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Serotonin (5-HT) has complex effects on the central nervous system (CNS), neuroendocrine mechanisms, immunological reactions, intestinal microbiome, and cancer. It has been associated with more severe signs and symptoms of colitis, as well as promoting colorectal cancer (CRC) cells toward expansion. However, recent findings revealed that impairments in 5-HT synthesis lead to high levels of DNA damage in colonocytes, which is linked with inflammatory reactions promoting the development of CRC. Here, we review the diverse roles of 5-HT in intestinal homeostasis and in CRC and discuss how improved understanding of the modulation of the 5-HT pathway could be helpful for the design of novel anticancer therapies.

Rationale: Disuse colitis is frequent in our country and the most effective treatment is high cost and there is a need for effective and low cost therapy. Objective: To evaluate the efficacy of Baccharis dracunculifolia (field rosemary) in the treatment of exclusion colitis in rats. Method: Eighteen Wistar rats were anesthetized and submitted to colostomy; they were then distributed into two groups: Control Group, receiving intrarectal saline infusion (n = 8) and Group BD receiving intrarectal infusion ofBaccharis dracunculifolia extract (n = 10); after 21 days of treatment they were euthanized, the intestinal segment excluded from intestinal transit was resected and submitted to histopathological study, classifying the degree of inflammation and degree of vascular congestion from 0 to 3. Results: Mean inflammation was 2.7 in Control Group versus 2.1 in BD Group (p = 0.049), while mean vascular congestion was 2.3 and 2, respectively, in Control and BD groups (p = 0.1642). Conclusion: Intra-rectal infusion ofBaccharis dracunculifolia extract significantly minimized the inflammatory process in the exclusion colitis of rats submitted to colostomy, without altering the degree of vascular congestion. Resumo: Racional: A colite de desuso é frequente em nosso meio e o tratamento de maior eficácia é de alto custo, havendo necessidade de se encontrar uma terapêutica eficaz e de baixo custo. Objetivo: Avaliar a eficácia da Baccharis dracunculifolia (alecrim-do-campo) no tratamento da colite de exclusão em ratos. Método: Utilizou-se 18 ratos Wistar, os quais foram anestesiados e submetidos à colostomia; em seguida distribuídos em 2 grupos: Grupo Controle, recebendo infusão intrarretal de solução salina (n = 8) e Grupo BD, recebendo infusão intrarretal de extrato de Baccharis dracunculifolia (n = 10); após 21 dias de tratamento foram submetidos a eutanásia, o segmento intesinal excluso de trânsito intestinal foi ressecado e submetido a estudo histopatológico classificando-se o grau de inflamação e grau de congestão vascular de 0 a 3. Resultados: Verificou-se média de inflamação 2,7 no Grupo Controle vs. 2,1 no Grupo BD (p = 0,049), enquanto as médias de congestão vascular foram 2,3 e 2, respectivamente, nos grupos controle e BD (p = 0,1642). Conclusão: A infusão intrarretal do extrato de Baccharis dracunculifolia minimizou significantemente o processo inflamatório na colite de exclusão de ratos submetidos à colostomia, sem alterar o grau de congestão vascular. Keywords: Baccharis dracunculifolia, Asteraceae, Colitis, Anti-inflammatory, Rats, Colostomy, Palavras-chave: Baccharis dracunculifolia, Asteraceae, Colite, Anti-inflamatórios, Ratos, Colostomia

In dogs, antimicrobial therapy for Clostridioides (Clostridium) difficile infection (CDI) is based solely on metronidazole, leaving limited treatment options in case of recurrent disease. Fecal microbiota transplantation (FMT) has been successfully used in humans with recurrent CDI, whereas the usefulness of this approach is largely unknown in dogs. In the present study, a dog with a chronic-recurring diarrhea was treated with FMT via colonoscopy. CDI was confirmed by A/B toxin detection and isolation of toxigenic C. difficile from ribotype 106, a strain also commonly associated with nosocomial infection in humans. The dog recovered well after the procedure and C. difficile was no longer isolated from its stool sample. The present research suggested that FMT could be a useful tool to treat recurrent CDI in dogs, corroborating the actual protocol in humans. RESUMO: Em cães, a terapia antimicrobiana para infecções por Clostridioides (Clostridium) difficile é baseada apenas no uso de metronidazol, limitando as opções de tratamento nos casos de recorrência. O transplante de microbiota fecal (FMT) tem sido utilizado com sucesso em seres humanos com infecções recorrentes por C. difficile, porém a utilidade desse método é ainda amplamente desconhecida em cães. O presente trabalho relata a utilização de FMT para o tratamento de um cão com diarreia crônica-recorrente por C. difficile. A infecção foi confirmada por detecção das toxinas A/B e isolamento de uma estirpe toxigênica do ribotipo 106, linhagem comumente associada a infecção em seres humanos. Após o transplante via colonoscopia, o animal se recuperou do quadro e C. difficile não mais foi encontrado em novas amostras fecais. O presente trabalho sugere que o FMT possa ser útil para o tratamento de quadros de C. difficile em cães, corroborando protocolo atual de tratamento em seres humanos.

Clostridioides (Clostridium) difficile is the main causative agent of antimicrobial-related diarrhea in humans and a major pathogen-associated enteric disorder in foals and adult horses. Moreover, studies have suggested that animals are a possible reservoir of toxigenic C. difficile strains for humans. Despite this known importance, the epidemiology of C. difficile infection (CDI) in equine is still largely unknown. Therefore, this study described six cases of equine CDI occurring in Minas Gerais, Brazil, including the characterization of the isolates. All but one equine included in this research developed CDI after antimicrobial therapy, three of which occurred during hospitalization. Coinfection with Salmonella Heidelberg and S. Infantis was detected in three cases, making the antimicrobial treatment challenging. All animals recovered after metronidazole administration. All C. difficile isolates were susceptible to metronidazole and vancomycin, while three were resistant to moxifloxacin and two were resistant to clindamycin. The isolates were classified as RT126 (n = 4), RT078 (n = 1), and RT014/020 (n = 1), all previously reported infecting humans and animals worldwide. RESUMO: Clostridioides (Clostridium) difficile é o principal agente envolvido em diarreias associadas ao uso de antimicrobianos em seres humanos e um enteropatógeno de grande relevância em quadros de diarreia em potros e equinos adultos. Em adição, estudos tem sugerido que animais são possíveis reservatórios de estirpes toxigênicas de C. difficile para humanos. Apesar da importância na saúde animal e humana, a epidemiologia da infecção por C. difficile (ICD) é ainda pouco conhecida. Dessa forma, o presente estudo tem como objetivo caracterizar seis casos de diarreia por C. difficile ocorridos em Minas Gerais, Brasil. Com exceção de um animal, todos os equinos incluídos no presente estudo desenvolveram ICD após antibioticoterapia, três dos quais durante a hospitalização. Coinfecção por Salmonella Heidelberg e S. Infantis foi detectada em três casos, tornando o tratamento antimicrobiano desafiador. Todos os animais recuperaram após administração de metronidazol. Os isolados obtidos no presente estudo foram sensíveis a metronidazol e vancomicina, porém três estirpes foram resistentes a moxifloxacina e duas a clindamicina. Os isolados foram classificados como ribotipos 126 (n=4), 078 (n=1) e 014/020 (n=1), todos previamente relatados em seres humanos com ICD no Brasil e em outros países.

Background Non specific colitis is defined as inflammatory condition of the colon that when examined microscopically lacks any characteristic features of any specific form of colitis and is commonly seen in reports of colonoscopy biopsies. There are many factors that cause it like obesity and H pylori. Aim of the study To determine the association of obesity and H pylori as contributory factors to this disease. Patients and methods This is a case-controlled study was carried out in Al-Kindy College of Medicine from January 2017 to June 2018. Sixty individuals were included; forty of them had non specific colitis. The rest were healthy control group. Demographic information's were taken like age and sex. Anthropometric measurement like weight in kilograms (kg), height in meters (m), waist circumference in centimeters (cm), and body mass index was done. H pylori IgG was done to both groups. Results Study results indicated that this disease was more common with increasing age, there is a significant difference (p = 0.002) between patients (48.12 ± 1.50) and control group (41.00 ± 1.10) regarding age. BMI of the patients is significantly higher in patients group (29.21 ± 0.41; p = 0.000) than the control (22.23 ± 0.41). Patients with non specific colitis showed significant (p = 0.000) increased in H pylori infection 33 (82.5%) compared with control group 2 (10%). Conclusions Obesity and infection withH pylori may predispose to non specific colitis. RESUMO Introdução Colite inespecífica é uma condição inflamatória do cólon que microscopicamente não apresenta características de qualquer forma específica de colite; é comumente observada em relatórios patológicos de biópsias de colonoscopia. Vários fatores podem causar colite inespecífica, dentre os quais obesidade e infecção por H. pylori. Objetivo do estudo Determinar o possível papel da obesidade e H. pylori como fatores contribuintes para esta doença. Pacientes e Métodos Este foi um estudo caso-controle, realizado na Al-Kindy College of Medicine entre janeiro de 2017 e junho de 2018. Um total de 60 indivíduos foram incluídos, 40 dos quais apresentavam colite inespecífica. Os demais foram incluídos no grupo de controles saudáveis. Foram coletadas informações demográficas, como idade e sexo. Medidas antropométricas, como peso (kg), altura (m), circunferência da cintura (cm) e índice de massa corporal, também foram coletadas. Nos dois grupos, foi feita serologia para H. pylori (IgG) Resultados Os presentes resultados indicaram que esta doença era mais comum entre pacientes de idade mais avançada; observou-se uma diferença significativa p = 0,002 entre os pacientes 48,12 ± 1,50 e o grupo controle 41,00 ± 1,10 quanto à idade. O IMC foi significativamente maior no grupo de pacientes 29,21 ± 0,41; p = 0,000 do que no grupo controle 22,23 ± 0,41. A infecção por H. pylori foi significamente mais frequentemente observada no grupo de pacientes (33; 82,5%) em comparação ao grupo controle (2; 10%; p = 0,000. Conclusões A obesidade e a infecção por H. pylori podem predispor à colite inespecífica.

Purpose: To verify if the application of enemas containing oily extracts of curcumin preserves the tissue content of mucins in the glands of the colonic mucosa without fecal stream. Method: Thirty-six Wistar rats were submitted to diversion of the fecal stream by proximal colostomy and distal mucous fistula. The animals were subdivided into three groups, and accordingly received enemas with saline and oily extract of curcumin at concentrations of 50 mg/kg/day or 200 mg/kg/day. After two or four weeks of intervention, the irrigated colic segments were removed. Neutral and acidic mucins were identified by Periodic-acid Schiff and Alcian-Blue techniques, respectively. The content of both mucin subtypes was measured by computerized morphometry. Mann–Whitney test was used to analyze the results, adopting a significance level of 5% (p ≤ 0.05). Results: There was an increase in the tissue content of neutral mucins in animals treated with curcumin at a concentration of 50 mg/kg/day for four weeks, whereas in the group treated with 200 mg/kg/day there was an increase independent of the time of intervention. The content of acidic mucins increased in animals treated with 200 mg/kg/day regardless of the intervention time, whereas in those treated with 50 mg/kg/day an increase was observed only after four weeks. Conclusion: Enemas with curcumin preserve the content of neutral and acidic mucins in the colonic epithelium without fecal stream. Resumo: Objetivo: Verificar se a aplicação de clisteres com extrato oleoso de curcumina preserva o conteúdo de mucinas nas glândulas da mucosa cólica sem trânsito intestinal. Método: Trinta e seis ratos Wistar foram submetidos à derivação intestinal por colostomia proximal e fístula mucosa distal. Os animais foram subdivididos em três grupos, segundo receberem clisteres com soro fisiológico 0,9%, extrato oleoso de curcumina nas concentrações de 50 mg/kg/dia ou 200 mg/kg/dia. Após duas ou quatro semanas de intervenção foram removidos os segmentos cólicos irrigados. As mucinas neutras e ácidas foram identificadas pelas técnicas do PAS e Alcian-Blue, respectivamente. O conteúdo tecidual de ambos os subtipos de mucinas foi mensurado por morfometria computadorizada. Utilizou-se teste de Mann-Whitney para análise dos resultados adotando-se nível de significância de 5% (p ≤ 0,05). Resultados: Houve aumento no conteúdo de mucinas neutras nos animais tratados com curcumina na concentração de 50 mg/kg/dia por quatro semanas, enquanto nos tratados com 200 mg/kg/dia houve aumento independente do tempo de intervenção. O conteúdo de mucinas ácidas aumentou nos animais tratados com 200 mg/kg/dia independente do tempo de intervenção, enquanto nos tratados com 50 mg/kg/dia encontrou-se aumento apenas após quatro semanas. Conclusão: Clisteres com curcumina preservam o conteúdo de mucinas neutras e ácidas no epitélio cólico sem trânsito intestinal. Keywords: Colitis, Mucins, Fatty acids, volatile, Image processing, computer-assisted, Palavras-chave: Colite, Mucinas, Ácidos graxos de cadeia curta, voláteis, Análise de imagem assistida por computador

Background Allergic proctocolitis is a disease that affects infants in the first months. The change in feed is the primary factor for clinical improvement and maintenance of the nutritional status of the infant. Objective Study the anthropometric evolution of infants with allergic proctocolitis at diagnosis and 1 to 6 months after nutritional intervention. Methods A retrospective cohort of infants with allergic proctocolitis diagnosis followed at the Pediatric Gastroenterology Institute of São Paulo (IGASTROPED), Brazil. The database with clinical, therapeutic and anthropometric data was obtained from medical records of outpatient infants. The therapeutic intervention was characterized by 1) exclusive breastfeeding with maternal exclusion diet of the six allergens (EBF-MED) or 2) no breastfeeding and use of hypoallergenic formulas. Results Of the 44 infants diagnosed with allergic proctocolitis, 23 were female. The median age of the infants was 3.5 months at the time of admission and 6 months after the intervention. The main clinical complaint was hematochezia with or without other symptoms of allergic proctocolitis. No difference was shown in the infants anthropometric evaluation between the two diets. Conclusion The duration of the allergic proctocolitis did not induce worsening of the infants nutritional status. Importantly, both nutritional interventions were able to keep the infants within the growth channel and resulted in the total clinical symptoms remission. Considering the fundamental mother-child link promoted by breastfeeding, the present data highlights the beneficial role of EBF-MED on the nutritional status of infants diagnosed with allergic proctocolitis in addition to the lower cost that breastfeeding brings compared the use of hypoallergenic formulas.

As Doenças Inflamatórias Intestinais (DII) se caracterizam pela inflamação do trato gastrointestinal e os dois tipos mais comuns são: doença de Crohn (DC) e Retocolite Ulcerativa (RCU). Ambas as doenças têm por característica a ativação imune recidivante. Dentro desse contexto, a melatonina (MLT), um indol formado enzimaticamente a partir do L-triptofano, tem se mostrado como um hormônio versátil favorável no tratamento da doença DII. Diante das principais complicações associadas a DII, o objetivo da presente revisão integrativa foi levantar os principais achados científicos relacionados ao uso da MLT no tratamento da DC e RCU. Para tanto, foi realizada uma revisão integrativa considerando-se bibliografias selecionadas nas principais bases de dados. A MLT parece desempenhar papel importante no TGI, considerando efeitos relacionados a regulação da motilidade gastrointestinal, eliminação de radicais livres, atividade anti-inflamatória local, bem como a moderação da sensação visceral. Assim, parece ser uma alternativa promissora no tratamento das DII.

Background: Diversion colitis is still very common in our country, since the stoma creation is a common practice especially in situations of trauma. needing treatment for this condition. Aim: To evaluate the therapeutic effect of rectal infusion of Curcuma longa (turmeric) in the excluded intestinal segment of rats. Method: Eighteen Wistar rats were used and submitted to colostomy: control group (n=8) under rectal saline infusion and group CL, receiving intra-rectal infusion of Curcuma longa extract (n=10). After 21 days of treatment they were submitted to euthanasia; the intestinal segment excluded from intestinal transit was resected and sent to histopathological evaluation, classifying the degree of inflammation and of vascular congestion. Results: The average of inflammation was 2.7 in the control group vs. 2.6 in the CL group (p=0.3125), while the mean vascular congestion was 2.3 and 2.1, respectively, in the control and CL groups (p=0.1642). Conclusion: Intra-rectal infusion of Curcuma longa extract was not able to minimize the inflammatory process or vascular congestion in the diversion colitis of rats subjected to colostomy. RESUMO Racional: A colite de exclusão é ainda muito frequente em nosso meio, uma vez que a confecção de estomas é prática comum especialmente em situações de trauma. Em consequência, há necessidade de tratamento para a colite de desuso. Objetivo: Avaliar o efeito terapêutico da infusão retal de Curcuma longa (açafrão-da-terra) no segmento intestinal excluso de ratos. Método: Utilizou-se 18 ratos Wistar submetidos à colostomiae distribuídos em dois grupos: grupo controle, recebendo infusão intrarretal de solução salina (n=8) e grupo CL, recebendo infusão intrarretal de extrato de Curcuma longa (n=10). Após 21 dias de tratamento foram submetidos a eutanásia; o segmento intestinal excluso de trânsito intestinal foi ressecado e submetido a estudo histopatológico classificando-se os graus de inflamação e de congestão vascular. Resultados: Verificou-se média de inflamação 2,7 no grupo controle vs. 2,6 no grupo CL (p=0,3125), enquanto as médias de congestão vascular foram 2,3 e 2,1, respectivamente, nos grupos controle e CL (p=0,1642). Conclusão: A infusão intrarretal do extrato de Curcuma longa não foi capaz de minimizar o processo inflamatório ou a congestão vascular na colite de exclusão de ratos submetidos a colostomia.

Summary Current therapies for inflammatory bowel diseases (IBD) are aimed at controlling the exacerbated response in the gut, but no treatment is fully effective for many refractory patients. Mesenchymal stromal cells (MSC) are multi-potent cells with regulatory immunosuppressive activity that may control inflammatory diseases. In this study, we investigated the short- and especially the long-term protective effects of MSC on experimental colitis. We show that MSC elicited protection to acute intestinal inflammation with gain of weight, improvement in the clinical disease score and expressive reduction in the mortality rate of treated mice. MSC changed the population of neutrophils, eosinophils and augmented the frequency of CD4 T lymphocytes in the gut-draining lymph nodes, together with reduced accumulation of these cells in the colon intraepithelial compartment. Interestingly, there were increased levels of programmed death 1 (PD-1) and glucocorticoid-induced tumour necrosis factor receptor family-related receptor (GITR) in the spleen regulatory T cells of mice that received MSC treatment, which also presented a reversal in the pattern of immune response in the gut, with diminished inflammatory, T helper type 1 (Th1) and Th17 profile, in contrast to augmented Th2 responses. Most strikingly, this balanced response elicited by a single administration of MSC during the acute colitis persisted long-term, with restored goblet cells, eosinophils and maintenance of elevated gut interleukin (IL)-4, besides increased CD4+CD25+PD-1+ cells in the spleen and reduced Th17 response in mesenteric lymph nodes (MLN) of treated mice on day 60. Taken together, our findings provided a significant contribution to translational immunology by pointing human adipose tissue-derived MSC as a novel therapeutic approach with long-term beneficial regulatory effects in experimental colitis.

Background: The effects of topical application of sucralfate (SCF) on the tissue content of MUC-2 protein have not yet been evaluated in experimental models of diversion colitis. Aim: To measure the tissue content of MUC-2 protein in the colonic mucosa diverted from fecal stream submitted to the SCF intervention. Methods: Thirty-six rats underwent derivation of intestinal transit through proximal colostomy and distal mucous fistula. The animals were divided into three groups which were submitted application of enemas with saline, SCF 1 g/kg/day and SCF 2 g/kg/day. Each group was divided into two subgroups, according to euthanasia was done after two or four weeks. The colitis diagnosis was established by histopathological study and the inflammatory intensity was evaluated by previously validated scale. The MUC-2 protein was identified by immunohistochemistry and the tissue content was measured computerized morphometry). Results: The application of enemas with SCF in the concentration of 2 g/kg/day reduced inflammatory score of the segments that were diverted from fecal stream. The content of MUC-2 in diverted colon of the animals submitted to the intervention with SCF, independently of intervention period and the used concentration, was significantly greater than animals submitted to the application of enemas containing saline (p< 0.01). The content of MUC-2 after the intervention with SCF in the concentration of 2 g/kg/day was significantly higher when compared to the animals submitted to the application containing SCF at concentration of 1.0 g/kg/day (p

Immune checkpoint inhibitors have shown anti-tumour activity in cancers such as melanoma, renal cell carcinoma, non-small-cell lung cancer, urothelial carcinoma, colorectal cancer, and Hodgkin's lymphoma. Though immune checkpoint inhibitors have revolutionized the treatment and prognosis of some advanced malignancies, they are also associated with a significant risk of immune-related adverse events. These adverse events can occur in any organ system, but gastrointestinal side effects are among the most commonly reported, with manifestations ranging from mild diarrhoea to severe colitis, sharing some features with inflammatory bowel disease. Anticipating a greater use of these drugs in the future, gastroenterologists should expect to be increasingly faced with gastrointestinal immune-related adverse events. Knowledge of these toxicities, as well as effective management algorithms, is essential to enable early diagnosis and treatment, decreasing morbidity and mortality. We reviewed the currently available literature on gastrointestinal toxicity induced by immune checkpoint inhibitors, namely the clinical features, diagnosis, and management. Os inibidores dos checkpoint imunológicos demonstraram atividade antitumoral em neoplasias como o melanoma, o carcinoma de células renais, o carcinoma pulmonar de não pequenas células, o carcinoma urotelial, o carcinoma colorretal e o linfoma de Hodgkin. Estes fármacos, embora tenham revolucionado o tratamento e o prognóstico de algumas neoplasias avançadas, também se associam a um risco considerável de efeitos adversos associadosao sistema imunitário. Qualquer órgão pode ser afetado, mas os efeitos adversos gastrointestinais estão entre os mais comumente relatados. As manifestações gastrointestinais variam desde diarreia ligeira a colite grave, a qual pode evidenciar características idênticas às da doença inflamatória intestinal. Antecipando uma maior utilização destes fármacos no futuro, os gastroenterologistas devem esperar confrontar-se cada vez mais com este tipo de efeitos adversos. O conhecimento dessas toxicidades, bem como dos algoritmos de abordagem destes doentes é fundamental para um diagnóstico e tratamento precoces, diminuindo desta forma a morbilidade e a mortalidade. Os autores pretenderam rever a literatura mais atual sobre a toxicidade gastrointestinal induzida pelos inibidores dos checkpoint imunológicos, nomeadamente apresentação clínica, abordagem diagnóstica e terapêutica. info:eu-repo/semantics/publishedVersion

Introduction Inflammatory bowel disease may cause both intestinal and extraintestinal manifestations. Respiratory symptoms in ulcerative colitis are rare and tracheal involvement is exceedingly rare in children. Case 1 Sixteen year-old female with a 4-week-complaint of abdominal pain, bloody diarrhea, fever and cough. The investigation was consistent with the diagnosis of concomitant ulcerative colitis/coinfection to Escherichia coli . On day 4 respiratory signs persisted so azithromycin and inhaled corticosteroids were added. By day 6 she progressed to respiratory failure and was diagnosed with necrotic tracheitis so started on intravenous steroids with fast clinical improvement. Case 2 Twelve-year-old male adolescent with ulcerative colitis and sclerosing cholangitis started dry cough and throat pain 10 days after diagnosis. Laboratory investigations showed increased inflammatory signs and normal chest X-ray. He started treatment with azithromycin without clinical improvement and on day five he presented dyspnea and fever. Laryngeal fibroscopy suggested tracheitis and so systemic steroids where added with fast clinical and analytic improvement. Discussion Tracheitis should be suspected if there are persistent respiratory symptoms even when exams are normal. Early recognition and early treatment are essential for a good prognosis preventing progression to respiratory failure.

The incidence of inflammatory bowel disease in the pediatric population has increased in the last years. The most common form of inflammatory bowel disease is Crohn's disease and, according to its form and age of presentation, it is possible to predict the evolution of the disease.

Objective: To identify risk factors, diagnosis and prognosis associated with ischemic colitis, focusing mainly on patients undergoing surgery. Materials and methods: This retrospective study included all patients admitted to the Centro Hospitalar de São João – E. P. E., diagnosed with ischemic colitis during the period from 2012 to 2013. Results: The study included 154 patients; 118 were undergoing medical treatment, with a 12% mortality rate, and 36 were undergoing surgery, with a 61% associated mortality rate. Hypertension was the most common risk factor in both groups. The presence of a large number of cardiovascular risk factors in both groups, such as hypertension and dyslipidemia, was recorded, but we still found no direct relationship with development of ischemic colitis. Comorbidities that affect blood flow, such as the presence of thrombi or aneurysms, do provide a worse prognosis and therefore require a more aggressive treatment. Conclusion: The diagnosis of ischemic colitis is not always immediately established due to a nonspecific presentation. Surgical treatment should be reserved for severe cases with a worse prognosis associated. Resumo: Objetivos: Identificar fatores de risco, diagnóstico e prognóstico associados à colite isquémica, incidindo mais em doentes submetidos à cirurgia. Materiais e métodos: O estudo retrospetivo incluiu todos os doentes admitidos no Centro Hospitalar de São João–E. P. E. com diagnóstico de colite isquémica durante o período de 2012 a 2013. Resultados: O estudo incluiu 154 doentes; desses, 118 foram submetidos a tratamento médico, com uma taxa de mortalidade de 12%, e 36 foram submetidos a tratamento cirúrgico, com uma taxa de mortalidade associada de 61%. Hipertensão arterial foi o fator de risco mais comum em ambos os grupos. Foi registada a presença de grande número de fatores de risco cardiovasculares em ambos os grupos, como hipertensão arterial e dislipidemia, mas ainda não foi encontrada nenhuma relação direta com o desenvolvimento de colite isquémica. Comorbilidades que afetam o fluxo sanguíneo, como a presença de trombos ou aneurismas, fazem prever um pior prognóstico e, por isso, exigem maior agressividade no tratamento. Conclusão: O diagnóstico de colite isquémica nem sempre é imediato, devido a uma apresentação pouco específica. O tratamento cirúrgico deverá ser reservado para casos mais severos, tendo pior prognóstico associado. Keywords: Ischemic colitis, Colitis, Risk factors, Prognosis, Palavras-chave: Colite isquémica, Colite, Fatores de risco, Prognóstico

Introduction: Microscopic colitis (MC) is a chronic inflammatory bowel disease with unclear etiology. Bile acid (BA) malabsorption has been described in MC patients. Farnesoid X receptor (FXR) is the main BA receptor; FXR-mediated mechanisms prevent the noxious effects of BA accumulation, preserving the integrity of the intestinal epithelial barrier and preventing intestinal inflammation. Aim: Our aim was to describe the expression of FXR in patients with MC. Methods: Archival formalin-fixed paraffin-embedded samples from the terminal ileum, right and left colon were obtained from patients with MC and matched controls. Immunohistochemistry was performed and nuclear FXR expression scored in a semi-quantitative way. Results: 169 formalin-fixed paraffinembedded samples from 35 patients with MC and 31 controls were retrieved. There was a significant reduction of FXR expression in patients with MC versus controls both in the right colon (moderate-strong FXR expression: 21.1 vs. 64.3%; p = 0.003) and left colon (moderate-strong FXR expression: 8.3 vs. 38.7%; p = 0.027). No significant differences in FXR expression were observed in the ileum of patients with MC (moderate-strong FXR expression: 76.9 vs. 90.9%; p = 0.5). We found no difference in FXR expression between the two types of MC. No association between the degree of lymphocyte infiltration or the thickness of collagen band and FXR expression was found. Conclusions: Patients with MC present a significantly lower expression of FXR in the colon. This could render colonic epithelial cells more susceptible to the deleterious effects of BA, contributing to disease pathogenesis and symptoms in MC. Introdução: A colite microscópica (CM) é uma doença inflamatória do intestino com etiologia desconhecida. A má-absorção de ácidos biliares (AB) encontra-se descrita em doentes com CM. O Recetor Farnesoid X (FXR) é o principal recetor dos AB; mecanismos mediados pelo FXR previnem o efeito nocivo da acumulação dos AB, preservando a integridade da barreira epitelial intestinal e impedindo inflamação. Objetivos: Avaliar a expressão do FXR em doentes com CM. Métodos: Foram obtidas amostras em parafina do ileon terminal, cólon direito e esquerdo de doentes com CM e controlos emparelhados; foi realizada imunohistoquímica para FXR e a sua expressão nuclear quantificada de forma semi-quantitativa. Resultados: Foram estudadas 169 amostras de 35 doentes com CM e 31 controlos. A expressão de FXR nos doentes com CM foi significativamente inferior à dos controlos no cólon direito (expressão FXR moderada-intensa: 21.1% versus 64.3%; p = 0.003) e esquerdo (expressão FXR moderada-intensa: 8.3% versus 38.7%; p = 0.027). Não observámos diferenças significativas na expressão do FXR no ileon em doentes com CM em comparação com controlos (expressão moderada- intensa em 76.9 versus 90.0%; p = 0.5). Não se verificaram diferenças na expressão FXR entre os dois tipos de CM. Não se encontrou associação entre o grau de infiltração linfocítica ou a espessura da banda de colagénio e a expressão de FXR. Conclusões: os doentes com CM apresentaram uma expressão significativamente reduzida do FXR no cólon; isto pode tornar as células epiteliais mais suscetíveis aos efeitos deletérios dos AB, contribuindo para a patogénese da doença e a sintomatologia da CM.

Background: The effects of topical application of sucralfate (SCF) on the tissue content of MUC-2 protein have not yet been evaluated in experimental models of diversion colitis. Aim: To measure the tissue content of MUC-2 protein in the colonic mucosa diverted from fecal stream submitted to the SCF intervention. Methods: Thirty-six rats underwent derivation of intestinal transit through proximal colostomy and distal mucous fistula. The animals were divided into three groups which were submitted application of enemas with saline, SCF 1 g/kg/day and SCF 2 g/kg/day. Each group was divided into two subgroups, according to euthanasia was done after two or four weeks. The colitis diagnosis was established by histopathological study and the inflammatory intensity was evaluated by previously validated scale. The MUC-2 protein was identified by immunohistochemistry and the tissue content was measured computerized morphometry). Results: The application of enemas with SCF in the concentration of 2 g/kg/day reduced inflammatory score of the segments that were diverted from fecal stream. The content of MUC-2 in diverted colon of the animals submitted to the intervention with SCF, independently of intervention period and the used concentration, was significantly greater than animals submitted to the application of enemas containing saline (p< 0.01). The content of MUC-2 after the intervention with SCF in the concentration of 2 g/kg/day was significantly higher when compared to the animals submitted to the application containing SCF at concentration of 1.0 g/kg/day (p

Objective: ultrasound (US) has been an important diagnostic tool to identify several causes of gastrointestinal bleeding. Infants with cow's milk allergy (CMA) may present hematochezia and the confirmation of the diagnosis can be difficult. The aim of this study is to describe grayscale and color Doppler ultrasound findings in patients with CMA. Methods: we retrospectively studied 13 infants with CMA. All infants presented severe hematochezia and abdominal pain. All underwent an US study with the diagnosis of allergic colitis. This diagnosis was based on clinical findings, recovery after infant or mother exclusion diets in the case of exclusive breastfeeding and positive oral challenge test. Results: the mean age ranged from 1 to 6 months (mean = 3.53). Seven out of 13 infants (53.8%) had grayscale and color Doppler sonographic repeated after exclusion diet. Twelve out of 13 (92,3%) showed abnormalities at US and CDUS at beginning. The positive findings suggesting colitis were thickened bowel walls and increased vascularity, especially in the descending and sigmoid colon. Colonoscopy and histopathological findings were compatible with allergic colitis. After a diet change the 13 infants recovered and their oral challenge tests were positive. Conclusion: Doppler US may be very useful in diagnosing secondary colitis, such as CMA, and to exclude several other abdominal diseases that can emulate this disease. Resumo: Objetivo: O ultrassom (US) tem sido uma importante ferramenta de diagnóstico para identificar várias causas de hemorragia gastrointestinal. Neonatos com alergia ao leite de vaca (ALV) podem apresentar hematoquezia, e a confirmação do diagnóstico pode ser difícil. O objetivo deste estudo é descrever achados com ultrassom em escala de cinza e com Doppler colorido em pacientes com ALV. Métodos: Estudamos, retrospectivamente, 13 neonatos com ALV. Todos eles apresentaram hematoquezia severa e dor abdominal e foram submetidos a um estudo com US, com o diagnóstico de colite alérgica. O diagnóstico teve como base os achados clínicos, a recuperação após a dieta de exclusão do neonato ou da mãe, no caso de amamentação exclusiva, e o teste de provocação oral positivo. Resultados: A idade média variou de um a seis meses (média = 3,53). Sete dos 13 neonatos (53,8%) passaram novamente por ultrassonografia em escala de cinza e com Doppler colorido após a dieta de exclusão. Dentre eles, 12 dos 13 (92,3%) mostraram anormalidades no US e no ultrassom com Doppler colorido (USDC) no início. Os achados positivos que sugeriram colite foram paredes intestinais espessas e aumento na vascularização, principalmente no cólon descendente e sigmoide. Os resultados da colonoscopia e histopatológicos foram compatíveis com colite alérgica. Após uma mudança na dieta, os 13 neonatos se recuperaram e seus testes de provocação oral foram positivos. Conclusão: O US com Doppler pode ser muito útil para diagnosticar a colite secundária, como a ALV, e para excluir várias outras doenças abdominais que podem imitar essa doença. Keywords: Cow's milk allergy, Colitis, Ultrasound, Palavras-chave: Alergia ao leite de vaca, Colite, Ultrassom

Resume Une chatte Exotic Shorthair de quatre ans est presentee en consultation pour une diarrhee associee a de l’hematochezie et du tenesme, evoluant depuis deux ans. L’exploration biologique et endoscopique a permis de mettre en evidence, apres biopsies, une colite ulcerative et granulomateuse associee a une infection a Anaerobiospirillum spp. L’animal est traite avec une antibiotherapie (metronidazole) et une corticotherapie : les symptomes ont disparu et aucune rechute n’est notee apres un an. Ce cas clinique discute du role pathogene d’Anaerobiospirillum spp. en medecine humaine et en medecine veterinaire : la notion de portage asymptomatique est evoquee ; il illustre egalement la difficulte diagnostique de cette infection et le recours indispensable a des examens complementaires, histologiques et coprologiques ; il discute de la prise en charge therapeutique et la compare aux donnees de la litterature.

Paracoccidioidomycosis (PBM) is an infection caused by a dimorphic fungus called Paracoccidioides brasiliensis. It occurs in Latin America, with incidence of 1 to 3 per 100,000 inhabitants in endemic areas. The digestive tract is usually not affected, but when it occurs, it may lead to events similar to colorectal neoplasm and inflammatory bowel disease (IBD). This is a case report of a 68-year-old female patient, with diarrhea without blood or mucus for 6 months, weight loss of 8 kg over the period. Abdominal ultrasonography showed some mass in the right colon, suggestive of cancer and liver perihilar lymph node. Colonoscopy showed lesions suggestive of Crohn's disease. Biopsy showed chronic granulomatous colitis of fungal etiology: Paracoccidioidomycosis. The patient did not tolerate oral treatment with itraconazole and subsequently sulfadiazine, requiring hospital admission for the treatment with amphotericin B. The presence of Paracoccidioidomycosis in the digestive tract may be associated with bloody diarrhea, mucus, rectal hemorrhage, abdominal pain, malabsorption syndrome. Histopathological studies show the fungus and a chronic inflammatory infiltrate and granulation tissue. The differential diagnoses are tuberculosis, colorectal cancer and inflammatory bowel disease. The treatment is oral antifungal (itraconazole, sulfadiazine) or intravenous (amphotericin B) based. The case has caused diagnostic confusion between colon cancer (clinical and US) and Crohn's disease (colonoscopy).Paracoccidioidomicose (PBM) é uma infecção causada por um fungo dimórfico: Paracoccidioides brasiliensis. Ocorre na América Latina, com incidência de 1 a 3 por 100.000 habitantes em áreas endêmicas. O acometimento do trato digestivo é infrequente, sendo que pode levar a manifestações semelhantes à neoplasia colorretal e doença inflamatória intestinal (DII). Relatamos o caso da paciente feminina, 68 anos, com diarreia sem sangue ou muco há seis meses, com perda ponderal de 8 kg no período. Ultrassom abdominal evidenciou massa em cólon direito sugestiva de neoplasia e linfonodomegalia peri-hilar hepática. A colonoscopia evidenciou lesões sugestivas de doença de Crohn. A biopsia mostrou colite crônica granulomatosa de etiologia fúngica: Paracoccidioidomicose. A paciente não tolerou tratamento oral com itraconazol e, posteriormente, sulfadiazina. Necessitou de internação para tratamento com anfotericina B. O acometimento da PBM no trato digestivo pode cursar com diarreia muco-sanguinolenta, retorragia, dor abdominal e síndrome de má absorção. O estudo histopatológico mostra o fungo e um infiltrado inflamatório crônico com tecido de granulação. Os diagnósticos diferenciais são tuberculose, câncer colorretal e doença inflamatória intestinal. O tratamento é feito com antifúngicos orais (itraconazol, sulfadiazina) ou endovenosos (anfotericina B). O caso levou à confusão diagnóstica entre câncer de cólon (US e quadro clínico) e doença de Crohn (colonoscopia).

A colite cística profunda consiste na presença de cistos submucosos, contendo muco, principalmente no reto e no cólon esquerdo. De etiologia controversa, com pouco mais de 200 casos relatados na literatura mundial. Tem importância pela capacidade de mimetizar neoplasia maligna colorretal. Descreveremos um caso de colite cística profunda localizada no reto e submetida a tratamento cirúrgico, seu acompanhamento pós-operatório e revisão da literatura. Colitis cystica profunda comprises submucous mucus-filled cysts, located mainly in rectum and left colon. Its etiology is controversial, with about 200 cases reported in the literature. This disease is important clinically in that mimics colorectal malignancies. We report a case of colitis cystica profunda localized in rectum treated surgically, its follow-up and review of the literature.

OBJETIVO: Estudo do papel da fibra dietética (Plantago ovata) na proteção e recuperação da parede intestinal de ratos submetidos a colite inflamatória induzida por ácido acético. MÉTODO: Utilizados 30 ratos Wistar machos, com peso variando entre 260 - 300g, distribuidos em três Grupos de 10 indivíduos: O Grupo I (n10) ou Grupo Controle, recebeu dieta padrão durante todo o experimento. O Grupo II (n10) ou Grupo Colite, recebeu igualmente, dieta padrão durante todo o experimento. O Grupo III (n10) ou Colite + Fibra, recebeu dieta padrão enriquecida com fibra dietética (10g de sementes e cutículas de Plantago ovata para cada 90g de dieta padrão). Os grupos II e II foram submetidos a indução de colite inflamatória no 14º dia, sendo todos os animais sacrificados no 21º dia de experimentação, quando foi efetuada a remoção do cólon. Os espécimes foram submetidos à análise estereológica e histológica, sendo avaliados estatisticamente pelo teste de Mann-Whitney. Analisou-se ainda, a variação ponderal dos animais durante o experimento. Os parâmetros estudados foram: os volumes parciais da mucosa, muscular da mucosa, submucosa, muscular própria, epitélio e lâmina própria do epitélio. RESULTADOS: a) A colite induzida pelo ácido acético causou diminuição dos volumes parciais do epitélio, muscular da mucosa e submucosa, além do aumento dos volumes parciais da lâmina própria e muscular própria. b) A suplementação de Plantago ovata (fibra dietética) evitou alterações causadas pela colite induzida por ácido acético nas camadas submucosa, muscular da mucosa e muscular própria. Não apresentou atuação sobre a mucosa, epitélio e lâmina própria. c) A colite induzida pelo ácido acético causou perda ponderal nos animais de experimentação, que pode ser evitada pela suplementação de Plantago ovata (fibra dietética). CONCLUSÕES: A suplementação dietética com o Plantago ovata (fibra dietética), exerce efeito benéfico na proteção do intestino submetido à colite inflamatória induzida por ácido acético a 8%. BACKGROUND: The objective of this paper was to study the role of the dietetic fiber (Plantago ovata) in the protection and recovery of the intestinal wall of rats submitted to acetic acid induced inflammatory colitis. METHODS: 30 Wistar male rats were studied, weighing between 260 and 300g, divided in three groups of 10 individuals. The distribution of the groups was made as follows: Group I (n 10), named control group, received a standard diet during the whole experiment. Group II (n 10), named colitis group, received an equally standard diet during the whole experiment and 8% acetic acid that induced inflammatory colitis. Group III (n 10), named colitis + fiber, received a standard diet with addition of dietetic fiber ( 10 g of seeds and peels of Plantago ovata for each 90 g of standard diet) and 8% acetic acid that induced inflammatory colitis. The experiment lasted 21 days and the inflammatory colitis induction was introduced on the fourteenth day in groups II and III. Twenty-one days after the start of the experiment the animals were sacrificed and total colectomies were performed. The specimens were submitted to stereologic and histological analysis, and they statistically evaluated by the Mann-Whitney test. The weight variation of the animals was also measured during the experiment. The studied parameters were: mucosa, muscularis mucosa, submucosa, lamina propria, epithelial and proper epithelial layer partial volumes. CONCLUSION: The results, through stereologic, histological and weight analysis, lead us to conclude that the addition of Plantago ovata (dietetic fiber) prevents the alterations caused by the 8% acetic acid induced colitis in the experimental animals.

Scope Inflammatory bowel disease (IBD) constitutes a growing public health concern in western countries. Bacteria with anti-inflammatory properties are lacking in the dysbiosis accompanying IBD. Selected strains of probiotic bacteria with anti-inflammatory properties accordingly alleviate symptoms and enhance treatment of ulcerative colitis in clinical trials. Such properties are also found in selected strains of dairy starters such as Propionibacterium freudenreichii and Lactobacillus delbrueckii (Ld). We thus investigated the possibility to develop a fermented dairy product, combining both starter and probiotic abilities of both lactic acid and propionic acid bacteria, designed to extend remissions in IBD patients. Methods and results We developed a single-strain Ld-fermented milk and a two-strain P. freudenreichii and Ld-fermented experimental pressed cheese using strains previously selected for their anti-inflammatory properties. Consumption of these experimental fermented dairy products protected mice against trinitrobenzenesulfonic acid induced colitis, alleviating severity of symptoms, modulating local and systemic inflammation, as well as colonic oxidative stress and epithelial cell damages. As a control, the corresponding sterile dairy matrix failed to afford such protection. Conclusion This work reveals the probiotic potential of this bacterial mixture, in the context of fermented dairy products. It opens new perspectives for the reverse engineering development of anti-inflammatory fermented foods designed for target populations with IBD, and has provided evidences leading to an ongoing pilot clinical study in ulcerative colitis patients.

Background This study investigated the therapeutic effects of hyperbaric oxygen in experimental acute distal colitis focusing on its effect on the production of pro-inflammatory cytokines, nitric oxide and hypoxia-inducible factor 1alpha. Methods Colitis was induced with a rectal infusion of 150 mg/kg of TNBS under anesthesia with Ketamine (50 mg/kg) and Xylazine (10 mg/kg). Control animals received only rectal saline. After colitis induction, animals were subjected to two sessions of hyperbaric oxygen and were then euthanized. The distal intestine was resected for macroscopic analysis, determination of myeloperoxidase activity, western-blotting analyses of inducible nitric oxide synthase and cyclooxygenase-2 expression and immunohistochemical analysis of hypoxia-inducible factor 1alpha and cyclooxygenase-2. Cytokines levels in the distal intestine were measured using an enzyme-linked immunosorbent assay. Results Hyperbaric oxygen therapy attenuated the severity of acute distal colitis, with reduced macroscopic damage score. This effect was associated with prevention in the increase of pro-inflammatory cytokine production; myeloperoxidase activity, in the expression of inducible nitric oxide synthase and cyclooxygenase-2. Finally, hyperbaric oxygen inhibited the acute distal colitis-induced up-regulation of hypoxia-inducible factor 1alpha. Conclusions The results indicate that hyperbaric oxygen attenuates the severity of acute distal colitis through the down-regulation of pro-inflammatory events.

Le cytomégalovirus (CMV) est responsable d'infections souvent asymptomatiques chez les immunocompétents mais également d'infections graves chez les immunodéprimés notamment chez les patients lupiques. La réactivation du CMV au cours du lupus est une complication fréquente mais rarement inaugurale. Nous rapportons l'observation d'un patient ayant présenté une colite à CMV révélatrice d'un lupus érythémateux systémique. Le diagnostic a été retenu sur les données sérologiques, de la biopsie colique et la bonne évolution après un traitement par ganciclovir.

After fecal diversion, nonspecific colitis may be seen in the defunctionalized colon. The purpose of this prospective study is to identify specific findings that could help in the differential diagnosis between diversion colitis and other inflammatory bowel diseases in order to avoid inappropriate diagnosis and therapy. It was studied, prospectively, thirteen consecutive patients from two public hospitals of Rio de Janeiro who had undergone temporary colostomy for indications other than inflammatory bowel disease. They were submitted to endoscopy with biopsy of both proximal and distal colorectal segments, and prospectively evaluated before and after restoration of intestinal continuity. Endoscopy with biopsy of both proximal and distal excluded colorectal segments showed a nonspecific mucosal and submucosal inflammation, resembling ulcerative colitis ( p < 0.01). There was endoscopic resolution in all patients once restoration of intestinal continuity was established (p < 0.01) and also histologic improvement after the stoma closure. In conclusion there are no specific findings that make possible an unequivocal distinction between diversion colitis and other nonspecific inflammatory diseases. Diagnosis should be achieved if after stoma closure occur remission of endoscopic large bowel inflammatory signs with improvement in mucosal histologic appearance and prompt relief of clinical complaints. Uma forma de colite relacionada à derivação fecal pode ser identificada nos segmentos colônicos excluídos do trânsito fecal. Esta condição inflamatória, ao mimetizar a doença de Crohn e a colite ulcerativa, pode resultar em diagnóstico e tratamento inapropriados. Este estudo prospectivo objetivou rever os efeitos da derivação fecal e caracterizar a evolução após a restauração do trânsito intestinal. Foram avaliados treze pacientes sem doença inflamatória intestinal e submetidos previamente à uma colostomia. Os achados da endoscopia com biópsia colo-retal, dos segmentos proximal e distal desfuncionalizados, evidenciaram uma inflamação inespecífica da mucosa e da submucosa, muito semelhante aquela da colite ulcerativa (p

Because exacerbation of colitis seems to be associated with stress, we proposed evaluating the influence of stress and the involvement of corticotropin-releasing factor (CRF) and arginine vasopressin (AVP) on experimental colitis in rats. Partial restraint stress was applied during 4 consecutive days, before or after intracolonic 2,4,6-trinitrobenzenesulfonic acid (TNB) instillation (15 mg) in rats. Finally, two groups of rats were centrally injected with alpha-helical CRF-(9-41) (5 micrograms) or AVP antagonist (5 micrograms) before each session of stress. Stress was applied before or right after TNB enhanced colitis, with an increase in macroscopic and histological scores and myeloperoxidase activity, alpha-Helical CRF-(9-41) or AVP antagonist had no effect on TNB-induced colitis but enhanced the effects of stress on colitis. These results show that stress may exacerbate experimental colitis in rats and that CRF and AVP are not responsible for this effect.

ContextInflammatory bowel disease, including ulcerative colitis and Crohn’s disease, comprising a broad spectrum of diseases those have in common chronic inflammation of the gastrointestinal tract, histological alterations and an increased activity levels of certain enzymes, such as, metalloproteinases.ObjectivesEvaluate a possible correlation of disease activity index with the severity of colonic mucosal damage and increased activity of metalloproteinases in a model of ulcerative colitis induced by dextran sulfate sodium.MethodsColitis was induced by oral administration of 5% dextran sulfate sodium for seven days in this group (n=10), whereas control group (n=16) received water. Effects were analyzed daily by disease activity index. In the seventh day, animals were euthanized and hematological measurements, histological changes (hematoxylin and eosin and Alcian Blue staining), myeloperoxidase and metalloproteinase activities (MMP-2 and MMP-9) were determined.ResultsDextran sulfate sodium group showed elevated disease activity index and reduced hematological parameters. Induction of colitis caused tissue injury with loss of mucin and increased myeloperoxidase (P

INTRODUCTION: Diversion colitis (DC) is a benign condition characterized by the appearance of inflammation in the mucosa of the colon or rectum devoid of fecal stream. Oxidative stress has been associated with the etiopathogenesis of the disease. N-acetylcysteine (NAC) is a substance with antioxidant properties, used in different treatments of inflammatory diseases. The purpose of this study was to evaluate the effects of topical applications of NAC in an experimental model of DC. METHODS: Thirty-six Wistar rats were submitted to deviation of fecal stream by proximal colostomy and a distal mucosal fistula. They were distributed into 3 experimental groups of 12 animals according to the daily application of enemas containing 0.9% saline or 2 doses of NAC, 25 mg/kg and 100 mg/kg, respectively. In each group, half of the animals were sacrificed after two weeks of irrigation and half after four weeks of irrigation. The diagnosis of colitis was assessed by histopathological analysis and the grade of inflammation by inflammatory grading scale. The results were evaluated with the Mann-Whitney test, adopting significance level of 5% (pINTRODUÇÃO: Colite de exclusão (CE) é uma condição benigna caracterizada pelo desenvolvimento de inflamação na mucosa do cólon desprovida de trânsito fecal. O estresse oxidativo tem sido implicado na patogênese da doença. A n-acetilcisteína (NAC) é uma substância com efeitos antioxidantes, sendo utilizada no tratamento de várias doenças inflamatórias. OBJETIVO: Avaliar os efeitos da aplicação tópica de NAC em modelo de CE. MÉTODO: Trinta e seis ratos Wistar foram submetidos ao desvio do trânsito por meio de colostomia proximal e fístula mucosa distal. Os animais foram distribuídos em três grupos experimentais de igual tamanho segundo a aplicação de enemas diários contendo soro fisiológico 0,9% ou NAC nas concentrações de 25 mg/kg ou 100 mg/kg. Em cada grupo, metade dos animais foi sacrificada após duas ou quatro semanas de irrigação. O diagnóstico de CE foi feito por estudo histopatológico e a graduação por escala inflamatória. Na avaliação dos resultados, utilizou-se o teste de Mann-Withney, adotando-se nível de significância de 5% (p

PURPOSE: To study the effects of progesterone on an experimental colitis model. METHODS: Wistar albino rats were treated subcutaneously with 2mg/kg once a day during seven days Colitis was induced by intrarectal administration of 5mg trinitrobenzene sulfonic acid (TNBS). Disease activities, macroscopic and microscopic scores were evaluated. To determine the response provoked by progesterone we measured Colonic malondialdehyde (MDA), TNF alfa, IL-6 and Nitric oxide (NO) levels in addition to the MPO (Myeloperoxidase) and caspase-3 activities. RESULTS: Progesterone ameliorated significantly the macroscopic and microscopic scores. TNBS-induced colitis significantly increased the colonic MDA levels and caspase-3 activities in group 2 in comparison to the control group. The results of the study revealed a decline in MDA, NO, IL6 and TNF-α levels in the colon tissue and in blood due to progesterone therapy in group 3 when compared to the group 2, a significant improvement. Progesterone treatment was associated with decreased MDA, MPO, TNF alfa and caspase-3 activity. CONCLUSION: Progesterone therapy decreased oxidative damage in the colonic mucosa. OBJETIVO: Investigar os efeitos da progesterona em um modelo de colite experimental. MÉTODOS: Ratos albinos Wistar foram tratados subcutaneamente com 2mg/kg por dia durante sete dias. A colite foi induzida por administração intrarretal de 5mg ácido sulfônico trinitrobenzeno (TNBS). Foram avaliadas as atividades da doença, escores macroscópicos e microscópicos Para determinar a resposta provocada pela progesterona foi medida no cólon os níveis de malondialdeído (MDA), TNF alfa, IL-6 e óxido nítrico (NO), além da atividade da MPO (Myeloperoxidase) e caspase-3. RESULTADOS: A progesterone melhorou significantemente os escores macroscópicos e microscópicos. A colite induzida pelo TNBS significantemente aumentou os níveis colônicos de MDA e a atividade da caspase-3 no grupo 2 em comparação com o grupo controle. Os resultados do estudo revelaram um declínio nos níveis de MDA, NO, IL6 e TNF-α no tecido colônico e no sangue devido à terapia com a progesterona no grupo 3 quando comparado ao grupo 2. O tratamento com a progesterona foi associado com decréscimo do MDA, MPO, TNF alfa e atividade da caspase-3. CONCLUSÃO: A terapia com progesterona decresce o dano oxidativo na mucosa do cólon.

pyoderma gangrenosum is a rare inflammatory skin condition characterized by progressive and recurrent skin ulceration of destructive course. It is usually associated with rheumatoid arthritis, paraproteinemia, myeloproliferative diseases and inflammatory bowel diseases, especially non-specific ulcerative proctocolitis. In these situations, skin lesions are described as concurrent with the intestinal condition. However, reports on pyoderma gangrenosum preceding intestinal findings are less frequent. The authors describe a case of a woman with febrile condition associated with skin lesions diagnosed by biopsy as pyoderma gangrenosum. Two weeks later, she developed diarrhea, arthralgia and sepsis, being diagnosed as ulcerative proctocolitis. After the administration of the treatment for ulcerative proctocolitis, she showed improvements in sepsis care, remission of diarrhea and regression of skin lesions. This case highlights the importance of considering pyoderma gangrenosum as a manifestation associated with inflammatory bowel disease, regardless of its timing in relation to intestinal symptoms.Pioderma gangrenoso é uma forma de inflamação cutânea, caracterizada por ulceração progressiva e recorrente da pele, com curso destrutivo. Geralmente é associada à artrite reumatoide, paraproteinemia, doenças mieloproliferativas e doença inflamatória intestinal, em especial retocolite ulcerativa inespecífica. Em tais casos, as lesões cutâneas são descritas concomitantes ao quadro intestinal, porém, relatos com descrição de pioderma gangrenoso precedendo achados intestinais são menos frequentes. Os autores relatam caso de mulher com quadro febril associado a lesões cutâneas diagnosticadas por biópsia como pioderma gangrenoso. Duas semanas depois, apresentou diarreia, artralgia e sepse sendo diagnosticada retocolite ulcerativa. Com o tratamento para retocolite ulcerativa apresentou melhora do quadro séptico, remissão da diarreia e regressão das lesões cutâneas. Este caso enfatiza a importância em considerar o pioderma gangrenoso como manifestação associada à doença inflamatória intestinal, independente de sua temporalidade em relação aos sintomas intestinais.

PURPOSE: To evaluate the antioxidant effects of enemas containing aqueous extract of Ilex paraguariensis, comparing segments with and without fecal stream and correlating the segments with the duration of intervention. METHODS: Twenty-six Wistar rats were subjected to a diversion of the fecal stream in the left colon by a proximal colostomy and distal mucosal fistula. The rats were distributed randomly into two experimental groups of 13 animals each based on the time of sacrifice after surgical procedure (two or four weeks). Each group was then divided into two experimental subgroups that received either second daily enemas containing 0.9% saline solution or aqueous extract of Ilex paraguariensis at 0.2g/100g. Colitis was diagnosed by histopathological analysis and the detection of oxidative tissue damage by measuring the levels of malondialdehyde. The Mann-Whitney test was used to compare the tissue levels of malondialdehyde between colon segments with and without fecal stream in each experimental group, and the Kruskal-Wallis test was used to verify the variance between the levels of oxidative stress according the duration of the irrigation; both tests determined significance at 5% (p

Clostridium difficile has emerged as a major cause of neonatal colitis in piglets, displacing classic bacterial pathogens. However, there is no information regarding the distribution of this microorganism in pig farms in Brazil. In the present study, the presence of toxins A/B and of C. difficile strains in stool samples from 60 diarrheic or non-diarrheic newborn piglets (one to seven days old), from 15 different farms, was studied. The presence of toxins A/B was detected by ELISA and PCR was used to identify toxin A, toxin B and binary toxin gene in each isolated strain. C. difficile A/B toxins were detected in ten samples (16.7%). Of these, seven were from diarrheic and three were from non-diarrheic piglets. C. difficile was recovered from 12 out of 60 (20%) fecal samples. Of those, three strains were non-toxigenic (A-B-) and nine were toxigenic. Of the nine toxigenic strains, four were A+B+ strains and five were A-B+ strains. The presence of binary toxin observed in the present study was much higher (50%) than in previously reported studies. All three non-toxigenic strains were isolated from otherwise healthy piglets. The results suggest the occurrence of neonatal diarrhea by C. difficile in farms in Brazil. Clostridium difficile tem sido relatado como o principal causador de colite neonatal em suínos. Apesar da crescente importância deste agente, não há dados sobre infecções causadas por C. difficile em suínos no Brasil. O objetivo do presente estudo foi detectar as toxinas A/B e isolar C. difficile a partir de 60 amostras de fezes de leitões diarreicos ou apararentemente saudáveis, com no máximo sete dias de vida, e oriundos de 15 granjas diferentes. As toxinas A/B foram detectadas por ELISA e uma PCR multiplex foi utilizada para detecção dos genes responsáveis pela codificação das toxinas A, B e toxina binária. As toxinas A/B de C. difficile foram detectadas em dez amostras de fezes (16.7%). Dessas, sete eram de animais diarreicos e três de leitões aparentemente saudáveis. Foi possível isolar C. difficile em 12 das 60 (20%) amostras trabalhadas. Dessas, três estirpes eram não-toxigênicas (A-B-) e nove eram toxigênicas, sendo quatro caracterizadas como A+B+ e cinco como A-B+. O gene responsável pela codificação da toxina binária foi encontrado em 50% das estirpes isoladas, proporção superior ao relatado em estudos anteriores. Todas as estirpes não toxigênicas foram isoladas de animais não diarreicos. Os resultados encontrados sugerem a ocorrência de diarreia por C. difficile em granjas no Brasil.

Submitted by Helena Donato (bibliotecaria@hospitaldebraga.com.pt) on 2012-01-11T19:07:55Z No. of bitstreams: 1 Hepatic abscess and colonic stenosis.pdf: 727496 bytes, checksum: 9aebbcfc318adb3a6a5cb3f213a114af (MD5) Approved for entry into archive by Helena Donato(bibliotecaria@hospitaldebraga.com.pt) on 2012-01-11T19:08:06Z (GMT) No. of bitstreams: 1 Hepatic abscess and colonic stenosis.pdf: 727496 bytes, checksum: 9aebbcfc318adb3a6a5cb3f213a114af (MD5) Made available in DSpace on 2012-01-11T19:08:06Z (GMT). No. of bitstreams: 1 Hepatic abscess and colonic stenosis.pdf: 727496 bytes, checksum: 9aebbcfc318adb3a6a5cb3f213a114af (MD5) Previous issue date: 2011 Restored into DSpace on 2014-05-09T11:26:33Z (GMT).

PURPOSE: To quantify the intensity of sulfomucin and sialomucin expression in the colon mucosa, by means of computer-assisted image processing, comparing segments with and without fecal stream and correlating with the duration of fecal transit exclusion. METHODS: Forty-five Wistar rats were subjected to diversion of the fecal stream in the left colon by means of constructing a proximal colostomy and distal mucosal fistula. They were distributed randomly into three experimental groups of 15 animals, of which 10 were subjected to colon diversion (experimental subgroup) and five were only subjected to laparotomy, without colon diversion (control subgroup). The three experimental groups were formed according to the sacrifice date, which was to be performed six weeks after the surgical procedure (Group A), 12 weeks (Group B) and 18 weeks (Group C). The sulfomucin and sialomucin expression in the colon mucosa was evaluated using the histochemical technique of high iron diamine-alcian blue (HID-AB). The tissue expression was quantified for each animal, in the segments with and without fecal stream, at a location where there were four complete contiguous crypts in two random fields, with the aid of the computer-assisted image analysis software. The final value was taken to be the mean reading from the two fields selected, in the segments with and without fecal stream. To compare the expressions of the two mucin subtypes in the segments with and without fecal stream, the paired Student t test was used. To analyze variance according to duration of exclusion, ANOVA with the Newman-Keuls post-test was used, setting the significance level at 5% (p

PURPOSE: Quantify the levels of oxidative DNA damage of epithelial colon cells comparing segments with and without fecal stream. METHODS: Sixty Wistar rats were subjected to deviation of fecal stream by proximal colostomy and a distal mucosal fistula. Animals were divided into three experimental groups that were sacrificed 6, 12 and 24 weeks after surgery. In each experimental group, five animals underwent laparotomy without intestinal deviation (sham subgroup). The diagnosis of colitis was made by histopathological analysis and the inflammatory activity index by graduated scale. The neutrophil infiltration was determined by myeloperoxidase tissue levels and the intensity of oxidative DNA damage by comet assay. The Mann-Withney and Student t test were used to compare the results among experimental subgroups and the Kruskal-Wallis test for variance analysis, adopting a significance level of 5% (p

PURPOSE: To evaluate histopathological alterations of the colon wall in segments with and without intestinal transit, by computer-assisted imaging, and to correlate these with the length of time diversion. METHODS: Thirty male Wistar rats were subjected to intestinal transit diversion by a proximal colostomy and distal mucosa fistula. The animals were divided into three experimental groups according to how long after the initial surgical procedure they were sacrificed: six, twelve and eighteen weeks. Colon segments with and without transit were subjected to histopathological study. The variables colon crypt length, mucosal ulceration, muscle layer thickness of the muscularis mucosa, submucosa and muscularis propria, vascular congestion, number of caliciform cells, inflammatory grade and degree of inflammation, comparing the two colon segments in the different experimental groups were studied. Intestinal crypt length, muscle layer thickness of the mucosa, submucosa and muscularis propria and caliciform cells were measured by computer-assisted imaging method. Mean equality, variance analysis and correlation tests were used in the statistical analysis, and the significance level was set at 5%. RESULTS: Comparison between segments with and without transit showed that the latter presented reduced length of colon crypts and increased muscle layer thickness of the muscularis mucosa, submucosa and muscularis propria. There were greater quantities of ulceration of the mucosal and greater degree of inflammation with increasing time without transit. Mucosal ulceration, submucosal vascular congestion, increased thickness of the submucosal and muscularis propria layers, presence of caliciform cells, inflammatory infiltrate and inflammatory grade correlated significantly with the length of time without transit. CONCLUSIONS: Histological alterations occurred in all layers of the colon wall, in the segments without intestinal transit. Ulcerations in the intestinal mucosa, increased number of caliciform cells, greater vascular congestion of the submucosal layer and inflammatory reaction were related to increasing length of time without transit. OBJETIVO: Avaliar por método de imagem assistida por computador as alterações histopatológicas da parede cólica em segmentos providos e desprovidos de trânsito intestinal e relacioná-las ao tempo de exclusão. MÉTODOS: Trinta ratos Wistar machos foram submetidos à derivação do trânsito no cólon esquerdo por meio de colostomia proximal e fístula mucosa distal. Os animais foram divididos em três grupos experimentais segundo o sacrifício ter sido realizado seis, doze e dezoito semanas após o procedimento cirúrgico inicial. Segmentos dos cólons providos e desprovidos de trânsito foram submetidos a estudo histopatológico. Foram analisadas as variáveis: comprimento das criptas cólicas, ulceração na mucosa, espessura das camadas muscular da mucosa, submucosa e muscular própria, congestão vascular, número de células caliciformes e graduação inflamatória comparando os dois segmentos cólicos nos diferentes grupos experimentais. As variáveis, comprimento das criptas intestinais, espessura das camadas muscular da mucosa, submucosa e muscular própria foram mensuradas por método de imagem assistida por computador. Na análise estatística foram utilizados testes de igualdade de médias e medianas, análise de variância e correlação estabelecendo-se nível de significância de cinco por cento. RESULTADOS: A exclusão de trânsito mostrou-se associada à redução do comprimento das criptas cólicas, aumento da espessura das camadas muscular da mucosa, submucosa e muscular própria. Verificou-se maior quantidade de ulcerações na mucosa e maior grau de inflamação com o progredir do tempo de exclusão. Houve correlação significante entre as ulcerações da mucosa, congestão vascular da submucosa, aumento da espessura das camadas submucosa e muscular própria, presença de células caliciformes, infiltrado inflamatório, graduação inflamatória e o tempo de exclusão de trânsito. CONCLUSÕES: Alterações histológicas ocorrem em todas as camadas da parede cólica, em segmentos sem trânsito intestinal. Ulcerações na mucosa intestinal, aumento no número de células caliciformes, maior congestão vascular na camada submucosa e reação inflamatória estavam relacionadas com o progredir do tempo de exclusão intestinal.

Estudos epidemiológicos recentes sugerem que a incidência da doença de Crohn (DC) e da retocolite ulcerativa (RCUI) está aumentando no Brasil, apesar de desconhecermos sua taxa real. OBJETIVO: Descrever o perfil epidemiológico dos pacientes com doença inflamatória intestinal (DII) que residem no estado de Mato Grosso. RESULTADOS: Foram avaliados 220 pacientes com doença inflamatória intestinal, 125 eram do sexo feminino e 95 do sexo masculino. Do total de casos, 117 tinham RCUI, 86 doença de Crohn e 17 colite indeterminada. A doença foi mais freqüente em casados (66,0%), em pacientes de cor parda (48,0%) e em não fumantes (61,8%). A média da idade foi de 39 anos, variando de 6 a 80 anos. Em algum momento da evolução da doença, 77 (35%) pacientes necessitaram de tratamento cirúrgico. A média de anos dos pacientes estudados foi de 9,17 anos, variando de 0 a 20 anos estudados. CONCLUSÃO: Apesar da pouca literatura sobre a doença, os dados deste estudo revelam que os portadores de DII, no estado de Mato Grosso, apresentam características epidemiológicas semelhantes aos portadores de outros estados do Brasil. Recent epidemiological studies suggest that the incidence of Crohn's disease (CD) and Ulcerative Colitis (UC) is increasing in Brazil despite the fact that we do not know what the actual rate is. OBJECTIVE: To describe the epidemiological profile of patients with inflammatory bowel disease in people resident in the state of Mato Grosso. RESULTS: 220 patients with inflammatory bowel disease were assessed. 125 were female and 95 were male. Of the total number of cases, 117 had UC, 86 had Crohn's disease and 17 had non-specific colitis. The disease was most common amongst married patients (66%), dark-skinned patients (48%) and non-smokers (61.8%). The average age was 39, and the age range was from 6 to 80. At some stage in the treatment 77 (35%) patients required surgical treatment. The average number of years studied was 9.17 with a variation from 0 to 20 years. CONCLUSION: Despite the lack of literature on the disease, the data from this study reveal that patients with IBD in the state of Mato Grosso show the same epidemiological features as those from other Brazilian states.

Pyoderma gangrenosum is a rare inflammatory skin condition, characterized by progressive and recurrent skin ulceration. There may be rapidly enlarging, painful ulcers with undermined edges and a necrotic, hemorrhagic base. Disorders classically associated with pyoderma gangrenosum include rheumatoid arthritis, inflammatory bowel disease, paraproteinemia and myeloproliferative disorders. There have been some reports of the occurrence of pyoderma gangrenosum in Africa, and in Nigeria, but only one specifically reported pyoderma gangrenosum in association with ulcerative colitis. We report on a 45-year-old man who presented with pyoderma gangrenosum associated with ulcerative colitis; the second report in Nigeria. The skin lesions were managed with daily honey wound dressings. Oral dapsone and prednisolone were started. The frequency of the bloody diarrhea decreased, and was completely resolved by the second week after admission. The ulcers also showed accelerated healing. The goal of therapy is directed towards the associated systemic disorder, if present. Pioderma gangrenoso é uma rara forma de inflamação dermatológica, caracterizada por ulceração progressiva e recorrente da pele. Pode ocorrer rápida formação de úlceras dolorosas expansivas, com bordas solapadas e base necrótica e hemorrágica. Condições classicamente associadas com pioderma gangrenoso incluem artrite reumatóide, doença inflamatória intestinal, paraproteinemia e doenças mieloproliferativas. Existem alguns relatos da ocorrência de pioderma gangrenoso na África e na Nigéria, mas apenas um relato específico da associação de pioderma gangrenoso e colite ulcerativa. Os autores relatam o caso de um homem de 45 anos que apresentou pioderma gangrenoso associado a colite ulcerativa, sendo este o segundo relato na Nigéria. As lesões de pele foram tratadas com curativos diários de mel. Foram utilizadas dapsona e prednisona via oral. A freqüência de diarréia sanguinolenta diminuiu e se resolveu completamente até a segunda semana após a admissão. As úlceras também mostraram rápida cicatrização. A meta do tratamento deve abordar também a doença sistêmica associada, quando presente.

OBJETIVO: Analisar o perfil da RCU. CASUÍSTICA E MÉTODOS: Análise retrospectiva de pacientes acompanhados pelos autores de 1996 a 2006. Confrontamos topografia das lesões, colonoscopia / histopatologia com ênfase na displasia e CCR. Rastreamos displasia após 7 anos de doença. Teste t de Student foi usado para média e qui-quadrado para números absolutos. P< 0,05 significativo. RESULTADOS: 127 pacientes, 40 homens e 87 mulheres. Média de idade 47±13 N=61 (48%) na pancolite e 45±15 na colite esquerda N=66 (52%) p> 0,05 para idade. Displasia em 9 (7%), 8 (6%) na pancolite p< 0,01. Dois (2%) em mucosa lisa e 7 (12,5%) em portadores de nodularidade e DALM (dysplasia associated lesion or mass) p< 0,05. Pseudopólipos N=55 (43%). CCR em 7 (5,5%). 13 colectomizados (10%), 3 por intratabilidade, 3 por megacólon tóxico, 1 por displasia com tumor na peça e 6 com CCR. CCR tinham mais de 12 anos de doença. Em 3 (2,3%) com doença ativa à histopatologia não foi detectado sangue macroscópico nas fezes. CONCLUSÕES: Reafirmamos a necessidade de vigilância para displasia e CCR. Pancolite aumenta risco de displasia e CCR. A idade não interfere na extensão da doença. Sangue nas fezes é importante no diagnóstico. OBJECTIVES: Ulcerative colitis is a risk factor for colorectal cancer CRC. The aim of this study was to evaluate the profile of this disease. METHODS: Retrospective data of patients with ulcerative colitis observed between 1996 and 2006 were analyzed for colonoscopic/histological findings. Colonoscopy surveillance started 7 years after disease onset. Student t test was used for means and chi-square to compare frequency. A p0,05 for age. Dysplasia was present in 9 (7%) being 8 (6%) in pancolitis p

BACKGROUND: Diarrhea in seropositive human immunodeficiency virus patients is one of the most important and disabling symptoms, and often decreases their quality of life. Cytomegalovirus colitis is among the principal causes of this symptom and colonoscopy is the gold standard examination to diagnose it. AIM: To define the main endoscopic findings in seropositive human immunodeficiency virus patients with cytomegalovirus colitis. METHODS: Two hundred and forty-three colonoscopies were performed in 200 seropositive human immunodeficiency virus patients with diarrhea associated or not to abdominal pain or gastrointestinal bleeding, over 10-year period, whom 51 patients were diagnosed with cytomegalovirus colitis. Full length colonoscopy with ileum intubation was always tried and multiple biopsies of all segments examined, including endoscopically normal segments, were attempted. All diagnoses were confirmed by histologic and immunohistochemical studies. RESULTS: Total colonoscopy was possible in 98.03% and ileum intubation in 88.23% of these cytomegalovirus colitis patients. At colonoscopy, a heterogeneous ulcerative pattern was presented in 72.54%, an inflammatory process of the mucosa in 21.56% and 5.88% of the patients mucosa was endoscopically normal. CONCLUSION: Full length colonoscopy with ileum intubation and multiples biopsies of all segments, even when they are endoscopically normal, have always to be attempted in cases of seropositive human immunodeficiency virus patient with diarrhea. RACIONAL: Diarréia em pacientes soropositivos para o vírus da imunodeficiência adquirida é um dos sintomas mais importantes e debilitantes e freqüentemente reduz sua qualidade de vida. Colite por citomegalovírus está entre as principais causas desse sintoma e a colonoscopia é o exame padrão-ouro para seu diagnóstico. OBJETIVO: Definir os principais achados endoscópicos em pacientes HIV+ com colite por citomegalovírus. MÉTODO: Duzentas e quarenta e três colonoscopias foram realizadas em 200 pacientes HIV+ com diarréia associada ou não à dor abdominal ou sangramento gastrointestinal, em período de 10 anos, dos quais 51 pacientes foram diagnosticados com colite por citomegalovírus. Colonoscopia total com entubação ileal foi sempre tentada e múltiplas biopsias de todos os segmentos, incluindo segmentos endoscopicamente normais, foram realizadas. Todos os resultados foram confirmados por estudos histológicos e imunoistoquímicos. RESULTADOS: A colonoscopia total foi possível em 98,03% e entubação ileal em 88,23% dos pacientes com colite por citomegalovírus. Nestes pacientes, identificou-se padrão ulcerativo heterogêneo em 72,54%, processo inflamatório da mucosa em 21,56% e mucosa de aspecto normal em 5,93% das colonoscopias. CONCLUSÃO: Podemos concluir que colonoscopia total com entubação ileal com múltiplas biopsias de todos os segmentos, mesmo quando são endoscopicamente normais, têm que ser sempre realizadas em casos de pacientes HIV+ com diarréia.

RACIONAL: Recentes estudos indicam a importância do infiltrado eosinofílico na mucosa retal que, juntamente com os dados clínicos, pode servir para estabelecer o diagnóstico de colite alérgica. OBJETIVOS: Descrever, prospectivamente, as características clínicas e a morfologia da mucosa retal em pacientes com enterorragia e suspeita diagnóstica de alergia às proteínas do leite de vaca. MATERIAL E MÉTODOS: Foram estudados 20 pacientes, menores de 6 meses para descrever suas características clínicas e a histologia da mucosa retal que foi comparada com um grupo controle, com suspeita de megacólon congênito. RESULTADOS: A idade média dos pacientes foi 97 ± 47 dias; enterorragia teve início antes dos 120 dias em 85% deles; em vigência de aleitamento materno (40%) artificial ou misto (60%). O achado histológico, estatisticamente significativo, foi o infiltrado aumentado de eosinófilos, na mucosa retal, em 18 pacientes. CONCLUSÃO: Pode-se afirmar que esses achados constituem, associados aos dados clínicos, os mais importantes elementos no diagnóstico de colite alérgica, em pacientes menores de 6 meses com enterorragia, que estejam recebendo aleitamento materno e/ou aleitamento artificial. BACKGROUND: Recent studies indicate the importance of eosinophilis infiltrated in the rectal mucous which jointly with the clinical features can serve to establish the diagnostic of allergic colitis. AIM: To describe prospectively, the clinical features and morphological abnormalities of the rectal mucosa in patients with rectal bleeding and clinical diagnosis of cow's milk allergy. METHODS: Clinical features of 20 infants under 6 months of age were described. Morphological findings in rectal mucosa were compared with control group, with suspicion of congenital megacolon. RESULTS: The mean age of the patients was 97 ± 47 days, rectal bleeding started before 120 days in 85% of them; 40% were breastfed, 60% cow's milk formula or both. The most striking morphological feature, in 18 patients, was eosinophilic infiltration in the rectal mucosa. There was a significant statistical difference when these values were compared with control group. CONCLUSIONS: The increased number of eosinophils in the rectal mucosa represent the most important characteristic of allergic colitis, in patients under 6 months, with rectal bleeding, when breastfed, cow's milk formula or both.