Neogélia Almeida

Analysis of fat and muscle mass in patients with inflammatory bowel disease during remission and active phase.

Inflammatory bowel disease (IBD) is often associated with malnutrition. The aim of this study was to compare the body composition of outpatients with IBD during remission and active phase. In order to evaluate disease activity we used Crohns Disease Activity Index for Crohns disease (CD) patients and Lichtigers Index for ulcerative colitis (UC) patients. All patients underwent the analysis of BMI, arm muscle area (AMA) and triceps plus subscapula skinfold thickness (TST+SST) to identify total, muscle and fat mass, respectively. In total 102 patients were evaluated (CD, n 50; UC, n 52) and the majority was young women. Malnutrition according to BMI was found in 14.0 % of patients with CD and 5.7 % of UC patients. Muscle mass depletion was detected in more than half of the CD and UC patients. The BMI, TST+SST and AMA values were lower in the active phase only in CD patients (P < 0.05). Fat mass depletion was associated with active phase in both CD and UC patients. Body composition parameters obtained using BMI, TST+SST and AMA were not correlated with the presence of fistula in CD patients (P>0.05). In conclusion, patients without signs of malnutrition had fat mass depletion especially in the active phase and muscle mass depletion occurred both in CD and UC patients.

Tuberculin skin testing in inflammatory bowel disease patients from an endemic area of Brazil

OBJECTIVE Inflammatory bowel disease (IBD) is a chronic disorder involving the gastrointestinal tract. Immunosuppressive drugs are usually prescribed to treat IBD patients, and this treatment can lead to tuberculosis reactivation. This paper aimed to analyze tuberculin skin test (TST) results in IBD patients at a reference center in Brazil. METHODS We evaluated TST results in IBD patients using a cross-sectional study. We also analyzed the medical records of patients treated at a reference IBD outpatient unit where TST is routinely performed. RESULTS We reviewed 119 medical records of 57 (47.9%) Crohns disease (CD), 57 (47.9%) ulcerative colitis (UC) and 5 (4.2%) indeterminate colitis (IC) patients. The mean (SD) age was 43.5 (13.7) years old. TST was positive in 24 (20.2%) of the patients. TST was positive in 16/57 (28.1%) UC and 6/57 (10.5%) CD patients (prevalence ratio [PR] 2.7). Forty-one patients (34.5%) were taking immunosuppressive drugs (azathioprine or prednisone) at the time of the TST, and six of these patients (14.6%) had positive test results. Two patients using infliximab had negative TST results. Thirty-five of the 41 patients (85.4%) on immunosuppressive treatment were anergic compared with 73.1% (57/78) of the untreated patients (PR 1.2). CONCLUSIONS Patients with IBD have TST results similar to the general Brazilian population. Within the IBD population, CD patients have a lower frequency of TST positivity than UC patients.

Clinical Features Associated With the Use of Immunosuppressive Drugs in Patients with Ulcerative Colitis in Two Referrals Centers in Salvador-Bahia/Brazil: P-73

BACKGROUND: Although GI and other somatic symptoms, concerns about body image, medication side effects, and surgical treatments and ostomies may impair sexual functioning in patients with inflammatory bowel diseases (IBD), few studies have examined this. We sought to evaluate sexual interest and satisfaction in a large cohort of adult patients with IBD and identify clinical and demographic factors associated with these patient-reported outcomes. METHODS: CCFA Partners is an ongoing internet cohort study of over 12,000 patients with IBD. We invited a randomly selected subset of the cohort to complete a six question supplemental survey regarding sexual interest and satisfaction, and whether IBD symptoms or ostomy (if applicable) affected sexual satisfaction. Measures were developed and validated as part of the NIH Patient Reported Outcome Measurement Information System (PROMIS) initiative. Demographic information, self-reported disease indices [Short Crohn’s Disease Activity Index (SCDAI), Simple Clinical Colitis Activity Index (SCCAI), and Manitoba Index], the Short IBD questionnaire (SIBDQ) quality of life index, and additional PROMIS outcomes were also measured. We used descriptive statistics and bivariate comparisons to assess relationships between sexual interest and satisfaction and the other measures. RESULTS: A total of 2581 individuals completed the supplemental survey (32% opted out). Mean age was 42(SD 1⁄4 14); 71% female. Of 2151 patients who reported active IBD symptoms, 80% indicated that their symptoms affected their sexual satisfaction and 33% indicated their symptoms affected their sexual satisfaction ‘quite a bit’ or ‘very much’ . Of 110 patients with an ostomy, equal numbers reported that their ostomy affected their satisfaction ‘not at all’ or ‘a little bit’ versus ‘quite a bit’ or ‘very much’ . On average, males had higher sexual interest and satisfaction than females (p < 0.001), while there was no difference in sexual interest or satisfaction among those with CD versus UC. Among CD patients, active perirectal disease was associated with lower levels of sexual interest and satisfaction. Sexual interest and satisfaction were both negatively associated with increasing disease activity as measured by SCDAI, SCCAI, and Manitoba Index and positively associated with higher levels of health-related quality of life as measured by SIBDQ (P < 0.001 for all comparisons). Sexual interest and satisfaction were both negatively associated with increasing levels of fatigue, anxiety, and depression. CONCLUSION(S): IBD patients are willing to respond to questions regarding their sexual interest and satisfaction, as indicated by the high response rate. IBD, particularly active disease, is associated with impaired sexual functioning. Only about half of patients with ostomies indicated that their ostomies affected sexual satisfaction. Providers should be aware that disease activity can affect sexual function and satisfaction, and counsel or screen appropriate patients.