Paulo Gustavo Kotze

Risk factors for complications after ileocolonic resection for Crohn’s disease with a major focus on the impact of preoperative immunosuppressive and biologic therapy: A retrospective international multicentre study

Background Author note: TY, AS, YS, FVT and PGK designed the study. All authors did data collection and gave scientific contribution to the study design and discussion. TY, AS and PGK drafted the article. All authors read and approved the final version of the manuscript. In the era of biologic agents, risk factors for complications following resection for Crohn’s disease have not been fully identified. In particular, the association of preoperative use of immunosuppressive and biologic agents with the incidence of complications after resection remains to be elucidated. Aim This retrospective multicentre study aimed to identify risk factors for complications after ileocolonic resection for Crohn’s disease, with a major focus on the impact of preoperative immunosuppressive and biologic therapy. Methods A total of 231 consecutive patients who underwent ileocolonic resections for active Crohn’s disease in seven inflammatory bowel disease referral centres from three countries (Japan, Brazil and Italy) were included. The following variables were investigated as potential risk factors: age at surgery, gender, behaviour of Crohn’s disease (perforating vs. non-perforating disease), smoking, preoperative use (within eight weeks before surgery) of steroids, immunosuppressants and biologic agents, previous resection, blood transfusion, surgical procedure (open vs. laparoscopic approach), and type of anastomosis (side-to-side vs. end-to-end). Postoperative complications occurring within 30 days after surgery were recorded. Results The rates of overall complications, intra-abdominal sepsis, and anastomotic leak were 24%, 12% and 8%, respectively. Neither immunosuppressive nor biologic therapy prior to surgery was significantly associated with the incidence of overall complications, intra-abdominal sepsis or anastomotic leak. In multivariate analysis, blood transfusion, perforating disease and previous resection were significant risk factors for overall complications (odds ratio [OR] 3.02, 95% confidence interval [CI] 1.21–7.52; P = 0.02), intra-abdominal sepsis (OR 2.67, 95% CI 1.04–6.86; P = 0.04) and anastomotic leak (OR 2.87, 95% CI 1.01–8.18; P = 0.048), respectively. Conclusions Blood transfusion, perforating disease and previous resection were significant risk factors for overall complications, intra-abdominal sepsis and anastomotic leak after ileocolonic resection for Crohn’s disease, respectively. Preoperative immunosuppressive or biologic therapy did not increase the risk of postoperative complications.

Results of the Fifth Scientific Workshop of the ECCO [II]: Clinical Aspects of Perianal Fistulising Crohn’s Disease—the Unmet Needs

BACKGROUND AND AIMS Perianal fistulas affect up to one-third of Crohns patients during the course of their disease. Despite the considerable disease burden, current treatment options remain unsatisfactory. The Fifth Scientific Workshop [SWS5] of the European Crohns and Colitis Organisation [ECCO] focused on the pathophysiology and clinical impact of fistulas in the disease course of patients with Crohns disease [CD]. METHODS The ECCO SWS5 Working Group on clinical aspects of perianal fistulising Crohns disease [pCD] consisted of 13 participants, gastroenterologists, colorectal surgeons, and a histopathologist, with expertise in the field of inflammatory bowel diseases. A systematic review of literature was performed. RESULTS Four main areas of interest were identified: natural history of pCD, morphological description of fistula tracts, outcome measures [including clinical and patient-reported outcome measures, as well as magnetic resonance imaging] and randomised controlled trials on pCD. CONCLUSIONS The treatment of perianal fistulising Crohns disease remains a multidisciplinary challenge. To optimise management, a reliable classification and proper trial endpoints are needed. This could lead to standardised diagnosis, treatment, and follow-up of Crohns perianal fistulas and the execution of well-designed trials that provide clear answers. The prevalence and the natural history of pCD need further evaluation.

Recommendations on the use of biosimilars by the Brazilian Society of Rheumatology, Brazilian Society of Dermatology, Brazilian Federation of Gastroenterology and Brazilian Study Group on Inflammatory Bowel Disease—Focus on clinical evaluation of monoclonal antibodies and fusion proteins used in the treatment of autoimmune diseases

The Brazilian Societies of Rheumatology (SBR) and Dermatology (SBD), the Brazilian Federation of Gastroenterology (FBG) and the Brazilian Study Group on Inflammatory Bowel Disease (GEDIIB) gathered a group of their respective specialists on the topic of interest to discuss the most relevant issues regarding the clinical use of biosimilar medicines in Brazil. The main aim of that meeting was to prepare a document with recommendations to guide medical specialists and to help the national regulatory and policy-making agencies as concerns the authorization for marketing biosimilars used in autoimmune diseases, such as rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, Crohns disease, juvenile idiopathic arthritis and ulcerative colitis. In addition to considerations on the typical differences between innovator medicines and biosimilars, the specialists established a set of seven recommendations on regulatory advances related to clinical studies, indication extrapolation, nomenclature, interchangeability, automatic substitution and pharmacovigilance.

Is there any relation between gastric bypass for morbid obesity and the development of Crohn's disease?

Dear Sir The relation between morbid obesity (MO) with Crohns disease (CD) is not yet perfectly understood. The proinflammatory status of obesity, with possibly subsequent high levels of inflammatory mediators such as tumour necrosis factor alpha and C-reactive protein, is also linked to a possible increase on intestinal permeability, that can lead to inflammatory conditions such as CD.1 In a study from Israel, severe and morbid obesity were seen in 2.3% of CD patients from a referral centre cohort.2 Data regarding the consequences of surgical procedures for …

Motor neuropathy with multiple conduction blocks associated with TNF-alpha antagonist

Professor da Disciplina de Neurologia e Neurocirurgia do Curso de Medicina da Universidade Estadual do Oeste do Parana UNIOESTE, Parana, Brasil; Professor da Disciplina de Clinica Cirurgica do Curso de Medicina da Universidade Estadual do Oeste do Parana UNIOESTE, Parana, Brasil; Chefe do Servico de Coloproctologia do Hospital Universitario Cajuru PUCPR, Parana, Brasil. Infliximab, eternecept and adalimumab are tumour necrosis alpha factor (TNFalpha) antagonists which recently became part of several auto-immune diseases therapeutic arsenal, mainly in rheumatoid arthritis, ankylosing spondilitis, psoriatic arthritis, as well as inflammatory bowel diseases. TNF-alpha plays a crucial role in many aspects of immune system development, immune-response regulation and T-cell-mediated tissue injury. It is a cytokine with both pro-inflammatory and immunoregulatory properties and is involved in normal inflammation and immune responses. TNF-alpha is an important growth factor for prothymocytes and thimocytes, and thereby influences the generation of the T-cell repertoire. In the peripheral immune system, TNF-alpha participates in antigen-presenting cellfunction and in regulating apoptosis of potentially auto-reactive Tcells. So that, immunological complications with drugs that antagonize TNF-alpha receptors were expected to occur. Demyelinating peripheral motor neuropathy is one of them, but it is relatively uncommon. We report a patient who had a severe form of Crohn’s disease, who developed a peripheral neuropathy with multiple motor conduction blocks at atypical sites, with axonal damage signs, probably associated with infliximab treatment.

Antibodies anti-Saccharomyces cerevisiae (ASCA) do not differentiate Crohn's disease from celiac disease.

CONTEXT Anti-Saccharomyces cerevisiae antibodies (ASCA), considered serologic markers for Crohns disease, were described in patients with celiac disease, disappearing after a gluten-free diet. OBJECTIVES Evaluation of ASCA positivity in patients with Crohns disease and celiac disease in relation to healthy individuals. METHODS A total of 145 individuals were studied: 36 with Crohns disease and 52 with celiac disease, that fulfilled the diagnostic criteria for both affections, and 57 healthy individuals for control. The celiac patients were divided as follow: group CeD I at diagnosis (n = 34), group CeD II with gluten-free diet compliance (n = 13) and group CeD III with transgressions to the diet (n = 5). ASCA IgA and IgG were determined by ELISA. RESULTS With statistical significance, ASCA IgA were positive in Crohns disease, celiac disease at diagnosis and celiac disease with diet transgressions; ASCA IgG in Crohns disease and in all groups with celiac disease. CONCLUSIONS The detection of ASCA in patients with celiac disease allows to suggest that ASCA is not a specific marker for Crohns disease, but was associated with the inflammation of the small intestine. The increased levels of positive ASCA may be due to genetic factors and increased intestinal permeability.

Análise de custo-minimização entre o Infliximabe (IFX) e o Adalimumabe (ADA) no tratamento da doença de Crohn (DC)

INTRODUCAO: ha uma preocupacao crescente com os custos da terapia biologica no tratamento da DC. O objetivo deste estudo foi simular o custo-minimizacao do tratamento continuo com o IFX e com o ADA em portadores de DC, num periodo de 1 ano, em variadas faixas de peso. METODO: estudo farmacoeconomico de custo-minimizacao na simulacao de tratamento com agentes biologicos de pacientes portadores de DC, com pesos diferentes. Os custos foram baseados no preco dos dois medicamentos isoladamente (IFX E ADA). RESULTADOS: o custo do tratamento com IFX (sistema publico) foi de R

Sarcoidosis during therapy with adalimumab in a Crohn's disease patient: A paradoxical effect

29.411,12 (entre 20 e 40 kg), R

Developing a Standard Set of Patient-Centred Outcomes for Inflammatory Bowel Disease-an International, Cross-disciplinary Consensus

44.116,68 (entre 41 e 60 kg), R

BIOSIMILARS IN INFLAMMATORY BOWEL DISEASES: an important moment for Brazilian gastroenterologists

58.822,24 (entre 61 e 80 kg) e R