimed to describe the effectiveness and safety of UST in a real-world multicenter cohort of Brazilian patients with UC. METHODS We conducted a multicenter retrospective observational cohort study, including patients with moderate-to-severe UC (total Mayo score 6-12, with an endoscopic subscore of 2 or 3) who received UST. The co-primary endpoints were clinical remission, defined as a total Mayo score ≤2 at 1 year, with a combined rectal bleeding and stool frequency subscore of ≤1, and endoscopic remission (endoscopic Mayo subscore of 0) within 1 year from baseline. Secondary endpoints included clinical response between weeks 12 and 16, endoscopic response within 1 year of starting UST, steroid-free clinical remission at week 52, and biochemical remission at week 52. We also evaluated UST treatment persistence and safety. RESULTS A total of 50 patients were included (female, n = 36, 72.0%), with a median disease duration of 9.2 years (1-27). Most patients had extensive colitis (n = 38, 76.0%), and 43 (86.0%) were steroid dependent at baseline. Forty patients (80.0%) were previously exposed to biologics (anti-TNF drugs, n = 31; vedolizumab [VDZ], n = 27). The co-primary endpoints of clinical remission at 1 year and endoscopic remission within 1 year were achieved by 50.0% and 36.0% of patients, respectively. Clinical response at weeks 12-16 was 56.0%, and endoscopic response, steroid-free clinical remission, and biochemical remission at week 52 were 68.0%, 46.5%, and 50.0%, respectively. The UST treatment persistence rate at 24 months was 73.7%. During the follow-up, 10 patients (20.0%) were hospitalized, mostly due to disease progression, and 3 patients required colectomy. Nine patients (18.0%) discontinued the drug mainly due to a lack of effectiveness. Twenty-seven adverse events (AEs) were reported, 16 of which were considered as serious AEs. CONCLUSIONS In this real-world cohort of difficult-to-treat UC patients, UST was associated with improvements in clinical, biochemical, and endoscopic outcomes. The safety profile was favorable, consistent with the known profile of UST.
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Affiliation(s)
- Rogério Serafim Parra
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Júlio Maria Fonseca Chebli
- Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Disease Center, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | | | - Liliana Andrade Chebli
- Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Disease Center, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Gilmara Pandolfo Zabot
- Department of Colon and Rectum Surgery, Moinhos de Vento Hospital, Feevale University, Porto Alegre, Brazil
| | - Ornella Sari Cassol
- Department of Colorectal Surgery, Hospital de Clínicas de Passo Fundo, Atitus Medical School, Rio Grande do Sul, Brazil
| | | | | | - Márcio Lubini
- Department of Surgery, Passo Fundo University, Rio Grande do Sul, Brazil
| | - Daniela Oliveira Magro
- Department of Surgery, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Marcello Imbrizi
- Department of Surgery, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | | | | | | | | | - Sandro da Costa Ferreira
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Natália Sousa Freitas Queiroz
- Health Sciences Graduate Program, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
- IBD Center, Santa Cruz Hospital, Curitiba, Brazil
- Internal Medicine Department, Hospital Copa D´Or, Rio de Janeiro, Brazil
| | - Paulo Gustavo Kotze
- Health Sciences Graduate Program, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
- Department of Colorectal Surgery, Hospital de Clínicas de Passo Fundo, Atitus Medical School, Rio Grande do Sul, Brazil
| | - Omar Féres
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Fróes RDSB, Andrade AR, Faria MAG, de Souza HSP, Parra RS, Zaltman C, Dos Santos CHM, Bafutto M, Quaresma AB, Santana GO, Luporini RL, de Lima Junior SF, Miszputen SJ, de Souza MM, Herrerias GSP, Junior RLK, do Nascimento CR, Féres O, de Barros JR, Sassaki LY, Saad-Hossne R. Clinical factors associated with severity in patients with inflammatory bowel disease in Brazil based on 2-year national registry data from GEDIIB. Sci Rep 2024; 14:4314. [PMID: 38383742 PMCID: PMC10881489 DOI: 10.1038/s41598-024-54332-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 02/12/2024] [Indexed: 02/23/2024] Open
Abstract
The Brazilian Organization for Crohn's Disease and Colitis (GEDIIB) established a national registry of inflammatory bowel disease (IBD). The aim of the study was to identify clinical factors associated with disease severity in IBD patients in Brazil. A population-based risk model aimed at stratifying the severity of IBD based on previous hospitalization, use of biologics, and need for surgery for ulcerative colitis (UC) and Crohn's Disease (CD) and on previous complications for CD. A total of 1179 patients (34.4 ± 14.7y; females 59%) were included: 46.6% with UC, 44.2% with CD, and 0.9% with unclassified IBD (IBD-U). The time from the beginning of the symptoms to diagnosis was 3.85y. In CD, 41.2% of patients presented with ileocolic disease, 32% inflammatory behavior, and 15.5% perianal disease. In UC, 46.3% presented with extensive colitis. Regarding treatment, 68.1%, 67%, and 47.6% received biological therapy, salicylates and immunosuppressors, respectively. Severe disease was associated with the presence of extensive colitis, EIM, male, comorbidities, and familial history of colorectal cancer in patients with UC. The presence of Montreal B2 and B3 behaviors, colonic location, and EIM were associated with CD severity. In conclusion, disease severity was associated with younger age, greater disease extent, and the presence of rheumatic EIM.
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Affiliation(s)
| | | | | | - Heitor Siffert Pereira de Souza
- Department of Clinical Medicine, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rogério Serafim Parra
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Cyrla Zaltman
- Department of Clinical Medicine, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Mauro Bafutto
- Department of Gastroenterology, Instituto Goiano de Gastroenterologia, Goiânia, Goiás, Brazil
| | - Abel Botelho Quaresma
- Universidade do Oeste de Santa Catarina - UNOESC - Department of Health Sciences, Joaçaba, Santa Catarina, Brazil
| | | | - Rafael Luís Luporini
- Department of Medicine, Federal University of São Carlos - UFSCar, São Carlos, São Paulo, Brazil
| | | | | | | | - Giedre Soares Prates Herrerias
- Department of Internal Medicine, Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, CEP 18618-970, Brazil
| | | | | | - Omar Féres
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Jaqueline Ribeiro de Barros
- Department of Internal Medicine, Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, CEP 18618-970, Brazil
| | - Ligia Yukie Sassaki
- Department of Internal Medicine, Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, CEP 18618-970, Brazil.
| | - Rogerio Saad-Hossne
- Department of Surgery, Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, Brazil
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Lima JS, de Brito CAA, Celani LMS, de Araújo MVT, de Lucena MT, Vasconcelos GBS, Lima GAS, Nóbrega FJF, Diniz GTN, Lucena-Silva N, Maio R, Martinelli VF. Body Mass Index Profile of Adult Patients with Inflammatory Bowel Disease in a Multicenter Study in Northeastern Brazil. Clin Exp Gastroenterol 2023; 16:213-224. [PMID: 38023814 PMCID: PMC10656846 DOI: 10.2147/ceg.s436699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Inflammatory bowel disease (IBD) is a disease of increasing prevalence in developing countries. Obesity has emerged as a potential risk for IBD; however, the data in the literature are conflicting, and relevant studies in Brazil are limited. Here, we report body mass index profile (BMI) of patients with IBD treated at reference centers in three states of northeastern Brazil. Patients and Methods Observational descriptive study conducted from January 2021 through December 2021 in patient with IBD. Results Of 470 patients with IBD, 194 (41%) were classified as normal weight, 42 (9%) as underweight, 155 (33%) as overweight, and 79 (17%) as obese; CD patients were significantly more likely to be underweight than UC patients (p=0.031)Overweight patients were older (median age: 47 years) than normal-weight and underweight patients at diagnosis (38.5 and 35.5 years, respectively [p<0.0001]). IBD onset and diagnosis among overweight and obese individuals were associated with older age. More extensive disease behavior patterns predominated in UC, while forms associated with complications were prevalent in CD, irrespective of nutritional status. There was a higher frequency of compatible symptoms with axial joint inflammation among obese patients (p=0.005) and a lower frequency of compatible symptoms with peripheral joint inflammation in underweight patients (p=0.044) than in patients of normal weight. No significant difference in the frequency of different drug or surgical treatments was observed among the groups. Conclusion Despite the predominance of overweight and obesity in patients with IBD, no differences in the patterns of disease were seen between the overweight and normal-weight groups; however, obesity was associated with IBD onset in older adults and a higher frequency compatible symptom with axial joint inflammation. These data reinforce the importance of monitoring the nutritional status of IBD patients and the need for a multidisciplinary approach, as recommended in the current guidelines.
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Affiliation(s)
- Jones Silva Lima
- Department of Gastroenterology, Hospital das Clínicas, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Carlos Alexandre Antunes de Brito
- Department of Gastroenterology, Hospital das Clínicas, Federal University of Pernambuco, Recife, Pernambuco, Brazil
- Department of Gastroenterology, Member of Organização Brasileira de Doença de Crohn e Retocolite – GEDIIB, São Paulo, Brazil
- Department of Internal Medicine, Center of Medical Sciences of Federal University of Pernambuco, Pernambuco, Brazil
- Department of Immunology, Autoimune Research Institute, Recife, Pernambuco, Brazil
| | - Lívia Medeiros Soares Celani
- Department of Gastroenterology, Member of Organização Brasileira de Doença de Crohn e Retocolite – GEDIIB, São Paulo, Brazil
- Department of Gastroenterology, Onofre Lopes Hospital, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Marcelo Vicente Toledo de Araújo
- Department of Gastroenterology, Member of Organização Brasileira de Doença de Crohn e Retocolite – GEDIIB, São Paulo, Brazil
- Department of Gastroenterology, Lauro Wanderley Hospital, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
| | | | - Graciana Bandeira Salgado Vasconcelos
- Department of Gastroenterology, Hospital das Clínicas, Federal University of Pernambuco, Recife, Pernambuco, Brazil
- Department of Gastroenterology, Member of Organização Brasileira de Doença de Crohn e Retocolite – GEDIIB, São Paulo, Brazil
- Department of Gastroenterology, University of Pernambuco, Recife, Pernambuco, Brazil
| | - Gustavo André Silva Lima
- Department of Gastroenterology, Hospital das Clínicas, Federal University of Pernambuco, Recife, Pernambuco, Brazil
- Department of Gastroenterology, Member of Organização Brasileira de Doença de Crohn e Retocolite – GEDIIB, São Paulo, Brazil
- Department of Immunology, Autoimune Research Institute, Recife, Pernambuco, Brazil
| | | | | | | | - Regiane Maio
- Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Valéria Ferreira Martinelli
- Department of Gastroenterology, Hospital das Clínicas, Federal University of Pernambuco, Recife, Pernambuco, Brazil
- Department of Gastroenterology, Member of Organização Brasileira de Doença de Crohn e Retocolite – GEDIIB, São Paulo, Brazil
- Department of Immunology, Autoimune Research Institute, Recife, Pernambuco, Brazil
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Marangoni K, Dorneles G, da Silva DM, Pinto LP, Rossoni C, Fernandes SA. Diet as an epigenetic factor in inflammatory bowel disease. World J Gastroenterol 2023; 29:5618-5629. [PMID: 38077158 PMCID: PMC10701328 DOI: 10.3748/wjg.v29.i41.5618] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 09/24/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023] Open
Abstract
Inflammatory bowel disease (IBD) has as a main characteristic the exacerbation of the immune system against enterocytes, compromising the individual's intestinal microbiota. This inflammatory cascade causes several nutritional deficiencies, which further compromise immunological functioning and, as a result, worsen the prognosis. This vicious cycle can be interrupted as the patient's dietary pattern meets their needs according to their clinical condition, acting directly on the inflammatory process of IBD through the interaction of food, intestinal microbiota, and epigenome. Specific nutritional intervention for IBD has a crucial role in preventing and managing disease activity. This review addresses epigenetic modifications through dietary compounds as a mechanism for modulating the intestinal microbiota of patients with IBD.
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Affiliation(s)
- Karina Marangoni
- Egas Moniz School of Health and Science, Caparica - Almada, Portugal, Caparica 2820-062, Portugal
- National Institute of Sciences and Technology - Theranostics and Nanobiotechnology, Federal University of Uberlandia - MG, Brazil, Uberlândia 38400-902, Brazil
| | - Gilson Dorneles
- Corporate Social Responsibility, Hospital Moinhos de Vento, Porto Alegre 90035-004, Brazil
| | - Daniella Miranda da Silva
- Postgraduate Program in Gastroenterology, Universidade Federal do Rio Grande do Sul, Porto Alegre 91540-000, Brazil
- Department of Nutrition, Uniasselvi - Group Vitru, Santa Catarina 89082-262, Brazil
| | - Letícia Pereira Pinto
- Postgraduate Program in Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre 90050-170, Brazil
| | - Carina Rossoni
- Faculty of Medicine, Institute of Environmental Health, University of Lisbon, Lisboa 1649-026, Portugal
- Master in Physical Activity and Health, Polytechnic Institute of Beja, Beja 7800-000, Portugal
- Degree in Nutrition Sciences, Lusófona University, Lisboa 1749-024, Portugal
| | - Sabrina Alves Fernandes
- Postgraduate Program in Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre 90050-170, Brazil
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Freitas Cardoso de Azevedo M, Barros LL, Fernandes Justus F, Oba J, Soares Garcia K, de Almeida Martins C, de Sousa Carlos A, Arruda Leite AZ, Miranda Sipahi A, Queiroz NSF, Omar Mourão Cintra Damião A. Active tuberculosis in inflammatory bowel disease patients: a case-control study. Therap Adv Gastroenterol 2023; 16:17562848231179871. [PMID: 37435180 PMCID: PMC10331078 DOI: 10.1177/17562848231179871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 05/17/2023] [Indexed: 07/13/2023] Open
Abstract
Background/Aims Anti-tumor necrosis factor (anti-TNF) drugs have been the mainstay therapy for moderate to severe inflammatory bowel disease (IBD) over the past 25 years. Nevertheless, these drugs are associated with serious opportunistic infections like tuberculosis (TB). Brazil is ranked among the 30 countries with the highest incidence of TB in the world. This study aimed at identifying risk factors for the development of active TB and describing clinical characteristics and outcomes in IBD patients followed at a tertiary referral center in Brazil. Methods We conducted a retrospective, case-control study between January 2010 and December 2021. Active TB cases in IBD patients were randomly matched 1:3 to controls (IBD patients with no previous history of active TB) according to gender, age, and type of IBD. Design This was a retrospective, case-control study. Results A total of 38 (2.2%) cases of TB were identified from 1760 patients under regular follow-up at our outpatient clinics. Of the 152 patients included in the analysis (cases and controls), 96 (63.2%) were male, and 124 (81.6%) had Crohn's disease. Median age at TB diagnosis was 39.5 [interquartile range (IQR) 30.8-56.3]. Half of the active TB cases were disseminated (50%). Overall, 36 patients with TB (94.7%) were being treated with immunosuppressive medications. Of those, 31 (86.1%) were under anti-TNF drugs. Diagnosis of TB occurred at a median of 32 months after the first dose of anti-TNF (IQR 7-84). In multivariate analysis, IBD diagnosis older than 17 years and anti-TNF therapy were significantly associated with the development of TB (p < 0.05). After the TB treatment, 20 (52.7%) patients received anti-TNF therapy, and only one developed 'de novo' TB 10 years after the first infection. Conclusions TB remains a significant health problem in IBD patients from endemic regions, especially those treated with anti-TNFs. In addition, age at IBD diagnosis (>17 years old) was also a risk factor for active TB. Most cases occur after long-term therapy, suggesting a new infection. The reintroduction of anti-TNFs agents after the anti-TB treatment seems safe. These data highlight the importance of TB screening and monitoring in IBD patients living in endemic areas.
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Affiliation(s)
| | - Luísa Leite Barros
- Department of Gastroenterology, University of
São Paulo School of Medicine, São Paulo, Brazil
| | - Filipe Fernandes Justus
- Department of Gastroenterology, University of
São Paulo School of Medicine, São Paulo, Brazil
| | - Jane Oba
- Department of Gastroenterology, University of
São Paulo School of Medicine, São Paulo, Brazil
| | - Karoline Soares Garcia
- Department of Gastroenterology, University of
São Paulo School of Medicine, São Paulo, Brazil
| | | | | | | | - Aytan Miranda Sipahi
- Department of Gastroenterology, University of
São Paulo School of Medicine, São Paulo, Brazil
| | - Natália Sousa Freitas Queiroz
- Health Sciences Graduate Program, Pontifícia
Universidade Católica do Paraná (PUCPR), Curitiba, BrazilIBD Center, Santa
Cruz Hospital, Curitiba, Brazil
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10
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de Brito CAA, Celani LMS, de Araújo MVT, de Lucena MT, Vasconcelos GBS, Lima GAS, Nóbrega FJF, Diniz GTN, Lucena-Silva N, Toneto GT, Falcão JVDC, Barbosa PM, de Oliveira PRF, Dantas LSX, Fernandes LKC, de Araújo SA, Martinelli VF. A Multicentre Study of the Clinical and Epidemiological Profile of Inflammatory Bowel Disease in Northeast Brazil. Clin Exp Gastroenterol 2023; 16:87-99. [PMID: 37366396 PMCID: PMC10290862 DOI: 10.2147/ceg.s411936] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/15/2023] [Indexed: 06/28/2023] Open
Abstract
Purpose Ulcerative colitis (UC) and Crohn's disease (CD) are inflammatory bowel diseases (IBDs) with multifactorial causes. They are becoming more prevalent in developing countries such as Brazil; however, relevant studies in poorer regions of the country are limited. Here, we report the clinical-epidemiological profile of patients with IBD treated at reference centers in three states of Northeast Brazil. Patients and Methods This was a prospective cohort study involving patients at referral outpatient clinics for IBD from January 2020 through December 2021. Results Of 571 patients with IBD, 355 (62%) had UC, and 216 (38%) had CD. The patients were predominantly women (355, 62%) for both UC and CD. Extensive colitis was the pattern present in 39% of the UC cases. For CD, ileocolonic disease was the predominant manifestation (38%), with 67% of cases showing penetrating and/or stenosing behavior. The majority of patients were diagnosed between the ages of 17 and 40, corresponding to 60.2% in CD and 52.7% in UC. The median time between symptom onset and diagnosis was 12 months for CD and 8 months for UC (p=0.042). Joint involvement was the most frequent extraintestinal manifestation, with arthralgia and arthritis present in 41.9% and 18.6% of the patients, respectively. Biological therapy was prescribed to 73% of CD patients and 26% of UC patients. A progressive increase in new cases was observed in every 5-year interval over the last five decades, with 58.6% being diagnosed in the last 10 years. Conclusion More extensive disease behavior patterns predominated in UC, while forms associated with complications were prevalent in CD. A prolonged time to diagnosis may have contributed to these findings. A progressive increase in IBD incidence was observed and may be related to greater urbanization and better access to specialized outpatient clinics, resulting in improvements in diagnosis.
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Affiliation(s)
- Carlos Alexandre Antunes de Brito
- Department of Gastroenterology, Hospital das Clínicas, Federal University of Pernambuco, Recife, Pernambuco, Brazil
- Department of Gastroenterology, Member of the Brazilian Organization of Crohn’s Disease and Colitis – GEDIIB, São Paulo, Brazil
- Department of Internal Medicine, Centre of Medical Sciences of the Federal University of Pernambuco, Recife, Pernambuco, Brazil
- Department of Immunology, Autoimune Research Institute, Recife, Pernambuco, Brazil
| | - Lívia Medeiros Soares Celani
- Department of Gastroenterology, Member of the Brazilian Organization of Crohn’s Disease and Colitis – GEDIIB, São Paulo, Brazil
- Department of Gastroenterology, Onofre Lopes Hospital, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Marcelo Vicente Toledo de Araújo
- Department of Gastroenterology, Member of the Brazilian Organization of Crohn’s Disease and Colitis – GEDIIB, São Paulo, Brazil
- Department of Gastroenterology, Lauro Wanderley Hospital, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
| | | | - Graciana Bandeira Salgado Vasconcelos
- Department of Gastroenterology, Hospital das Clínicas, Federal University of Pernambuco, Recife, Pernambuco, Brazil
- Department of Gastroenterology, Member of the Brazilian Organization of Crohn’s Disease and Colitis – GEDIIB, São Paulo, Brazil
- Department of Gastroenterology, University of Pernambuco, Recife, Pernambuco, Brazil
| | - Gustavo André Silva Lima
- Department of Gastroenterology, Hospital das Clínicas, Federal University of Pernambuco, Recife, Pernambuco, Brazil
- Department of Gastroenterology, Member of the Brazilian Organization of Crohn’s Disease and Colitis – GEDIIB, São Paulo, Brazil
- Department of Immunology, Autoimune Research Institute, Recife, Pernambuco, Brazil
| | - Fernando Jorge Firmino Nóbrega
- Department of Gastroenterology, Member of the Brazilian Organization of Crohn’s Disease and Colitis – GEDIIB, São Paulo, Brazil
- Department of Gastroenterology, Lauro Wanderley Hospital, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
| | | | | | - Germano Tose Toneto
- Department of Immunology, Autoimune Research Institute, Recife, Pernambuco, Brazil
| | | | | | | | - Luan Samy Xavier Dantas
- Department of Gastroenterology, Onofre Lopes Hospital, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Luanna Karen Chagas Fernandes
- Department of Gastroenterology, Lauro Wanderley Hospital, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
| | - Samara Amorim de Araújo
- Department of Gastroenterology, Lauro Wanderley Hospital, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
| | - Valéria Ferreira Martinelli
- Department of Gastroenterology, Hospital das Clínicas, Federal University of Pernambuco, Recife, Pernambuco, Brazil
- Department of Gastroenterology, Member of the Brazilian Organization of Crohn’s Disease and Colitis – GEDIIB, São Paulo, Brazil
- Department of Immunology, Autoimune Research Institute, Recife, Pernambuco, Brazil
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Nicolas M, Lasalo M, Chow S, Antheaume C, Huet K, Hnawia E, Guillemin GJ, Nour M, Matsui M. Anti-inflammatory activities of Coleus forsteri (formerly Plectranthus forsteri) extracts on human macrophages and chemical characterization. Front Pharmacol 2023; 13:1081310. [PMID: 36699063 PMCID: PMC9868419 DOI: 10.3389/fphar.2022.1081310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/22/2022] [Indexed: 01/11/2023] Open
Abstract
Introduction: Formerly named Plectranthus forsteri, Coleus forsteri (Benth.) A.J.Paton, 2019 is a Lamiaceae traditionally used to treat flu-like symptoms and shock-related ecchymosis, especially in the Pacific region. Few studies investigated chemical composition and anti-inflammatory potential of this plant. Method: Herein, we investigated anti-inflammatory potential of C. forsteri ethanolic (ePE) and cyclohexane (cPE) plant extract on LPS-induced human macrophages models and quantified cytokines and quinolinic acid (QUIN) as inflammatory markers. Results: Our results show that extract of ePE and cPE significantly inhibit inflammatory cytokine IL-6 and TNF-α induced by LPS on PMA-derived THP-1 macrophages. QUIN production is also diminished under ePE and cPE treatment in activated human monocyte-derived macrophages (MDMs). Seven abietane diterpenes were characterized from C. forsteri cPE including coleon U (1), coleon U-quinone (2), 8α,9α-epoxycoleon U-quinone (3), horminone or 7α-hydroxyroyleanone (4), 6β,7α-dihydroxyroyleanone (5), 7α-acetoxy-6β-hydroxyroyleanone (6) and 7α-formyloxy-6β-hydroxyroyleanone (7). Discussion: We discussed potential contributions of these molecules from C. forsteri extracts for their anti-inflammatory activities.
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Affiliation(s)
- Mael Nicolas
- Département de Chimie, Université Côte d’Azur, Nice, France
| | - Malia Lasalo
- Group Bioactivities of Natural compounds and derivatives (BIONA), Formerly Group Immunity and Inflammation (GIMIN), Institut Pasteur of New Caledonia, Member of the Pasteur Network, Noumea, New Caledonia
| | - Sharron Chow
- Neuroinflammation Group, Macquarie Medical School, Macquarie University, Sydney, NSW, Australia
| | - Cyril Antheaume
- Institut de Science et d’Ingénierie Supramoléculaires, Université de Strasbourg, Strasbourg, France
| | - Karl Huet
- Group Bioactivities of Natural compounds and derivatives (BIONA), Formerly Group Immunity and Inflammation (GIMIN), Institut Pasteur of New Caledonia, Member of the Pasteur Network, Noumea, New Caledonia
| | - Edouard Hnawia
- PHARMADEV, UMR152, Institut de Recherche pour le Développement (IRD), Noumea Center, Noumea, New Caledonia
| | - Gilles J. Guillemin
- Neuroinflammation Group, Macquarie Medical School, Macquarie University, Sydney, NSW, Australia
| | - Mohammed Nour
- Institut des Sciences Exactes et Appliqués (ISEA), EA7484, Université de Nouvelle-Calédonie, Noumea, New Caledonia
| | - Mariko Matsui
- Group Bioactivities of Natural compounds and derivatives (BIONA), Formerly Group Immunity and Inflammation (GIMIN), Institut Pasteur of New Caledonia, Member of the Pasteur Network, Noumea, New Caledonia
- Institut des Sciences Exactes et Appliqués (ISEA), EA7484, Université de Nouvelle-Calédonie, Noumea, New Caledonia
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12
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Sacramento CDSB, Motta MP, Alves CDO, Mota JA, Codes LMGD, Ferreira RF, Silva PDA, Palmiro LDP, Barbosa RM, Andrade MN, Andrade VD, Vasconcelos VB, Thiara BW, Netto EM, Santana GO. Variables associated with progression of moderate-to-severe Crohn's disease. BMJ Open Gastroenterol 2022; 9:e001016. [PMID: 36379617 PMCID: PMC9667999 DOI: 10.1136/bmjgast-2022-001016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Determine the variables associated with hospitalisations in patients with Crohn's disease and those associated with surgery, intestinal resection, hospital readmission, need for multiple operations and immunobiological agent use. DESIGN A cross-sectional study was conducted from 2019 to 2021, using two centres for inflammatory bowel diseases in the Brazilian Public Health System. RESULTS This study included 220 patients. Only perianal disease was associated with hospitalisation (31.6% vs 13.0%, p=0.012). Stricturing or penetrating behaviour (35.8% vs 12.6%, p<0.001) and perianal disease (45.9% vs 9.9%, p<0.001) were associated with surgery. Ileal or ileocolonic location (80.0% vs 46.5%, p=0.044) and stricturing or penetrating behaviour (68.0% vs 11.2%, p<0.001) were associated with intestinal resection. Steroids use at first Crohn's disease occurrence and postoperative complications were associated with hospital readmission and need for multiple operations, respectively. Age below 40 years at diagnosis (81.3% vs 62.0%, p=0.004), upper gastrointestinal tract involvement (21.8% vs 10.3%, p=0.040) and perianal disease (35.9% vs 16.3%, p<0.001) were associated with immunobiological agent use. CONCLUSION Perianal disease and stricturing or penetrating behaviour were associated with more than one significant outcome. Other variables related to Crohn's disease progression were age below 40 years at diagnosis, an ileal or ileocolonic disease localisation, an upper gastrointestinal tract involvement, the use of steroids at the first Crohn's disease occurrence and history of postoperative complications. These findings are similar to those in the countries with a high prevalence of Crohn's disease.
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Affiliation(s)
| | - Marina Pamponet Motta
- Department of Gastroenterology, Hospital Universitário Professor Edgard Santos, Salvador, Brazil
| | | | - Jaciane Araujo Mota
- Department of Gastroenterology, Hospital Geral Roberto Santos, Salvador, Brazil
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