Elia Paula Peruzzi, Fogaça Homero Soares, Barros Rodrigo G G Rego, Zaltman Cyrla, Elia Celeste Siqueira C
Serviço de Endoscopia Digestiva Pediátrica, Departamento de Cirurgia Pediátrica, Instituto Fernandes Figueira, Fiocruz, Brazil.
Arq Gastroenterol. 2007 Oct-Dec;44(4):332-9. doi: 10.1590/s0004-28032007000400010.
The epidemiologic survey in Brazil is limited probably due to a diagnosis deficiency and a small number of population-based studies performed. The majority of the prevalence studies available have evaluated inflammatory bowel diseases outpatients, but the knowledge of the profile of inflammatory bowel diseases inpatients is important in order to detect predictive markers of disease severity that will allow earlier medical intervention decreasing the rate of hospitalization and reducing the Health System costs.
To determine social, clinical, laboratorial and anthropometric profiles of hospitalized adults inflammatory bowel diseases patients of a tertiary university hospital.
Prospective study was performed with 43 inflammatory bowel diseases inpatients from clinical and surgical wards and emergency section of university hospital. We characterized demographic data, presence of comorbidities, disease location and behavior, surgical past-history, extra intestinal manifestations using standardized definitions. Laboratory results were abstracted from medical records and anthropometric measures were performed during our visit.
The vast majority of the inflammatory bowel diseases patients had Crohn's disease (72.1%), with ileocolic involvement (60%), with a penetrating disease behavior (77.4%) while ulcerative colitis group presented mostly pancolitis (50%). Articular pain was the most common (44.2%) extra intestinal manifestation of inflammatory bowel diseases patients and 97.7% of them had at least one type of complication related to disease. Although, the previous use of specific medical therapies to inflammatory bowel diseases before the hospitalization (more frequently corticosteroids) was done (79%), the majority of the patients were hospitalized because of inflammatory bowel diseases activity. Disease activity was present in 80.7% of Crohn's disease and 50% ulcerative colitis patients. Inflammatory bowel diseases mortality rate was 5.5% (2/36). Comorbidities presence occurred only in 30.2% of inflammatory bowel diseases patients. The predominant surgery performed was intestinal resection. The interval between the symptoms appearance and the definitive diagnosis was less than 1 year in more than 70% of inflammatory bowel diseases patients. Laboratory findings detected were a decreased serum albumin (85.7%) and anemia (69.8%). The majority of the patients had at least one anthropometric alteration. The social stratification of the inflammatory bowel diseases group was similar to the Brazilian population.
The inflammatory bowel diseases inpatients from the university hospital wards had more severe evolution of these illnesses with an active and extensive disease with complications and frequent extra intestinal manifestations, despite the prolonged use of corticosteroids. The higher prevalence of Crohn's disease inpatients than ulcerative colitis could reflect a higher aggressive behavior of this disease. The reduced serum albumin, anemia and anthropometric alterations are common inflammatory bowel diseases inpatients and could be related to a major severity of inflammatory bowel diseases evolution.
巴西的流行病学调查可能受到限制，这可能是由于诊断不足以及基于人群的研究开展较少。现有的大多数患病率研究评估的是炎症性肠病门诊患者，但了解炎症性肠病住院患者的特征对于发现疾病严重程度的预测标志物很重要，这将有助于早期医疗干预，降低住院率并减少卫生系统成本。
确定一所三级大学医院中住院的成年炎症性肠病患者的社会、临床、实验室和人体测量学特征。
对来自大学医院临床、外科病房及急诊科的43例炎症性肠病住院患者进行前瞻性研究。我们使用标准化定义对人口统计学数据、合并症的存在情况、疾病部位和行为、手术史、肠外表现进行了特征描述。实验室结果从病历中提取，人体测量在我们访视期间进行。
绝大多数炎症性肠病患者患有克罗恩病（72.1%），病变累及回结肠（60%），疾病行为为穿透性（77.4%），而溃疡性结肠炎组大多为全结肠炎（50%）。关节疼痛是炎症性肠病患者最常见的肠外表现（44.2%），其中97.7%的患者至少有一种与疾病相关的并发症。尽管在住院前曾使用过针对炎症性肠病的特定药物治疗（最常用的是皮质类固醇）（79%），但大多数患者因炎症性肠病活动而住院。80.7%的克罗恩病患者和50%的溃疡性结肠炎患者存在疾病活动。炎症性肠病死亡率为5.5%（2/36）。仅30.2%的炎症性肠病患者存在合并症。主要进行的手术是肠切除术。超过70%的炎症性肠病患者症状出现至明确诊断的间隔时间少于1年。检测到的实验室结果包括血清白蛋白降低（85.7%）和贫血（69.8%）。大多数患者至少有一种人体测量学改变。炎症性肠病组的社会分层与巴西人群相似。
尽管长期使用皮质类固醇，但大学医院病房的炎症性肠病住院患者病情进展更为严重，疾病活跃且广泛，伴有并发症和频繁的肠外表现。克罗恩病住院患者的患病率高于溃疡性结肠炎，这可能反映了该疾病更具侵袭性的行为。血清白蛋白降低、贫血和人体测量学改变在炎症性肠病住院患者中很常见，可能与炎症性肠病进展的更严重程度有关。
