Marcia H. Costa

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.

P-023 Multiform Erythema A Cutaneous Adverse Drug Reaction To Infliximab—Case Report

BACKGROUND: Skin effects constitute one of the possible adverse effects of biologic therapy for inflammatory bowel disease (IBD). Although, multiform erythema is a rare condition with an estimated prevalence of 1%. Mucocutaneous lesions in IBD patients can be an extra-intestinal manifestation, due to infections or a cutaneous adverse drug reaction to treatment. Despite such skin changes are not life-threatening, they can have extensive clinical impact, in some cases leading to discontinuation of treatment. METHODS: Case report. RESULTS: A 31-year-old man with ileal Crohn´s disease and primary sclerosing cholangitis that had 2 previous small bowel resections was under use of 6 mercaptopurine and ursodesoxicolic acid for 2 years. Despite asymptomatic a MR imaging of small bowel was performed detecting signs of activity disease in distal parts of ileum and transverse colon. Infliximab was started at a dose of 5 mg/kg (0,2 e 6 week) with a very good tolerance and a maintenance therapy with infusions in the same dosage every 8 weeks was prescribed. A clinical, lab and radiological remission was obtained, and patient remained asymptomatic for 3 years when presented with multiple maculopapular non itchy eruptions on the lips, hands and pre-tibial region. Skin biopsy was consistent with a drug-induced reaction. The lesions disappeared after discontinuation of infliximab and the start of antihistaminic. DISCUSSION: The use of anti-TNF drugs has been related to cutaneous and mucosal lesions. Multiform erythema is one of these skin conditions and is considered a hypersensitivity reaction, possibly mediated by deposition of immune complex (mostly IgM) in the superficial microvasculature of the skin and oral mucosa, that usually follows an infection (viral or bacterial) or drug exposure. Various types of cutaneous lesions can be observed: maculopapular eruption and erythematous plates with the classic appearance of target lesions, limited to less than 10% of the skin and usually with mucosal involvement. The course is benign, usually self-limited with a resolution within 7–10 days in the norm, healing with no scars, but it can recur. In the case reported as patient was in clinical remission and with no signs f infection, anti-TNF drug was temporarily interrupted and the skin lesions healed. CONCLUSION: The management of erythema multiform in IBD patients in anti-TNF therapy requires exclusion of infections and disease activity as causes of the skin lesions before attributing them as a cutaneous adverse drug reaction that can require treatment interruption.

Association of dietary factors and development of Inflammatory Bowel Disease (IBD) in Rio de Janeiro, Brazil: P-84.

those observed in 2009 (Table 1). CONCLUSIONS: These findings indicate that IFX utilization for CD and UC patients was stable from 2009 to 2010 and was consistent across different sites-of-care (i.e., IOI, HOPD, and ASOC). While this analysis indicated consistent IFX vial utilization per infusion across different sites-of-care, further research exploring additional measures, such as patient adherence and patient satisfaction, may provide further insight into the complete patient care experience across sites and support optimal site of care decision making.

Deficiência de ferro nas afecções gastrointestinais do adulto

A anemia por deficiencia de ferro (ADF) ou a deficiencia de ferro (DF) isolada sao comuns em criancas e mulheres pre-menopausa. Entretanto, em adultos do sexo masculino e mulheres pos-menopausa, essa condicao se associa frequentemente a perdas sanguineas gastrointestinais ou mal absorcao. A prevalencia das lesoes gastrointestinais torna essencial o exame do aparelho digestorio superior e inferior atraves da endoscopia. Investigacoes complementares devem ser realizadas se os procedimentos endoscopicos nao evidenciarem sangramento em situacoes clinicas, tais como a necessidade de multiplas hemotransfusoes, a ausencia de sangramento visivel a endoscopia digestiva alta e colonoscopia e a falta de resposta a reposicao de ferro.Esses casos devem ser direcionados para investigacao do intestino delgado com metodos radiologicos ou, mais recentemente, com a capsula endoscopica e da enteroscopia com duplo balao. A cintigrafia com hemacias marcadas e a angiografia tem papel restrito, sendo utilizadas apenas no sangramento aberto. O tratamento varia de acordo com a etiologia, a intensidade da perda sanguinea e da deficiencia de ferro.

M1170 Nutritional Status, Disease and Physical Activities of Patients with Inflammatory Bowel Disease in a Tertiary Hospital in Rio De Janeiro - Brazil

In IBD, weight loss is frequently associated to abdominal pain, diarrhea, arthralgias and fatigue .Nutritional status can be related to disease activity, poor intake, restrictive diets, small bowel inflammation and decreased physical activity. Aim: Evaluate nutritional status of IBD outpatients followed up in the gastroenterology unit of a tertiary hospital in Rio de Janeiro and correlate with disease activity and location, and physical activity. Patients and Methods: Sectional study enrolling 82 consecutive IBD patients (48 CD and 34 UC) with mild and moderate activity of disease according to CDAI and Truelove-Witts index. They were assessed by body mass index ( BMI), triceps skin fold (TSF), mid-arm circumference (MAC), mid-arm muscle circumference (MAMC) and waist circumference (WC). Body composition was assessed by bioelectrical impedance analysis and lean mass (LM), lean mass index (LMI), fat mass (FM), fat mass index (FMI) and the fat mass percentage were measured. In all patients food frequency and Baeckes questionnaires were recorded. Statistical analysis was performed using the statistical software SPSS for windows (version 11.0, SPSS Inc, 1989-1999, USA). Comparisons between the groups were evaluated by T student test. The level of significance was set at p 0.05). Just 10% of IBD patients (8/82) were undernourished according to BMI (7 CD and 1 UC). In CD patients with low BMI the MAMC was also decreased reflecting a caloric malnutrition with preservation of lean mass. In both groups male patients with active disease had weight, BMI, MAC and WC lower than the ones in remission (p<0.05) but they were all in a normal range. The same results were find when the LM and LMI were analyzed in this groups (p<0.05, mean 4.9 ± 1.8 Kg/m2). The food frequency questionnaire detected lower intake levels of food rich in calcium and vitamin A. The majority of patients were sedentary and a according to Baeckes questionnaires scores in patients with active disease were significantly lower than the one obtained in patients in remission (p<0.05). Conclusions: Protein-calorie malnutrition was not detected, being 10% of calorie malnutrition secondary to weight loss. The predominance of no physical activity can justify the increase of body mass index. So the dietitian orientation and physical exercises were necessary to maintain the index of the body mass.