The relationship of major depressive disorder with Crohn's disease activity

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

Perianal fistulizing Crohn's disease is associated with a higher prevalence of HPV in the anorectal fistula tract. A comparative study

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

Depressive symptoms in patients with Crohn\'s disease and their relationship with disease phenotype

Introdução: Na última década, houve um aumento no número de pesquisas publicadas em todo o mundo, relacionando os aspectos psicológicos com as doenças inflamatórias intestinais (DII). Foi descrito que o transtorno psiquiátrico é maior em indivíduos com doença de Crohn (DC) que na população geral, incluindo maior risco de suicídio (RS). Contudo, existem muitas incertezas sobre os fatores envolvidos e suas interações. Objetivo: Avaliar a prevalência de depressão em pacientes com DC e sua relação com a atividade, localização e o comportamento da doença. Métodos: Trata-se de um estudo transversal, envolvendo pacientes com DC de ambos os sexos, maiores de 14 anos que estavam em acompanhamento no ambulatório de DII do Serviço de Cirurgia do Cólon, reto e anus do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo entre setembro de 2019 e fevereiro de 2020. Foram excluídos pacientes com baixa acuidade visual e analfabetos. A atividade da DC foi avaliada pelo índice de Harvey-Bradshaw e o fenótipo, de acordo com a classificação de Montreal. A taxa de depressão foi medida pelo escore do questionário da saúde do paciente-9, considerando o valor igual ou maior a 10, como positivo para depressão maior (DM). A avaliação de dados sociodemográficos foi realizada por meio de questionário, além da análise de prontuário eletrônico para verificação de exames laboratoriais, tratamento medicamentoso, cirurgias e demais características clínicas. Resultados: Participaram do estudo 283 pacientes com DC. A faixa etária no diagnóstico da doença foi maior entre 20 e 40 anos (67,8%; n = 192), o tempo de duração média da doença 13,2 anos e a maioria (65,7%; n= 186) já havia realizado ao menos uma cirurgia (65,8%, n= 186). Os pacientes com doença ativa totalizaram 45,3% (n = 128). A prevalência de DM na população estudada foi 41,7% (n = 118). O envolvimento do íleo em associação com o trato gastrointestinal superior apresentou maior taxa de pacientes com DM (46,4% n = 13), porém sem diferenças estatisticamente significativas. Com relação ao comportamento da doença, a maior prevalência de DM foi maior nos indivíduos com comportamento inflamatório 45,5% (n = 30), seguida de penetrante 42,2% (n = 57) e fibroestenosante 37,8% (n = 31) (p<0,001). O uso de anti-TNF e terapia imunomoduladora não esteve associada a sintomas depressivos. Avaliados como positivos para o RS pelo item 9 do PHQ-9 foram 19,8% (n = 56). Os pacientes do sexo feminino apresentaram chance de DM 5,3 vezes maior que os do sexo masculino (IC 95%; 1,95- 14,48) e a duração da doença foi inversamente correlacionada com a DM (p=0,021). Pacientes com DC ativa apresentaram, aproximadamente, 800 vezes mais a chance de DM (OR 796,0 IC 95%: 133,7 4738,8) que aqueles em remissão. Conclusão: Observou-se uma elevada prevalência de DM na população estudada. Houve associação positiva entre DM com atividade de doença e comportamento inflamatório, porém a localização da doença não exerceu influência nas taxasIntroduction: In the last decade, there has been an increase in the number of studies published around the world, relating psychological aspects to inflammatory bowel diseases (IBD). Psychiatric disorder has been reported to be greater in individuals with Crohn\'s disease (CD) than in the general population, including a higher suicide risk (SR). However, there are many uncertainties about the factors involved and their interactions. Aim: The aims of this study are to assess the prevalence of depression in patients with CD, and to verify whether there is a relationship between depression and the activity, location and behavior of CD. Methods: A cross-sectional study was performed, involving patients with CD of both sexes, over 14 years old who were being followed up at the IBD outpatient clinic of the Serviço de Cirurgia do Cólon, reto e anus do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo between September 2019 and February 2020. Patients with low visual acuity and illiterate were excluded. CD activity was evaluated by the Harvey-Bradshaw index and the phenotype according to the Montreal classification. The rate of depression was measured by the score on the Patient Health Questionnaire-9, considering a value equal to or greater than 10 as positive for major depression (MD). The evaluation of sociodemographic data was carried out through a questionnaire, in addition to the analysis of electronic medical records to verify laboratory tests, treatments, surgeries and other clinical characteristics. Results: Two hundred and eight three patients with CD participated in the study. The age range at diagnosis of the disease was greater between 20 and 40 years (67.8%; n = 192), the mean duration of the disease was 13.2 years and the majority (65.7%; n=186) had already performed at least one surgery (65,8%, n= 186). Patients with active disease registered 45.3% (n = 128). The prevalence of MD in the population studied was 41.7% (n = 118). The involvement of the ileum in association with the upper gastrointestinal tract was the one with the highest rate of patients with MD (46.4% n = 13), but without statistically significant differences. Regarding the behavior of the disease, the highest prevalence of MD was among individuals with inflammatory disease 45.5% (n = 30), followed by penetrating 42.2% (n = 57) and stricturing 37.8% (n = 31) (p<0,001). The use of anti-TNF and immunomodulatory therapy was not associated with depressive symptoms. Assessed as positive for SR by item 9 of the PHQ-9, it was 19.8% (n = 56). Female patients were 5.3 times more likely to have MD than male patients (95% IC; 1.95-14.48) and disease duration was inversely correlated with MD (p=0.021). Patients with active CD were approximately 800 times more likely to have MD (OR 796.0 95% CI: 133.7 4738.8) than patients in remission. Conclusion: There is a high prevalence of MD in the population studied. There was a positive association between MD, disease activity and inflammatory behavior, but the location of the disease did not influence the rate

Coexistence of Takayasu’s Arteritis in Patients with Inflammatory Bowel Diseases

Background. Takayasu’s arteritis (TA) and inflammatory bowel disease (IBD) are chronic inflammatory granulomatous disorders that have rarely been concomitantly reported in case reports and small case series. Objective. We report a series of seven cases of TA and IBD association in two referral centers with a comprehensive review of literature. Methods. We analyzed retrospectively the electronic medical charts of TA-IBD patients at the University Hospital of São Paulo, Brazil, and at the Sheba Medical Center at Tel Aviv University, Israel. Results. Overall, five patients had Crohn’s disease (DC) and two had ulcerative colitis (UC), and they were mostly female and non-Asian. All patients developed IBD first and, subsequently, TA. Two underwent colectomy and one ileocecectomy due to IBD activity, while three required cardiovascular surgery due to TA activity. Most patients are currently in clinical remission of both diseases with conventional drug treatment. Conclusion. Although the coexistence of TA and IBD is uncommon, both seem to be strongly associated through pathophysiological pathways