Perfil clínico-epidemiológico de pacientes com Doença de Crohn em uso de terapia biológica de um centro de referência em Salvador, Bahia / Clinical and epidemiological profile of patients with Crohn's disease in biological therapy from a reference center in Salvador, Bahia

Objetivo: Descrever o perfil clínico-epidemiológico dos pacientes com Doença de Crohn em terapia biológica em um centro de referência em Salvador, Bahia. Metodologia: Estudo transversal, realizado entre julho de 2017 e julho de 2018, através da aplicação de questionário e revisão de prontuários de pacientes atendidos em centro de referência em Salvador, Bahia. Foram analisadas variáveis epidemiológicas, classificação de Montreal e Índice de Harvey-Bradshaw. A análise estatística foi realizada utilizando o software SPSS versão 21.0 Resultados: Foram incluídos 116 pacientes com Doença de Crohn, sendo que 50% (N=58) utilizavam terapia biológica. Desses, a maioria era proveniente de zona urbana (87,1%), pardos (55,2%) e negros (32,7%) com renda familiar de até 2 salários mínimos (74,9%), idade média de 39 anos, tempo médio de doença de 94,8 meses, com mesma proporção (50%) de homens e mulheres. Maior parte dos pacientes apresentaram idade ao diagnóstico entre 17-40 anos (75,9%), localização colônica (46,5%), comportamento não estenosante não penetrante (44,6%) e alta taxa de remissão (83,7%). Conclusão: Os pacientes avaliados com doença de Crohn em uso de terapia biológica eram na maioria adultos jovens, procedentes de área urbana, pardos ou negros, com baixa renda familiar, tinham alta frequência de remissão da doença, apresentavam idade ao diagnóstico entre 17-40 anos, localização colônica e doença complicada

Mediastinal Tuberculosis Lymphadenitis during Anti-TNF Therapy - Case Report

Tuberculosis is described during the use of monoclonal antibodies against tumour necrosis factor (TNF) for Crohn’s disease treatment. We report a case of a 44 year old man that developed fever, night sweats and weight loss during immunosuppressive and anti-TNF therapy for Crohn’s disease. After extensive investigation we performed mediastinoscopy with biopsy of the paratracheal lymph node. A istopathological study revealed caseous necrosis. The patient improved after therapy against tuberculosis. During anti-TNF therapy, the diagnosis of tuberculosis may be mainly difficult when an atypical location is present. Clinical skills are important mainly in countries where tuberculosis is endemic.</p

Endoscopic and Histopathological Findings of the Esophagus, Stomach, and Duodenum in Patients with Crohn’s Disease from a Reference Center in Bahia, Brazil

(1) The aim of the present study was to describe the endoscopic and histopathological findings in the esophagus, stomach, and duodenum in patients with Crohn’s disease. (2) Methods: This was a cross-sectional study that included patients receiving treatment from the inflammatory bowel disease outpatient clinic. Esophagogastroduodenoscopies with biopsies of the stomach and proximal duodenum were performed. Presence of Helicobacter pylori bacteria was assessed by Giemsa staining. (3) Results: We included 58 patients. Erosive esophagitis was identified in 25 patients (43.1%), gastritis was diagnosed in 32 patients (55.2%) and erosive duodenitis was found in eight (13.8%). The most frequent histopathological finding in the H. pylori-positive group was increased inflammatory activity in the gastric body and antrum, with a predominance of mononuclear and polymorphonuclear cells. In turn, the most frequent finding in the H. pylori-negative group was chronic inflammation with predominance of mononuclear cells. Focally enhanced gastritis was identified in four patients (6.9%), all of whom were negative for H. pylori. Granulomas were not observed. H. pylori infection was present in 19 patients (32.8%). (4) Conclusions: Nonspecific endoscopic and histological findings were frequent in patients with Crohn’s disease. Focally enhanced gastritis was uncommon and observed only in H. pylori-negative patients. The time from the diagnosis, patient age, and therapy in use may have influenced the nondetection of epithelioid granuloma