Influência do sexo na apresentação clínica da doença inflamatória intestinal
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Tipo
TCC
Data de publicação
2023-11-27
Periódico
Citações (Scopus)
Autores
Pascholatto, Khadija Assis
Santos, Laura Ribeiro
Santos, Laura Ribeiro
Orientador
Nisihara, Renato Mitsunori
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Introdução: A doença inflamatória intestinal (DII) é um conjunto de síndromes que envolvem a Doença de Crohn (DC), retocolite ulcerativa (RCU) e colite indeterminada. Fatores genéticos, ambientais e do próprio indivíduo contribuem ao desenvolvimento. A patologia é caracterizada por doença crônica imunomediada que afeta o trato gastrointestinal, causando inflamação da mucosa. A sintomatologia geral da DII abrange episódios de diarreia, dor abdominal, fezes sanguinolentas e perda de peso. Os sintomas são inespecíficos e podem ser insidiosos. O diagnóstico pode ser arrastado, comprometendo a gravidade da doença e a qualidade de vida do paciente. A prevalência da DII depende de fatores extrínsecos e intrínsecos do indivíduo, entre eles o sexo. As mulheres são mais propensas a doenças autoimunes, tendo maior risco de desenvolvimento da DII. Estudos de outros países mostram diferenças na gravidade da DII de acordo com o sexo do paciente, sendo, em geral, mais grave nas mulheres. Objetivos: Identificar as diferenças na apresentação clínica das DII, comparando-se homens e mulheres no momento do diagnóstico. Métodos: Estudo do tipo retrospectivo e descritivo com análise de prontuários médicos de pacientes atendidos previamente (de janeiro de 2018 a setembro de 2021) no Ambulatório de Gastroenterologia do Hospital Universitário Evangélico Mackenzie, todos diagnosticados com DIl. Foram incluídos pacientes diagnosticados com DII com mais de 18 anos e excluídas gestantes ou prontuários incompletos. As fichas foram separadas em dois grupos: homens e mulheres. Os sintomas analisados foram: diarreia, perda de peso, dor abdominal, anorexia, sangramento retal, constipação, muco em fezes, melena, hematoquezia e tenesmo. Resultados: Foram estudados 160 pacientes com DII, sendo 100 mulheres e 60 homens. Dos casos totais, 43 (26,9%) eram de DC, 115 (71,9%) RCU e 2 (1,2%) colite indeterminada. Dos 43 casos de DC, 29 (67,4%) eram mulheres. A diferença de idade entre homens e mulheres no diagnóstico foi insignificante (p = 0.32). Não se observou diferença significativa na distribuição da localização da doença ou na apresentação clínica entre homens e mulheres. Dos 115 casos de RCU, 70 (60,9%) eram mulheres. A diferença de idade entre os sexos não foi significativa (p = 0.77), assim como a idade ao diagnóstico (p=0,90). Não houve diferença entre os sexos em relação à localização da doença. Presença de diarreia, dor abdominal, hematoquezia, alterações de fezes, perda de peso e sangramento retal não foi significativamente diferente entre os sexos. A constipação ocorreu em 11/115 (9,5%) pacientes, acometendo significativamente maior número de mulheres com RCU (10 (90,1%) mulheres; p=0.048). Conclusão: Na amostra estudada, não se verificou diferença significativa na frequência das manifestações clínicas de ambas as DII entre os sexos, exceto pela constipação, que foi mais prevalente em mulheres com RCU.
Introduction: Inflammatory bowel disease (IBD) is a group of syndromes that include Crohn's disease (CD), ulcerative colitis (UC), and indeterminate colitis. Genetic, environmental, and individual factors contribute to its development. The pathology is characterized by chronic immune-mediated disease that affects the gastrointestinal tract, causing inflammation of the mucosa. The general symptoms of IBD include episodes of diarrhea, abdominal pain, bloody stools, and weight loss. The symptoms are nonspecific and can be insidious. The diagnosis can be prolonged, compromising the severity of the disease and the patient's quality of life. The prevalence of IBD depends on extrinsic and intrinsic factors, including gender. Women are more prone to autoimmune diseases and have a higher risk of developing IBD. Studies from other countries show differences in the severity of IBD based on the patient's gender, generally being more severe in women. Objectives: To identify differences in the clinical presentation of IBD by comparing men and women at the time of diagnosis. Methods: A retrospective and descriptive study with analysis of medical records of patients previously evaluated (from January 2018 to September 2021) at the Gastroenterology service of the Hospital Universitário Evangélico Mackenzie, in Curitiba-PR, all diagnosed with IBD. Patients diagnosed with IBD over 18 years of age were included, and pregnant individuals or incomplete medical records were excluded. The records were divided into two groups: men and women. In total, 160 medical records were collected. The analyzed symptoms included diarrhea, weight loss, abdominal pain, anorexia, rectal bleeding, constipation, mucus in stools, melena, hematochezia, and tenesmus. Results: 160 IBD patients were studied, counting 100 women and 60 men. Of the total cases, 43 (26,9%) were CD, 115 (71,9%) UC, and 2 (1,2%) indeterminate colitis (CI). Of the 43 CD cases, 29 (67,4%) were women. The age difference between men and women at diagnosis was insignificant (p = 0.32). There is no statistically significant difference between men and women in the distribution of disease anatomical location. The clinical presentation of patients also showed no significant differences. Of the 115 UC cases, 70 (60,9%) were women. The age difference between genders is not statistically significant (p = 0.77), nor is the age at diagnosis (p = 0.90). The distribution of disease anatomical location showed no statistically significant differences. Clinical symptoms of diarrhea, abdominal pain, hematochezia, stool changes, weight loss, and rectal bleeding showed no statistical differences between genders. Constipation occurred in 11/115 (9.5%) patients, affecting a significantly greater number of women with UC (10 (90.1%) women; p=0.048). Conclusion: In the sample studied, there was no significant difference in the frequency of clinical manifestations of both IBD between the genders, except for constipation, which was more prevalent in women with UC.
Introduction: Inflammatory bowel disease (IBD) is a group of syndromes that include Crohn's disease (CD), ulcerative colitis (UC), and indeterminate colitis. Genetic, environmental, and individual factors contribute to its development. The pathology is characterized by chronic immune-mediated disease that affects the gastrointestinal tract, causing inflammation of the mucosa. The general symptoms of IBD include episodes of diarrhea, abdominal pain, bloody stools, and weight loss. The symptoms are nonspecific and can be insidious. The diagnosis can be prolonged, compromising the severity of the disease and the patient's quality of life. The prevalence of IBD depends on extrinsic and intrinsic factors, including gender. Women are more prone to autoimmune diseases and have a higher risk of developing IBD. Studies from other countries show differences in the severity of IBD based on the patient's gender, generally being more severe in women. Objectives: To identify differences in the clinical presentation of IBD by comparing men and women at the time of diagnosis. Methods: A retrospective and descriptive study with analysis of medical records of patients previously evaluated (from January 2018 to September 2021) at the Gastroenterology service of the Hospital Universitário Evangélico Mackenzie, in Curitiba-PR, all diagnosed with IBD. Patients diagnosed with IBD over 18 years of age were included, and pregnant individuals or incomplete medical records were excluded. The records were divided into two groups: men and women. In total, 160 medical records were collected. The analyzed symptoms included diarrhea, weight loss, abdominal pain, anorexia, rectal bleeding, constipation, mucus in stools, melena, hematochezia, and tenesmus. Results: 160 IBD patients were studied, counting 100 women and 60 men. Of the total cases, 43 (26,9%) were CD, 115 (71,9%) UC, and 2 (1,2%) indeterminate colitis (CI). Of the 43 CD cases, 29 (67,4%) were women. The age difference between men and women at diagnosis was insignificant (p = 0.32). There is no statistically significant difference between men and women in the distribution of disease anatomical location. The clinical presentation of patients also showed no significant differences. Of the 115 UC cases, 70 (60,9%) were women. The age difference between genders is not statistically significant (p = 0.77), nor is the age at diagnosis (p = 0.90). The distribution of disease anatomical location showed no statistically significant differences. Clinical symptoms of diarrhea, abdominal pain, hematochezia, stool changes, weight loss, and rectal bleeding showed no statistical differences between genders. Constipation occurred in 11/115 (9.5%) patients, affecting a significantly greater number of women with UC (10 (90.1%) women; p=0.048). Conclusion: In the sample studied, there was no significant difference in the frequency of clinical manifestations of both IBD between the genders, except for constipation, which was more prevalent in women with UC.
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Palavras-chave
doença inflamatória intestinal , clínica , sexo , inflammatory bowel disease , clinical presentation , gender