Cyrla Zaltman

Prevalence of periodontitis and DMFT index in patients with Crohn's disease and ulcerative colitis

AIMnTo compare the prevalence of periodontal disease and the decayed, missing and filled teeth (DMFT) index in patients with Crohns disease (CD) and ulcerative colitis (UC) with those without these diseases.nnnMATERIAL AND METHODSnNinety-nine CD (39.0 SD+/-12.9 years), 80 UC (43.3 SD+/-13.2) and 74 healthy controls (40.3 SD+/-12.9) were compared for DMFT index and presence of periodontitis. Probing pocket depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), plaque and DMFT index were measured on all subjects. The presence of periodontitis was defined as having CAL > or =3 mm in at least four sites in different teeth.nnnRESULTSnSignificantly more patients with UC (90.0%; p<0.001) and CD (81.8%; p=0.03) had periodontitis than controls (67.6%). Among smokers, UC patients had significantly more periodontitis. CD had a greater mean DMFT score (18.7 versus 13.9; p=0.031) compared with controls and UC had greater median PPD (2.2 versus 1.7 mm; p<0.0001) than controls. Among non-smokers, CD (2.4 mm; p<0.0001) and UC showed deeper pockets (2.3 mm; p<0.0001) compared with controls (1.5 mm). UC had a greater mean DMFT score (15.3 versus 12.1; p=0.037) compared with controls.nnnCONCLUSIONSnCD and UC patients had higher DMFT and prevalence of periodontitis than controls, but smoking was an effect modifier.

Upper gastrointestinal bleeding in a Brazilian hospital: a retrospective study of endoscopic records.

BACKGROUNDnUpper gastrointestinal bleeding is a frequent and potentially severe complication of most digestive diseases of the upper gastrointestinal tract. Upper endoscopy has a crucial role in the diagnosis and treatment of upper gastrointestinal bleeding, however epidemiological studies are still limited in our country. Aims - To assess the clinical characteristics, endoscopic accuracy, treatment efficiency and clinical outcome of patients admitted to the endoscopic unit with upper gastrointestinal bleeding.nnnMETHODSnA retrospective study of consecutive records from patients who underwent emergency endoscopy for upper gastrointestinal bleeding was performed during a period of 2 years.nnnRESULTSnMost patients were male 68.7%, with a mean age of 54.5 +/- 17.5 years. A bleeding site could be detected in 75.6% of the patients. Diagnostic accuracy was greater within the first 24 hours of the bleeding onset, and in the presence of hematemesis. Peptic ulcer was the main cause of upper gastrointestinal bleeding (35%). The prevalence of variceal bleeding (20.45%) indicates a high rate of underlying liver disease. Endoscopic treatment was performed in 23.86% of the patients. Permanent hemostasis was achieved in 86% of the patients at the first endoscopic intervention, and in 62.5% of the patients after rebleeding. Emergency surgery was seldom necessary. The average number of blood units was 1.44 +/- 1.99 per patient. The average length of hospital stay was 7.71 +/- 12.2 days. Rebleeding was reported in 9.1% of the patients. The overall mortality rate of 15.34% was significantly correlated with previous liver disease.nnnCONCLUSIONSnDiagnostic accuracy was related to the time interval between the bleeding episode and endoscopy, and to clinical presentation. Endoscopic therapy was an effective tool for selected patients. The resulting increased duration of hospitalization and higher mortality rate in the patients submitted to therapeutic endoscopy were attributed to a higher prevalence of variceal bleeding and underlying liver disease.

Quality-of-life measurement in patients with inflammatory bowel disease receiving social support.

Background: Crohns disease and ulcerative colitis, referred to as inflammatory bowel diseases, affect mainly young adults and have an elevated morbidity and a negative effect on quality of life. This study aimed to compare the health‐related quality of life between 2 randomized groups of patients with inflammatory bowel disease: (1) the supported group (SG), patients receiving social support for an 18‐month period, and (2) the control group (CG), patients receiving no social support Methods: Health‐related quality of life was assessed at 4 moments with the Portuguese versions of the Medical Outcomes Study Short Form 36 and the Inflammatory Bowel Disease Questionnaire (IBDQ), both validated in Brazil. Results: In the SG, using analysis of variance for repeated measures complemented by the Bonferroni test positive variations were observed (1) in the Social Aspects domain, between the first and third evaluations (P = 0.044), and (2) in the Emotional Aspects domain, between the first and second and the third and fourth evaluations (P = 0.029). Conclusions: In the sample studied, social support, measured by use of the Inflammatory Bowel Disease Questionnaire, had a positive impact on the social and emotional aspects of quality of life.

Subgingival microflora in inflammatory bowel disease patients with untreated periodontitis.

Objective To analyze the subgingival microflora composition of inflammatory bowel disease (IBD) patients with untreated chronic periodontitis and compare them with systemically healthy controls also having untreated chronic periodontitis. Method Thirty IBD patients [15 with Crohn’s disease (CD) and 15 with ulcerative colitis (UC)] and 15 control individuals participated in the study. All patients had been diagnosed with untreated chronic periodontitis. From every patient, subgingival plaque was collected from four gingivitis and four periodontitis sites with paper points. Samples from the same category (gingivitis or periodontitis) in each patient were pooled together and stored at −70°C until analysis using a checkerboard DNA–DNA hybridization technique for 74 bacterial species. Results Multiple-comparison analysis showed that the groups differed in bacterial counts for Bacteroides ureolyticus, Campylobacter gracilis, Parvimonas micra, Prevotella melaninogenica, Peptostreptococcus anaerobius, Staphylococcus aureus, Streptococcus anginosus, Streptococcus intermedius, Streptococcus mitis, Streptococcus mutans, and Treponema denticola (P<0.001). CD patients had significantly higher levels of these bacteria than UC patients either in gingivitis or in periodontitis sites (P<0.05). CD patients harbored higher levels of P. melaninogenica, S. aureus, S. anginosus, and S. mutans compared with controls both at gingivitis and at periodontitis sites (P<0.05). UC patients harbored higher levels of S. aureus (P=0.01) and P. anaerobius (P=0.05) than controls only in gingivitis sites. Conclusion Our study showed that even with similar clinical periodontal parameters, IBD patients harbor higher levels of bacteria that are related to opportunistic infections in inflamed subgingival sites that might be harmful for the crucial microbe–host interaction.

Lower extremity mobility limitation and impaired muscle function in women with ulcerative colitis

BACKGROUND AND AIMnFatigue, weakness and musculoskeletal manifestations are associated with IBD. An impaired nutritional status and a reduced physical activity can contribute to these clinical outcomes, impacting quality of life and increasing disability. This study aims to assess muscle strength and lower limb physical performance in female UC patients, taking into consideration disease activity, body composition and habitual physical activity.nnnMETHODSnA case-control study was performed including 23 UC female outpatients and 23 age- and BMI-matched healthy women as controls. Quadriceps strength (QS), handgrip strength (HGS), physical performance based measures (five repetitions sit-up test and 4meter gait speed test), body composition (bioelectrical impedance analysis, anthropometry), and habitual physical activity (HPA) levels were assessed.nnnRESULTSnUC group had decreased QS (-6%; P=0.012), slower sit-up test (-32%; P=0.000), slower gait speed (-17% P=0.002) and decreased HPA level (-30%, P=0.001) compared with controls. No difference in HGS was observed between groups. Logistic regression showed that UC was an independent factor for decreased QS and slower sit-up test, while HPA was a protective factor for impaired gait speed. Multivariate linear regression showed that BMI was independently associated with an improved QS and slower sit-up test in the UC group.nnnCONCLUSIONnWomen with UC had decreased lower limb strength and mobility limitations, which were associated with BMI and the level of physical activity. Early evaluation of nutritional status and performance of the lower limbs could identify UC patients with pre-clinical disability who may benefit from earlier health lifestyle modifications.

Pseudomelanosis duodeni associated with chronic renal failure

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.

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

AIMnTo assess the vitamin A status of patients with Crohns disease (CD) by evaluating serum retinol levels and the relative dose response (RDR) test (liver retinol stores).nnnMETHODSnVitamin 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 semi-quantitative food frequency questionnaire.nnnRESULTSnThis 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.nnnCONCLUSIONnPatients with CD have higher prevalence of vitamin A deficiency, as assessed by two independent methods.

Análise descritiva dos perfis social, clínico, laboratorial e antropométrico de pacientes com doenças inflamatórias intestinais, internados no Hospital Universitário Clementino Fraga Filho, Rio de Janeiro

BACKGROUNDnThe epidemiologic survey in Brazil is limited probably due to a diagnosis deficiency and a small number of population-based studies performed. The majority of the prevalence studies available have evaluated inflammatory bowel diseases outpatients, but the knowledge of the profile of inflammatory bowel diseases inpatients is important in order to detect predictive markers of disease severity that will allow earlier medical intervention decreasing the rate of hospitalization and reducing the Health System costs.nnnAIMnTo determine social, clinical, laboratorial and anthropometric profiles of hospitalized adults inflammatory bowel diseases patients of a tertiary university hospital.nnnMETHODSnProspective study was performed with 43 inflammatory bowel diseases inpatients from clinical and surgical wards and emergency section of university hospital. We characterized demographic data, presence of comorbidities, disease location and behavior, surgical past-history, extra intestinal manifestations using standardized definitions. Laboratory results were abstracted from medical records and anthropometric measures were performed during our visit.nnnRESULTSnThe vast majority of the inflammatory bowel diseases patients had Crohns disease (72.1%), with ileocolic involvement (60%), with a penetrating disease behavior (77.4%) while ulcerative colitis group presented mostly pancolitis (50%). Articular pain was the most common (44.2%) extra intestinal manifestation of inflammatory bowel diseases patients and 97.7% of them had at least one type of complication related to disease. Although, the previous use of specific medical therapies to inflammatory bowel diseases before the hospitalization (more frequently corticosteroids) was done (79%), the majority of the patients were hospitalized because of inflammatory bowel diseases activity. Disease activity was present in 80.7% of Crohns disease and 50% ulcerative colitis patients. Inflammatory bowel diseases mortality rate was 5.5% (2/36). Comorbidities presence occurred only in 30.2% of inflammatory bowel diseases patients. The predominant surgery performed was intestinal resection. The interval between the symptoms appearance and the definitive diagnosis was less than 1 year in more than 70% of inflammatory bowel diseases patients. Laboratory findings detected were a decreased serum albumin (85.7%) and anemia (69.8%). The majority of the patients had at least one anthropometric alteration. The social stratification of the inflammatory bowel diseases group was similar to the Brazilian population.nnnCONCLUSIONnThe inflammatory bowel diseases inpatients from the university hospital wards had more severe evolution of these illnesses with an active and extensive disease with complications and frequent extra intestinal manifestations, despite the prolonged use of corticosteroids. The higher prevalence of Crohns disease inpatients than ulcerative colitis could reflect a higher aggressive behavior of this disease. The reduced serum albumin, anemia and anthropometric alterations are common inflammatory bowel diseases inpatients and could be related to a major severity of inflammatory bowel diseases evolution.

Common NOD2/CARD15 and TLR4 Polymorphisms Are Associated with Crohn’s Disease Phenotypes in Southeastern Brazilians

AimTo investigate whether variants in NOD2/CARD15 and TLR4 are associated with CD and ulcerative colitis (UC) in a genetically admixed population of Rio de Janeiro, where IBD has continued to rise.MethodsWe recruited 67 consecutive patients with CD, 61 patients with UC, and 86xa0healthy and ethnically matched individuals as controls. DNA was extracted from buccal brush samples and genotyped by PCR with restriction enzymes for G908R and L1007finsC NOD2/CARD15 single-nucleotide polymorphisms (SNPs) and for T399I and D299G TLR4 SNPs. Clinical data were registered for subsequent analysis with multivariate models.ResultsNOD2/CARD15 G908R and L1007finsC SNPs were found in one and three patients, respectively, with CD. NOD2/CARD15 G908R and L1007finsC SNPs were not found in any patients with UC, but were found in three and three controls, respectively. With regard to the TLR4 gene, no significant difference was detected among the groups. Overall, none of the SNPs investigated determined a differential risk for a specific diagnosis. Genotype–phenotype associations were found in only CD, where L1007finsC was associated with colonic localization; however, TLR4 T399I SNP was associated with male gender, and D299G SNP was associated with colonic involvement, chronic corticosteroid use, and the need for anti-TNF-alpha therapy.ConclusionVariants of NOD2/CARD15 and TLR4 do not confer susceptibility to IBD, but appear to determine CD phenotypes in this southeastern Brazilian population.

In vitro ultrasound biomicroscopic imaging of colitis in rats.

Objective. The purpose of this study was to show the feasibility of 50‐MHz ultrasound biomicroscopy (UBM) to image the rat colon. Methods. B‐mode images were obtained from ex vivo colon samples (n = 4) collected from Rattus norvegicus (Berkenhout, 1769) rats, with 2,4,6‐trinitrobenzene sulfonic acid–induced colitis in 3 of them. Left colon rectangular fragments (5 × 5 mm) were obtained after necropsy, and UBM images were acquired with the samples immersed in saline at 37°C. All layers of the normal intestinal wall were analyzed according to their thickness and the presence of uneven bowel mucosa (ulcers). The folds and layers detected by UBM were correlated with histopathologic analysis. Results. The 4 layers of the normal colon were identified on the UBM images: the mucosa (hyperechoic), muscularis mucosae (hypoechoic), submucosa (hyperechoic), and muscularis externa (hypoechoic). On 2 UBM images, superficial ulcers were detected, approximately 0.5 mm in size, with intestinal involvement limited to the mucosa. The histopathologic analysis verified enlargement of submucosa layers due to an edema associated with sub‐mucosa leukocyte infiltration. On 1 UBM image, it was possible to detect a deep ulcer, which was confirmed by the light microscopic analysis. Conclusions. An ultrasound imaging system was scaled and optimized to visualize the rat colon. Ultrasound biomicroscopy provided axial and lateral resolutions close to 25 and 45 μm, respectively, and adequate penetration depth to visualize the whole thickness of an inflamed colon. The system identified the colon layers and was able to detect mural changes and superficial ulcers on the order of 500 μm.