The Impact of a Real-Life Inflammatory Bowel Disease Education Course for Brazilian Physicians from the Perspective of Its Participants

Background: Physicians must acquire the necessary skills to provide Inflammatory Bowel Disease (IBD) patients with state-of-the-art clinical care, aiming to improve patient’s quality of life and disease outcomes. Purpose: To describe the queries and experiences of doctors enrolled in an IBD education course and to evaluate the impact of the course. Methods: A retrospective study included 100 physicians, of which 78 attended the course. A questionnaire was applied evaluating how the course had an impact on their IBD-knowledge. The 20-hour-course consisted of practical “real-life” activities and theoretical discussions. Results: The majority of doctors’ expertise was in gastroenterology (53%) and coloproctology (44%). A significant portion had no experience with biological therapy for ulcerative colitis (19.4%) or Crohn’s disease (5.05%). The main topics doctors wanted to discuss were biological therapy (93%), new drugs (74%) and differential diagnosis (64%). A considerable number of physicians did not feel confident at prescribing biological therapy before the course (44.4%), a percentage that decreased to 8.5% after the course (p < 0.0001). The impact of the course was considered high (grades 9 and 10) by most of the participants (78.2%). Discussion: The ideal course should have a practical and theoretical component, as well as the support of an experienced multidisciplinary team. A real-life practical-theoretical IBD course proved a success at increasing IBD knowledge.

MicroRNA expression in inflammatory bowel disease-associated colorectal cancer

MicroRNAs(miRNAs)are non-coding RNA molecules composed of 19–25 nucleotides that regulate gene expression and play a central role in the regulation of several immune-mediated disorders,including inflammatory bowel diseases(IBD).IBD,represented by ulcerative colitis and Crohn’s disease,is characterized by chronic intestinal inflammation associated with an increased risk of colorectal cancer(CRC).CRC is one of the most prevalent tumors in the world,and its main risk factors are obesity,physical inactivity,smoking,alcoholism,advanced age,and some eating habits,in addition to chronic intestinal inflammatory processes and the use of immunosuppressants administered to IBD patients.Recent studies have identified miRNAs associated with an increased risk of developing CRC in this population.The identification of miRNAs involved in this tumorigenic process could be useful to stratify cancer risk development for patients with IBD and to monitor and assess prognosis.Thus,the present review aimed to summarize the role of miRNAs as biomarkers for the diagnosis and prognosis of IBD-associated CRC.In the future,therapies based on miRNA modulation could be used both in clinical practice to achieve remission of the disease and restore the quality of life for patients with IBD,and to identify the patients with IBD at high risk for tumor development.

Artificial intelligence in colorectal cancer screening in patients with inflammatory bowel disease

Artificial intelligence(AI)is a branch of computer science that develops intelligent machines.In recent years,medicine has been contemplated with this recent modality to aid in the diagnosis of diseases in several specialties,including gastroenterology and gastrointestinal endoscopy.This new technology has superior ability to perform tasks mimicking human behavior and can identify possible pathological alterations,such as pre-malignant lesions and dysplasia,precursor lesions of colorectal cancer(CRC),and support medical decisionmaking.CRC is among the three most prevalent cancer types,and the second most common cause of cancer-related deaths worldwide;in addition,it is a leading cause of death in patients with inflammatory bowel disease(IBD).Patients with IBD tend to have greater inflammatory cell activity in the intestinal mucosa,which can favor cell proliferation and CRC development.AI can contribute to the detection of pre-neoplastic lesions in patients at risk of CRC development,such as those with extensive IBD or when additional CRC risk factors,such as smoking,are present.In fact,AI systems could improve all aspects of care related to both the detection of pre-malignant and malignant lesions and the screening of patients with IBD.In this review,we aimed to show the benefits and innovations of AI in the screening of CRC in patients with IBD.The promising applications of AI have the potential to revolutionize clinical practice and gastrointestinal endoscopy,especially in at-risk patients,such as those with IBD.

Heart failure as an adverse effect of infliximab for Crohn's disease: A case report and review of the literature

BACKGROUND Anti-tumor necrosis factor agents were the first biologic therapy approved for the management of Crohn's disease(CD).Heart failure(HF)is a rare but potential adverse effect of these medications.The objective of this report is to describe a patient with CD who developed HF after the use of infliximab.CASE SUMMARY A 50-year-old woman with a history of hypertension and diabetes presented with abdominal pain,diarrhea,and weight loss.Colonoscopy and enterotomography showed ulcerations,areas of stenosis and dilation in the terminal ileum,and thickening of the intestinal wall.The patient underwent ileocolectomy and the surgical specimen confirmed the diagnosis of stenosing CD.The patient started infliximab and azathioprine treatment to prevent post-surgical recurrence.At 6 mo after initiating infliximab therapy,the patient complained of dyspnea,orthopnea,and paroxysmal nocturnal dyspnea that gradually worsened.Echocardiography revealed biventricular dysfunction,moderate cardiac insufficiency,an ejection fraction of 36%,and moderate pericardial effusion,consistent with HF.The cardiac disease was considered an infliximab adverse effect and the drug was discontinued.The patient received treatment with diuretics for HF and showed improvement of symptoms and cardiac function.Currently,the patient is using anti-interleukin for CD and is asymptomatic.CONCLUSION This reported case supports the need to investigate risk factors for HF in inflammatory bowel disease patients and to consider the risk-benefit of introducing infliximab therapy in such patients presenting with HF risk factors.