Clinical Profile of Patients With Inflammatory Bowel Disease in Brazil: Analysis of the National Registry (GEDIIB)
AIBD 2023
Background:
In response to the rising prevalence of inflammatory bowel disease (IBD) in Brazil, which now exceeds 100 cases per 100,000 inhabitants, the Brazilian Crohn’s Disease and Colitis Organization (GEDIIB) established a National Registry of Patients with IBD to gather information about these conditions. This study presents a comprehensive analysis, encompassing all five geographic regions of the country (North, Northeast, Center-West, Southeast, and South), based on data collected over a span of three years.
Methods:
A cohort study was conducted from August 2020 to August 2023. The data were sourced from medical records and patient consultations using the REDCap platform, with approvals obtained from the ethics boards of participating institutions.
Results:
The study comprised 2,831 patients, with 47% diagnosed with ulcerative colitis (UC) and 51.1% with Crohn’s disease (CD). Sixty-two percent were followed in public centers, and 38% in the private system. The average age at diagnosis was 38 ± 15.5 years for UC and 33.7 ± 14.9 years for CD. Females predominated, constituting 64.5% of UC cases and 53.4% of CD cases. The majority of patients were of Caucasian descent (58.4% for UC, 63.7% for CD), followed by mixed-race individuals (32.3% for UC, 29.1% for CD) and Black individuals (8.8% for UC, 6.6% for CD). The most prevalent initial symptoms included abdominal pain, diarrhea, and weight loss, with CD patients experiencing them more frequently. Bleeding, such as enterorrhagia and hematochezia, was more common in UC. On average, diagnosis occurred approximately three years after the onset of symptoms. The Montreal CD classification revealed a predominance of A2 (58.8%), L3 (38.2%), and B1 (38.9%), with 19.3% perianal involvement. UC exhibited pancolitis (43.5%), left colitis (28.8%), and proctitis (27.7%). Notable oncologic comorbidities included colorectal and breast cancer, with 75% of colorectal cancers occurring in UC patients. Malnutrition affected only 3.9% of UC patients and 8.1% of CD patients, while overweight/obesity were alarmingly more prevalent (32% for UC, 18% for CD, and 27% for UC, 17% for CD, respectively). Among the extraintestinal manifestations, the most observed were rheumatological (19.4% for UC, 19.3% for CD), dermatological (5% for UC, 6.8% for CD), and hepatobiliary (3.8% for UC, 1.2% for CD). Comparing the data to previous years, the use of biological therapy, particularly infliximab, increased, while the use of 5-aminosalicylates (5-ASA) decreased in CD cases. Corticosteroid use was common at the time of diagnosis, affecting 50% of IBD patients. In the case of CD, there was a higher occurrence of urgent surgeries (40.8% vs 31%), resulting in 187 ostomies. Considering the surgeries of all IBD patients, 45% were open, and 10% were laparoscopic. Only 14 patients in the cohort died.
Conclusions:
The GEDIIB National Registry offers valuable insights into the profile of IBD in Brazil. Severe cases persist, and there is a growing trend in the use of biological therapy. The decline in 5-ASA use in CD cases suggests that increased medical education is promoting a more judicious use of medications, avoiding ineffective treatments that may delay the therapeutic window of opportunity and lead to greater complications.
