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Crohn's disease environmental factors in the developing world: A case-control study in a statewide catchment area in Brazil

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World Journal of Gastroenterology 2017年第30期23卷 5549-5556页

作者： Valéria Cristina Loureiro Salgado Ronir Raggio Luiz Neio Boechat Bianca C Schorr Isabella S Leao Tiago Nunes cyrla zaltman Division of Gastroenterology Department of Internal MedicineClementino Fraga Filho HospitalFederal University of Rio de Janeiro Institute for Studies in Public Health Federal University of Rio de Janeiro Multidisciplinary Research Laboratory Clementino Fraga Filho University HospitalInstitute of Thoracic DiseasesFaculty of MedicineFederal University of Rio de Janeiro Gastrointestinal Physiology Institute of Nutritional ScienceNestle Research Center

AIM To identify environmental risk factors associated with the development of Crohn's disease(CD) in order to reassess the hygiene hypothesis.METHODS A hospital-based, case-control study was carried out with CD patients(n = 145) and controls(n = 163)representing a socioeconomically diverse statewide catchment area in Brazil. Controls were recruited from caregivers of patients seen in different outpatient clinics at the same hospital. A multi-item survey with 94 questions regarding family history of CD, perinatal and childhood circumstances, living conditions, tobacco use and familial socioeconomic status was carried out by interviewers. RESULTS On the univariate analysis, predictive variables for CD included being male, under age of 40, a high education level, urban dweller, smaller family size, exposure to enteric pathogens and user of treated water(P < 0.005). On the multivariate analysis, variables significantly associated with CD were male gender(OR = 2.09), under age 40(OR = 3.10), white(OR = 2.32), from a small family in childhood(OR = 2.34) and adulthood(OR = 3.02), absence of viral infections in childhood(OR = 2.23), exposure to enteric pathogens(OR = 2.41), having had an appendectomy(OR = 2.47) and prior or current smoker(OR = 2.83/1.12). CONCLUSION Most variables supporting the "hygiene hypothesis" are associated with the development of CD but are not independent predictors of the diagnosis.

关键词： Crohns 疾病环境卫生假设冒险因素

Pseudomelanosis duodeni associated with chronic renal failure

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World Journal of Gastroenterology 2012年第12期18卷 1414-1416页

作者： Marcia Henriques de Magalhes Costa Maria da Gloria Fernandes Pegado Cleber Vargas Maria Elizabeth C Castro Kalil Madi Tiago Nunes cyrla zaltman Gastroenterology Section Department of Internal MedicineClementino Fraga Filho University HospitalUniversidade Federal do Rio de JaneiroRio de Janeiro 21941-913Brazil Department of Pathology Clementino Fraga Filho University HospitalUniversidade Federal do Rio de JaneiroRio de Janeiro 21941-913Brazil Hospital Clínic i Provincial/IDIBAPS Barcelona 08036Spain

Pseudomelanosis duodeni (PD) is a rare dark speckled appearance of the duodenum associated with gastrointestinal bleeding,hypertension,chronic heart failure,chronic renal failure and consumption of different drugs.We report four cases of PD associated with chronic renal failure admitted to the gastroenterology outpatient unit due to epigastric pain,nausea,melena and progressive reduction of hemoglobin index.Gastroduodenal endoscopy revealed erosions in the esophagus and stomach,with no active bleeding at the moment.In addition,the duodenal mucosa presented marked signs of melanosis;later confirmed by histopathological study.Even though PD is usually regarded as a benign condition,its pathogenesis and clinical significance is yet to be defined.

关键词：慢性肾功能衰竭病理组织学十二指肠血红蛋白临床意义发病机制胃肠 PD

Hepatitis B virus prevalence and transmission risk factors in inflammatory bowel disease patients at Clementino Fraga Filho university hospital

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World Journal of Gastroenterology 2008年第20期14卷 3201-3206页

作者： Yolanda Faia Manhes Tolentino Homero Soares Fogaa cyrla zaltman Lia Laura Lewis Ximenes Henrique Sérgio Moraes Coelho Internal Medicine Department Gastroenterology Unit of Clementino Fraga Filho University Hospital Federal University of Rio de Janeiro Rio de Janeiro 21941-913 Brazil Virology Department OswaldoCruz Foundation 21045-900 Brazil

AIM: To evaluate the prevalence of hepatitis B virus (HBV) infection in inflammatory bowel disease (IBD) patients that followed up in our hospital and try to identify the possible risk factors involved in this infection transmission. METHODS: This was a cross-sectional study for which 176 patients were selected according to their arrival for the medical interview. All these patients had already IBD diagnosis. The patient was interviewed and a questionnaire was filled out. RESULTS: In the group of 176 patients whom we examined, we found that 17% (30) were anti-HBc positive. Out of 30 patients with positive anti-HBc, 2.3% (4) had positive HBsAg and negative HBV-DNA. In an attempt to identify the possible HBV infection transmission risk factors in IBD patients, it was observed that 117 patients had been submitted to some kind of surgical procedure, but only 24 patients had positive anti-HBc (P = 0.085). It was also observed that surgery to treat IBD complications was not a risk factor for HBV infection transmission, since we did not get a statically significant P value. However, IBDpatients that have been submitted to surgery to treat IBD complications received more blood transfusions then patients submitted to other surgical interventions (P = 0.015). CONCLUSION: There was a high incidence of positive anti-HBc (17%) and positive HBsAg (2.3%) in IBD patient when compared with the overall population (7.9%).

关键词：流行疾病免疫性肠炎肝炎病毒治疗方法

High prevalence of vitamin A deficiency in Crohn's disease patients according to serum retinol levels and the relative dose-response test

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World Journal of Gastroenterology 2015年第5期21卷 1614-1620页

作者： Márcia Soares-Mota Tianny A Silva Luanda M Gomes Marco AS Pinto Laura MC Mendon?a Maria Lúcia F Farias Tiago Nunes Andrea Ramalho cyrla zaltman Instituto de Nutricao Josué de Castro Federal University of Rio de JaneiroRio de Janeiro 21941-913Brazil Departamento de Clínica Médica Hospital Universitário Clementino Fraga FilhoFederal University of Rio de JaneiroRio de Janeiro 21941-901Brazil Nutrition and Immunology Chair ZIEL Research Center for Nutrition and Food SciencesTechnical University of MünchenFreising-Weihenstephan80333 MünchenGermany

AIM:To assess the vitamin A status of patients with Crohn's disease(CD) by evaluating serum retinol levels and the relative dose response(RDR) test(liver retinol stores).METHODS:Vitamin A nutritional status was measured by serum retinol obtained by high performance liquid chromatography and the RDR test for evaluation of the hepatic stores.Body composition was performed by densitometry by dual-energy X-ray absorptiometry.Vitamin A dietary intake was assessed from a semiquantitative food frequency questionnaire.RESULTS:This study included 38 CD patients and 33 controls.Low serum retinol concentrations were detected in 29% of CD patients vs 15% in controls(P < 0.005).The RDR test was positive in 37% of CD patients vs 12% in controls,which indicated inadequate hepatic vitamin A stores(P < 0.005).Individuals with hypovitaminosis A had lower BMI and body fat compared with those without this deficiency.There was no association between vitamin A deficiency and its dietary intake,ileal location,presence of disease activity and prior bowel resections.CONCLUSION:Patients with CD have higher prevalence of vitamin A deficiency,as assessed by two independent methods.

关键词： Crohn's disease Vitamin A Serum retinol Relative dose response test Body composition

Risk factors associated with inflammatory bowel disease: A multicenter case-control study in Brazil

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World Journal of Gastroenterology 2020年第25期26卷 3611-3624页

作者： Valéria Cristina Loureiro Salgado Ronir Raggio Luiz Neio Lucio Fernandes Boéchat Isabella Sued Leao Bianca do Carmo Schorr JoséMiguel Luz Parente Daniela Calado Lima Eduardo Santos Silveira Júnior Genoile Oliveira Santana Silva Neogélia Pereira Almeida Andrea Vieira Maria Luiza Queiroz de Bueno Júlio Maria Chebli érika Ruback Bertges Luísa Martins da Costa Brugnara Columbano Junqueira Neto Stefania Burjack Gabriel Campbell Luana Letiza Discacciati Joao Paulo Silva Cézar Tiago Nunes Gilaad G Kaplan cyrla zaltman Division of Gastroenterology Department of Internal MedicineClementino Fraga Filho HospitalFederal University of Rio de JaneiroRio de Janeiro 21940-230Brazil Institute for Studies in Public Health Federal University of Rio de JaneiroRio de Janeiro 21940-230Brazil Multidisciplinary Research Laboratory Clementino Fraga Filho HospitalInstitute of Thoracic DiseasesFaculty of MedicineFederal University of Rio de JaneiroRio de Janeiro 21940-230Brazil Division of Gastroenterology Department of Internal MedicineHospital UniversityFaculty of MedicineFederal University of PiauíPiauí64049-550Brazil Almeida Division of GastroenterologyInflammatory Bowel Disease Outpatient ClinicRoberto Santos General Hospital(HGRS)of the Bahia State Department of HealthBahia 40110-060Brazil Division of Gastroenterology Inflammatory Bowel Disease Outpatient ClinicIrmandade Santa Casa da Misericórdia of São PauloSão Paulo 01221020Brazil Division of Gastroenterology Department of Internal MedicineHospital UniversityFaculty of MedicineFederal University of Juiz de ForaMinas Gerais 36036-247Brazil Division of Gastroenterology Inflammatory Bowel Disease Outpatient ClinicFederal District Base HospitalBrasília 70330-150Brazil Gastrointestinal Physiology Institute of Nutritional ScienceNestle Research CenterLausanne 1000Switzerland Departments of Medicine and Community Health Sciences University of CalgaryCalgary T2N4Z6Canada

BACKGROUND The etiology of inflammatory bowel disease(IBD)is unknown,but it is believed to be multifactorial.The hygiene hypothesis proposes that better hygiene conditions would lead to less infectious disease during childhood and favor the development of immune-mediated diseases.AIM To test the hygiene hypothesis in IBD by assessing the environmental risk factors associated with IBD development in different regions of Brazil with diverse socioeconomic development indices.METHODS A multicenter case-control study was carried out with 548 Crohn’s disease(CD)and 492 ulcerative colitis(UC)outpatients and 416 healthy controls,from six IBD centers within different Brazilian states at diverse socioeconomic development stages.A semi-structured questionnaire with 87 socioeconomic and environmental questions was applied.Logistic regression model was created to assess the odds ratio(OR)with P value and 95%confidence intervals(CI).RESULTS Predictive variables for both diseases(CD and UC)were women[odd ratios(OR)=1.31;OR=1.69],low monthly family income(OR=1.78;OR=1.57),lower number of cohabitants(OR=1.70;OR=1.60),absence of vaccination(OR=3.11;OR=2.51),previous history of bowel infections(OR=1.78;OR=1.49),and family history of IBD(OR=5.26;OR=3.33).Associated risk factors for CD were age(18-39 years)(OR=1.73),higher educational level(OR=2.22),absence of infectious childhood diseases(OR=1.99).The UC predictive variables were living in an urban area(OR=1.62),inadequate living conditions(OR=1.48)and former smokers(OR=3.36).Appendectomy was a risk factor for CD(OR=1.58)with inverse association with UC(OR=4.79).Consumption of treated and untreated water was associated with risk of CD(OR=1.38)and UC(OR=1.53),respectively.CONCLUSION This is the first examining environmental exposures as risk factors for inflammatory bowel disease in Brazil.Most of the variables associated with disease risk support the role of the hygiene hypothesis in IBD development.

关键词： Crohn’s disease Ulcerative colitis Risk factors Environmental factors Hygiene hypothesis

Quality of life, work productivity impairment and healthcare resources in inflammatory bowel diseases in Brazil

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World Journal of Gastroenterology 2019年第38期25卷 5862-5882页

作者： Rogerio Serafim Parra Julio MF Chebli Heda MBS Amarante Cristina Flores Jose ML Parente Odery Ramos Milene Fernandes Jose JR Rocha Marley R Feitosa Omar Feres Antonio S Scotton Rodrigo B Nones Murilo M Lima cyrla zaltman Carolina D Goncalves Isabella M Guimaraes Genoile O Santana Ligia Y Sassaki Rogerio S Hossne Mauro Bafutto Roberto LK Junior Mikaell AG Faria Sender J Miszputen Tarcia NF Gomes Wilson R Catapani Anderson A Faria Stella CS Souza Rosana F Caratin Juliana T Senra Maria LA Ferrari Department of Surgery and Anatomy Ribeirao Preto Medical SchoolUniversity of Sao PauloRibeirao PretoSP 14049-900Brazil Hospital Universitario da Universidade Federal do Piaui TeresinaPI 64049-550Brazil Carolina D Gonclves Isabella M GuimaraesUniversidade Federal do Rio de JaneiroRio de JaneiroRJ 21941-913Brazil Universidade do Estado da Bahia -SalvadorBA 41150-000Brazil Department of Internal Medicine Botucatu Medical School at Sao Paulo State University(UNESP)BotucatuSP 18618-687Brazil Instituto Goiano de Gastroenterologia e Endoscopia Digestiva Ltda GoianiaGO 74535-170Brazil Kaiser Clinica Sao Jose do Rio PretoSP 15015-110Brazil Escola Paulista de Medicina Sao PauloSP 04023-900Brazil UNIFESP Disciplina de GastroenterologiaSao PauloSP 04040-002Brazil Faculdade de Medicina do ABC Santo AndreSP 09060-870Brazil Faculdade de Medicina UFMG Belo HorizonteMG30130-100Brazil Inflammatory Bowel Disease Center Federal University of Juiz de ForaJuiz de ForaMG 36036-247Brazil Takeda Pharmaceuticals Brazil Sao PauloSP 04709-011Brazil 不详 Hospital de Clinicas da Universidade Federal do Parana CuritibaPR 80060-900Brazil Hospital de Clinicas de Porto Alegre Porto Alegre-RS 90035-007Brazil Universidade Federal do Piaui TeresinaPI 64073-500Brazil Hospital de Clínicas da Universidade Federal do Parana CuritibaPR 80060-900Brazil CTI Clinical Trial&Consulting Services Lisbon 1070-274Portugal CMIP Centro Mineiro de Pesquisa Juiz de ForaMG 36010-570Brazil Hospital Nossa Senhora das Gracas CuritibaPR 80810-040Brazil

BACKGROUND Inflammatory bowel diseases(IBD)have been associated with a low quality of life(QoL)and a negative impact on work productivity compared to the general population.Information about disease control,patient-reported outcomes(PROs),treatment patterns and use of healthcare resources is relevant to optimizing IBD management.AIM To describe QoL and work productivity and activity impairment(WPAI),treatment patterns and use of healthcare resources among IBD patients in Brazil.METHODS A multicenter cross-sectional study included adult outpatients who were previously diagnosed with moderate to severe Crohn’s disease(CD)or ulcerative colitis(UC).At enrolment,active CD and UC were defined as having a Harvey Bradshaw Index≥8 or a CD Activity Index≥220 or calprotectin>200μg/g or previous colonoscopy results suggestive of inadequate control(per investigator criteria)and a 9-point partial Mayo score≥5,respectively.The PRO assessment included the QoL questionnaires SF-36 and EQ-5D-5L,the Inflammatory Bowel Disease Questionnaire(IBDQ),and the WPAI questionnaire.Information about healthcare resources and treatment during the previous 3 years was collected from medical records.Chi-square,Fisher’s exact and Student’s t-/Mann-Whitney U tests were used to compare PROs,treatment patterns and the use of healthcare resources by disease activity(α=0.05).RESULTS Of the 407 patients in this study(CD/UC:64.9%/35.1%,mean age 42.9/45.9 years,54.2%/56.6%female,38.3%/37.1%employed),44.7%/25.2%presented moderate-to-severe CD/UC activity,respectively,at baseline.Expressed in median values for CD/UC,respectively,the SF-36 physical component was 46.6/44.7 and the mental component was 45.2/44.2,the EQ-visual analog scale score was 80.0/70.0,and the IBDQ overall score was 164.0/165.0.Moderate to severe activity,female gender,being unemployed,a lower educational level and lower income were associated with lower QoL(P<0.05).Median work productivity impairment was 20%and 5%for CD and UC patients,respectively,and activity impairment was 30%,the l

关键词： Inflammatory bowel disease Crohn’s disease Ulcerative colitis Quality of life Healthcare resources

Real-world treatment patterns and disease control over one year in patients with inflammatory bowel disease in Brazil

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World Journal of Gastroenterology 2021年第23期27卷 3396-3412页

作者： Ligia Yukie Sassaki Sender J Miszputen Roberto Luiz Kaiser Junior Wilson R Catapani Mauro Bafutto António S Scotton cyrla zaltman Julio Pinheiro Baima Hagata S Ramos Mikaell Alexandre Gouvea Faria Carolina D Gonçalves Isabella Miranda Guimaraes Cristina Flores Heda M B S Amarante Rodrigo Bremer Nones JoséMiguel Luz Parente Murilo Moura Lima Júlio Maria Chebli Maria de Lourdes Abreu Ferrari Julia F Campos Maria G P Sanna Odery Ramos Rogério Serafim Parra Jose J R da Rocha Omar Feres Marley R Feitosa Rosana Fusaro Caratin Juliana Tosta Senra Genoile Oliveira Santana Department of Internal Medicine Botucatu Medical School at Sao Paulo State University(UNESP)Botucatu 18618-687São PauloBrazil Department of Gastroenterology Escola Paulista de MedicinaSao PauloSão Paulo 18618-687São PauloBrazil Department of Proctology Kaiser Day HospitalSão Jose do Rio Preto 15015-110São PauloBrazil Department of Gastroenterology Faculdade de Medicina do ABCSanto Andre 09060-870São PauloBrazil Department of Gastroenterology Faculdade de MedicinaGoiania 74535-170GoiásBrazil Department of Gastroenterology CMIP Centro Mineiro de PesquisaJuiz de Fora 36010-570Minas GeraisBrazil Department of Internal Medicine Federal University of Rio de JaneiroRio de Janeiro 21941-913Rio de JaneiroBrazil Department of Gastroenterology Escola Paulista de MedicinaSão Paulo 04023-900São PauloBrazil Hospital de Clínicas de Porto Alegre Hospital de Clínicas de Porto AlegrePorto Alegre 90035-903Rio Grande do SulBrazil Hospital de Clinicas da Universidade Federal do Paraná Hospital de Clinicas da Universidade Federal do ParanáCuritiba ParanáParanáBrazil Gastroenterology Department Hospital Nossa Senhora das GraçasCuritiba 80810-040ParanáBrazil Department of General Medicine Universidade Federal do PiauíTeresina 64049-550PiauíBrazil Gastroenterology Hospital Universitario da Universidade Federal do PiauiTeresina 64049-550PiauíBrazil Department of Medicine University Hospital of Federal University of Juiz de ForaJuiz de ForaJuiz de Fora 36036-247Minas GeraisBrazil Department of Clinical Medicine Universidade Federal de Minas GeraisBelo Horizonte 30130-100Minas GeraisBrazil Hospital de Clinicas da Universidade Federal do Paraná Hospital de Clinicas da Universidade Federal do ParanáCuritiba 80060-900ParanáBrazil Department of Surgery and Anatomy Ribeirao Preto Medical SchoolUniversity of Sao PauloRibeirão Preto 14048-900São PauloBrazil Scientific Affairs Takeda Pharmaceuticals BrazilSao Paulo 04709-011Brazil Clinical Research Takeda PharmaceuticalsSão Paulo 04709-011Sã

BACKGROUND Crohn’s disease(CD)and ulcerative colitis(UC)are inflammatory bowel diseases(IBDs)with a remission-relapsing presentation and symptomatic exacerbations that have detrimental impacts on patient quality of life and are associated with a high cost burden,especially in patients with moderate-to-severe disease.The Real-world Data of Moderate-to-Severe Inflammatory Bowel Disease in Brazil(RISE BR)study was a noninterventional study designed to evaluate disease control,treatment patterns,disease burden and health-related quality of life in patients with moderate-to-severe active IBD.We report findings from the prospective follow-up phase of the RISE BR study in patients with active UC or CD.AIM To describe the 12-mo disease evolution and treatment patterns among patients with active moderate-to-severe IBD in Brazil.METHODS This was a prospective,noninterventional study of adult patients with active Crohn’s disease(CD:Harvey-Bradshaw Index≥8,CD Activity Index≥220),inadequate CD control(i.e.,calprotectin>200μg/g or colonoscopy previous results),or active ulcerative colitis(UC:Partial Mayo score≥5).Enrollment occurred in 14 centers from October 2016 to February 2017.The proportion of active IBD patients after 9-12 mo of follow-up,Kaplan-Meier estimates of the time to mild or no activity and a summary of treatment initiation,discontinuation and dose changes were examined.RESULTS The study included 118 CD and 36 UC patients,with mean±SD ages of 43.3±12.6 and 44.9±16.5 years,respectively.The most frequent drug classes at index were biologics for CD(62.7%)and 5-aminosalicylate derivates for UC patients(91.7%).During follow-up,65.3%of CD and 86.1%of UC patients initiated a new treatment at least once.Discontinuations/dose changes occurred in 68.1%of CD patients[median 2.0(IQR:2-5)]and 94.3%of UC patients[median 4.0(IQR:3-7)].On average,CD and UC patients had 4.4±2.6 and 5.0±3.3 outpatient visits,respectively.The median time to first mild or no activity was 319(IQR:239-358)d for CD and 320(IQR:288-358)d for UC patient

关键词： Crohn’s disease Ulcerative colitis Inflammatory bowel diseases Prospective study

Real-world disease activity and sociodemographic,clinical and treatment characteristics of moderate-to-severe inflammatory bowel disease in Brazil

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World Journal of Gastroenterology 2021年第2期27卷 208-223页

作者： cyrla zaltman Rogério Serafim Parra Ligia Yukie Sassaki Genoile Oliveira Santana Maria de Lourdes Abreu Ferrari Sender J Miszputen Heda M B S Amarante Roberto Luiz Kaiser Junior Cristina Flores Wilson R Catapani JoséMiguel Luz Parente Mauro Bafutto Odery Ramos Carolina D Gonçalves Isabella Miranda Guimaraes Jose J R da Rocha Marley R Feitosa Omar Feres Rogerio Saad-Hossne Francisco Guilherme Cancela Penna Pedro Ferrari Sales Cunha Tarcia NF Gomes Rodrigo Bremer Nones Mikaell Alexandre Gouvea Faria Mírian Perpétua Palha Dias Parente António S Scotton Rosana Fusaro Caratin Juliana Senra Júlio Maria Chebli Department of Internal Medicine Federal University of Rio de JaneiroRio de Janeiro 21941-913Brazil Department of Surgery and Anatomy Ribeirão Preto Medical SchoolUniversity of São PauloRibeirao Preto 14049-900São PauloBrazil Department of Internal Medicine São Paulo State University(UNESP)Medical SchoolBotucatu 18618-687São PauloBrazil IBD Unit Federal University of BahiaSalvador 41150-000BahiaBrazil Department of Clinical Medicine Medical SchoolUniversidade Federal de Minas GeraisBelo Horizonte 30130-100Minas GeraisBrazil Department of Gastroenterology Escola Paulista de MedicinaSão Paulo 04023-900Brazil Hospital de Clinicas Universidade Federal do ParanaCuritiba 80060-900ParanaBrazil Department of Proctology Beneficencia Portuguesa Hospital/Kaiser Day HospitalSao Jose do Rio Preto 15015110São PauloBrazil Department of Gastroenterology and Hepatology Sciences Hospital de ClínicasUniversidade Federal do Rio Grande do SulPorto Alegre 90560002Rio Grande do SulBrazil Department of Gastroenterology Faculdade de Medicina do ABCSanto Andre 09060-870São PauloBrazil Department of General Medicine Gastroenterology UnitUniversity HospitalFederal University of PiauiTeresina 64049-550PiauíBrazil Department of Gastroenterology Faculdade de MedicinaUniversidade Federal de GoiásGoiania 74535-170GoiasBrazil Department of Surgery Botucatu Medical School at São Paulo State University(UNESP)Botucatu 18618687São PauloBrazil Department of Gastroenterology UNIFESPSão Paulo 04040-002Brazil IBD unit Gastroenterology DepartmentHospital Nossa Senhora das GraçasCuritiba 80810-040ParanaBrazil Department of Proctology Kaiser Hospital DiaSao Jose do Rio Preto 15015-110São PauloBrazil Health Sciences Center Epidemiology UnitState University of PiauiTeresina 64001-280PiauíBrazil Department of Gastroenterology CMIP Centro Mineiro de PesquisaJuiz de Fora 36010-570Minas GeraisBrazil Scientific Affairs Takeda Pharmaceuticals BrazilSão Paulo 04709-011Brazil Clinical Research Takeda Pharma

BACKGROUND Understanding the treatment landscape of inflammatory bowel diseases(IBD)is essential for improving disease management and patient outcomes.Brazil is the largest Latin American country,and it presents socioeconomic and health care differences across its geographical regions.This country has the highest increase in IBD incidence and prevalence in Latin America,but information about the clinical and treatment characteristics of IBD is scarce.AIM To describe the sociodemographic,clinical,and treatment characteristics of IBD outpatients in Brazil overall and in the Southeast,South and Northeast/Midwest regions.METHODS Multicenter,cross-sectional study with a 3-year retrospective chart review component.Patients with moderate-to-severe Crohn’s disease(CD)or ulcerative colitis(UC)were consecutively enrolled between October 2016 and February 2017.Active CD at enrollment was defined as a Harvey Bradshaw Index≥8 or a CD Activity Index≥220 or a calprotectin level>200μg/g or an active result based on colonoscopy suggestive of inadequate control during the previous year;active UC was defined as a partial Mayo score≥5.Descriptive statistics were used to analyze all variables.RESULTS In a total of 407 included patients,CD was more frequent than UC,both overall(264 CD/143 UC patients)and by region(CD:UC ratios of 2.1 in the Southeast,1.6 in the South and 1.2 in the Northeast/Midwest).The majority of patients were female(54.2%of CD;56.6%of UC),and the mean ages were 45.9±13.8 years(CD)and 42.9±13.0 years(UC).The median disease duration was 10.0(range:0.5-45)years for both IBD types.At enrollment,44.7%[95%confidence interval(CI):38.7-50.7]of CD patients and 25.2%(95%CI:18.1-32.3)of UC patients presented with active disease.More than 95%of IBD patients were receiving treatment at enrollment;CD patients were commonly treated with biologics(71.6%)and immunosuppressors(67.4%),and UC patients were commonly treated with mesalazine[5-Aminosalicylic acid(5-ASA)]derivates(69.9%)and immunosuppressors(44.1%).More than 50%of the CD

关键词： Inflammatory bowel disease Crohn's disease Ulcerative colitis Disease activity Epidemiology Treatment