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

Long-term follow-up of pediatric and young adult patients with Crohn\'s disease involving the proximal small bowel

Introdução: Aproximadamente 25% das doenças inflamatórias intestinais são diagnosticadas na infância, evoluindo cronicamente e podendo ter efeitos desfavoráveis com o tempo, associado à possibilidade de pior prognóstico quando há envolvimento do intestino delgado proximal. Assim, faz-se necessário uma melhor compreensão do curso desta afecção nesta população específica de pacientes. O objetivo deste estudo é descrever a atividade clínica e endoscópica de pacientes pediátricos com doença de Crohn com envolvimento do intestino delgado proximal em dois períodos, com intervalo de 10 anos entre eles. Métodos: Foi realizada uma coorte prospectiva em pacientes pediátricos com doença de Crohn e envolvimento do intestino delgado proximal confirmado por enteroscopia de duplo-balao, sendo estes pacientes avaliados clinicamente, pelo escore de Harvey-Bradshaw modificado e endoscopicamente pelo SES-CD, no momento da enteroscopia e após 10 anos de seguimento. Resultados: 20 pacientes pediátricos e adultos jovens com diagnóstico de doença de Crohn foram avaliados. Ao longo de 10 anos, 3 pacientes mudaram de diagnóstico. A idade média foi de 11 anos com maioria do sexo masculino e sendo o fenótipo inflamatório predominante. Houve melhora estatisticamente significativa nos índices globais de atividade inflamatória e endoscópica após 10 anos de seguimento, entretanto, 4 pacientes com diagnóstico de Crohn antes dos 10 anos de idade evoluíram para cirurgia. Conclusão: Houve melhora clínica e endoscópica dos pacientes ao longo de 10 anos, no entanto, em pacientes com diagnóstico antes dos 10 anos de idade, houve pior evolução e dificuldade em alcançar a remissão profunda a despeito da terapia biológica, sugerindo um fenótipo distinto, com maior agressividade da doençaIntroduction: Approximately 25% of inflammatory bowel diseases are diagnosed in childhood, progressing chronically and may have unfavorable effects over time, associated with the possibility of a worse prognosis when there is involvement of the proximal small bowel. Thus, a better understanding of the course of this pathology in this specific patient population is necessary. The aim of this study is to describe the clinical and endoscopic activity of pediatric patients with Crohn\'s disease with proximal small bowel involvement in two periods, with an interval of 10 years between them. Methods: A prospective cohort was performed in pediatric patients with Crohn\'s disease and involvement of the proximal small bowel, confirmed by double-balloon enteroscopy, and these patients were assessment clinically, by the modified Harvey-Bradshaw score and endoscopically, by the SES-CD, in the period in which the enteroscopy was performed and after 10 years of follow-up. Results: 20 pediatric and young adult patients diagnosed with Crohn\'s disease were assessment. Over 10 years, 3 patients changed their diagnosis. The mean age was 11 years, most were male and the inflammatory phenotype was the most prevalent. There was a statistically significant improvement in the global indices of inflammatory and endoscopic activity after 10 years of followup, however, 4 patients diagnosed with Crohn\'s before 10 years of age progressed to surgery. Conclusion: There was clinical and endoscopic improvement of patients over 10 years, however, in patients diagnosed before 10 years of age, there was worse evolution and difficulty in achieving deep remission despite biological therapy, suggesting a distinct phenotype, with greater disease aggressivenes