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Hilley P, Wong D, Ma R, Peterson A, De Cruz P. Transitioning patients from intravenous to subcutaneous infliximab and vedolizumab for inflammatory bowel disease: what is the opportunity cost of improving access to healthcare? Intern Med J 2024; 54:970-979. [PMID: 38214034 DOI: 10.1111/imj.16311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 11/21/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Biologic drugs are highly effective for inflammatory bowel disease (IBD) management but are key drivers of costs of care especially when administered intravenously (i.v.). Availability of subcutaneous (SC) formulations has increased convenience for patients and improved access to care, but at the cost of revenue to health services. AIMS To evaluate the economic impact of transitioning a tertiary centre IBD cohort from i.v. to SC biologic administration and assess the implications for key stakeholders. METHODS A retrospective analysis of all patients who received i.v. infliximab or vedolizumab in the outpatient infusion centre of a tertiary IBD centre between July 2019 and June 2021 was undertaken. Data were collated from electronic medical records, pharmacy dispensing systems and the hospital business intelligence unit. An economic analysis and theoretical financial/capacity impact analysis of a transition to an SC model were estimated under two scenarios using a random 10% and 30% of the patient cohort. RESULTS Transitioning our IBD cohort from i.v. to SC administration would result in a loss to our health service of AU$2 732 123.75, composed of AU$1 463 003.75 in Weighted Inlier Equivalent Separation (WIES) and AU$1 269 120 in drug procurement revenue. However, it would ease capacity in the infusion centre by up to 5256 h. CONCLUSIONS Transitioning patients to SC administration results in improved access to infusion centres and substantial savings to state governments; however, switching results in a loss of i.v. biologic-generated WIES to health services. Alternative funding models are required to achieve sustainability in IBD care and reduce reliance on i.v. biologic-generated income.
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Affiliation(s)
- Patrick Hilley
- Department of Gastroenterology, The Austin Hospital, Melbourne, Victoria, Australia
| | - Darren Wong
- Department of Gastroenterology, The Austin Hospital, Melbourne, Victoria, Australia
- Department of Medicine, Austin Academic Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - Ronald Ma
- Department of Medicine, Austin Academic Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - Adam Peterson
- Department of Gastroenterology, The Austin Hospital, Melbourne, Victoria, Australia
| | - Peter De Cruz
- Department of Gastroenterology, The Austin Hospital, Melbourne, Victoria, Australia
- Department of Medicine, Austin Academic Centre, University of Melbourne, Melbourne, Victoria, Australia
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Zacharias P, Magro DO, Perussolo M, Baraúna FDSB, Kotze PG. HOSPITALIZATION, USE OF BIOLOGICS AND SURGERY RATES IN INFLAMMATORY BOWEL DISEASES: A SINGLE-CENTRE COMPARATIVE ANALYSIS BETWEEN PUBLIC AND PRIVATE HEALTHCARE SYSTEMS IN A TERTIARY UNIT FROM LATIN AMERICA. ARQUIVOS DE GASTROENTEROLOGIA 2024; 61:e23140. [PMID: 38451670 DOI: 10.1590/s0004-2803.24612023-140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/05/2023] [Indexed: 03/08/2024]
Abstract
BACKGROUND Inflammatory bowel diseases (IBD) have rising incidence and prevalence rates globally. In IBD, there are scarce stu-dies comparing differences between patients according to socioeconomic status. Our aim was to comparatively evaluate hospitalizations, use of biologics and rates of surgery in patients with IBD between public and private healthcare systems. METHODS Single-center retrospective cohort study in patients with IBD from a tertiary referral unit from Latin America, between 2015 and 2021. CD and UC patients were classified into two subgroups: public and private systems. Demographic characteristics, hospitalizations, need for surgery and biologics were compared. RESULTS A total of 500 patients were included, 322 with CD and 178 with UC. CD-related hospitalizations were frequently observed in both healthcare systems (76.28% in private and 67.46% in public). More than half of the patients had been submitted to one or more CD-related abdominal surgery, with no significant difference between the subgroups. Although there was no difference in the rates of use of biological therapy in CD subgroups, infliximab was more used in the public setting (57.69% vs 43.97%). There was no difference in UC-related hospitalizations between the subgroups (public 30.69% and private 37.66%) as well as the rates of colectomy (public: 16.83%, private: 19.48%). Biologics were prescribed almost twice as often in private as compared to public (45.45 vs 22.77%). CONCLUSION There were no differences in the rates of hospitalization and abdominal surgery between the systems. In patients with UC, there was greater use of biological therapy in the private healthcare setting. BACKGROUND • In a tertiary IBD center in Latin America. BACKGROUND • More than half of the patients had been submitted to one or more CD-related abdominal surgical procedure. BACKGROUND • Between the two healthcare systems, there was no difference in the rates of use of biological therapy in patients with CD, and in UC-related hospitalizations. BACKGROUND • Biologics were prescribed almost twice as often in the private system as compared to the public in patients with UC.
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Affiliation(s)
- Patrícia Zacharias
- Pontifícia Universidade Católica do Paraná, Departamento de Cirurgia Colorretal, Curitiba, PR, Brasil
| | - Daniéla Oliveira Magro
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Cirurgia, Campinas, SP, Brasil
| | - Milena Perussolo
- Pontifícia Universidade Católica do Paraná, Departamento de Cirurgia Colorretal, Curitiba, PR, Brasil
| | | | - Paulo Gustavo Kotze
- Pontifícia Universidade Católica do Paraná, Departamento de Cirurgia Colorretal, Curitiba, PR, Brasil
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Fróes RDSB, Andrade AR, Faria MAG, de Souza HSP, Parra RS, Zaltman C, Dos Santos CHM, Bafutto M, Quaresma AB, Santana GO, Luporini RL, de Lima Junior SF, Miszputen SJ, de Souza MM, Herrerias GSP, Junior RLK, do Nascimento CR, Féres O, de Barros JR, Sassaki LY, Saad-Hossne R. Clinical factors associated with severity in patients with inflammatory bowel disease in Brazil based on 2-year national registry data from GEDIIB. Sci Rep 2024; 14:4314. [PMID: 38383742 PMCID: PMC10881489 DOI: 10.1038/s41598-024-54332-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 02/12/2024] [Indexed: 02/23/2024] Open
Abstract
The Brazilian Organization for Crohn's Disease and Colitis (GEDIIB) established a national registry of inflammatory bowel disease (IBD). The aim of the study was to identify clinical factors associated with disease severity in IBD patients in Brazil. A population-based risk model aimed at stratifying the severity of IBD based on previous hospitalization, use of biologics, and need for surgery for ulcerative colitis (UC) and Crohn's Disease (CD) and on previous complications for CD. A total of 1179 patients (34.4 ± 14.7y; females 59%) were included: 46.6% with UC, 44.2% with CD, and 0.9% with unclassified IBD (IBD-U). The time from the beginning of the symptoms to diagnosis was 3.85y. In CD, 41.2% of patients presented with ileocolic disease, 32% inflammatory behavior, and 15.5% perianal disease. In UC, 46.3% presented with extensive colitis. Regarding treatment, 68.1%, 67%, and 47.6% received biological therapy, salicylates and immunosuppressors, respectively. Severe disease was associated with the presence of extensive colitis, EIM, male, comorbidities, and familial history of colorectal cancer in patients with UC. The presence of Montreal B2 and B3 behaviors, colonic location, and EIM were associated with CD severity. In conclusion, disease severity was associated with younger age, greater disease extent, and the presence of rheumatic EIM.
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Affiliation(s)
| | | | | | - Heitor Siffert Pereira de Souza
- Department of Clinical Medicine, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rogério Serafim Parra
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Cyrla Zaltman
- Department of Clinical Medicine, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Mauro Bafutto
- Department of Gastroenterology, Instituto Goiano de Gastroenterologia, Goiânia, Goiás, Brazil
| | - Abel Botelho Quaresma
- Universidade do Oeste de Santa Catarina - UNOESC - Department of Health Sciences, Joaçaba, Santa Catarina, Brazil
| | | | - Rafael Luís Luporini
- Department of Medicine, Federal University of São Carlos - UFSCar, São Carlos, São Paulo, Brazil
| | | | | | | | - Giedre Soares Prates Herrerias
- Department of Internal Medicine, Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, CEP 18618-970, Brazil
| | | | | | - Omar Féres
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Jaqueline Ribeiro de Barros
- Department of Internal Medicine, Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, CEP 18618-970, Brazil
| | - Ligia Yukie Sassaki
- Department of Internal Medicine, Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, CEP 18618-970, Brazil.
| | - Rogerio Saad-Hossne
- Department of Surgery, Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, Brazil
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Parra RS, da Costa Ferreira S, Machado VF, Nigro CMC, da Rocha JJR, de Almeida Troncon LE, Feres O. Access to High-Cost Biological Agents: Perceptions of Brazilian Patients with Inflammatory Bowel Diseases. J Clin Med 2023; 12:2672. [PMID: 37048755 PMCID: PMC10095198 DOI: 10.3390/jcm12072672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/22/2023] [Accepted: 03/30/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND AND AIMS Brazilian patients with inflammatory bowel diseases (IBD) requiring therapy with biological agents usually have access to medicines through the National Unified Health Care System (SUS). This study aimed to analyze Brazilian IBD patient perception regarding access (availability and provision quality) to high-cost drugs in the public health care system. METHODS A questionnaire-based survey was carried out in an IBD referral center in Brazil. All adult patients with an established diagnosis of ulcerative colitis (UC) or Crohn's disease (CD) that use biological therapy were invited to participate. Data were collected on the biological in use, lack of distribution (number of absences, average time to regularization, impairment in patient treatment), and difficulties reported by patients in obtaining the drugs. RESULTS Overall, 205 patients met the inclusion criteria and answered the questionnaire. Most of the patients had CD (n = 161, 78.5%), nearly half of them (n = 104, 50.7%) were female; 87 patients (42.4%) were unemployed, and of these, 40 patients (19.5%) had government assistance as the main source of income. Regarding the medications used, infliximab (n = 128, 62.5%) was the most used medication, followed by adalimumab (n = 39, 19.0%). Most patients (n = 172, 83.9%) reported at least one failed delivery of biological medicine in the last year, with a single shortage in forty-two patients (24.4%), at least two shortages in forty-seven patients (27.3%), and three or more shortages in seventy-eight patients (45.3%). The average time to regularize the distribution was up to 1 month in 44 cases (25.6%), up to 2 months in 64 cases (37.2%), and more than 3 months in 56 patients (32.6%). Among patients who reported delays, 101 patients (58.7%) felt that it may have impaired their treatment. CONCLUSION Brazilian IBD patients reported high rates of failure to dispense biological drugs by the national healthcare system within one year. Our data highlight the need for improvement in this system for the correct supply of medication to avoid treatment failure and relapse.
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Affiliation(s)
- Rogerio Serafim Parra
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14048-900, Brazil
| | - Sandro da Costa Ferreira
- Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14048-900, Brazil
| | - Vanessa Foresto Machado
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14048-900, Brazil
| | - Cintia Maura Caseiro Nigro
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14048-900, Brazil
| | - José Joaquim Ribeiro da Rocha
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14048-900, Brazil
| | | | - Omar Feres
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14048-900, Brazil
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Renuzza SSS, Vieira ER, Cornel CA, Lima MN, Ramos Junior O. INCIDENCE, PREVALENCE, AND EPIDEMIOLOGICAL CHARACTERISTICS OF INFLAMMATORY BOWEL DISEASES IN THE STATE OF PARANÁ IN SOUTHERN BRAZIL. ARQUIVOS DE GASTROENTEROLOGIA 2022; 59:327-333. [PMID: 36102427 DOI: 10.1590/s0004-2803.202203000-60] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The epidemiology of inflammatory bowel diseases (IBD) varies between different regions of Brazil. This cross-sectional study examined the epidemiological characteristics of IBD in the Southern Brazilian state of Paraná. METHODS We included patients with IBD (n=6.748) selected across 11,468,818 population of Paraná. All patients had a known diagnosis of either Crohn's disease (CD) or ulcerative colitis (UC) and had started treatment through the Government Program of the Brazilian Unified Health System (2010-2019). The primary outcomes were changes in the incidence and prevalence rates of IBD. RESULTS The study population consisted of 4.931 (73.1%) patients with UC and 1.817 (26.9%) patients with CD. In participants aged 11-30 years, CD was more common, while in participants aged 40-80 years, UC predominated. UC was more common in female compared to male patients, with a similar incidence between the sexes evident for CD. In 2010, the incidence of IBD was 2.00/100,00 population; this increased to 13.77/100,000 population by 2019. The highest concentration of IBD patients was found in the eastern macro-region of Paraná, which includes the 2nd Health Regional of Curitiba, where the capital of the state is located. CONCLUSION This is the first study to describe the epidemiological characteristics of IBD in the state of Paraná and showed an increase in its incidence and prevalence. We also identified that IBD was concentrated in the eastern macro-region of this Brazilian state.
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Affiliation(s)
| | - Elizabete Regina Vieira
- Universidade Federal do Paraná, Programa de Pós-Graduação em Medicina Interna e Ciências da Saúde, Curitiba, PR, Brasil
| | - César Augusto Cornel
- Universidade Federal do Paraná, Programa de Pós-Graduação em Medicina Interna e Ciências da Saúde, Curitiba, PR, Brasil
| | - Mônica Nunes Lima
- Universidade Federal do Paraná, Programa de Pós-Graduação em Medicina Interna e Ciências da Saúde, Curitiba, PR, Brasil
| | - Odery Ramos Junior
- Universidade Federal do Paraná, Programa de Pós-Graduação em Medicina Interna e Ciências da Saúde, Curitiba, PR, Brasil
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Sudhakar P, Alsoud D, Wellens J, Verstockt S, Arnauts K, Verstockt B, Vermeire S. Tailoring Multi-omics to Inflammatory Bowel Diseases: All for One and One for All. J Crohns Colitis 2022; 16:1306-1320. [PMID: 35150242 PMCID: PMC9426669 DOI: 10.1093/ecco-jcc/jjac027] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/02/2022] [Accepted: 02/10/2022] [Indexed: 12/13/2022]
Abstract
Inflammatory bowel disease [IBD] has a multifactorial origin and originates from a complex interplay of environmental factors with the innate immune system at the intestinal epithelial interface in a genetically susceptible individual. All these factors make its aetiology intricate and largely unknown. Multi-omic datasets obtained from IBD patients are required to gain further insights into IBD biology. We here review the landscape of multi-omic data availability in IBD and identify barriers and gaps for future research. We also outline the various technical and non-technical factors that influence the utility and interpretability of multi-omic datasets and thereby the study design of any research project generating such datasets. Coordinated generation of multi-omic datasets and their systemic integration with clinical phenotypes and environmental exposures will not only enhance understanding of the fundamental mechanisms of IBD but also improve therapeutic strategies. Finally, we provide recommendations to enable and facilitate generation of multi-omic datasets.
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Affiliation(s)
- Padhmanand Sudhakar
- Corresponding author: Padhmanand Sudhakar, Translational Research in Gastrointestinal Disorders [TARGID], ON I, Herestraat 49, box 701, 3000 Leuven, Belgium. Tel.: 0032 [0]16 19 49 40;
| | - Dahham Alsoud
- KU Leuven Department of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders [TARGID], Leuven, Belgium
| | - Judith Wellens
- KU Leuven Department of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders [TARGID], Leuven, Belgium
| | - Sare Verstockt
- KU Leuven Department of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders [TARGID], Leuven, Belgium
| | - Kaline Arnauts
- KU Leuven Department of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders [TARGID], Leuven, Belgium
| | - Bram Verstockt
- KU Leuven Department of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders [TARGID], Leuven, Belgium,Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Severine Vermeire
- KU Leuven Department of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders [TARGID], Leuven, Belgium,Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
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Guedes ALV, Lorentz AL, Rios LFDAR, Freitas BC, Dias AGN, Uhlein ALE, Vieira Neto FO, Jesus JFS, Torres TDSN, Rocha R, Andrade VD, Santana GO. Hospitalizations and in-hospital mortality for inflammatory bowel disease in Brazil. World J Gastrointest Pharmacol Ther 2022; 13:1-10. [PMID: 35116179 PMCID: PMC8788161 DOI: 10.4292/wjgpt.v13.i1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/28/2021] [Accepted: 01/05/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is associated with complications, frequent hospitalizations, surgery and death. The introduction of biologic drugs into the therapeutic arsenal in the last two decades, combined with an expansion of immunosuppressant therapy, has changed IBD management and may have altered the profile of hospitalizations and in-hospital mortality (IHM) due to IBD. AIM To describe hospitalizations from 2008 to 2018 and to analyze IHM from 1998 to 2017 for IBD in Brazil. METHODS This observational, retrospective, ecological study used secondary data on hospitalizations for IBD in Brazil for 2008-2018 to describe hospitalizations and for 1998-2017 to analyze IHM. Hospitalization data were obtained from the Hospital Information System of the Brazilian Unified Health System and population data from demographic censuses. The following variables were analyzed: Number of deaths and hospitalizations, length of hospital stay, financial costs of hospitalization, sex, age, ethnicity and type of hospital admission. RESULTS There was a reduction in the number of IBD hospitalizations, from 6975 admissions in 1998 to 4113 in 2017 (trend: y = -0.1682x + 342.8; R2 = 0.8197; P < 0.0001). The hospitalization rate also decreased, from 3.60/100000 in 2000 to 2.17 in 2010. IHM rates varied during the 20-year period, between 2.06 in 2017 and 3.64 in 2007, and did not follow a linear trend (y = -0.0005049x + 2.617; R2 = 0,00006; P = 0.9741). IHM rates also varied between regions, increasing in all but the southeast, which showed a decreasing trend (y = -0.1122x + 4.427; R2 = 0,728; P < 0.0001). The Southeast region accounted for 44.29% of all hospitalizations. The Northeast region had the highest IHM rate (2.86 deaths/100 admissions), with an increasing trend (y = 0.1105x + 1.110; R2 = 0.6265; P < 0.0001), but the lowest hospitalization rate (1.15). The Midwest and South regions had the highest hospitalization rates (3.27 and 3.17, respectively). A higher IHM rate was observed for nonelective admissions (2.88), which accounted for 81% of IBD hospitalizations. The total cost of IBD hospitalizations in 2017 exhibited an increase of 37.5% compared to 2008. CONCLUSION There has been a notable reduction in the number of hospitalizations for IBD in Brazil over 20 years. IHM rates varied and did not follow a linear trend.
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Affiliation(s)
| | - Amanda Lopes Lorentz
- Life Sciences Department, State University of Bahia, Salvador 41150-000, Bahia, Brazil
| | | | | | | | | | | | | | | | - Raquel Rocha
- Sciences of Nutrition, Federal University of Bahia, Salvador 40110-060, Bahia, Brazil
| | - Vitor D Andrade
- Medicine Department, Universidade Salvador (UNIFACS), Salvador 41820-021, Bahia, Brazil
| | - Genoile Oliveira Santana
- Life Sciences Department, State University of Bahia, Salvador 41150-000, Bahia, Brazil
- Medicine and Health Postgraduate Program, Federal University of Bahia, Salvador 40110-060, Bahia, Brazil
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Oba J, Sobrado CW, Damião AOMC, Azevedo M, Carlos A, Queiroz N, Len CA, Toma RK, Deboni M, Ozaki MJ, Carrilho FJ, Nahas S, Silva CA. HEALTH-RELATED QUALITY OF LIFE IN ADOLESCENTS AND YOUNG ADULTS WITH INFLAMMATORY BOWEL DISEASE IS ASSOCIATED WITH REDUCTION IN SCHOOL AND WORK PRODUCTIVITY RATHER THAN PHYSICAL IMPAIRMENT: A MULTIDISCIPLINARY STUDY. ARQUIVOS DE GASTROENTEROLOGIA 2021; 58:541-547. [PMID: 34909863 DOI: 10.1590/s0004-2803.202100000-96] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Inflammatory bowel diseases (IBD), comprising Crohn's disease and ulcerative colitis, are chronic inflammatory diseases of the gastrointestinal tract that often have their onset among adolescents and young adults (AYA). IBD are characterized by episodes of active disease interspersed with periods of remission, and its activity is inversely correlated with health-related quality of life (HRQL). OBJECTIVE This study aimed to determine whether AYA in remission or with low IBD activity would exhibit HRQL similar to that of age-matched healthy individuals, and whether demographic and disease factors could affect HRQL using a 'patient-reported outcome' instrument. METHODS This study enrolled only AYA with IBD, with low activity. This research included five multidisciplinary clinics of two academic hospitals: Paediatric Gastroenterology, Gastroenterology, Coloproctology, Paediatric Rheumatology and Adolescent divisions, São Paulo, Brazil. A total of 59 AYA with IBD (age, 13-25 years) and 60 healthy AYA (age, 13-25 years) completed the Pediatric Quality of Life Inventory 4.0 and 36-Item Short-Form Health Survey questionnaires and the visual analogue scale (VAS) for pain. Demographic data, extra-intestinal manifestations, treatment, and outcomes regarding CD and UC were evaluated. RESULTS AYA with IBD and healthy controls were similar with respect to median ages (18.63 [13.14-25.80] years vs 20.5 [13.68-25.84] years, P=0.598), proportion of female sex (42% vs 38%, P=0.654), and percentage of upper middle/middle Brazilian socioeconomic classes (94% vs 97%, P=0.596). The school/work score was significantly lower in AYA with IBD than in healthy controls (70 [10-100] vs 75 [5-100], P=0.037). The 'general health-perception' score was significantly lower in AYA with IBD than in healthy controls (50 [10-80] vs 0 [25-90], P=0.0002). The median VAS, FACES pain rating scale, and total VAS scores were similar between the two groups (2 [0-10] vs 3 [0-9], P=0.214). No association between HRQL and clinical and demographic parameters was identified among IBD patients. CONCLUSION AYA with low IBD activity reported poor HRQL in school/work and general health perception domains, which highlights a disability criterion in this vulnerable population.
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Affiliation(s)
- Jane Oba
- Faculdade de Medicina da Universidade de São Paulo, Gastroenterologia Pediátrica, São Paulo, SP, Brasil
| | - Carlos W Sobrado
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Disciplina de Coloproctologia, São Paulo, SP, Brasil.,Faculdade de Medicina da Universidade de São Paulo, Divisão de Gastroenterologia e Hepatologia Clínica, São Paulo, SP, Brasil
| | - Aderson O M C Damião
- Faculdade de Medicina da Universidade de São Paulo, Divisão de Gastroenterologia e Hepatologia Clínica, São Paulo, SP, Brasil
| | - Matheus Azevedo
- Faculdade de Medicina da Universidade de São Paulo, Divisão de Gastroenterologia e Hepatologia Clínica, São Paulo, SP, Brasil
| | - Alexandre Carlos
- Faculdade de Medicina da Universidade de São Paulo, Divisão de Gastroenterologia e Hepatologia Clínica, São Paulo, SP, Brasil
| | - Natália Queiroz
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Disciplina de Coloproctologia, São Paulo, SP, Brasil
| | - Claudio A Len
- Universidade Federal de São Paulo, Reumatologia Pediátrica, São Paulo, SP, Brasil
| | - Ricardo K Toma
- Faculdade de Medicina da Universidade de São Paulo, Gastroenterologia Pediátrica, São Paulo, SP, Brasil
| | - Mariana Deboni
- Faculdade de Medicina da Universidade de São Paulo, Gastroenterologia Pediátrica, São Paulo, SP, Brasil
| | - Marcos J Ozaki
- Faculdade de Medicina da Universidade de São Paulo, Gastroenterologia Pediátrica, São Paulo, SP, Brasil
| | - Flair José Carrilho
- Faculdade de Medicina da Universidade de São Paulo, Divisão de Gastroenterologia e Hepatologia Clínica, São Paulo, SP, Brasil
| | - Sergio Nahas
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Disciplina de Coloproctologia, São Paulo, SP, Brasil
| | - Clovis A Silva
- Universidade de São Paulo, Instituto da Criança e do Adolescente, São Paulo, SP, Brasil
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de Sá Brito Fróes R, da Luz Moreira A, Carneiro AJDV, Moreira JPL, Luiz RR, de Barros Moreira AMH, Monnerat CC, de Souza HSP, Carvalho ATP. Prevalence, Indirect Costs, and Risk Factors for Work Disability in Patients with Crohn's Disease at a Tertiary Care Center in Rio de Janeiro. Dig Dis Sci 2021; 66:2925-2934. [PMID: 33044678 DOI: 10.1007/s10620-020-06646-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/28/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Crohn's disease (CD) can lead to work disability with social and economic impacts worldwide. In Brazil, where its prevalence is increasing, we assessed the indirect costs, prevalence, and risk factors for work disability in the state of Rio de Janeiro and in a tertiary care referral center of the state. METHODS Data were retrieved from the database of the Single System of Social Security Benefits Information, with a cross-check for aid pension and disability retirement. A subanalysis was performed with CD patients followed up at the tertiary care referral center using a prospective CD database, including clinical variables assessed as possible risk factors for work disability. RESULTS From 2010 to 2018, the estimated prevalence of CD was 26.05 per 100,000 inhabitants, while the associated work disability was 16.6%, with indirect costs of US$ 8,562,195.86. Permanent disability occurred more frequently in those aged 40 to 49 years. In the referral center, the prevalence of work disability was 16.7%, with a mean interval of 3 years between diagnosis and the first benefit. Risk factors for absence from work were predominantly abdominal surgery, anovaginal fistulas, disease duration, and the A2 profile of the Montreal classification. CONCLUSIONS In Rio de Janeiro, work disability affects one-sixth of CD patients, and risk factors are associated with disease duration and complications. In the context of increasing prevalence, as this disability compromises young patients after a relatively short period of disease, the socioeconomic burden of CD is expected to increase in the future.
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Affiliation(s)
- Renata de Sá Brito Fróes
- Disciplina de Gastroenterologia e Endoscopia Digestiva, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, 20551-900, Brazil
- Perícia Médica Federal (PMF), Superintendência Regional 9 da Subsecretaria de PMF do Ministério da Economia, Rio de Janeiro, RJ, 20030-030, Brazil
| | - André da Luz Moreira
- Disciplina de Proctologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, 20551-900, Brazil
- D'Or Institute for Research and Education (IDOR), Rua Diniz Cordeiro 30, Botafogo, Rio de Janeiro, RJ, 22281-100, Brazil
| | - Antonio José de V Carneiro
- Serviço de Gastroenterologia, Departamento de Clínica Médica, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco 255, Ilha do Fundão, Rio de Janeiro, RJ, 21941-913, Brazil
| | - Jessica P L Moreira
- Instituto de Estudos de Saúde Coletiva (IESC), Universidade Federal do Rio de Janeiro, Rio de Janeiro, 21944-970, Brazil
| | - Ronir R Luiz
- Instituto de Estudos de Saúde Coletiva (IESC), Universidade Federal do Rio de Janeiro, Rio de Janeiro, 21944-970, Brazil
| | - Adriana Maria Hilu de Barros Moreira
- Perícia Médica Federal (PMF), Superintendência Regional 9 da Subsecretaria de PMF do Ministério da Economia, Rio de Janeiro, RJ, 20030-030, Brazil
| | - Camila Cesar Monnerat
- Perícia Médica Federal (PMF), Superintendência Regional 9 da Subsecretaria de PMF do Ministério da Economia, Rio de Janeiro, RJ, 20030-030, Brazil
| | - Heitor Siffert Pereira de Souza
- D'Or Institute for Research and Education (IDOR), Rua Diniz Cordeiro 30, Botafogo, Rio de Janeiro, RJ, 22281-100, Brazil.
- Serviço de Gastroenterologia, Departamento de Clínica Médica, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco 255, Ilha do Fundão, Rio de Janeiro, RJ, 21941-913, Brazil.
| | - Ana Teresa Pugas Carvalho
- Disciplina de Gastroenterologia e Endoscopia Digestiva, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, 20551-900, Brazil
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de Mello-Neto JM, Nunes JGR, Tadakamadla SK, da Silva Figueredo CM. Immunological Traits of Patients with Coexistent Inflammatory Bowel Disease and Periodontal Disease: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18178958. [PMID: 34501547 PMCID: PMC8430503 DOI: 10.3390/ijerph18178958] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/21/2021] [Accepted: 08/23/2021] [Indexed: 12/24/2022]
Abstract
This systematic review assessed studies that evaluated the immunological traits of patients with both inflammatory bowel disease (IBD) and periodontal disease. An electronic search for literature was conducted on PubMed, Embase, Scopus, Cochrane and Web of Science. Studies that evaluated the immunological response in patients with IBD and periodontal disease were considered eligible for inclusion. A total of 6 cross-sectional studies of 275 patients were included. Immunological analyses were performed in gingival crevicular fluid, saliva, serum, intestinal and gingival biopsies. Four studies identified that the presence of IBD and periodontal disease was associated with higher levels of prostaglandin E2, aMMP8, IL-18 and S100A12, respectively, when compared to patients without the coexistence of both diseases. Furthermore, another study identified higher aMMP-8 levels with increasing severity of periodontitis in Crohn’s disease patients. The quality of overall evidence ranged from high to low due to the observational nature of contributing studies. The coexistence of IBD and periodontal disease seems to be associated with a more responsive inflammatory reaction compared with individuals having one or the other. More randomized controlled studies evaluating the coexistence of IBD and periodontitis are required to better explore the immunological interplay between them.
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Affiliation(s)
- João Martins de Mello-Neto
- School of Medicine and Dentistry, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia; (J.M.d.M.-N.); (S.K.T.)
| | - Jessica Gomes Rodrigues Nunes
- Department of Periodontology, Faculty of Odontology, Rio de Janeiro State University, Rio de Janeiro 20551-030, Brazil;
| | - Santosh Kumar Tadakamadla
- School of Medicine and Dentistry, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia; (J.M.d.M.-N.); (S.K.T.)
| | - Carlos Marcelo da Silva Figueredo
- School of Medicine and Dentistry, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia; (J.M.d.M.-N.); (S.K.T.)
- Correspondence: ; Tel.: +61-756780767
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11
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Palacio FGM, de Souza LMP, Moreira JPDL, Luiz RR, de Souza HSP, Zaltman C. Hospitalization and surgery rates in patients with inflammatory bowel disease in Brazil: a time-trend analysis. BMC Gastroenterol 2021; 21:192. [PMID: 33906627 PMCID: PMC8077865 DOI: 10.1186/s12876-021-01781-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/20/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The prevalence of inflammatory bowel disease (IBD) is increasing globally, and the disease is frequently managed surgically. The aim of this study was to investigate the time trends and geographic distribution of IBD hospitalizations, surgeries and surgical-associated lethality. METHODS Data from the Brazilian Health Public System were retrospectively collected regarding hospitalizations, in-hospital deaths, IBD-related surgical procedures and lethality from 2005 to 2015. RESULTS This eleven-year period revealed decreases in the rates of hospitalization (24%), IBD-related surgeries (35%), and IBD-related surgical lethality (46%). Most surgeries were performed in Crohn's disease patients, and the predominant procedure was small bowel resection, mostly in young adults. A higher prevalence of ulcerative was observed throughout the country. The highest hospitalization and surgical rates were observed in the more industrialized regions of the South and the Southeast and in the municipalities integrated with metropolitan regions (MRs). The highest surgical-related lethality rates were seen in the less-developed regions and in municipalities not integrated with MRs. The length of hospital stay showed a slight increase throughout the period. CONCLUSIONS Brazil follows the global trend of decreases in hospitalizations, lethality, surgeries, and surgical lethality associated with IBD. The unequal distribution of hospitalizations and surgeries, concentrated in the industrialized areas, but with a shift towards the Northeast and from urbanized to rural areas, indicates ongoing changes within the country. Reductions in the rates of IBD-related hospitalizations, surgeries and lethality suggest the effectiveness of decentralization and improvements in the quality of public health services and the advances in medical therapy during the study period.
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Affiliation(s)
- Flávia Gonçalves Musauer Palacio
- Departamento de Clínica Médica, Hospital Universitário, Universidade Federal Do Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco 255, Ilha Do Fundão, Rio de Janeiro, RJ, 21941-913, Brazil
| | - Lucila Marieta Perrotta de Souza
- Departamento de Clínica Médica, Hospital Universitário, Universidade Federal Do Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco 255, Ilha Do Fundão, Rio de Janeiro, RJ, 21941-913, Brazil
| | | | - Ronir Raggio Luiz
- Instituto de Estudos de Saúde Coletiva (IESC), Universidade Federal Do Rio de Janeiro, Rio de Janeiro, 21944-970, Brazil
| | - Heitor Siffert Pereira de Souza
- Departamento de Clínica Médica, Hospital Universitário, Universidade Federal Do Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco 255, Ilha Do Fundão, Rio de Janeiro, RJ, 21941-913, Brazil.
- D'Or Institute for Research and Education (IDOR), Rua Diniz Cordeiro 30, Botafogo, Rio de Janeiro, RJ, 22281-100, Brazil.
| | - Cyrla Zaltman
- Departamento de Clínica Médica, Hospital Universitário, Universidade Federal Do Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco 255, Ilha Do Fundão, Rio de Janeiro, RJ, 21941-913, Brazil
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Gomes TNF, de Azevedo FS, Argollo M, Miszputen SJ, Ambrogini O. Clinical and Demographic Profile of Inflammatory Bowel Disease Patients in a Reference Center of São Paulo, Brazil. Clin Exp Gastroenterol 2021; 14:91-102. [PMID: 33762838 PMCID: PMC7982433 DOI: 10.2147/ceg.s288688] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/23/2021] [Indexed: 12/17/2022] Open
Abstract
Background Crohn's disease (CD) and ulcerative colitis (UC) are chronic inflammatory diseases of the gastrointestinal tract with an increasing incidence in developing countries. Purpose To report clinical and demographic data of CD and UC at a referral center for inflammatory bowel disease (IBD) in São Paulo. Patients and Methods We conducted a retrospective cross-sectional study on adult patients with established IBD. Demographic and clinical data were obtained by medical records analysis from the IBD Outpatient Clinic of EPM-UNIFESP, from October 1997 to October 2017. Results Of 658 patients included, 355 had UC (54%) and 303 had CD (46%). UC was more prevalent in women than CD (219 [61.7%] vs 152 [50.2%], p=0.003). The median time between the onset of symptoms and diagnosis was 13 (5-38) months, with a longer duration for CD patients. CD mostly affected the ileocolonic location (47.9%). CD patients with stricture, fistula and/or perianal disease (213/303, 70.3%) were younger at diagnosis, had a longer disease duration, higher rates of corticosteroid, immunomodulatory, and biological therapy, hospitalization, and referral to surgery, compared to patients without complication. Extensive colitis was the most common extension of UC (50.6%), which was more frequently associated with younger age at diagnosis, hepatobiliary disease, increased need for hospitalization, higher use of immunomodulatory, and biologic therapy, compared to patients with less extensive disease. In the last 5 years, CD patients were more frequently on biologic and/or immunomodulatory (70.9%) therapy, and UC patients often received salicylates (78.1%) and immunomodulatory (28.1%) treatments. There was a consistent reduction in salicylate usage for CD in the last 5 years compared to the total period of follow-up. Conclusion Despite the increasing incidence, we highlight the diagnostic delay and a more complicated CD and extensive UC in this cohort, reflecting a high need for immunomodulatory and biological treatment, hospitalization, and surgery.
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Affiliation(s)
- Tarcia Nogueira Ferreira Gomes
- Disciplina de Gastroenterologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Fabio Silva de Azevedo
- Disciplina de Gastroenterologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Marjorie Argollo
- Disciplina de Gastroenterologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Sender Jankiel Miszputen
- Disciplina de Gastroenterologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Orlando Ambrogini
- Disciplina de Gastroenterologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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Posegger KR, Maeda CT, Taveira JP, Caetano EM, Ferraz MB, de Brito Rocha MJA, Lopes Filho GDJ, Linhares MM. Brazilian-Portuguese Validation Assessment of the Gastrointestinal Quality of Life Index for Patients After Laparoendoscopic Cholecystectomy. J Laparoendosc Adv Surg Tech A 2021; 32:125-131. [PMID: 33449870 DOI: 10.1089/lap.2020.0921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Cholelithiasis is currently one of the most common diagnosis in Brazil. The aim of this study was to validate the Gastrointestinal Quality of Life Index (GIQLI) as a quality-of-life (QoL) assessment among the Brazilian population with syntomatic gallstone. Materials and Methods: The questionnaire was translated and culturally adapted after the linguistic validation process determined by the international methodology. Sixty-three patients who underwent laparoscopic cholecystectomy responded to the GIQLI-Brazil and Short-Form Health Survey (SF-36) instruments. For the evaluation of reproducibility, 30 patients responded to GIQLI-Brazil two more times after 2 and 4 weeks. After the University of São Paulo Ethics Commitee Board approval (UNIFESP/CEP: 1270/2019), the study was carryed out between May 2019 and February 2020 at the Gastroenterology outpatient clinic of Hospital São Paulo-Federal University of São Paulo (UNIFESP). Cronbach's alpha, the calculation of the intraclass correlation coefficient (ICC), and Spearman's correlation were used to assess the validity and reproducibility of the instrument translated into Portuguese, and to measure correlation between the domains of the GIQLI-Brazil and SF-36 (P < .05). Results: Seven questions were modified during the process of translation and cultural adaptation. The Brazilian version of the instrument presented a Cronbach's alpha of 0.89, and excellent reproducibility through the ICC, with the following variation between domains: meteorism (ICC = 0.918; P < .001) and gastrointestinal function (lower tract) (ICC = 0.956; P < .001). The dimensions of the GIQLI-Brazil and SF-36 demonstrated a significant correlation (P < .001), except between the domains: functional aspects of the SF-36 and gastrointestinal function (lower tract) of the GIQLI-Brazil (r = 0.211). Conclusion: The GIQLI was translated and validated for Portuguese-Brazil and can be used to assess the QoL of adult patients with gastrointestinal diseases and/or disorders.
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Affiliation(s)
- Karin Romano Posegger
- Division of Gastroenterology, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Carlos Toshinori Maeda
- Division of Gastroenterology, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - Elesiário Marques Caetano
- Division of Gastroenterology, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Marcos Bosi Ferraz
- Division of Medicine, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - Gaspar de Jesus Lopes Filho
- Division of Gastroenterology, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Marcelo Moura Linhares
- Division of Gastroenterology, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
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14
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Parra RS, Chebli JMF, Amarante HMBS, Flores C, Parente JML, Ramos O, Fernandes M, Rocha JJR, Feitosa MR, Feres O, Scotton AS, Nones RB, Lima MM, Zaltman C, Goncalves CD, Guimaraes IM, Santana GO, Sassaki LY, Hossne RS, Bafutto M, Junior RLK, Faria MAG, Miszputen SJ, Gomes TNF, Catapani WR, Faria AA, Souza SCS, Caratin RF, Senra JT, Ferrari MLA. Quality of life, work productivity impairment and healthcare resources in inflammatory bowel diseases in Brazil. World J Gastroenterol 2019; 25:5862-5882. [PMID: 31636478 PMCID: PMC6801193 DOI: 10.3748/wjg.v25.i38.5862] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/30/2019] [Accepted: 09/13/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Inflammatory bowel diseases (IBD) have been associated with a low quality of life (QoL) and a negative impact on work productivity compared to the general population. Information about disease control, patient-reported outcomes (PROs), treatment patterns and use of healthcare resources is relevant to optimizing IBD management. AIM To describe QoL and work productivity and activity impairment (WPAI), treatment patterns and use of healthcare resources among IBD patients in Brazil. METHODS A multicenter cross-sectional study included adult outpatients who were previously diagnosed with moderate to severe Crohn's disease (CD) or ulcerative colitis (UC). At enrolment, active CD and UC were defined as having a Harvey Bradshaw Index ≥ 8 or a CD Activity Index ≥ 220 or calprotectin > 200 µg/g or previous colonoscopy results suggestive of inadequate control (per investigator criteria) and a 9-point partial Mayo score ≥ 5, respectively. The PRO assessment included the QoL questionnaires SF-36 and EQ-5D-5L, the Inflammatory Bowel Disease Questionnaire (IBDQ), and the WPAI questionnaire. Information about healthcare resources and treatment during the previous 3 years was collected from medical records. Chi-square, Fisher's exact and Student's t-/Mann-Whitney U tests were used to compare PROs, treatment patterns and the use of healthcare resources by disease activity (α = 0.05). RESULTS Of the 407 patients in this study (CD/UC: 64.9%/35.1%, mean age 42.9/45.9 years, 54.2%/56.6% female, 38.3%/37.1% employed), 44.7%/25.2% presented moderate-to-severe CD/UC activity, respectively, at baseline. Expressed in median values for CD/UC, respectively, the SF-36 physical component was 46.6/44.7 and the mental component was 45.2/44.2, the EQ-visual analog scale score was 80.0/70.0, and the IBDQ overall score was 164.0/165.0. Moderate to severe activity, female gender, being unemployed, a lower educational level and lower income were associated with lower QoL (P < 0.05). Median work productivity impairment was 20% and 5% for CD and UC patients, respectively, and activity impairment was 30%, the latter being higher among patients with moderate to severe disease activity compared to patients with mild or no disease activity (75.0% vs 10.0%, P < 0.001). For CD/UC patients, respectively, 25.4%/2.8% had at least one surgery, 38.3%/19.6% were hospitalized, and 70.7%/77.6% changed IBD treatment at least once during the last 3 years. The most common treatments at baseline were biologics (75.3%) and immunosuppressants (70.9%) for CD patients and 5-ASA compounds (77.5%) for UC patients. CONCLUSION Moderate to severe IBD activity, especially among CD patients, is associated with a substantial impact on QoL, work productivity impairment and an increased number of IBD surgeries and hospitalizations in Brazil.
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Affiliation(s)
- Rogerio S Parra
- Department of Surgery and Anatomy, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP 14049-900, Brazil
| | - Julio MF Chebli
- Inflammatory Bowel Disease Center, Federal University of Juiz de Fora, Juiz de Fora, MG 36036-247, Brazil
| | - Heda MBS Amarante
- Hospital de Clinicas da Universidade Federal do Parana, Curitiba, PR 80060-900, Brazil
| | - Cristina Flores
- Hospital de Clinicas de Porto Alegre, Porto Alegre – RS 90035-007, Brazil
| | - Jose ML Parente
- Universidade Federal do Piaui, Teresina, PI 64073-500, Brazil
| | - Odery Ramos
- Hospital de Clínicas da Universidade Federal do Parana, Curitiba, PR 80060-900, Brazil
| | - Milene Fernandes
- CTI Clinical Trial & Consulting Services, Lisbon 1070-274, Portugal
| | - Jose JR Rocha
- Department of Surgery and Anatomy, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP 14049-900, Brazil
| | - Marley R Feitosa
- Department of Surgery and Anatomy, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP 14049-900, Brazil
| | - Omar Feres
- Department of Surgery and Anatomy, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP 14049-900, Brazil
| | | | - Rodrigo B Nones
- Hospital Nossa Senhora das Gracas, Curitiba, PR 80810-040, Brazil
| | - Murilo M Lima
- Hospital Universitario da Universidade Federal do Piaui, Teresina, PI 64049-550, Brazil
| | - Cyrla Zaltman
- Carolina D Gonçalves, Isabella M Guimaraes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ 21941-913, Brazil
| | | | | | | | - Ligia Y Sassaki
- Department of Internal Medicine, Botucatu Medical School at Sao Paulo State University (UNESP), Botucatu, SP 18618-687, Brazil
| | - Rogerio S Hossne
- Department of Internal Medicine, Botucatu Medical School at Sao Paulo State University (UNESP), Botucatu, SP 18618-687, Brazil
| | - Mauro Bafutto
- Instituto Goiano de Gastroenterologia e Endoscopia Digestiva Ltda, Goiania, GO 74535-170, Brazil
| | | | | | | | - Tarcia NF Gomes
- UNIFESP, Disciplina de Gastroenterologia, Sao Paulo, SP 04040-002, Brazil
| | | | - Anderson A Faria
- Faculdade de Medicina UFMG, Belo Horizonte, MG, 30130-100, Brazil
| | - Stella CS Souza
- Faculdade de Medicina UFMG, Belo Horizonte, MG, 30130-100, Brazil
| | | | - Juliana T Senra
- Takeda Pharmaceuticals Brazil, Sao Paulo, SP 04709-011, Brazil
| | - Maria LA Ferrari
- Faculdade de Medicina UFMG, Belo Horizonte, MG, 30130-100, Brazil
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Cury DB, Oliveira R, Cury MS. Inflammatory bowel diseases: time of diagnosis, environmental factors, clinical course, and management - a follow-up study in a private inflammatory bowel disease center (2003-2017). J Inflamm Res 2019; 12:127-135. [PMID: 31213873 PMCID: PMC6543909 DOI: 10.2147/jir.s190929] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The governmental program of Brazilian Unified National Health System has already published studies on the incidence of inflammatory bowel diseases (IBD), but up until now, there have been no epidemiological studies in private centers in Brazil. However, these diseases tend to affect people from a higher socioeconomic class, mainly in the capital of MS state that has the third highest GDP in Brazil. OBJECTIVES The aim was to analyze an observational, descriptive study of an IBD database in a private center including: the side, behavior of the disease and medical management, the association of extra-intestinal manifestations, and the main clinical symptoms which led to the investigation and diagnosis of IBD. PATIENTS AND METHODS A cohort study was developed in which data of all patients with IBD were analyzed with SPSS software in a constructed electronic database. RESULTS Of 329 patients, 212 (64.4%) had Crohn's disease (CD) and 117 (35.6%) had ulcerative colitis (UC). Average age at diagnosis of CD was 36.19 (±14.33) and of UC was 41.61 (±15.37). An amount of 50.05% of the patients with CD and 72.7% (P<0.001) with UC were female. We have observed that concerning the first symptoms, diahrrea and blood feces corresponded to 70% in UC while in CD 50% of the patients presented diahrrea with blood feces, loss of weight corresponded to 50% and only diahrrea 25%. (P<0.001). Anti-TNFs corresponded to 56.2% being more frequent in CD 0.001%. CD patients used biologic therapy and antibiotics more frequently than those with UC. In conclusion, IBD is also frequent in private health care centers in Brazil; women are most affected. Symptoms such as diarrhea and bleeding, as well as diarrhea and weight loss, must be taken as warning signs to investigate for inflammatory disease. The use of biologic therapies is frequent in referral centers when patients have severe disease.
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Affiliation(s)
- D B Cury
- Inflammatory Bowel Disease Center, Scope Clinic, Campo Grande/MS, Brazil,
| | - R Oliveira
- Biostatistics, UNESP, Botucatu, São Paulo, SP, Brazil
| | - M S Cury
- Advanced Endoscopy Center, Scope Clinic, Campo Grande/MS, Brazil
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16
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A hybrid approach of intelligent systems to help predict absenteeism at work in companies. SN APPLIED SCIENCES 2019. [DOI: 10.1007/s42452-019-0536-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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17
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Paixão DL, Poyares D, de Paula MS, Duarte JW, Castelo PM, Ambrogini-Júnior O, Miszputen SJ, Oshima CTF, Chagas JR, Paiotti APR. Evaluation of Home Polysomnography Findings, Quality of Sleep, and Fatigue in Inflammatory Bowel Disease: A Case Series. J Clin Sleep Med 2019; 15:39-45. [PMID: 30621826 DOI: 10.5664/jcsm.7566] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 08/30/2018] [Indexed: 12/18/2022]
Abstract
STUDY OBJECTIVES The pathogenesis of inflammatory bowel disease (IBD) is not well understood, and sleep disorders may be potential triggers for IBD. Thus, an evaluation of the sleep characteristics, fatigue symptoms, and cytokine levels was performed in patients with IBD during periods of active disease and remission. METHODS A total of 20 participants presenting with Crohn's disease or ulcerative colitis, with active disease (n = 7) or in remission (n = 13), underwent home polysomnography (H-PSG). Pittsburgh Sleep Quality Index (PSQI) and Modified Fatigue Impact Scale (MFIS) were applied, in addition to the evaluation of interleukin (IL)-6, IL-10, and tumor necrosis factor alpha (TNF-α) serum levels. Exploratory analysis, t test and Mann-Whitney U test were used. RESULTS The mean sleep latency in patients with active disease was 133.07 minutes and 106.79 minutes in those in remission. The sleep efficiency and sleep fragmentation in patients with active disease and those in remission were 80.90% and 84.20% (median), and 76.36/min and 69.82/min (mean), respectively, although the H-PSG parameters did not differ between the groups. The PSQI scores indicated poor sleep quality (global score above 5) in all participants with IBD, and the participants with active disease presented more symptoms of fatigue (P = .032). IL-6 and TNF-α average levels were higher in the participants with disease remission, although with a larger dispersion of the data. CONCLUSIONS No significant difference in the H-PSG characteristics was observed between the patients with IBD with active disease and those in remission; however, the perception of the participants with IBD showed significant effect on the sleep quality and fatigue symptoms.
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Affiliation(s)
- Deise Lun Paixão
- Department of Pathology, Universidade Federal de São Paulo, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil
| | - Dalva Poyares
- Department of Psychobiology, Universidade Federal de São Paulo, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil.,Sleep Institute, Universidade Federal de São Paulo, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil
| | - Marta Sevilh de Paula
- Sleep Institute, Universidade Federal de São Paulo, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil
| | - Joselmo Willamy Duarte
- Department of Pathology, Universidade Federal de São Paulo, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil
| | - Paula Midor Castelo
- Department of Pharmaceutical Sciences, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil
| | - Orlando Ambrogini-Júnior
- Department of Medicine, Discipline of Gastroenterology, Universidade Federal de São Paulo, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil
| | - Sender Jankie Miszputen
- Department of Medicine, Discipline of Gastroenterology, Universidade Federal de São Paulo, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil
| | - Celina Tizuko Fujiyam Oshima
- Department of Pathology, Universidade Federal de São Paulo, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil.,Department of Medicine, Discipline of Gastroenterology, Universidade Federal de São Paulo, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil
| | - Jair Ribeir Chagas
- Department of Psychobiology, Universidade Federal de São Paulo, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil
| | - Ana Paula Ribeir Paiotti
- Department of Pathology, Universidade Federal de São Paulo, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil.,Department of Medicine, Discipline of Gastroenterology, Universidade Federal de São Paulo, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil
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18
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Everhov ÅH, Khalili H, Askling J, Myrelid P, Ludvigsson JF, Halfvarson J, Nordenvall C, Söderling J, Olén O, Neovius M. Sick Leave and Disability Pension in Prevalent Patients With Crohn's Disease. J Crohns Colitis 2018; 12:1418-1428. [PMID: 30165593 DOI: 10.1093/ecco-jcc/jjy123] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Crohn's disease may affect the ability to work and lead to permanent disability. We aimed to investigate work loss in prevalent patients. METHODS We identified patients with Crohn's disease and general population comparators matched by sex, birth year, healthcare region and education. We assessed days of sick leave and disability pension retrieved from the Swedish Social Insurance Agency and estimated the absolute and relative risk of receiving disability pension [minimum 25% work impairment]. RESULTS In 2014, the 20638 Crohn's disease patients [median age 44 years] had more than twice as many mean lost workdays [disability pension: 44; sick leave: 19] as the 102038 comparators [disability pension: 20; sick leave: 8], mean difference 35 days [95% confidence interval 33-37]. However, the majority had no lost workdays [68% of patients and 85% of comparators]. The proportion of patients receiving disability pension was 15% (6.5% in the comparators, risk ratio 2.34 [2.25-2.43]) and was higher in all subgroups, especially in female patients [28% vs 13% in the comparators], in those with ≤9 years of education [41% vs 23%] and in ages 60-64 years [46% vs 25%]. The relative risk of disability pension within the patient cohort [adjusted for age, sex, region and education] was higher in patients with complicated disease behaviour, extraintestinal manifestations, need of surgery or treatment with biologics. The differences between patients and comparators remained when comparing other calendar years [2006-2013]. CONCLUSION Work loss was found in approximately one-third of patients. The mean number of lost workdays was twice as high as in the comparators.
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Affiliation(s)
- Åsa H Everhov
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Hamed Khalili
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Gastroenterology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Johan Askling
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Pär Myrelid
- Division of Surgery, Department of Clinical and Experimental Medicine, Faulty of Health Sciences, Linköping University and Department of Surgery, County Council of Östergötland Linköping, Sweden
| | - Jonas F Ludvigsson
- Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Caroline Nordenvall
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Center for Digestive Disease, Division of Coloproctology, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Söderling
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ola Olén
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatric gastroenterology and Nutrition, Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Martin Neovius
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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19
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Mathias H, van Zanten SV, Kits O, Heisler C, Jones J. Patient-ly Waiting: A Review of Patient-Centered Access to Inflammatory Bowel Disease Care in Canada. J Can Assoc Gastroenterol 2018; 1:26-32. [PMID: 31294393 PMCID: PMC6487989 DOI: 10.1093/jcag/gwy001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Canada has one of the highest prevalence estimates of inflammatory bowel disease (IBD) in the world. Like other chronic illnesses, access to specialist care is required for disease management. Traditionally, access to care is evaluated through wait times (actual access); however, new patient-oriented definitions of access (perceived access) highlight other equally important facets of access to care (e.g., appropriateness). Aim: How does access to gastroenterology speciality care influence disease-related outcomes for IBD patients in Canada? A comprehensive literature review was undertaken. Cochrane, PubMed and CINHAL databases were searched for peer-reviewed English language articles published between 2006 and 2016. Inclusion/exclusion criteria focussed on access to IBD care in Canada. Included articles were classified using Levesque et al.’s patient-centered access framework (e.g., affordability, accessibility, appropriateness, acceptability, availability and accommodation). Eight articles were found, including six which addressed patient-centered access. Most of the articles addressed issues of availability (e.g., wait times), appropriateness and affordability. Only one article addressed approachability and acceptability of IBD care. All articles emphasized a need for greater patient-centered measures (e.g., multidisciplinary clinics) with a goal to improve patient access and, ultimately, patient outcomes. Understanding patient-centered access to IBD care is important for managing IBD and improving patient outcomes. Literature examining access to gastroenterology services is limited. Increased investment in patient-oriented research should be made to better understand the relationship between access to specialist care and patient outcomes.
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Affiliation(s)
- Holly Mathias
- Nova Scotia Collaborative IBD Program, Division of Digestive Care and Endoscopy, QEII Health Sciences Centre, Centre for Clinical Research, Halifax, NS
| | - Sander Veldhuyzen van Zanten
- Division of Gastroenterology, University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, NW, Edmonton, AB
| | - Olga Kits
- Research Methods Unit, Nova Scotia Health Authority, Centre for Clinical Research Building, Halifax, NS
| | - Courtney Heisler
- Nova Scotia Collaborative IBD Program, Division of Digestive Care and Endoscopy, QEII Health Sciences Centre, Centre for Clinical Research, Halifax, NS
| | - Jennifer Jones
- Nova Scotia Collaborative IBD Program, Division of Digestive Care and Endoscopy, QEII Health Sciences Centre, Centre for Clinical Research, Halifax, NS
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20
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Zhou Y, Xu ZZ, He Y, Yang Y, Liu L, Lin Q, Nie Y, Li M, Zhi F, Liu S, Amir A, González A, Tripathi A, Chen M, Wu GD, Knight R, Zhou H, Chen Y. Gut Microbiota Offers Universal Biomarkers across Ethnicity in Inflammatory Bowel Disease Diagnosis and Infliximab Response Prediction. mSystems 2018; 3:e00188-17. [PMID: 29404425 PMCID: PMC5790872 DOI: 10.1128/msystems.00188-17] [Citation(s) in RCA: 226] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 12/05/2017] [Indexed: 12/14/2022] Open
Abstract
Gut microbiota dysbiosis contributes to the onset and perpetuation of inflammatory bowel disease (IBD). Given that gut microbiotas vary across geography and ethnicity, it remains obscure whether any universal microbial signatures for IBD diagnosis and prognosis evaluation exist irrespective of populations. Here we profiled the fecal microbiota of a series of Chinese IBD patients and combined them with two Western IBD cohorts, PRISM and RISK, for meta-analyses. We found that the gut microbial alteration patterns in IBD are similar among Chinese and Westerners. Our prediction model based on gut microbiome for IBD diagnosis is robust across the cohorts, which showed 87.5% and 79.1% prediction accuracy in Crohn's disease (CD) and ulcerative colitis (UC) patients, respectively. A relative increase in the levels of Actinobacteria and Proteobacteria (Enterobacteriaceae) and a relative decrease in the levels of Firmicutes (Clostridiales) were strongly correlated with IBD severity (P < 0.05). Additionally, restoration of gut microbiota diversity and a significant increase in Clostridiales relative abundance were found in patients responding to infliximab (IFX [Remicade]) treatment compared to those in relapse. Moreover, certain microbes, mainly Clostridiales, predicted the treatment effectiveness with 86.5% accuracy alone and 93.8% accuracy in combination with calprotectin levels and Crohn's disease activity index (CDAI). Taking the results together, we conclude that gut microbiota can offer a set of universal biomarkers for diagnosis, disease activity evaluation, and infliximab treatment response prediction in IBD. IMPORTANCE In the present report, we show that the human fecal microbiota contains promising and universal biomarkers for the noninvasive evaluation of inflammatory bowel disease severity and IFX treatment efficacy, emphasizing the potential ability to mine the gut microbiota as a modality to stratify IBD patients and apply personalized therapy for optimal outcomes.
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Affiliation(s)
- Youlian Zhou
- Department of Gastroenterology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of Gastroenterology, Guangzhou Digestive Disease Center, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Zhenjiang Zech Xu
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
- School of Food and Technology, Nanchang University, Nanchang, China
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang, China
| | - Yan He
- Department of Environmental Health, School of Public Health and Tropical Medicine, State Key Laboratory of Organ Failure Research, Southern Medical University, Guangzhou, China
- State Key Laboratory of Organ Failure Research, Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yunsheng Yang
- Institute of Digestive Diseases, Chinese PLA General Hospital, Beijing, China
| | - Le Liu
- Department of Gastroenterology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qianyun Lin
- Department of Gastroenterology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yuqiang Nie
- Department of Gastroenterology, Guangzhou Digestive Disease Center, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Mingsong Li
- Department of Gastroenterology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fachao Zhi
- Department of Gastroenterology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Side Liu
- Department of Gastroenterology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Amnon Amir
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | - Antonio González
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | - Anupriya Tripathi
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | - Minhu Chen
- Department of Gastroenterology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Gary D. Wu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rob Knight
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
- Department of Computer Science and Engineering, University of California, San Diego, La Jolla, California, USA
- Center for Microbiome Innovation, University of California, San Diego, La Jolla, California, USA
| | - Hongwei Zhou
- State Key Laboratory of Organ Failure Research, Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Ye Chen
- Department of Gastroenterology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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