Avaliação da influência na barreira intestinal, por meio do teste de permeabilidade e dosagem de calprotectina fecal, em pacientes com Doença de Crohn, em resposta ao tratamento com terapia biológica (anticorpos anti-TNF Alfa)

Abstract

Crohn's disease (CD) is characterized by chronic intestinal inflammation that may affect any part of the digestive tract, from mouth to anus. The currently available treatment allows the disease activity control and the symptoms relief, but does not provide a cure. The intestinal epithelium has different properties and thus acts as a barrier as well as substances transport in the intestinal lumen. It is known that the macromolecules permeation increases over the course of inflammation caused through processes in the intestinal mucosa. This study aimed at the assessment, on a prospective basis, of the biological therapy association (anti-TNF- antibodies) to the inflammatory process and the intestinal barrier recovery in patients with CD. To do so, individuals with CD were evaluated, who had infliximab or adalimumab usage statement, between August 2012 and August 2014. Patients underwent clinical evaluation; laboratory review of serum inflammatory markers (C-reactive protein and erythrocyte sedimentation rate); Activity degree evaluation of the CD through the Crohn's Disease Activity Index (CDAI); intestinal permeability test through the sugars urinary excretion and the calprotectin fecal dosing, before and after induction therapy with anti-TNF- antibodies. 22 patients participated in the study, 59.1% female, 38.0 ± 12.8 years of mean age. The majority (63.6%) had the CD diagnosis between 17 and 40 years of age which was the same proportion of patients with ileocolonic diagnosis. For the CD behavior, 45.4% of patients had the penetrating profile. A downward intestinal permeability trend was perceived after treatment with anti-TNF- antibodies, 0.0082 to 0.0059 (p=0.057). Both CDAI, as serum markers of inflammatory activity and the fecal calprotectin dosage showed no difference between assessments (p>0.05). There was positive correlation between PCR values, and intestinal permeability (coefficient=0.519, p=0.033) and both fecal calprotectin and ESR levels (coefficient=0.678, p=0.031), both after the remission induction treatment.