assista nosso video

Como podemos ajudar?

INFORMAÇÕES PARA OS PROFISSIONAIS DE SAÚDE

VIDEOAULAS DE ATUALIZAÇÃO E RECICLAGEM


Saiba mais

ARTIGOS CIENTÍFICOS


Saiba mais

Cursos de Exames Complementares


Saiba mais

Livros de Doença Inflamatória Intestinal


Saiba mais

Manual do Paciente


Saiba mais

Consensos Médicos


Saiba mais

Aulas de Aprimoramento em Estomas Intestinais


Saiba mais

Revistas Médicas


Saiba mais

Protocolos clínicos-cirúrgicos


Saiba mais

Loja GAMEDII


Saiba mais

INFORMAÇÕES PARA OS PACIENTES

Anatomia


Saiba mais

Artigos de saúde


Saiba mais

Vídeos 3D


Saiba mais

Estomas Intestinais


Saiba mais

Direitos dos pacientes


Saiba mais

Dietas Nutricionais


Saiba mais

Folhetos ABCD


Saiba mais

Sala de Espera Ambulatorial


Saiba mais

Saúde Intestinal


Saiba mais

Consenso ECCO para pacientes


Saiba mais

Câncer


Saiba mais

Vídeos Educacionais


Saiba mais

Associação de Estomizados


Saiba mais

Centro de Infusões


Saiba mais

Espaço do Artista


Saiba mais

NOTÍCIAS & EVENTOS

CONHEÇA NOSSAS ATIVIDADES

Clique nos tópicos para saber mais
ubs.png
maioroxonovo.png
pacientes.png
jornada.png
logogamedii.png
advocacy.png
cursoatualizacao.png
cursoimersao.png
meetingmultidisciplicar.png

SOLICITAÇÃO DE RENOVAÇÃO DOS DOCUMENTOS DE ALTO CUSTO

EQUIPE MULTIPROFISSIONAL

ENFERMAGEM
  • VACINAS
  • MEDICAMENTOS
NUTRIÇÃO
  • NUTRIÇÃO
  • WEBINAR
PSICOLOGIA
  • PSICOLOGIA
  • WEBINAR
SERVIÇO SOCIAL
  • ENCAMINHAMENTO MÉDICO

J Autoimmun. 2015 Aug 6.
Understanding inflammatory bowel disease via immunogenetics.
de Lange KM, Barrett JC.

The major inflammatory bowel diseases, Crohn's disease and ulcerative colitis, are both debilitating disorders of the gastrointestinal tract, characterized by a dysregulated immune response to unknown environmental triggers. Both disorders have an important and overlapping genetic component, and much progress has been made in the last 20 years at elucidating some of the specific factors contributing to disease pathogenesis. Here we review our growing understanding of the immunogenetics of inflammatory bowel disease, from the twin studies that first implicated a role for the genome in disease susceptibility to the latest genome-wide association studies that have identified hundreds of associated loci. We consider the insight this offers into the biological mechanisms of the inflammatory bowel diseases, such as autophagy, barrier defence and T-cell differentiation signalling. We reflect on these findings in the context of other immune-related disorders, both common and rare. These observations include links both obvious, such as to pediatric colitis, and more surprising, such as to leprosy. As a changing picture of the underlying genetic architecture emerges, we turn to future directions for the study of complex human diseases such as these, including the use of next generation sequencing technologies for the identification of rarer risk alleles, and potential approaches for narrowing down associated loci to casual variants. We consider the implications of this work for translation into clinical practice, for example via early therapeutic hypotheses arising from our improved understanding of the biology of inflammatory bowel disease. Finally, we present potential opportunities to better understand environmental risk factors, such as the human microbiota in the context of immunogenetics.


J Crohns Colitis. 2015 Jul 29. [Epub ahead of print]
Benefit for earlier anti-TNF treatment on IBD disease complications?
Nuij VJ, Fuhler GM, Edel MJ, et al.

BACKGROUND: Anti-Tumor Necrosis Factor (anti-TNF) treatment was demonstrated to have disease modifying abilities in IBD. With this study, we aimed to determine the effect of anti-TNF timing on IBD-disease complications and mucosal healing (MH).

METHODS: The following IBD-related complications were tested in relation to timing of anti-TNF therapy start in newly diagnosed IBD patients (n=413): fistula formation, abscess formation, EIM, surgery, referral to academic center and MH. RESULTS: Eighty-five patients (21%) received anti-TNF (66 CD, 16 UC, 3 IBDU) of whom 57% (48 pts) < 16 months after diagnosis. Patients receiving anti-TNF early (<16 months="" did="" not="" differ="" from="" patients="" receiving="" anti-tnf="" late="">16 months) regarding gender, age, smoking status and familial IBD. More importantly, patients receiving anti-TNF early did not suffer less IBD-related complications during follow-up as compared to patients started on anti-TNF late, nor was more MH observed. Similar results were obtained when anti-TNF treated patient were stratified more stringently, i.e. <12 months="" 40="" pts="" vs="">24 months (24 pts). Cox-regression analysis showed no beneficial correlations between anti-TNF timing and IBD-related complications. Anti-TNF treated patients achieving MH were 11 times less likely to develop EIMs compared to patients who did not achieved MH while on anti-TNF.

CONCLUSION: This study was unable to confirm a benefit for earlier anti-TNF treatment on IBD-disease complications. This could be explained by more aggressive treatment earlier in disease, resulting in fewer IBD complications. However, it seems more likely that inappropriate selection of patients for therapy leads to suboptimal treatment and subsequently outcome.


Am J Gastroenterol. 2015 Jul 28. [Epub ahead of print]
Detection of small bowel mucosal healing and deep remission in patients with known small bowel Crohn's disease using biomarkers, capsule endoscopy, and imaging.
Kopylov U, Yablecovitch D, Lahat A, et al.

OBJECTIVES: Mucosal healing (MH) and deep remission (DR) are associated with improved outcomes in Crohn's disease (CD). However, most of the current data pertain to colonic MH and DR, whereas the evidence regarding the prevalence and impact of small bowel (SB) MH is scarce. The aim of this study was to to evaluate the prevalence of SBMH and DR in quiescent SBCD.

METHODS: Patients with known SBCD in clinical remission (CDAI<150) or with mild symptoms (CDAI<220) were prospectively recruited and underwent video capsule endoscopy after verification of SB patency. Inflammation was quantified using the Lewis score (LS). SBMH was defined as LS<135, whereas a significant inflammation was defined as LS>790. Clinico-biomarker remission was defined as a combination of clinical remission and normal biomarkers. DR was defined as a combination of clinico-biomarker remission and MH. RESULTS: Fifty-six patients with proven SB patency were enrolled; 52 (92.9%) patients were in clinical remission and 21 (40.4%) in clinico-biomarker remission. SBMH was demonstrated in 8/52 (15.4%) of patients in clinical remission. Moderate-to-severe SB inflammation was demonstrated in 11/52 (21.1%) of patients in clinical remission and in 1/21 (4.7%) of patients in clinical and biomarker remission. Only 7/52 (13.5%) patients were in DR.

CONCLUSIONS: SB inflammation is detected in the majority of CD patients in clinical and biomarker remission. SBMH and DR were rare and were independent of treatment modality. Our findings represent the true inflammatory burden in quiescent patients with SBCD.


Gastroenterology. 2015 Jun;148(7):1474-5. Epub 2015 Apr 30.
The POCER Trial: Bet on Active Care.
Vuitton L, Peyrin-Biroulet L.

No abstract available.


Scand J Gastroenterol. 2015 Jul 22:1-10. [Epub ahead of print]
Infliximab in ulcerative colitis: real-life analysis of factors predicting treatment discontinuation due to lack of response or colectomy: ECIA (ACAD Colitis and Infliximab Study).
Fernández-Salazar L, Muñoz F, Barrio J, et al.

OBJECTIVE: To describe clinical practice with infliximab (IFX) in ulcerative colitis (UC); identification of predictive factors for IFX treatment discontinuation due to insufficient response and for colectomy.

MATERIAL AND METHODS: Retrospective, multicentric and observational study including every UC IFX-treated patient in 10 Spanish hospitals. Variables analyzed: epidemiological data; variables for poor prognosis; IFX prior treatments; characteristics of the IFX treatment; time from the UC diagnosis to induction with IFX; time from induction to colectomy or until data collection. Predictive and protective factors for IFX discontinuation due to lack of response and for colectomy were analyzed with binary logistic regression and Cox analysis.

RESULTS: Follow-up time from induction with IFX to the collection of data or colectomy: 36.7 ± 25.7 months. Prior treatment with immunomodulator medications (IMM): 79%; IFX + immunosuppressant therapy: 77%; discontinuation of IFX: 26%, colectomy 16%. Independent predictive or protective factors for IFX discontinuation: IMM resistance (OR: 2.9, p = 0.022, 95%CI: 1.2-7.2), prior use of leukocytapheresis (OR: 3.3, p = 0.024, 95%CI: 1.1-9.4), IFX + IMM therapy (OR: 0.3, p = 0.022, 95%CI: 0.1-0.9, and HR: 0.4, p = 0.006, 95%CI: 0.2-0.8) and corticosteroid use in induction (HR: 1.9, p = 0.049, 95%CI: 1.0-3.8). Independent predictive or protective factors for colectomy: Use of leukocytapheresis (OR: 3.0, p = 0.036, 95%CI: 1.1-8.4), IFX + IMM therapy (OR: 0.3, p = 0.022, 95%CI: 0.1-0.8, and HR: 0.3, p = 0.011, 95%CI: 0.1-0.8) and severe cortico-resistant flare-up (HR: 2.5, p = 0.032, 95%CI: 1.1-5.9).

CONCLUSIONS: Prior use of IMM and leukocytapheresis, the use of corticosteroids in induction and a severe cortico-resistant flare predict a worse response to IFX and the need for colectomy. Combination therapy is a protective factor for both.


J Gastroenterol Hepatol. 2015 Jul 25. [Epub ahead of print]
Fecal calprotectin is a clinically relevant biomarker of mucosal healing in patients with quiescent ulcerative colitis.
Yamaguchi S, Takeuchi Y, Arai K, et al.

BACKGROUND AND AIM: Calprotectin is an abundant protein in neutrophils, which infiltrate the mucosa during inflammation. Fecal calprotectin (FC) level has shown correlation with disease activity in ulcerative colitis (UC) patients. Additionally, FC level is expected to indicate mucosal healing (MH). This study was to see the significance of FC for predicting MH in patients with quiescent UC.

METHODS: A total of 112 patients with quiescent UC were included. After taking blood and stool samples, patients underwent total colonoscopy and the Mayo endoscopic subscore was recorded. FC was measured by fluorescence enzyme immunoassay. C-reactive protein, hemoglobin, erythrocyte sedimentation rate, and serum albumin were measured as conventional biomarkers. MH was defined as Mayo 0 or 0&1, and receiver operator characteristic (ROC) analyses were undertaken to determine the significance levels of measurements.

RESULTS: Data from 105 patients were available. Eleven patients showed Mayo ≥2. The median (interquartile range) of FC level of all patients was 115 μg/g (45.4-420). The area under the curve (AUC) in ROC analysis of FC to predict Mayo 0&1 was 0.869 with a cut-off value of 200 μg/g yielding 67% sensitivity and 91% specificity, which were the best among all biomarkers. However, the power of FC to predict Mayo 0 was modest; the AUC was 0.639, cut-off value 194 μg/g with 71% sensitivity and 58% specificity.

CONCLUSIONS: Based on the findings of this study, we believe that FC is a clinically relevant biomarker of MH in patients with quiescent UC. Other favorable features of FC test include feasibility and non-invasiveness.


Aliment Pharmacol Ther. 2015 Aug 24. [Epub ahead of print]
Review article: the histological assessment of disease activity in ulcerative colitis.
Marchal Bressenot A, Riddell RH, Boulagnon-Rombi C, et al.

BACKGOUND: In patients with ulcerative colitis (UC), mucosal healing has emerged as a major therapeutic goal, and is usually assessed endoscopically. Histological healing does not correlate very well with endoscopic mucosal healing in UC and persistent histological inflammation might be a better predictor of future clinical relapse than the endoscopic appearance alone. AIM: To define how histological assessment of disease activity should be best done in UC.

METHODS: Electronic (PubMed/Embase) and manual search.

RESULTS: At least 18 histological indices to assess disease activity in UC have been described, though none are fully validated. However, histological assessment is increasingly used as a secondary endpoint in clinical trials in UC. After reviewing and discussing existing histological scoring systems for UC activity, we describe features of histological response and define three grades of activity: (i) histological healing - complete resolution of abnormalities; (ii) quiescent disease, - lack of mucosal neutrophils but chronic inflammation may remain; (iii) active disease - presence of neutrophils plus possible epithelial damage. It is recommended that two biopsies are taken from each colonic segment which should include always biopsy of the rectum and the most affected segments. There is to date no agreed preferable scoring system but the Geboes Index is the best validated (kappa for interobserver variation 0.59-0.70).

CONCLUSION: Histological assessment of disease activity in UC is increasingly used, but needs to be carefully defined.


Scandinavian Journal of Gastroenterology. 2015;
The epidemiology of inflammatory bowel disease
JOHAN BURISCH1,2 & PIA MUNKHOLM2

Abstract

Background and aims. The inflammatory bowel diseases (IBD), Crohn’s disease (CD) and ulcerative colitis (UC), are chronic relapsing disorders of unknown aetiology. The aim of this review is to present the latest epidemiology data on occurrence, disease course, risk for surgery, as well as mortality and cancer risks. Material and methods. Gold standard epidemiology data on the disease course and prognosis of patients with inflammatory bowel disease (IBD) are based on unselected population-based cohort studies.

Results. The incidence of ulcerative colitis (UC) and Crohn’s disease (CD) has increased overall in Europe from 6.0 per 100,000 person-years in UC and 1.0 per 100,000 person-years in CD in 1962 to 9.8 per 100,000 person-years and 6.3 per 100,000 person-years in 2010, respectively. The highest incidence of IBD is found on the Faroe Islands. Overall, surgery rates have been declining over the last decades, partly due to aggressive medical therapy. Among IBD patients, mortality risk is increased by up to 50% in CD when compared to the background population, but this is not the case for UC. In CD, 25 – 50% deaths are disease-specific deaths, e.g. malnutrition, postoperative complications and intestinal cancer. In UC, disease-specific causes of deaths include colorectal cancer (CRC), and surgical and postoperative complications. The risk of CRC and small bowel cancer is increased two- to eightfold among IBD patients. Various subgroups carry increased risk of malignancy, e.g. those with persistent inflammation, long-standing disease, extensive disease, young age at diagnosis, family history of CRC and co-existing primary sclerosing cholangitis. The risk of extra-intestinal cancers, including lymphoproliferative disorders (LD) and intra- and extrahepatic cholangio carcinoma, is significantly higher among IBD patients.

Conclusion. In recent years, self-management and patient empowerment, combined with evolving eHealth solutions, has utilized epidemiological knowledge on disease patterns and has been improving compliance and the timing of adjusting therapies, thus optimizing efficacy by individualizing medication in the community setting.


Inflamm Bowel Dis. 2015 Sep;21(9):2172-7.
An optimized anti-infliximab bridging enzyme-linked immunosorbent assay for harmonization of anti-infliximab antibody titers in patients with inflammatory bowel diseases.
Van Stappen T, Billiet T, Vande Casteele N, et al.

BACKGROUND: The formation of anti-infliximab antibodies (ATI) is associated with loss of response and adverse events in patients with inflammatory bowel diseases, leading to the introduction of ATI monitoring for guiding treatment adjustments. However, a lack of standardization among current available assays exists, hampering comparison of results from different studies. This study aimed to improve the harmonization of clinically validated ATI enzyme-linked immunosorbent assays (ELISAs) by introducing a monoclonal anti-infliximab antibody (MA-IFX).

METHODS: A panel of MA-IFX was evaluated as calibrator in the first generation ATI ELISA. After selection of 1 MA-IFX, assay conditions were optimized and biotin-streptavidin-enhanced detection of bound infliximab was introduced. The novel second generation ELISA was used for reanalysis of 127 serum samples from a cohort of 12 patients with inflammatory bowel disease, previously identified as ATI positive.

RESULTS: Of 55 MA-IFX, MA-IFX10F9 was selected as calibrator in the ATI ELISA. After optimization of the assay conditions, a 4-fold improvement in sensitivity was obtained. Reanalysis of 127 serum samples revealed that in 5 of 12 patients (46%), ATI were detected at least 1 time point earlier with the second generation ELISA compared with the first generation ELISA. In 1 patient, the second generation ELISA allowed to detect ATI before the reinitiation of IFX after a drug holiday.

CONCLUSIONS: In addition to the improved sensitivity and specificity of the second generation ATI ELISA, MA-IFX10F9 can serve as a universal calibrator to achieve assay harmonization. Moreover, the superiority of the second generation assay in analyzing serum of restarters was demonstrated.


J Crohns Colitis. 2015 Aug 20. [Epub ahead of print]
European evidence-based consensus: inflammatory bowel disease and malignancies.
Annese V, Beaugerie L, Egan L, et al.

No abstract available.

APOIO INSTITUCIONAL

GAMEDII

Nas Redes Sociais

Facebook

Youtube

Instagram

Blog

CARTÃO PRIORIDADE

Cartão Prioridade

História em Quadrinhos

Clique para Download

QUERO ME CADASTRAR