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au:VILELA, Eduardo Garcia

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CLINICAL OUTCOME AND SEVERITY OF CLOSTRIDIOIDES (CLOSTRIDIUM) DIFFICILE INFECTION AT A TERTIARY REFERRAL HOSPITAL IN BRAZIL
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CARVALHO, Fernando Antônio Castro

; SILVA, Rodrigo Otávio Silveira

; SANTOS, Bárbara Moreira Ribeiro Trindade dos

; DINIZ, Amanda Nádia

; VILELA, Eduardo Garcia

Arquivos de Gastroenterologia

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sep 2023, Volume 60 N. 3 Pages 330 - 338

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

ABSTRACT Background: Clostridioides difficile infection (CDI) is a potentially severe disease that can present with refractoriness, recurrence, and evolution to death. In Brazil, the epidemiology of CDI seems to differ from that of the United States and most European countries, with only one ribotype (RT) 027-related case and a high prevalence of RT106. Objective: The aim of this study was to evaluate the outcomes of CDI and its possible association with ribotypes at a university hospital in Brazil. Methods: A total of 65 patients with CDI were included and stool samples were submitted to A/B toxin detection and toxigenic culture, and toxigenic isolates (n=44) were also PCR ribotyped. Results: Patients’ median age was 59 (20-87) years and there were 16 (24.6%) deaths. The median Charlson comorbidity index (CCI) was 4 (0-15) and 16.9% of the patients had CCI ≥8. The ATLAS score and non-improvement of diarrhea were related to higher mortality. A longer length of hospitalization was related to the enteral nutrition and use of multiple antibiotics. The period between CDI diagnosis and hospital discharge was longer in those who received new antibiotics after diagnosis, multiple antibiotics, and required intensive care treatment. Recurrence was associated with CCI >7. Twenty ribotypes were identified and RT106 was the most frequently detected strain (43.2%). No relationship was observed between the ribotypes and outcomes. CDI was present in patients with more comorbidities. Conclusion: Risk factors for higher mortality, longer hospital stay and recurrence were identified. A diversity of ribotypes was observed and C. difficile strains were not related to the outcomes.

RESUMO Contexto: A infecção pelo Clostridioides difficile (ICD) é uma doença potencialmente grave que pode se apresentar com refratariedade, recidiva e evoluir para óbito. No Brasil, a epidemiologia da ICD parece diferir da dos Estados Unidos e da maioria dos países europeus, com apenas um caso relacionado ao ribotipo (RT) 027 e alta prevalência do RT106. Objetivo: Avaliar os desfechos da ICD e sua possível associação com ribotipos em um hospital universitário do Brasil. Métodos: Um total de 65 pacientes com ICD foram incluídos e amostras de fezes foram submetidas à detecção de toxina A/B e cultura toxigênica e as cepas toxigênicas isoladas (n=44) também foram ribotipadas por PCR. Resultados: A idade mediana dos pacientes foi de 59 (20-87) anos e houve 16 (24,6%) óbitos. A mediana do índice de comorbidade de Charlson (ICC) foi de 4 (0-15) e 16,9% dos pacientes apresentaram ICC ≥8. O escore ATLAS e a não melhora da diarreia foram relacionados a maior mortalidade. Maior tempo de internação esteve relacionado à nutrição enteral e ao uso de múltiplos antibióticos. O período entre o diagnóstico de ICD e a alta hospitalar foi maior naqueles que receberam novos antibióticos após o diagnóstico, múltiplos antibióticos e necessitaram de tratamento intensivo. A recorrência foi associada com ICC >7. Vinte ribotipos foram identificados e o RT106 foi a cepa mais frequentemente detectada (43,2%). Não foi observada relação entre os ribotipos e os desfechos. ICD esteve presente em pacientes com mais comorbidades. Conclusão: Foram identificados fatores de risco para maior mortalidade, maior tempo de internação e recorrência. Uma diversidade de ribotipos foi observada e cepas de C. difficile não foram relacionadas aos desfechos.

https://doi.org/10.1590/s0004-2803.230302023-36

SECOND BRAZILIAN CONSENSUS ON THE MANAGEMENT OF CROHN’S DISEASE IN ADULTS: A CONSENSUS OF THE BRAZILIAN ORGANIZATION FOR CROHN’S DISEASE AND COLITIS (GEDIIB)
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IMBRIZI, Marcello

; BAIMA, Júlio Pinheiro

; AZEVEDO, Matheus Freitas Cardoso de

; ANDRADE, Adriana Ribas

; QUEIROZ, Natália Souza Freitas

; CHEBLI, Júlio Maria Fonseca

; CHEBLI, Liliane Andrade

; ARGOLLO, Marjorie Costa

; SASSAKI, Ligia Yukie

; PARRA, Rogerio Serafim

; QUARESMA, Abel Botelho

; VIEIRA, Andrea

; DAMIÃO, Adérson Omar Mourão Cintra

; MORAES, Antonio Carlos da Silva

; FLORES, Cristina

; ZALTMAN, Cyrla

; VILELA, Eduardo Garcia

; MORSOLETTO, Eloá Marussi

; GONÇALVES FILHO, Francisco de Assis

; PENNA, Francisco Guilherme Cancela e

; SANTANA, Genoile Oliveira

; ZABOT, Gilmara Pandolfo

; PARENTE, José Miguel Luz

; COSTA, Marcia Henriques de Magalhães

; ZERÔNCIO, Marco Antonio

; MACHADO, Marta Brenner

; CASSOL, Ornella Sari

; KOTZE, Paulo Gustavo

; FRÓES, Renata de Sá Brito

; MISZPUTEN, Sender Jankiel

; AMBROGINI JUNIOR, Orlando

; SAAD-HOSSNE, Rogério

; COY, Cláudio Saddy Rodrigues

Arquivos de Gastroenterologia

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2022, Volume 59 Suppl. 1 Pages 20 - 50

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

ABSTRACT Background: Inflammatory bowel disease (IBD) is an immune-mediated disorder that includes Crohn’s disease (CD) and ulcerative colitis. CD is characterized by a transmural intestinal involvement from the mouth to the anus with recurrent and remitting symptoms that can lead to progressive bowel damage and disability over time. Objective: To guide the safest and effective medical treatments of adults with CD. Methods: This consensus was developed by stakeholders representing Brazilian gastroenterologists and colorectal surgeons (Brazilian Organization for Crohn's disease and Colitis (GEDIIB)). A systematic review of the most recent evidence was conducted to support the recommendations/statements. All included recommendations and statements were endorsed in a modified Delphi panel by the stakeholders and experts in IBD with an agreement of at least 80% or greater consensus rate. Results and conclusion: The medical recommendations (pharmacological and non-pharmacological interventions) were mapped according to the stage of treatment and severity of the disease in three domains: management and treatment (drug and surgical interventions), criteria for evaluating the effectiveness of medical treatment, and follow-up/patient monitoring after initial treatment. The consensus is targeted towards general practitioners, gastroenterologists, and surgeons interested in treating and managing adults with CD and supports the decision-making of health insurance companies, regulatory agencies, and health institutional leaders or administrators.

RESUMO Contexto: A doença inflamatória intestinal (DII) é uma doença imunomediada que inclui a doença de Crohn (DC) e a retocolite ulcerativa. A DC é caracterizada por um envolvimento intestinal transmural da boca ao ânus com sintomas recorrentes e remitentes que podem levar a danos intestinais progressivos e incapacidade ao longo do tempo. Objetivo: Orientar os tratamentos médicos mais seguros e eficazes de adultos com DC. Métodos: Este consenso foi desenvolvido por autores que representam gastroenterologistas e cirurgiões brasileiros especialistas em doenças colorretais (GEDIIB, Organização Brasileira de Doença de Crohn e Colite). Uma revisão sistemática das evidências mais recentes foi realizada para apoiar as recomendações/declarações. Todas as recomendações e declarações incluídas foram endossadas em um painel Delphi modificado pelas partes interessadas e especialistas em DII com uma concordância de pelo menos 80% ou mais. Resultados e conclusão: As recomendações médicas (intervenções farmacológicas e não farmacológicas) foram mapeadas de acordo com o estágio de tratamento e gravidade da doença em três domínios: manejo e tratamento (intervenções medicamentosas e cirúrgicas), critérios para avaliar a eficácia do tratamento médico, e acompanhamento/monitoramento do paciente após o tratamento inicial. O consenso é direcionado a clínicos gerais, gastroenterologistas e cirurgiões interessados em tratar e gerenciar adultos com DC e apoia a tomada de decisões de companhias de seguro de saúde, agências reguladoras e líderes ou administradores de instituições de saúde.

https://doi.org/10.1590/s0004-2803.2022005s1-02

SECOND BRAZILIAN CONSENSUS ON THE MANAGEMENT OF ULCERATIVE COLITIS IN ADULTS: A CONSENSUS OF THE BRAZILIAN ORGANIZATION FOR CROHN’S DISEASE AND COLITIS (GEDIIB)
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BAIMA, Júlio Pinheiro

; IMBRIZI, Marcello

; ANDRADE, Adriana Ribas

; CHEBLI, Liliane Andrade

; ARGOLLO, Marjorie Costa

; QUEIROZ, Natália Sousa Freitas

; AZEVEDO, Matheus Freitas Cardoso de

; VIEIRA, Andrea

; COSTA, Marcia Henriques de Magalhães

; FRÓES, Renata de Sá Brito

; PENNA, Francisco Guilherme Cancela e

; QUARESMA, Abel Botelho

; DAMIÃO, Aderson Omar Mourão Cintra

; MORAES, Antonio Carlos da Silva

; SANTOS, Carlos Henrique Marques dos

; FLORES, Cristina

; ZALTMAN, Cyrla

; VILELA, Eduardo Garcia

; MORSOLETTO, Eloá

; GONÇALVES FILHO, Francisco de Assis

; SANTANA, Genoile Oliveira

; ZABOT, Gilmara Pandolfo

; PARENTE, José Miguel Luz

; SASSAKI, Ligia Yukie

; ZERÔNCIO, Marco Antonio

; MACHADO, Marta Brenner

; CASSOL, Ornella Sari

; KOTZE, Paulo Gustavo

; PARRA, Rogerio Serafim

; MISZPUTEN, Sender Jankiel

; COY, Cláudio Saddy Rodrigues

; AMBROGINI JUNIOR, Orlando

; CHEBLI, Júlio Maria Fonseca

; SAAD-HOSSNE, Rogério

Arquivos de Gastroenterologia

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2022, Volume 59 Suppl. 1 Pages 51 - 84

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

ABSTRACT Background: Inflammatory bowel diseases are immune-mediated disorders that include Crohn’s disease (CD) and ulcerative colitis (UC). UC is a progressive disease that affects the colorectal mucosa causing debilitating symptoms leading to high morbidity and work disability. As a consequence of chronic colonic inflammation, UC is also associated with an increased risk of colorectal cancer. Objective: This consensus aims to provide guidance on the most effective medical management of adult patients with UC. Methods: A consensus statement was developed by stakeholders representing Brazilian gastroenterologists and colorectal surgeons (Brazilian Organization for Crohn’s Disease and Colitis [GEDIIB]). A systematic review including the most recent evidence was conducted to support the recommendations and statements. All recommendations/statements were endorsed using a modified Delphi Panel by the stakeholders/experts in inflammatory bowel disease with at least 80% or greater consensus. Results and conclusion: The medical recommendations (pharmacological and non-pharmacological) were mapped according to the stage of treatment and severity of the disease onto three domains: management and treatment (drug and surgical interventions), criteria for evaluating the effectiveness of medical treatment, and follow-up/patient monitoring after initial treatment. The consensus targeted general practitioners, gastroenterologists and surgeons who manage patients with UC, and supports decision-making processes by health insurance companies, regulatory agencies, health institutional leaders, and administrators.

RESUMO Contexto: As doenças inflamatórias intestinais são doenças imunomediadas que incluem a doença de Crohn (DC) e a retocolite ulcerativa (RCU). A RCU é uma doença progressiva que acomete a mucosa colorretal causando sintomas debilitantes levando a alta morbidade e incapacidade laboral. Como consequência da inflamação crônica do cólon, a RCU também está associada a um risco aumentado de câncer colorretal. Objetivo: Este consenso visa fornecer orientações sobre o manejo médico mais eficaz de pacientes adultos com RCU. Métodos: As recomendações do consenso foram desenvolvidas por gastroenterologistas e cirurgiões colorretais referências no Brasil (membros da Organização Brasileira para Doença de Crohn e Colite [GEDIIB]). Uma revisão sistemática, incluindo as evidências mais recentes, foi conduzida para apoiar as recomendações. Todas as recomendações foram endossadas pelas partes interessadas/especialistas em doença inflamatória intestinal usando um Painel Delphi modificado. O nível de concordância para alcançar consenso foi de 80% ou mais. Resultados e conclus ão: As recomendações médicas (farmacológicas e não farmacológicas) foram mapeadas de acordo com o estágio de tratamento e gravidade da doença em três domínios: manejo e tratamento (intervenções medicamentosas e cirúrgicas), critérios para avaliar a eficácia do tratamento médico, e acompanhamento/monitoramento do paciente após o tratamento inicial. O consenso foi direcionado a clínicos gerais, gastroenterologistas e cirurgiões que tratam pacientes com RCU e apoia os processos de tomada de decisão por companhias de seguro de saúde, agências reguladoras, líderes institucionais de saúde e administradores.

https://doi.org/10.1590/s0004-2803.2022005s1-03

STRUCTURING A FECAL MICROBIOTA TRANSPLANTATION CENTER IN A UNIVERSITY HOSPITAL IN BRAZIL
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TERRA, Daniel Antônio de Albuquerque

; VILELA, Eduardo Garcia

; SILVA, Rodrigo Otávio Silveira

; LEÃO, Laiane Alves

; LIMA, Karine Sampaio

; PASSOS, Raissa Iglesias Fernandes Ângelo

; DINIZ, Amanda Nádia

; COELHO, Luiz Gonzaga Vaz

Arquivos de Gastroenterologia

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dec 2020, Volume 57 N. 4 Pages 434 - 458

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO CONTEXTO: O Transplante de microbiota fecal (TMF) é uma importante opção terapêutica para a infecção recorrente ou refratária pelo Clostridioides difficile, sendo método seguro e eficaz. Resultados iniciais sugerem que o TMF também desempenha papel relevante em outras afecções cuja patogênese envolve a alteração da microbiota intestinal. No entanto, seu uso sistematizado é pouco difundido, especialmente no Brasil. Na última década, surgiram múltiplos relatos e séries de casos utilizando diferentes protocolos para o TMF, sem padronização de métodos e com taxas de resposta variáveis. No Brasil, poucos casos isolados de TMF foram relatados sem a implantação de um Centro de Transplante de Microbiota Fecal (CTMF). OBJETIVO: O principal objetivo deste estudo foi descrever o processo de implantação de um CTMF com banco de fezes, em hospital universitário brasileiro, para tratamento de infecção recorrente e refratária pelo C. difficile. MÉTODOS: O CTMF foi estruturado dentro dos critérios exigidos e aprovados por organismos internacionais como o Food and Drug Administration, Grupo Europeu de Transplante de Microbiota Fecal e em consonância com os aspectos epidemiológicos e regulatórios nacionais. RESULTADOS: Foi estabelecida toda uma plataforma envolvida na estruturação de um centro de transplante com fezes congeladas. Determinou-se os critérios para seleção de doadores, processamento e armazenamento de amostras, manejo dos receptores antes e após o procedimento, uniformização de vias de administração do substrato fecal e seguimento a curto e longo prazo dos pacientes transplantados. A seleção dos doadores foi conduzida em três etapas: pré-triagem, avaliação clínica e exames laboratoriais. Boa parte dos candidatos foram excluídos na primeira (75,4%) e segunda etapa (72,7%). Os principais critérios clínicos de exclusão foram: diarreia aguda recente, excesso de peso (IMC ≥25 kg/m2) e distúrbios gastrointestinais crônicos. Quatro dos 134 candidatos foram selecionados após a triagem completa, com taxa de detecção de doadores de 3%. CONCLUSÃO: A implantação de um CTMF, inédito no nosso meio, possibilita o acesso de pacientes com infecção recorrente e refratária pelo C. difficile a tratamento inovador, seguro, com elevada taxa de sucesso e pouco disponível no Brasil. A seleção apropriada de doadores qualificados é vital no processo de implantação de um CTMF. A avaliação clínica rigorosa dos doadores permitiu o uso racional de recursos para realização de exames laboratoriais. Um CTMF possibilita tratamento sob demanda, em maior escala, menos personalizados, com mais segurança e rastreabilidade. Este protocolo fornece subsídios para a realização de TMF em países emergentes.

ABSTRACT BACKGROUND: Fecal microbiota transplantation (FMT) is an important therapeutic option for recurrent or refractory Clostridioides difficile infection, being a safe and effective method. Initial results suggest that FMT also plays an important role in other conditions whose pathogenesis involves alteration of the intestinal microbiota. However, its systematized use is not widespread, especially in Brazil. In the last decade, multiple reports and several cases emerged using different protocols for FMT, without standardization of methods and with variable response rates. In Brazil, few isolated cases of FMT have been reported without the implantation of a Fecal Microbiota Transplantation Center (FMTC). OBJECTIVE: The main objective of this study is to describe the process of implanting a FMTC with a stool bank, in a Brazilian university hospital for treatment of recurrent and refractory C. difficile infection. METHODS: The center was structured within the criteria required by international organizations such as the Food and Drug Administration, the European Fecal Microbiota Transplant Group and in line with national epidemiological and regulatory aspects. RESULTS: A whole platform involved in structuring a transplant center with stool bank was established. The criteria for donor selection, processing and storage of samples, handling of recipients before and after the procedure, routes of administration, short and long-term follow-up of transplant patients were determined. Donor selection was conducted in three stages: pre-screening, clinical evaluation and laboratory screening. Most of the candidates were excluded in the first (75.4%) and second stage (72.7%). The main clinical exclusion criteria were: recent acute diarrhea, overweight (body mass index ≥25 kg/m2) and chronic gastrointestinal disorders. Four of the 134 candidates were selected after full screening, with a donor detection rate of 3%. CONCLUSION: The implantation of a transplant center, unprecedented in our country, allows the access of patients with recurrent or refractory C. difficile infection to innovative, safe treatment, with a high success rate and little available in Brazil. Proper selection of qualified donors is vital in the process of implementing a FMTC. The rigorous clinical evaluation of donors allowed the rational use of resources. A transplant center enables treatment on demand, on a larger scale, less personalized, with more security and traceability. This protocol provides subsidies for conducting FMT in emerging countries.

https://doi.org/10.1590/s0004-2803.202000000-79 1136 downloads

PROXIMAL SERRATED POLYP DETECTION RATE: A COMPLEMENTARY QUALITY INDICATOR FOR ADENOMA DETECTION RATE?
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LEITE, Fernando Antônio Vieira

; ROCHA, Luiz Cláudio Miranda

; SILVA, Rodrigo Roda Rodrigues

; VILELA, Eduardo Garcia

; ALBERTI, Luiz Ronaldo

; MADUREIRA, Camila Marque

Arquivos de Gastroenterologia

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dec 2020, Volume 57 N. 4 Pages 466 - 470

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO CONTEXTO: A efetividade da colonoscopia no rastreamento do câncer colorretal (CCR) depende de indicadores de qualidade, sendo a taxa de detecção de adenoma (TDA) a mais importante. A taxa de detecção de pólipos serrilhados proximais (TDPSp) tem sido estudada como um potencial indicador de qualidade para a colonoscopia. OBJETIVO: O objetivo é analisar e comparar a diferença de TDA e TDPSp entre pacientes submetidos à colonoscopia de rastreamento e uma população não selecionada com outras indicações para colonoscopia, incluindo vigilância e diagnóstico. MÉTODOS: Esta é uma coorte histórica de pacientes submetidos à colonoscopia no serviço de endoscopia digestiva de um hospital terciário. Das 1554 colonoscopias realizadas, 573 pacientes foram excluídos. Os 981 pacientes restantes foram divididos em dois grupos: pacientes submetidos à colonoscopia de rastreamento (n=428; 43,6%); pacientes com outras indicações, incluindo vigilância e diagnóstico (n=553; 56,4%). RESULTADOS: A taxa de detecção de adenoma do grupo com outras indicações (50,6%) foi superior à do grupo de rastreamento (44,6%; P=0,03). Em relação ao TDPSp, não houve diferença entre os dois grupos (triagem 13,6%; outras indicações 13,7%; P=0,931). Não houve diferença significativa na idade média (P=0,259) ou na proporção de homens e mulheres (P=0,211) entre os grupos. CONCLUSÃO: A taxa de detecção proximal de pólipos serrilhados mostrou uma diferença insignificante entre os grupos com diferentes indicações para colonoscopia e poderia ser utilizada como um indicador complementar a TDA. Isso beneficiaria colonoscopistas com baixo volume de colonoscopias ou baixo volume de colonoscopias de rastreamento.

ABSTRACT BACKGROUND: The effectiveness of colonoscopy for colorectal cancer (CRC) screening depends on quality indicators, which adenoma detection rate (ADR) being the most important. Proximal serrated polyp detection rate (pSPDR) has been studied as a potential quality indicator for colonoscopy. OBJECTIVE: The aim is to analyze and compare the difference in ADR and pSPDR between patients undergoing screening colonoscopy and an unselected population with other indications for colonoscopy, including surveillance and diagnosis. METHODS: This is a historical cohort of patients who underwent colonoscopy in the digestive endoscopy service of a tertiary hospital. Out of 1554 colonoscopies performed, 573 patients were excluded. The remaining 981 patients were divided into two groups: patients undergoing screening colonoscopy (n=428; 43.6%); patients with other indications including surveillance and diagnosis (n=553; 56.4%). RESULTS: Adenoma detection rate of the group with other indications (50.6%) was higher than that of the screening group (44.6%; P=0.03). In regarding pSPDR, there was no difference between pSPDR in both groups (screening 13.6%; other indications 13.7%; P=0.931). There was no significant difference in the mean age (P=0.259) or in the proportion of men and women (P=0.211) between both groups. CONCLUSION: Proximal serrated polyp detection rate showed an insignificant difference between groups with different indications and could be used as a complementary indicator to adenoma detection rate. This could benefit colonoscopists with low colonoscopy volume or low volume of screening colonoscopies.

https://doi.org/10.1590/s0004-2803.202000000-81 620 downloads

INFLAMMATORY BOWEL DISEASE CARE IN BRAZIL: HOW IT IS PERFORMED, OBSTACLES AND DEMANDS FROM THE PHYSICIANS’ PERSPECTIVE
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VILELA, Eduardo Garcia

; ROCHA, Henrique Carvalho

; MORAES, Antônio Carlos

; SANTANA, Genoile Oliveira

; PARENTE, José Miguel

; SASSAKI, Ligia Yukie

; MISZPUTEN, Sender Jenkiel

; QUARESMA, Abel Botelho

; CLARA, Ana Paula Hamer Sousa

; JESUS, Adélia Carmen Silva de

; PINTO, Arlene dos Santos

; SILVA, Bianca Loyo Pona Schiavetti da

; SILVA, Bruno César da

; FREIRE, Caio César Furtado

; SANTOS, Carlos Henrique Marques dos

; BRITO, Carlos

; TEIXEIRA, Ellen Francioni Lima

; MIRANDA, Eron Fabio

; ZABOT, Gilmara Pandolfo

; DUARTE, Jozelda Lemos

; LUDVIG, Juliano Coelho

; CAMPOS-LOBATO, Luiz Felipe de

; CASSOL, Ornella Sari

; SOUZA, Mardem Machado de

; ALMEIDA, Neogélia Pereira de

; PARRA, Rogério Serafim

; LIMA JÚNIOR, Sérgio Figueiredo de

; SAAD-HOSSNE, Rogério

Arquivos de Gastroenterologia

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dec 2020, Volume 57 N. 4 Pages 416 - 427

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO CONTEXTO: As doenças inflamatórias intestinais (DII) são afecções inflamatórias crônicas de caráter recorrente, cujas taxas de incidência e prevalência têm aumentado, inclusive no Brasil. A longo prazo, são responsáveis por danos estruturais que impactam na qualidade de vida, morbidade e mortalidade dos pacientes. OBJETIVO: Avaliar o perfil dos médicos que atendem pacientes com DII, assim como as características deste atendimento, demandas não atendidas e dificuldades. MÉTODOS: Um questionário contendo 17 variáveis foi elaborado e enviado para médicos, selecionados a partir do cadastro da Comissão das Estaduais do Grupo de Estudos da Doença Inflamatória Intestinal do Brasil (GEDIIB), totalizando 286 médicos de 101 cidades brasileiras distribuídas por 21 estados e Distrito Federal. RESULTADOS: A maioria dos médicos que respondeu o questionário foram Gastroenterologistas e Coloproctologistas. Mais de 60% tinham até 20 anos de atuação na especialidade e 53,14% trabalhavam em três locais ou mais. A dificuldade no acesso ou liberação de medicamentos ficou evidenciada neste questionário, assim como a dificuldade no encaminhamento para profissionais não médicos que atuam em DII. Mais de 75% dos médicos relataram dificuldades para realização de enteroscopia por duplo balão e cápsula endoscópica, e 67,8% para realização da calprotectina. Em relação ao número de pacientes atendidos por cada médico, foi evidenciado que não há uma concentração de pacientes sob a responsabilidade de poucos médicos. O infliximabe e o adalimumabe foram os biológicos mais utilizados e ficou evidenciada prescrição maior de derivados de 5-ASA para retocolite ulcerativa quando comparada à doença de Crohn. Os corticoides foram prescritos para uma parcela menor de pacientes em ambas doenças. Os temas “falha a terapia biológica” e “novas drogas” foram referidos como aqueles com maior prioridade para discussão em eventos científicos. Em relação às possíveis diferenças entre cada região e o restante do país, os médicos da região Norte relataram maior dificuldade no acesso a exames complementares e os médicos da região Nordeste, maior dificuldade no acesso ou liberação de medicamentos. CONCLUSÃO: Os dados obtidos por meio deste estudo mostram o perfil do atendimento médico especializado em DII e podem se constituir em ferramenta útil para para elaboração de políticas governamentais e para sociedade brasileira como um todo.

ABSTRACT BACKGROUND: Inflammatory bowel diseases (IBD) are chronic inflammatory affections of recurrent nature whose incidence and prevalence rates have increased, including in Brazil. In long term, they are responsible for structural damage that impacts quality of life, morbidity and mortality of patients. OBJECTIVE: To describe the profile of physicians who treat IBD patients as well as the characteristics of IBD care, unmet demands and difficulties. METHODS: A questionnaire containing 17 items was prepared and sent to 286 physicians from 101 Brazilian cities across 21 states and the Federal District, selected from the register of the State Commission of the “Study Group of Inflammatory Bowel Disease of Brazil” (GEDIIB). RESULTS: The majority of the physicians who answered the questionnaire were gastroenterologists and colorectal surgeons. More than 60% had up to 20 years of experience in the specialty and 53.14% worked at three or more locations. Difficulties in accessing or releasing medicines were evident in this questionnaire, as was referrals to allied healthy professionals working in IBD-related fields. More than 75% of physicians reported difficulties in performing double-balloon enteroscopy and capsule endoscopy, and 67.8% reported difficulties in measuring calprotectin. With regard to the number of patients seen by each physician, it was shown that patients do not concentrate under the responsibility of few doctors. Infliximab and adalimumab were the most commonly used biological medicines and there was a higher prescription of 5-ASA derivatives for ulcerative colitis than for Crohn’s disease. Steroids were prescribed to a smaller proportion of patients in both diseases. The topics “biological therapy failure” and “new drugs” were reported as those with higher priority for discussion in medical congresses. In relation to possible differences among the country’s regions, physicians from the North region reported greater difficulty in accessing complementary exams while those from the Northeast region indicated greater difficulty in accessing or releasing medicines. CONCLUSION: The data obtained through this study demonstrate the profile of specialized medical care in IBD and are a useful tool for the implementation of government policies and for the Brazilian society as a whole.

https://doi.org/10.1590/s0004-2803.202000000-77 1133 downloads

Ulcerative colitis - treatment with biologicals
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Teixeira, Fabio Vieira

; Vilela, Eduardo Garcia

; Damião, Aderson Omar Mourão Cintra

; Vieira, Andrea

; Albuquerque, Idblan Carvalho De

; Parente, José Miguel Luz

; Chebli, Júlio Maria Fonseca

; Ambrogini Junior, Orlando

; Hossne, Rogerio Saad

; Miszputen, Sender Jankiel

Revista da Associação Médica Brasileira

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apr 2019, Volume 65 N. 4 Pages 547 - 553

Abstract: En | Text: En | PDF: En

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.

https://doi.org/10.1590/1806-9282.65.4.547 1716 downloads

SARCOPENIA, OBESITY AND SARCOPENIC OBESITY IN LIVER TRANSPLANTATION: A BODY COMPOSITION PROSPECTIVE STUDY
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ANASTÁCIO, Lucilene Rezende

; FERREIRA, Lívia Garcia

; RIBEIRO, Helem Sena

; DINIZ, Kiara Gonçalves Dias

; LIMA, Agnaldo Soares

; CORREIA, Maria Isabel T.D.

; VILELA, Eduardo Garcia

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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2019, Volume 32 N. 2 elocation e1434

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Racional: A sarcopenia é prevalente antes do transplante de fígado e é considerada fator de risco para morbidade/mortalidade desses pacientes. Após o transplante hepático, alguns autores sugerem que a sarcopenia permanece, e os pacientes ganham peso na forma de gordura, atingindo o status de obesidade sarcopênica. Objetivo: Avaliar prospectivamente as mudanças na composição corporal, prevalência e fatores associados em relação à sarcopenia, obesidade e obesidade sarcopênica após o transplante. Métodos: Os pacientes foram avaliados em dois momentos diferentes para composição corporal, 4,0±3,2 e 7,6±3,1 anos e após o transplante. Os dados da composição corporal foram obtidos por meio de bioimpedância elétrica. O índice de massa livre de gordura e o índice de massa gorda foram calculados, e os pacientes foram classificados nas seguintes categorias: sarcopênico; obesidade; obesidade sarcopênica. Resultados: Foram avaliados 100 pacientes (52,6±13,3 anos; 57,0% homens). A prevalência de sarcopenia (19,0% para 22,0%), obesidade (32,0% para 37,0%) e índice de massa livre de gordura (17,9±2,5 para 17,5±3,5 kg/m2), índice de massa gorda aumentou (8,5±3,5 para 9,0±4,0 kg/m2), e obesidade sarcopênica (0 para 2,0%) também aumentaram, embora não significativamente. O gênero feminino foi associado à sarcopenia. Conclusão: Após a operação, a gordura aumentou ao longo dos anos e a massa magra diminuiu, embora não significativamente. A sarcopenia e a obesidade estavam presentes após o transplante; no entanto, a obesidade sarcopênica não foi realidade observada nesses pacientes.

ABSTRACT Background: Sarcopenia is prevalent before liver transplantation, and it is considered to be a risk factor for morbidity/mortality. After liver transplantation, some authors suggest that sarcopenia remains, and as patients gain weight as fat, they reach sarcopenic obesity status. Aim: Prospectively to assess changes in body composition, prevalence and associated factors with respect to sarcopenia, obesity and sarcopenic obesity after transplantation. Methods: Patients were evaluated at two different times for body composition, 4.0±3.2y and 7.6±3.1y after transplantation. Body composition data were obtained using bioelectrical impedance. The fat-free mass index and fat mass index were calculated, and the patients were classified into the following categories: sarcopenic; obesity; sarcopenic obesity. Results: A total of 100 patients were evaluated (52.6±13.3years; 57.0% male). The fat-free mass index decreased (17.9±2.5 to 17.5±3.5 kg/m2), fat mass index increased (8.5±3.5 to 9.0±4.0; p<0.05), prevalence of sarcopenia (19.0 to 22.0%), obesity (32.0 to 37.0%) and sarcopenic obesity (0 to 2.0%) also increased, although not significantly. The female gender was associated with sarcopenia. Conclusion: The fat increased over the years after surgery and the lean mass decreased, although not significantly. Sarcopenia and obesity were present after transplantation; however, sarcopenic obesity was not a reality observed in these patients.

https://doi.org/10.1590/0102-672020190001e1434 3211 downloads

EVALUATION OF THE BEHAVIOR OF LEVELS OF HMGB1 AND IL6 AS PREDICTORS OF INFECTION, ACUTE KIDNEY INJURY AND MORTALITY IN CIRRHOTIC PATIENTS WITH VARICEAL BLEEDING
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VILELA, Eduardo Garcia

; PINHEIRO, Camilla dos Santos

; SATURNINO, Saulo Fernandes

; GOMES, Célio Geraldo de Oliveira

; NASCIMENTO, Vanuza Chagas do

; ANDRADE, Marcos Vinicius Melo de

Arquivos de Gastroenterologia

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dec 2018, Volume 55 N. 4 Pages 338 - 342

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO CONTEXTO: Varizes esofagogástricas são a maior causa de morbimortalidade em pacientes cirróticos. OBJETIVO: Avaliar o papel de biomarcadores, High Mobility Group Box 1 (HMGB 1) e interleucina-6 (IL-6) como preditores de infecção, injúria renal aguda e mortalidade nestes pacientes. MÉTODOS: Estudo prospectivo, observacional que incluiu 32 pacientes com cirrose hepática na fase aguda do sangramento. RESULTADOS: A média de idade dos pacientes foi de 52±5 anos sendo 20 (62,5%) do gênero masculino. A média do MELD foi de 17,53±5 e a média do MELD-Na 20,63±6,06. Trinta (93,3%) pacientes foram classificados como Child B ou C. Complicação infecciosa esteve presente em 9 (28,1%) pacientes, injúria renal aguda em 6 (18,1%) e 4 (12,5%) evoluíram para o óbito. A mediana do nível sérico de HMGB 1 foi de 1487 pg/mL (0,1- 8593,1) e da IL-6 foi de 62,1pg/mL (0,1-1102,4). Os níveis séricos de HMGB 1 e IL-6 foram significativamente maiores nos pacientes que evoluíram com infecção, injúria renal aguda e óbito (P<0,05). Os valores da correlação de Spearman para os níveis séricos de HMGB 1 e IL-6 foram de 0,794 e 0,374 para infecção, 0,53 e 0,374 para injuria renal aguda e 0,467 e 0,404 para óbito, respectivamente. CONCLUSÃO: Níveis séricos de HMGB 1 e IL-6 foram maiores nos três desfechos estudados. Níveis séricos de HMGB 1 apresentaram alta correlação para com o desfecho infecção e moderada correlação para com injúria renal aguda e óbito, enquanto os níveis séricos de IL-6 apresentaram moderada correlação para com infecção e óbito e baixa correlação para com injúria renal aguda.

ABSTRACT BACKGROUND: Gastroesophageal varices and associated bleeding are a major cause of morbidity and mortality in cirrhotic patients. OBJECTIVE: To evaluate the potential role of the biomarkers HMGB1 (High Mobility Group Box 1) and IL-6 (Interleukin-6) as predictors of infection, acute kidney injury and mortality in these patients. METHODS: It is a prospective, observational study that included 32 cirrhotic patients with variceal bleeding. RESULTS: The subjects’mean age was 52±5 years and 20 (62.5%) were male. The average MELD was 17.53±5 and the average MELD-Na was 20.63±6.06. Thirty patients (93.3%) patients were Child-Pugh class B or C. Infection was present in 9 subjects (28.1%), acute kidney injury was present in 6 (18.1%) and 4 (12.5%) patients died. The median serum levels of HMGB1 were 1487 pg/mL (0.1 to 8593.1) and the median serum level of IL-6 was 62.1 pg/mL (0.1 to 1102.4). The serum levels of HMGB1 and IL-6 were significantly higher in patients who developed infection, acute kidney injury and death (P<0.05). The Spearman’s correlations for HMGB1 and IL-6 were 0.794 and 0.374 for infection, 0.53 and 0.374 for acute kidney injury and 0.467 and 0.404 for death, respectively. CONCLUSION: Serum levels of HMGB1 and IL-6 were higher in patients with the three studied outcomes. HMGB1 serum levels showed a high correlation with infection and a moderate correlation with acute kidney injury and death, while IL-6 showed a moderate correlation with infection and death and a low correlation with acute kidney injury.

https://doi.org/10.1590/s0004-2803.201800000-75 928 downloads

10.

Clostridium difficile ribotypes in humans and animals in Brazil
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Silva, Rodrigo Otávio Silveira

; Rupnik, Maja

; Diniz, Amanda Nádia

; Vilela, Eduardo Garcia

; Lobato, Francisco Carlos Faria

Memórias do Instituto Oswaldo Cruz

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dec 2015, Volume 110 N. 8 Pages 1062 - 1065

Abstract: En | Text: En | PDF: En

Clostridium difficile is an emerging enteropathogen responsible for pseudomembranous colitis in humans and diarrhoea in several domestic and wild animal species. Despite its known importance, there are few studies aboutC. difficile polymerase chain reaction (PCR) ribotypes in Brazil and the actual knowledge is restricted to studies on human isolates. The aim of the study was therefore to compare C. difficileribotypes isolated from humans and animals in Brazil. Seventy-six C. difficile strains isolated from humans (n = 25), dogs (n = 23), piglets (n = 12), foals (n = 7), calves (n = 7), one cat, and one manned wolf were distributed into 24 different PCR ribotypes. Among toxigenic strains, PCR ribotypes 014/020 and 106 were the most common, accounting for 14 (18.4%) and eight (10.5%) samples, respectively. Fourteen different PCR ribotypes were detected among human isolates, nine of them have also been identified in at least one animal species. PCR ribotype 027 was not detected, whereas 078 were found only in foals. This data suggests a high diversity of PCR ribotypes in humans and animals in Brazil and support the discussion of C. difficile as a zoonotic pathogen.

https://doi.org/10.1590/0074-02760150294 1669 downloads

11.

The effect of Saccharomyces boulardii in patients eligible for liver transplantation
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Costa Liboredo, Juliana

; Abreu Ferrari, Maria de Lourdes

; García Vilela, Eduardo

; Soares Lima, Agnaldo

; Correia, Maria Isabel Toulson Davisson

Nutrición Hospitalaria

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feb 2015, Volume 31 N. 2 Pages 778 - 784

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Objective: The aim of this study was to evaluate the influence of Saccharomyces boulardii on the intestinal permeability, laboratory parameters and MELD and Child-Pugh severity scores in cirrhotic patients eligible for liver transplantation. Methods: Eighteen patients followed in a Transplant Outpatient Clinic were evaluated immediately before the beginning of treatment, after a 30-day period of treatment period with probiotics and at the end of the second study month (after a thirty-day period without probiotics). Fifteen healthy controls also underwent the intestinal permeability test (lactulose/mannitol). Results: Before the probiotic, the median lactulose/mannitol ratio was greater in the cirrhotic patients (0.0209, range 0.0012-0.1984) compared to the healthy controls (0.0030, range 0.0020-0.0013) (p < 0.05). Eight of fifteen patients, half of whom had ascites, showed increased intestinal permeability above the higher value observed in the controls. No significant association was found between the severity scores for liver disease, age, presence of ascites and intestinal permeability immediately before the beginning of study. After treatment with S. boulardii, there was no improvement in intestinal permeability or significant differences in the laboratory parameters for the three evaluations. Conclusions: Patients eligible for liver transplants presented with increased intestinal permeability compared to healthy controls. A thirty-day treatment with S. boulardii did not improve this intestinal permeability or the severity scores, nor did it impact the laboratory parameters.

Objetivo: Evaluar la influencia del Saccharomyces boulardii en la permeabilidad intestinal, parámetros bioquímicos, de MELD y de Child-Pugh en pacientes cirróticos candidatos al trasplante de hígado. Métodos: Dieciocho pacientes seguidos en ambulatorio de Transplantes fueron evaluados inmediatamente antes del inicio del tratamiento con probióticos, después de período de 30 días con probióticos y al final del segundo mes de estudio (período de treinta días sin probióticos). Quince controles sanos también se sometieron a la prueba de permeabilidad intestinal (lactulosa/manitol). Resultados: Antes del probiótico, la relación de lactulosa / manitol media fue mayor en los pacientes cirróticos (0,0209; 0,0012-0,1984) en comparación con los controles sanos (0,0030; 0,0020-0,0013) (p < 0,05). Ocho de los quince pacientes, la mitad de los cuales tenía ascitis, presentaron con aumento de la permeabilidad intestinal por encima del valor más alto observado en los controles. No se observó asociación significativa entre los critérios de Meld, Child-Pugh y la edad, la presencia de ascitis y la permeabilidad intestinal inmediatamente antes del inicio del estudio. El tratamiento con S. boulardii, no resultó en mejoría de la permeabilidad intestinal, de los critérios de Meld y Child-Pugh así como de los los parámetros bioquímicos a lo largo de las tres evaluaciones. Conclusiones: Pacientes en lista de espera para transplantes hepático presentan mayor permeabilidad intestinal en comparación con los controles sanos. El tratamiento de treinta días con S. boulardii no resultó en mejoría de la permeabilidad intestinal, del MELD y Child-Pugh, asi como de los parámetros bioquímicos.

https://doi.org/10.3305/nh.2015.31.2.7949 265 downloads

12.

Intestinal permeability in leukemic patients prior to chemotherapy
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Leite, Juliana Brovini

; Vilela, Eduardo Garcia

; Torres, Henrique Oswaldo da Gama

; Ferrari, Maria de Lourdes de Abreu

; Cunha, Aloísio Sales da

Revista Brasileira de Hematologia e Hemoterapia

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dec 2014, Volume 36 N. 6 Pages 409 - 413

Abstract: En | Text: En | PDF: En

Objective:The objective of this study was to evaluate the intestinal barrier function in leukemia patients before the start of the chemotherapy with an intestinal permeability test using lactulose and mannitol as markers.Methods:The study enrolled 20 patients diagnosed with leukemia (acute and chronic). Ten healthy volunteers were also submitted to the test as a control group.Results:The median lactulose/mannitol ratio was 0.019 for the Leukemia Patient Group, whereas in healthy controls the median was 0.009 (p-value = 0.244). The median lactulose/mannitol ratio in acute leukemia patients was 0.034 giving a p-value of 0.069 when compared to healthy controls. This same comparison was made between acute myeloid leukemia patients and healthy controls with a p-value of 0.149. There was no significant difference in the intestinal permeability between acute and chronic leukemia patients (p-value = 0.098).Conclusion:The intestinal barrier function measured using the intestinal permeability test was similar in leukemic patients overall and healthy controls, but a tendency toward a different pattern was found in the intestinal barrier function of acute leukemia patients.

https://doi.org/10.1016/j.bjhh.2014.07.007 939 downloads

13.

Evaluation of three enzyme immunoassays and a nucleic acid amplification test for the diagnosis of Clostridium difficile-associated diarrhea at a university hospital in Brazil
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Silva, Rodrigo Otávio Silveira

; Vilela, Eduardo Garcia

; Neves, Monique Silva

; Lobato, Francisco Carlos Faria

Revista da Sociedade Brasileira de Medicina Tropical

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aug 2014, Volume 47 N. 4 Pages 447 - 450

Abstract: En | Text: En | PDF: En

Introduction Despite the known importance of Clostridium difficile as a nosocomial pathogen, few studies regarding Clostridium difficile infection (CDI) in Brazil have been conducted. To date, the diagnostic tests that are available on the Brazilian market for the diagnosis of CDI have not been evaluated. The aim of this study was to compare the performances of four commercial methods for the diagnosis of CDI in patients from a university hospital in Brazil. Methods Three enzyme immunoassays (EIAs) and one nucleic acid amplification test (NAAT) were evaluated against a cytotoxicity assay (CTA) and toxigenic culture (TC). Stool samples from 92 patients with suspected CDI were used in this study. Results Twenty-five (27.2%) of 92 samples were positive according to the CTA, and 23 (25%) were positive according to the TC. All EIAs and the NAAT test demonstrated sensitivities between 59 and 68% and specificities greater than 91%. Conclusions All four methods exhibited low sensitivities for the diagnosis of CDI, which could lead to a large number of false-negative results, an increased risk of cross-infection to other patients, and overtreatment with empirical antibiotics.

https://doi.org/10.1590/0037-8682-0100-2014 2451 downloads

14.

Antimicrobial susceptibility of Clostridium difficile isolated from animals and humans in Brazil
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Silva, Rodrigo Otávio Silveira

; Oliveira Junior, Carlos Augusto

; Diniz, Amanda Nádia

; Alves, Guilherme Guerra

; Guedes, Roberto Maurício Carvalho

; Vilela, Eduardo Garcia

; Lobato, Francisco Carlos Faria

Ciência Rural

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may 2014, Volume 44 N. 5 Pages 841 - 846

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

O objetivo do presente trabalho foi avaliar a sensibilidade antimicrobiana de estirpes de Clostridium difficile isoladas de animais e humanos no Brasil. Foram utilizados 54 estirpes de C. difficile isoladas de fezes de leitões (n=16), cães (n=13), seres humanos (n=13), potros (n=8), bezerros (n=2), jaguatirica (n=1) e um lobo-guará (n=1). A sensibilidade antimicrobiana foi determinada pelo método de diluição seriada em ágar para penicilina, florfenicol, oxitetraciclina, eritromicina, vancomicina, metronidazol e tilosina. Todos os isolados foram sensíveis ao metronidazol e á vancomicina. Resistência ao florfenicol foi rara, sendo que 52 (96,4%) das estirpes foram sensíveis a esse antimicrobiano. Cinco (9,3%), cinco (9,3%), 14 (25,9%) e 20 (37,0%) foram resistentes a oxitetraciclina, penicilina, tilosina e eritromicina, respectivamente.

The objective of this study was to evaluate antimicrobial susceptibility in Clostridium difficile strains isolated from animals and humans in Brazil. The 54 C. difficile strains used were isolated from stool samples from piglets (n=16), dogs (n=13), humans (n=13), foals (n=8) calves (n=2), an ocelot (n=1) and a maned wolf (n=1). Antimicrobial susceptibility was determined using the serial plate agar dilution method for penicillin, florfenicol, oxytetracycline, erythromycin, vancomycin, metronidazole and tylosin. The C. difficile strains assessed were susceptible to metronidazole and vancomycin. Florfenicol resistance was rarely observed; 52 (96.4%) strains were sensitive to this antimicrobial. Five (9.3%), five (9.3%), 14 (25.9%) and 20 (37.0%) strains were resistant to oxytetracycline, penicillin, tylosin and erythromycin respectively.

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15.

A atuação do Estado e a saúde do trabalhador
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Vilela, Rodolfo Andrade de Gouveia

; Garcia, Eduardo Garcia

; Almeida, Ildeberto Muniz de

; Jackson Filho, José Marçal

Revista Brasileira de Saúde Ocupacional

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dec 2013, Volume 38 N. 128 Pages 177 - 178

Abstract: Pt | Text: Pt | PDF: Pt

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