BEATRIZ BRITO

BACKGROUND: The diagnosis of inflammatory bowel disease is often delayed because of the lack of an ability to recognize its major clinical manifestations. OBJECTIVE: Our study aimed to describe the onset of clinical manifestations in inflammatory bowel disease patients. METHODS: A cross-sectional study. Investigators obtained data from interviews and the medical records of inflammatory bowel disease patients from a reference centre located in Brazil. RESULTS: A total of 306 patients were included. The mean time between onset of symptoms and diagnosis was 28 months for Crohn's disease and 19 months for ulcerative colitis. The main clinical manifestations in Crohn's disease patients were weight loss, abdominal pain, diarrhoea and asthenia. The most relevant symptoms in ulcerative colitis patients were blood in the stool, faecal urgency, diarrhoea, mucus in the stool, weight loss, abdominal pain and asthenia. It was observed that weight loss, abdominal pain and distension, asthenia, appetite loss, anaemia, insomnia, fever, nausea, perianal disease, extraintestinal manifestation, oral thrush, vomiting and abdominal mass were more frequent in Crohn's patients than in ulcerative colitis patients. The frequencies of urgency, faecal incontinence, faeces with mucus and blood, tenesmus and constipation were higher in ulcerative colitis patients than in Crohn's disease patients. The mean time from the onset of clinical symptoms to the diagnosis of Crohn's disease was 37 months for patients with ileocolonic location, 26 months for patients with ileum location and 18 months for patients with colon location. In ulcerative colitis patients, the mean time from the onset of symptoms to diagnosis was 52 months for proctitis, 12 months for left-sided colitis and 12 months for extensive colitis. CONCLUSION: Ulcerative colitis presented a high frequency of intestinal symptoms, and Crohn's disease showed a high frequency of systemic manifestations at the onset of manifestation. There was a long delay in diagnosis, but individuals with more extensive disease and more obvious symptoms showed a shorter delay.

BACKGROUND: In inflammatory bowel disease (IBD) patients there are reports of the occurrence of hepatobiliary manifestations, so the aim of this study was to evaluate the hepatobiliary manifestations in patients with Crohn's disease (CD) and ulcerative colitis (UC) from an IBD reference center. METHODS: Cross-sectional study in an IBD reference center, with interviews and review of medical charts, between July 2015 and August 2016. A questionnaire addressing epidemiological and clinical characteristics was used. RESULTS: We interviewed 306 patients, and the majority had UC (53.9%) and were female (61.8%). Hepatobiliary manifestations were observed in 60 (19.6%) patients with IBD. In the greater part of the patients (56.7%) hepatobiliary disorders were detected after the diagnosis of IBD. In UC (18.2%) patients, the hepatobiliary disorders identified were 11 (6.7%) non-alcoholic fatty liver disease, 9 (5.5%) cholelithiasis, 6 (3.6%) primary sclerosing cholangitis (PSC), 3 (1.8%) hepatotoxicity associated with azathioprine, 1 (0.6%) hepatitis B, and 1 (0.6%) hepatic fibrosis. In CD (21.3%) patients, 11 (7.8%) had cholelithiasis, 11 (7.8%) non-alcoholic fatty liver disease, 4 (2.8%) PSC, 3 (2.1%) hepatotoxicity, 1 (0.7%) hepatitis B, (0.7%) hepatitis C, 1 (0.7%) alcoholic liver disease, and 1 (0.7%) autoimmune hepatitis (AIH). There was one case of PSC/AIH overlap syndrome. CONCLUSION: The frequency of hepatobiliary disorders was similar in both forms of IBD in patients evaluated. The most common nonspecific hepatobiliary manifestations in IBD patients were non-alcoholic liver disease and cholelithiasis. The most common specific hepatobiliary disorder was PSC in patients with extensive UC or ileocolonic CD involvement; this was seen more frequently in male patients.

A doença de Crohn (DC) faz parte do grupo de doença inflamatória intestinal (DII). A DC pode ter comportamento desde mais leves (inflamatória), até as formas mais graves (estenosante e penetrante). O presente trabalho tem objetivo de caracterizar a DC de acordo com o comportamento da doença inflamatório, estenosante ou penetrante. Trata-se de um estudo transversal observacional, com entrevista dos pacientes e revisão dos prontuários após aplicação do TCLE. As variáveis foram analisadas pelo pacote estatístico SPSS versão 21.0. Foram incluídos 92 pacientes, 55,4% (51) eram do sexo feminino. A média de idade foi 44,4 anos (± 14,6) e a média de tempo de doença foi 114,6 meses. A idade de diagnóstico mais frequente nos três fenótipos foi entre 17 e 40 anos. Um total de 54,3% (50) apresentavam o comportamento não estenosante/não penetrante, 23,9% (22) estenosante e 22,2% (20) penetrante. Em todos os comportamentos da doença, a grande maioria se autodeclarou como pardo, seguido por negro. Os comportamentos estenosante e penetrante mantiveram predominância do sexo feminino, enquanto que na forma não estenosante/ não penetrante, do sexo masculino. Entre os pacientes com doença de comportamento não penetrante e não estenosante e com o comportamento penetrante, a principal localização foi a colônica, Entre os pacientes com doença estenosante, a maioria apresentou localização ileocônica. Os pacientes com a doença penetrante foram mais jovens no momento da entrevista, com localização mais frequente colônica e maior frequência de doença perianal associada.Nosso trabalho conclui que o comportamento não penetrante/não estenosante foi o mais observado na amostra estudada. Os pacientes com as formas complicadas, tiveram o diagnóstico mais tardio e apresentaram maior tempo de duração da doença. A forma penetrante apresentou mais frequente localização colônica e doença perianal associada. O comportamento estenosante teve predominante localização ileocolonica, enquanto na doença não penetrante/ não estenosante a localização colônica foi a mais frequente.