Epidemiology, demographic characteristics and prognostic predictors of ulcerative colitis

Introduction. The purpose of this study was to describe the clinical and demographic characteristics of UC in Bahia, a Brazilian state, and to identify the variables associated with extensive colitis, steroid therapy, immunosuppression, and colectomy.Methods. In this cross-sectional study UC patients were interviewed, and additional information was collected from the medical records. Descriptive statistics and multivariate Poisson regression analysis were used.Results. This study included 267 individuals, the mean age of whom was 39.4 years at diagnosis. There was a predominance of females and left-side colitis. Extensive colitis was positively associated with male gender, diarrhea, weight loss, and a younger age at diagnosis. In contrast, active smoking and a family history of IBD were negatively associated with extensive colitis. Positive associations were observed between steroid therapy and diarrhea, weight loss, urban patients, extraintestinal manifestations (EIMs), and hospitalization. Younger age and weight loss at diagnosis, a family history of IBD, extensive colitis, EIMs, hospitalization, and steroid therapy were all positively associated with immunosuppression. In contrast, Caucasian individuals, smokers, patients with rectal bleeding, and rural patients areas were all observed to have a decreased likelihood of immunosuppression.Conclusions. Our results corroborate the association between higher prevalence of extensive colitis and younger age at diagnosis. An association between steroid therapy and clinical presentation at diagnosis was observed. The observation that white individuals and rural patients use less immunosuppressive drugs highlights the need to study the influence of environmental and genetic factors on the behavior of UC in this population.

Background: Small intestinal bacterial overgrowth (SIBO) is a condition characterized by an abnormal increase in bacterial population in the small intestine, leading to symptoms such as bloating, abdominal pain, distension, diarrhea, and eventually malabsorption. The diagnosis and management of SIBO remain challenging due to overlapping symptoms with other gastrointestinal disorders such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), and coeliac disease.

Key words: Pleural tuberculosis; Extrapulmonary tuberculosis; Nested PCR diagnosis; Mycobacterium tuberculosis

Background and Aims: This systematic review aims to elucidate the use of corticosteroids in randomized clinical trials (RCTs) evaluating biologics and small molecules for inflammatory bowel disease (IBD). We analyzed corticosteroid use during both the induction and maintenance phases, highlighting areas needing standardization and improvement in clinical research. Methods: We selected placebo-controlled phase 3 RCTs involving adults with moderate to severe IBD. These studies included detailed reports on corticosteroid use during induction and maintenance phases, with clinical remission and/or corticosteroid-free clinical remission (CSF-CR) as primary endpoints. Results: Initially, 324 studies were identified and refined to 26 RCTs after screening. Analysis revealed variability in corticosteroid administration. Over time, corticosteroid use showed a decreasing trend (Spearman ρ = −0.42, P = .045). Studies allowing higher corticosteroid doses (up to 40 mg/day of prednisone or equivalent) reported a higher proportion of corticosteroid users (51.8%, range: 42.9%-61%) compared to those excluding patients on doses >20 mg/day (37.5%, range: 31.6%-51.8%; P = .007) or >30 mg/day (41.1%, range: 29.6%-53.7%; P = .023). Trials with mandatory tapering protocols showed a narrower gap between overall clinical remission and CSF-CR rates, with an average difference of 6% in the group without mandatory tapering and 1.2% in the group with forced tapering (T-test P = .038; Cohen’s d ≈ 1.1). Conclusions: This review highlights the variability in corticosteroid use across RCTs and its impact on evaluating new IBD therapies. Standardizing tapering protocols and defining CSF-CR are essential for accurate outcomes.

The extraintestinal manifestations of inflammatory bowel disease have been described in association with almost every organ system. IBD can be associated with several respiratory disorders. Histologically, the nodules usually show sterile aggregates of neutrophils containing areas of necrosis. We found published reports of 15 cases of pulmonary nodules associated with IBD, as of august 2011, predominantly as a manifestation of Crohn’s disease (CD) A 17- year-old male patient was diagnosed with ulcerative colitis (UC), with extensive colitis, and primary sclerosing cholangitis (PSC) 2 years ago. He had been treated with topical combined with oral mesalazine and ursodeoxycholic acid since the diagnosis of the disease. The patient started on azathioprine 3 months ago. He was current in remission, but increased ESR and CRP still remained. He presented with symptoms of cough, pleuritic chest pain and mild dyspnea. He described no fevers. He was treated with ceftriaxone and azithromycin, azathioprine was stopped, but it appeared to be ineffective. CT of the thorax revealed pleural effusion and multiple small pulmonary nodules in both lungs. Open lung biopsy showed a granuloma with central coagulative and lytic necrosis, neutrophils in the periphery and foamy histiocytes, consistent with necrobiotic nodules, interstitial pneumonia, organizing pneumonia and focal bronchiolitis obliterans. His respiratory symptoms improved with a course of prednisone (1 mg/kg/day). A follow-up CT scan showed resolution of the pleural effusion and a >75% reduction in pulmonary nodules size. Respiratory manifestations can be observed in patients with IBD, but they remain uncommon. The incidence of respiratory involvement is greater in UC than in CD, although the necrobiotic nodules have been reported most frequently in CD. We report a case of UC associated with PSC presenting lung involvement with predominance of necrobiotic nodules and serositis. Unlike other cases, this patient presents at younger age than usual. Of 15 reported patients with the association of IBD and necrobiotic nodules, CD was present in 10 patients and UC in five (aged 20 to 75 years). The respiratory disease can develop at any point during the course of IBD. Most patients have respiratory and constitutional symptoms, but quiescent bowel disease, as occurred in this case. Most cases responded well to steroids, but the exclusion of an infectious cause is mandatory. In most reported cases steroid therapy was prescribed alone, however in some patients there was an association with other drugs such as immunosuppressive drugs and infliximab. Clinical and radiologic spontaneous resolution, although controversial, has been reported, which may raise questions about the optimal therapeutic management for this condition. Pulmonary necrobiotic nodules are a rare manifestation of IBD. Although steroid therapy provides favorable clinical and radiological response, further studies are needed to define the best approach.