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Magro F.,Institute of Pharmacology and Therapeutics | Magro F.,University of Porto | Rodrigues A.,Bio Clinical and Translational Research Center | Vieira A.I.,Hospital Garcia de Orta | And 11 more authors.
Inflammatory Bowel Diseases | Year: 2012

Background: Ulcerative colitis (UC) has a large impact on patients' lives. Clinical course studies of population-based cohorts contribute to our understanding of the disease as it progresses. We reviewed the clinical course of UC as reported in adult population-based longitudinal cohort studies. Methods: A MEDLINE literature search to identify all adult population-based studies published up to June 2010 with data on the clinical course of UC was performed. Demographic and clinical data were reviewed. Results: Twenty-two studies reporting data from seven prospective longitudinal cohorts were identified. Extension from initial location varied from 10%-19% of the patients after 5 years of disease and from 11%-28% after 10 years in two of the cohorts. Disease activity appeared to improve over the disease course. The majority of patients had relapses in the first years of disease. The cumulative relapse rate varied from 67%-83% after 10 years of disease. From 1962-2004 a decreasing trend in the proportion of colectomies was observed. Most colectomies were performed during the first 2 years of disease and in patients with pancolitis. Salycilates were the most consumed medication followed by systemic steroids, immunosuppressors, and antitumor necrosis factors, with the latter two showing a substantial increased intake over time. Mortality increased with disease duration. Conclusions: This review shows how the clinical course of UC has changed over time and alerts to the need for more prospective cohort studies to evaluate long-term outcomes especially to study the impact of biologic agents on UC. Copyright © 2011 Crohn's & Colitis Foundation of America, Inc.

Burisch J.,Copenhagen University | Pedersen N.,Copenhagen University | Cukovic-Cavka S.,University of Zagreb | Brinar M.,University of Zagreb | And 51 more authors.
Gut | Year: 2014

Objective: The incidence of inflammatory bowel disease (IBD) is increasing in Eastern Europe. The reasons for these changes remain unknown. The aim of this study was to investigate whether an East-West gradient in the incidence of IBD in Europe exists. Design: A prospective, uniformly diagnosed, population based inception cohort of IBD patients in 31 centres from 14 Western and eight Eastern European countries covering a total background population of approximately 10.1 million people was created. One-third of the centres had previous experience with inception cohorts. Patients were entered into a low cost, web based epidemiological database, making participation possible regardless of socioeconomic status and prior experience. Results: 1515 patients aged 15 years or older were included, of whom 535 (35%) were diagnosed with Crohn's disease (CD), 813 (54%) with ulcerative colitis (UC) and 167 (11%) with IBD unclassified (IBDU). The overall incidence rate ratios in all Western European centres were 1.9 (95% CI 1.5 to 2.4) for CD and 2.1 (95% CI 1.8 to 2.6) for UC compared with Eastern European centres. The median crude annual incidence rates per 100 000 in 2010 for CD were 6.5 (range 0-10.7) in Western European centres and 3.1 (range 0.4-11.5) in Eastern European centres, for UC 10.8 (range 2.9-31.5) and 4.1 (range 2.4-10.3), respectively, and for IBDU 1.9 (range 0-39.4) and 0 (range 0-1.2), respectively. In Western Europe, 92% of CD, 78% of UC and 74% of IBDU patients had a colonoscopy performed as the diagnostic procedure compared with 90%, 100% and 96%, respectively, in Eastern Europe. 8% of CD and 1% of UC patients in both regions underwent surgery within the first 3 months of the onset of disease. 7% of CD patients and 3% of UC patients from Western Europe received biological treatment as rescue therapy. Of all European CD patients, 20% received only 5-aminosalicylates as induction therapy. Conclusions: An East-West gradient in IBD incidence exists in Europe. Among this inception cohort-including indolent and aggressive cases-international guidelines for diagnosis and initial treatment are not being followed uniformly by physicians.

Moreira-Rodrigues M.,Nephrology Research and Development Unit | Quelhas-Santos J.,Nephrology Research and Development Unit | Serrao P.,Institute of Pharmacology and Therapeutics | Fernandes-Cerqueira C.,Nephrology Research and Development Unit | And 3 more authors.
Nephrology Dialysis Transplantation | Year: 2010

Background. It was demonstrated in streptozotocin (STZ)-induced diabetic rats that the D1 receptor agonist failed to promote sodium excretion as a result of reduced renal D1 receptor expression and decreased receptor G protein coupling. The present study examined the influence of glycaemic control with insulin on the renal D1 receptor dysfunction in STZ-induced type 1 diabetes.Methods. Renal function, blood pressure, the natriuretic response to 5% volume expansion (VE) and the effects of the D1 receptor agonist fenoldopam on natriuresis and on Na+/K+-ATPase activity in renal tubules were evaluated in uninephrectomized and sham-operated Wistar rats treated with STZ and compared with controls and STZ-treated rats made euglycaemic with insulin. D1 receptor immunohistochemistry and protein abundance by western blot were also determined in all groups.Results. Treatment of sham and uninephrectomized rats with STZ caused a 4-fold increase in glucose plasma levels compared to controls and euglycaemic diabetic rats. A blunted natriuretic response to VE was observed in both sham and uninephrectomized hyperglycaemic diabetic rats, and this was accompanied by failure of fenoldopam to increase natriuresis and to inhibit renal Na+/K+-ATPase activity. In contrast, in both sham and uninephrectomized euglycaemic diabetic rats, the natriuretic response to VE, the fenoldopam-induced natriuresis and the accompanied inhibition of Na+/K+-ATPase activity were similar to those of the corresponding controls. D1 receptor immunodetection and protein abundance were reduced in hyperglycaemic diabetic rats, but not in euglycaemic diabetic animals.Conclusions. We conclude that the renal expression and natriuretic response to D1 receptor activation is compromised in both sham and uninephrectomized rats with STZ-induced diabetes. These abnormalities were prevented by lowering glucose blood levels with insulin, thus providing evidence for the involvement of hyperglycaemia in the disturbances that underlie the compromised dopamine-sensitive natriuresis and increase of blood pressure in type 1 diabetes. © The Author 2010. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Soares J.-B.,Hospital of Braga | Marinho A.S.,Hospital of Braga | Marinho A.S.,University of Minho | Fernandes D.,Hospital of Braga | And 8 more authors.
European Journal of Gastroenterology and Hepatology | Year: 2015

Background/aims Structural equation modeling (SEM) is a very popular data-analytic technique for the evaluation of customer satisfaction. We aimed to measure the overall satisfaction of inflammatory bowel disease (IBD) patients with healthcare in Portugal and to define its main determinants using SEM. Patients and methods The study included three steps: (i) specification of a patient satisfaction model that included the following dimensions: Image, Expectations, Facilities, Admission process, Assistant staff, Nursing staff, Medical staff, Treatment, Inpatient care, Outpatient care, Overall quality, Overall satisfaction, and Loyalty; (ii) sample survey from 2000 patients, members of the Portuguese Association of the IBD; and (iii) estimation of the satisfaction model using partial least squares (XLSTAT-PLSPM). Results We received 498 (25%) valid questionnaires from 324 (66%) patients with Crohn's disease and 162 (33%) patients with ulcerative colitis. Our model provided a substantial explanation for Overall satisfaction (R 2 =0.82). The mean index of overall satisfaction was 74.4 (0-100 scale). The main determinants of Overall satisfaction were the Image (β=0.26), Outpatient care (β=0.23), and Overall quality (β=0.21), whose mean indices were 83, 75, and 81, respectively. Facilities and Inpatient care were the variables with a significant impact on Overall satisfaction and the worst mean indices. Conclusion SEM is useful for the evaluation of IBD patient satisfaction. The Overall satisfaction of IBD patients with healthcare in Portugal is good, but to increase it, IBD services need to focus on the improvement of Outpatient care, Facilities, and Inpatient care. Our model could be a matrix for a global model of IBD patient satisfaction. © 2015 Wolters Kluwer Health, Inc. All rights reserved.

Barreiro-De Acosta M.,EIGA Inflammatory Bowel Disease Group of Galicia | Barreiro-De Acosta M.,University of Santiago de Compostela | Magro F.,Portuguese Group of Studies of Inflammatory Bowel Diseases | Magro F.,Institute of Pharmacology and Therapeutics | And 19 more authors.
Inflammatory Bowel Diseases | Year: 2010

Background: Clinical and therapeutic patterns of ulcerative colitis (UC) are variable in different world regions. The purpose of this study was to examine two close independent southern European UC populations from 2 bordering countries and observe how demographic and clinical characteristics of patients can influence the severity of UC. Methods: A cross-sectional study was conducted during a 15-month period (September 2005 to December 2006) based on data of 2 Web registries of UC patients. Patients were stratified according to the Montreal Classification and disease severity was defined by the type of treatment taken. Results: A total of 1549 UC patients were included, 1008 (65%) from northern Portugal and 541 (35%) from Galicia (northwest Spain). A female predominance (57%) was observed in Portuguese patients (P < 0.001). The median age at diagnosis was 35 years and median years of disease was 7. The majority of patients (53%) were treated only with mesalamine, while 15% had taken immunosuppressant drugs, and 3% biologic treatment. Most patients in both groups were not at risk for aggressive therapy. Extensive colitis was a predictive risk factor for immunosuppression in northern Portugal and Galicia (odds ratio [OR] 2.737, 95% confidence interval [CI]: 1.846-4.058; OR 5.799, 95% CI: 3.433-9.795, respectively) and biologic treatment in Galicia (OR 6.329, 95% CI: 2.641-15.166). Younger patients presented a severe course at onset with more frequent use of immunosuppressors in both countries. Conclusions: In a large population of UC patients from two independent southern European countries, most patients did not require aggressive therapy, but extensive colitis was a clear risk factor for more severe disease. Copyright © 2009 Crohn's & Colitis Foundation of America, Inc.

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