Abstract The authors aim to study Religiosity/Spirituality (R/S) and Quality of Life (QoL) in patients with Crohn's disease and their correlation with the disease phenotypes. Methods Prospective cross-sectional cohort study with 151 consecutive patients enrolled from March 2021 to October 2021 at the Colorectal IBD Outpatient of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP). Sociodemographic, Religiosity/Spirituality (Duke University Religion Index - Durel) questionnaires and QoL (Inflammatory Bowel Disease Questionnaire - Short IBDQ-S) were applied. When necessary, qualitative variables were evaluated using the chi-square or Fisher's exact test. The Mann-Whitney and Kruskall-Wallis tests were used to analyze quantitative variables and compare more than two groups, both non-parametric statistical techniques. Results The most frequent location was Ileocolonic followed by Ileal and colonic (41.1 %, 27.2 %, and 25.2 %); only 6.6 % of subjects had a perianal presentation. Inflammatory, stenosing, and penetrating behaviors showed 36.4 %, 19.1 %, and 44.4 % respectively. The majority of the population is Catholic, Evangelical, or Spiritualist (92.4 %). QoL score showed no significant difference in the phenotypes. The scores for DUREL domains were 61.4 % for organizational religiosity, 75 % for non-organizational religiosity, 98.6 %, 93.6 % and 89.3 % for intrinsic spirituality, with high results in all disease phenotypes. Conclusions The studied population presented homogeneous sociodemographic results and high religious and spiritual activity. R/S in a positive context were not associated with better QoL or phenotype. R/S is present in the patients’ lives and could be seen as an important tool for adherence to treatment and the professional relationship between doctor and patient. The homogeneity of the sample difficult for an appropriate evaluation, which leads us to suggest new studies with more heterogeneous groups. ReligiositySpirituality Religiosity Spirituality RS R S (R/S (QoL Crohns Crohn s phenotypes crosssectional cross sectional 15 202 HCFMUSP. HCFMUSP . (HCFMUSP) Sociodemographic Duke Durel Inflammatory IBDQS IBDQ IBDQ-S applied necessary chisquare chi square Fishers Fisher test MannWhitney Mann Whitney KruskallWallis Kruskall Wallis groups nonparametric non parametric techniques 41.1 411 41 1 (41. 272 27 2 27. 252 25 25. %) 66 6 6. presentation stenosing 364 36 4 36. 191 19 19. 444 44 44. respectively Catholic Evangelical 92.4 924 92 (92. %. 614 61 61. religiosity 7 nonorganizational 986 98 98. 936 93 93. 893 89 3 89. spirituality activity phenotype patient evaluation 20 (HCFMUSP 41. (41 92. 9 (92 8 (4 (9 (

Abstract Introduction: Crohn’s disease (CD) has been related to an increased prevalence of psychiatric disorders and suicide risk (SR). However, the nature of their relationship still deserves clarification. The aim of this study is to assess the prevalence of major depressive disorder (MDD) in patients with CD, and to investigate the relationship between MDD and CD outcomes. Methods: A cross-sectional study involving CD patients was performed. CD activity was evaluated by the Harvey-Bradshaw index and CD phenotype by the Montreal classification. The presence of MDD was assessed by the Patient Health Questionnaire score-9 (PHQ-9). Sociodemographic data and other characteristics were retrieved from electronic medical records. Results: 283 patients with CD were included. The prevalence of MDD was 41.7%. Females had a risk of MDD 5.3 times greater than males. CD disease duration was inversely correlated with MDD severity. Individuals with active CD were more likely to have MDD (OR = 796.0; 95% CI 133.7‒4738.8) than individuals with CD remission. MDD was more prevalent in inflammatory behavior (45.5%) and there were no statistical differences regarding the disease location. 19.8% of the sample scored positive for SR. Conclusion: The present results support data showing an increased prevalence of MDD in individuals with CD. Additionally, it indicates that MDD in CD might be related to the activity of CD. Prospective studies are warranted to confirm these results and to address whether MDD leads to CD activity, CD activity leads to MDD or both ways are existent. Introduction Crohns Crohn s (CD SR . (SR) However clarification (MDD outcomes Methods crosssectional cross sectional performed HarveyBradshaw Harvey Bradshaw classification score9 score 9 score- PHQ9. PHQ9 PHQ (PHQ-9) records Results 28 included 417 41 7 41.7% 53 5 3 5. males severity OR 796.0 7960 796 0 95 133.7‒4738.8 133747388 133 4738 8 remission 45.5% 455 45 (45.5% location 198 19 19.8 Conclusion Additionally existent (SR (PHQ-9 2 4 41.7 796. 79 133.7‒4738. 13374738 13 473 45.5 (45.5 1 19. (PHQ- 41. 133.7‒4738 1337473 47 45. (45. (PHQ 133.7‒473 133747 (45 133.7‒47 13374 (4 133.7‒4 1337 ( 133.7‒ 133.7 133.

Abstract Background & Aims Perianal fistulizing Crohn's disease is the main risk factor for anal cancer in patients with inflammatory bowel disease. Whether this occurs due to a higher frequency of human papillomavirus remains unclear. The authors aimed to evaluate the prevalence of HPV and high-risk HPV in patients with perianal Crohn's disease, compared with a control group. Methods The authors conducted a two-center cross-sectional study in which perianal fistulizing Crohn's disease patients were matched for age and sex with patients with anorectal fistula without Crohn's disease. Biopsy specimens were obtained from fistulous tracts during examination under anesthesia for both groups. The samples were sent for HPV detection and genotyping using the INNO-LiPA test. Results A total of 108 subjects (54 in each group) were recruited. The perianal fistulizing Crohn's disease group showed a statistically higher frequency of HPV in the fistulous tract than the control group (33.3% vs. 16.7%; p = 0.046). Separate analyses on high-risk types demonstrated that there was a numerically higher frequency of HPV in the perianal fistulizing Crohn's disease group. In multiple logistic regression, patients with perianal fistulizing Crohn's disease were found to have a chance of HPV 3.29 times higher than patients without Crohn's disease (OR = 3.29; 95% CI 1.20‒9.01), regardless of other variables. The types most frequently identified in the perianal fistulizing Crohn's disease group were HPV 11 (12.96%) and HPV 16 (9.26%). Conclusion Perianal fistulizing Crohn's disease is associated with a higher prevalence of HPV than in patients with anorectal fistula without Crohn's disease. Crohns Crohn s unclear highrisk high twocenter two center crosssectional cross sectional groups INNOLiPA INNO LiPA test 10 54 (5 recruited 33.3% 333 33 3 (33.3 vs 16.7% 167 7 0.046. 0046 0.046 . 0 046 0.046) regression 329 29 3.2 OR 95 1.20‒9.01, 120901 1.20‒9.01 , 1 20 9 01 1.20‒9.01) variables 12.96% 1296 12 96 (12.96% 9.26%. 926 9.26% 26 (9.26%) 5 ( 33.3 (33. 16.7 004 0.04 04 32 2 3. 12090 1.20‒9.0 12.96 129 (12.96 92 9.26 (9.26% 33. (33 16. 00 0.0 1209 1.20‒9. 12.9 (12.9 9.2 (9.26 (3 0. 120 1.20‒9 12. (12. 9. (9.2 1.20‒ (12 (9. 1.20 (1 (9 1.2 1.

RESUMO RACIONAL: Apesar dos enormes avanços no tratamento das doenças inflamatórias intestinais (DII), alguns pacientes apresentam quadros de colite aguda refratária ao tratamento clínico, e necessitam de cirurgia de urgência. OBJETIVOS: Avaliar os fatores de risco associados com complicações pós-operatórias precoces nos pacientes com colite aguda submetidos a colectomia na era das terapias biológicas. MÉTODOS: Pacientes com DII admitidos com colite aguda grave submetidos a colectomia total em hospital terciário no período de 2012 a 2022 foram analisados. As complicações pós-operatórias foram graduadas de acordo com a classificação Clavien-Dindo (CCD). Pacientes com complicações mais graves (CCD≥2) foram comparados com os menos graves (CCD<2). RESULTADOS: Foram submetidos a cirurgia 46 pacientes. As indicações foram: falha do tratamento conservador (n=34), preferência do paciente ou do cirurgião (n=5), hemorragia (n=3), megacólon tóxico (n=2) e perfuração intestinal (n=2). Reoperação foi necessária em oito pacientes, 60,9% tiveram complicações classificadas como CCD≥2, e três pacientes foram a óbito. Análise univariada identificou que uso de antibióticos no pré-operatório, diagnóstico de colite ulcerativa, hipoalbuminemia na admissão e período de internação maior que sete dias foi associada à complicações pós-operatória mais graves. CONCLUSÕES: Pacientes com colite aguda submetidos a cirurgia de urgência apresentaram alta taxa de complicações pós-operatórias. Uso pré-operatório de antibióticos, diagnóstico de retocolite ulcerativa, hipoalbuminemia na admissão e retardo na operação por mais que sete dias, esteve associado a complicações pós-operatórias mais graves. Uso de biológicos não se associou a piores desfechos. RACIONAL DII, , (DII) clínico OBJETIVOS pósoperatórias pós operatórias biológicas MÉTODOS 201 202 analisados ClavienDindo Clavien Dindo CCD. CCD . (CCD) CCD≥2 CCD2 2 (CCD≥2 CCD<2. CCD<2 (CCD<2) RESULTADOS 4 n=34, n34 n n=34 34 (n=34) n=5, n5 n=5 5 (n=5) n=3, n3 n=3 3 (n=3) n=2 n2 (n=2 n=2. 609 60 9 60,9 óbito préoperatório, préoperatório pré operatório, operatório ulcerativa pósoperatória operatória CONCLUSÕES pósoperatórias. operatórias. desfechos (DII 20 (CCD CCD≥ (CCD≥ CCD< (CCD<2 (n=34 n= (n=5 (n=3 (n= 6 60, (CCD< (n

ABSTRACT BACKGROUND: Despite major advances in the clinical treatment of inflammatory bowel disease, some patients still present with acute colitis and require emergency surgery. AIMS: To evaluate the risk factors for early postoperative complications in patients undergoing surgery for acute colitis in the era of biologic therapy. METHODS: Patients with inflammatory bowel disease admitted for acute colitis who underwent total colectomy at a single tertiary hospital from 2012 to 2022 were evaluated. Postoperative complications were graded according to Clavien-Dindo classification (CDC). Patients with more severe complications (CDC≥2) were compared with those with less severe complications (CDC<2). RESULTS: A total of 46 patients underwent surgery. The indications were: failure of clinical treatment (n=34), patients’ or surgeon's preference (n=5), hemorrhage (n=3), toxic megacolon (n=2), and bowel perforation (n=2). There were eight reoperations, 60.9% of postoperative complications classified as CDC≥2, and three deaths. In univariate analyses, preoperative antibiotics use, ulcerative colitis diagnosis, lower albumin levels at admission, and preoperative hospital stay longer than seven days were associated with more severe postoperative complications. CONCLUSIONS: Emergency surgery for acute colitis was associated with a high incidence of postoperative complications. Preoperative use of antibiotics, ulcerative colitis, lower albumin levels at admission, and delaying surgery for more than seven days were associated with more severe early postoperative complications. The use of biologics was not associated with worse outcomes. BACKGROUND AIMS therapy METHODS 201 202 evaluated ClavienDindo Clavien Dindo CDC. CDC . (CDC) CDC≥2 CDC2 2 (CDC≥2 CDC<2. CDC<2 (CDC<2) RESULTS 4 n=34, n34 n n=34 , 34 (n=34) surgeons surgeon s n=5, n5 n=5 5 (n=5) n=3, n3 n=3 3 (n=3) n=2, n2 n=2 (n=2) n=2. reoperations 609 60 9 60.9 deaths analyses diagnosis admission CONCLUSIONS outcomes 20 (CDC CDC≥ (CDC≥ CDC< (CDC<2 (n=34 n= (n=5 (n=3 (n=2 6 60. (CDC< (n= (n

RESUMO Contexto A doença de Behçet é uma doença imunomediada rara que pode afetar o trato gastrointestinal. A prevalência e extensão do envolvimento do intestino delgado é desconhecida. Objetivo O objetivo deste estudo foi descrever as lesões do intestino delgado diagnosticadas por enteroscopia de duplo balão (EDB) e verificar se esses achados estavam associados à presença de sintomas gastrointestinais e atividade da doença após seguimento de longo prazo. Métodos Este estudo incluiu 19 pacientes com doença de Behçet que foram submetidos a EDB. Após seguimento médio de 15 anos, os achados endoscópicos foram associados à presença de sintomas gastrointestinais, atividade da doença e terapia atual por meio de coleta de prontuário eletrônico. Resultados Um total de 63,2% dos pacientes eram do sexo feminino e a média de idade era de 37 anos no momento da EDB. A duração média da doença no início do estudo foi de 24 anos. 11 pacientes não apresentaram sintomas gastrointestinais e oito pacientes apresentaram dor abdominal, sangramento gastrointestinal ou diarréia. O tempo médio do procedimento foi de 1 hora e 30 minutos e o íleo foi atingido em todos os pacientes, exceto em um. Úlceras de intestino delgado foram diagnosticadas em 78,9%, sendo 63,1% de acometimento jejunal. Dois pacientes apresentaram apenas edema de intestino delgado e dois apresentaram EDB normais. Oito pacientes tinham úlceras gástricas concomitantes. Sintomas gastrointestinais prévios à EDB estavam presentes em 36,8% dos pacientes e, após o seguimento, todos persistiram com alguns dos sintomas. Sangramento foi relatado por três pacientes no início do estudo e persistiu em apenas um paciente. A frequência de tratamento com esteroides e imunomoduladores foi de 31,6% e 57,9% no início do estudo, respectivamente, e 21% em ambos ao final do seguimento. Nenhum paciente foi tratado com biológicos no momento da EDB e a taxa atual de uso de biológicos é de 21%. Conclusão O envolvimento do intestino delgado na doença de Behçet foi frequentemente demonstrado por EDB mesmo em pacientes assintomáticos. Compreender a evolução clínica da doença ao longo dos anos e o impacto de tal diagnóstico ainda representa um desafio, possivelmente com a necessidade de novos tratamentos.

ABSTRACT Background Behçet’s disease is a rare immune-mediated disorder that can affect the gastrointestinal tract. The prevalence and extension of small bowel involvement is largely unknown. Objective The aim of this study was to describe the small bowel lesions diagnosed by double-balloon enteroscopy (DBE) and to verify if these findings were associated to the presence of gastrointestinal symptoms and disease activity after long-term follow-up. Methods This study included 19 Behçet’s disease patients who underwent DBE. After a mean follow-up of 15 years the endoscopic findings were associated to the presence of gastrointestinal symptoms, disease activity and current therapy through collection of electronic medical records. Results A total of 63.2% patients were female and the mean age was 37 years at the time of DBE. Mean disease duration at baseline was 24 years. 11 patients had no gastrointestinal symptoms and eight patients presented either abdominal pain, gastrointestinal bleeding or diarrhea. The average procedure time was 1 hour and 30 minutes and the ileum was achieved in all patients but one. Small bowel ulcers were diagnosed in 78.9%, with 63.1% of jejunal involvement. Two patients presented only small bowel edema and two were normal by DBE. Eight patients had concomitant gastric ulcers. Gastrointestinal symptoms prior to DBE were present in 36.8% of the patients and, after follow-up, all of them persisted with some of the symptoms. Bleeding was reported by three patients at baseline and persisted in only one patient. The frequency of treatment with steroids and immunomodulators was 31.6% and 57.9% at baseline, respectively, and 21% in both at the end of the follow-up. No patient was treated with biologics at the time of the DBE procedure and the current rate of biologic use is 21%. Conclusion Small bowel involvement in Behçet’s disease was frequently demonstrated by DBE even in asymptomatic patients. Understanding clinical evolution of the disease over the years and the impact of such diagnosis still represents a challenge, possibly with the need for novel treatment.