Análise de concordância entre enterotomografia, exames endoscópicos e a cirurgia na Doença de Crohn
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Data
2021-12-20
Autores
Renosto, Fernanda Lofiego
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: Doença de Crohn (DC) é uma doença inflamatória crônica, de etiologia multifatorial caracterizada por processo inflamatório persistente ou recidivante no trato gastrointestinal. A doença pode evoluir com complicações como estenoses, abscessos e fístulas que comprometem sobremaneira a qualidade de vida de seus portadores. A enterotomografia (entero-TC) é uma técnica de alta resolução que permite avaliar atividade inflamatória em cada segmento intestinal sem sobreposição de alças além da presença de complicações. Apesar de ser muito utilizada na abordagem do paciente com DC, nem sempre há concordância entre os achados radiológicos, a atividade clínica e os achados cirúrgicos. Portanto, os objetivos do presente estudo é avaliar a concordância entre os achados da entero- TC e a atividade da doença, os achados endoscópicos e cirúrgicos nos pacientes com DC e avaliar associação entre as características clínicas dos pacientes com a presença de complicações e atividade da doença visualizada com a entero-TC. Métodos: Realizado estudo observacional de corte transversal. Foram selecionados pacientes com DC atendidos no Hospital das Clínicas da Faculdade de Medicina de Botucatu submetidos a entero-TC para avaliação do processo inflamatório (sinal do pente) ou presença de complicações como estenose, dilatação, abscesso ou fístula. Os critérios radiológicos de avaliação da atividade inflamatória foram divididos em fase aguda e crônica. Fase aguda compreendeu espessamento parietal, realce estratificado da parede, densificação/obliteração de planos adiposos mesentéricos, presença de úlceras, fístulas e coleções e linfonodos mesentéricos. Fase crônica compreendeu realce homogêneo, proliferação adiposa mesentérica, estenoses fixas/dilatação a montante. Foram avaliados a presença de atividade inflamatória e complicações nos exames endoscópicos e na cirurgia dos pacientes que tinham esses dados. Análise Estatística: descritiva, testes de associação (p<0,05) e teste de coeficiente de concordância (Kappa). Resultados: Foram avaliados 105 pacientes, idade média de 41,61 ±15,33 anos e 56 (53,33%) mulheres. Presença de estenose na entero-TC foi associada com uso de infliximabe (p=0,0262), e uso de nenhuma medicação (p=0,0482). Houve associação entre estenose e fase aguda (p=0,0030) e fase crônica (p=0,0004) da doença. A presença do abscesso foi associada com PCR aumentado (p=0,0205), atividade clínica (p<,0001), fase aguda (p=0,0396) e fase crônica da doença (p=0,0398). O sinal do Resumo 3 pente foi associado com albumina alterada (p=0,0323) e fase aguda da doença (p=0,0003). Houve associação entre a presença de fístula e a atividade clínica da doença (p=0,0029), uso do adalimumabe (p= 0,0431), uso de antibiótico (p=0,0122) e fase aguda da doença (p=0,0047). Dilatação foi associada com a fase crônica (p<,0001). Não houve concordância entre a presença de complicações da DC e os exames de entero-TC, endoscopia e colonoscopia e não houve concordância entre os achados da cirurgia e endoscopia com as fases aguda e crônica da entero- TC. Conclusões: Não houve concordância entre os achados da entero-TC e achados endoscópicos e cirúrgicos nos pacientes com DC.
Introduction: Crohn's disease (CD) is a chronic inflammatory disease of multifactorial etiology characterized by persistent or recurrent inflammatory process in the gastrointestinal tract. The disease can evolve with complications such as susthesis, abscesses and fistulas that compromise the quality of life of its patients. Enterotomography (entero-CT) is a high-resolution technique that allows the evaluation of inflammatory activity in each intestinal segment without overlap of loops beyond the presence of complications. Although it is widely used in the approach of patients with CD, there is always no agreement between radiological findings, clinical activity and surgical findings. Therefore, the objectives of the present study is to evaluate the agreement between the findings of entero-CT and the activity of the disease, the endoscopic and surgical findings in patients with CD and to evaluate the association between the clinical characteristics of patients with the presence of complications and disease activity visualized with entero-CT. Methods: Cross-sectional observational study was conducted. Patients with CD treated at the Hospital das Clínicas of the Botucatu Medical School submitted to CT enterotous were selected for evaluation of the inflammatory process (comb sign) or presence of complications such as sthesis, dilation, abscess or fistula. The radiological criteria for evaluating inflammatory activity were divided into acute and chronic phanse. Acute phase comprised parietal thickening, stratified wall enhancement, densification/obliteration of mesenteric adipose planes, presence of ulcers, fistulas and collections and mesenteric lymph nodes. Chronic phase comprised homogeneous enhancement, mesenteric adipose proliferation, fixed suthesis/upstream dilation. The presence of inflammatory activity and complications in endoscopic examinations and surgery of patients with these data were evaluated. Statistical analysis: descriptive, association tests (p<0.05) and coefficient of agreement test (Kappa). Results: We evaluated 105 patients, mean age of 41.61 ±15.33 years and 56 (53.33%) women. Presence of ct enterosis snose was associated with the use of infliximab (p=0.0262), and use of no medication (p=0.0482). There was an association between sthesis and acute phase (p=0.0030) and chronic phase (p=0.0004) of the disease. The presence of abscess was associated with increased CRP (p=0.0205), clinical activity (p<.0001), acute phase (p=0.0396) and chronic phase of the disease (p=0.0398). The comb sign was Abstract 6 associated with altered albumin (p=0.0323) and acute phase of the disease (p=0.0003). There was an association between the presence of fistula and the clinical activity of the disease (p=0.0029), use of adalimumab (p= 0.0431), use of antibiotics (p=0.0122) and acute phase of the disease (p=0.0047). Dilation was associated with the chronic phase (p<.0001). There was no agreement between the presence of COMPLICATIONS of CD and ct entero-ct, endoscopy and colonoscopy scans, and there was no agreement between the findings of surgery and endoscopy with the acute and chronic phases of CT entero. Conclusions: There was no agreement between the findings of ct entero and endoscopic and surgical findings in patients with CD.
Introduction: Crohn's disease (CD) is a chronic inflammatory disease of multifactorial etiology characterized by persistent or recurrent inflammatory process in the gastrointestinal tract. The disease can evolve with complications such as susthesis, abscesses and fistulas that compromise the quality of life of its patients. Enterotomography (entero-CT) is a high-resolution technique that allows the evaluation of inflammatory activity in each intestinal segment without overlap of loops beyond the presence of complications. Although it is widely used in the approach of patients with CD, there is always no agreement between radiological findings, clinical activity and surgical findings. Therefore, the objectives of the present study is to evaluate the agreement between the findings of entero-CT and the activity of the disease, the endoscopic and surgical findings in patients with CD and to evaluate the association between the clinical characteristics of patients with the presence of complications and disease activity visualized with entero-CT. Methods: Cross-sectional observational study was conducted. Patients with CD treated at the Hospital das Clínicas of the Botucatu Medical School submitted to CT enterotous were selected for evaluation of the inflammatory process (comb sign) or presence of complications such as sthesis, dilation, abscess or fistula. The radiological criteria for evaluating inflammatory activity were divided into acute and chronic phanse. Acute phase comprised parietal thickening, stratified wall enhancement, densification/obliteration of mesenteric adipose planes, presence of ulcers, fistulas and collections and mesenteric lymph nodes. Chronic phase comprised homogeneous enhancement, mesenteric adipose proliferation, fixed suthesis/upstream dilation. The presence of inflammatory activity and complications in endoscopic examinations and surgery of patients with these data were evaluated. Statistical analysis: descriptive, association tests (p<0.05) and coefficient of agreement test (Kappa). Results: We evaluated 105 patients, mean age of 41.61 ±15.33 years and 56 (53.33%) women. Presence of ct enterosis snose was associated with the use of infliximab (p=0.0262), and use of no medication (p=0.0482). There was an association between sthesis and acute phase (p=0.0030) and chronic phase (p=0.0004) of the disease. The presence of abscess was associated with increased CRP (p=0.0205), clinical activity (p<.0001), acute phase (p=0.0396) and chronic phase of the disease (p=0.0398). The comb sign was Abstract 6 associated with altered albumin (p=0.0323) and acute phase of the disease (p=0.0003). There was an association between the presence of fistula and the clinical activity of the disease (p=0.0029), use of adalimumab (p= 0.0431), use of antibiotics (p=0.0122) and acute phase of the disease (p=0.0047). Dilation was associated with the chronic phase (p<.0001). There was no agreement between the presence of COMPLICATIONS of CD and ct entero-ct, endoscopy and colonoscopy scans, and there was no agreement between the findings of surgery and endoscopy with the acute and chronic phases of CT entero. Conclusions: There was no agreement between the findings of ct entero and endoscopic and surgical findings in patients with CD.
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Palavras-chave
Enterotomografia, Doença de Crohn, Doenças Inflamatórias Intestinais, Endoscopia, Intestinos - Cirurgia