Manual para o diagnóstico das doenças inflamatórias intestinais no Amazonas: manual voltado para o diagnóstico na Atenção Primária

Abstract

BACKGROUND: Inflammatory bowel disease (IBD) is defined as a chronic intestinal inflammation, whose main forms, Crohn's Disease (CD) and Ulcerative Colitis (UC), are distinct chronic inflammatory bowel disorders. Data on Inflammatory Bowel Disease in the state of Amazonas are scarce, with no official number of diagnosed patients, but it is known that the incidence of IBD has increased around the world. Early and correct treatment avoids complications and increases symptom-free time, but for that, early diagnosis is necessary, for this it is necessary to bring information about the disease and how to make its diagnosis to professionals who work in primary care, which is the gateway to the Unified Health System (SUS). OBJECTIVES: To develop a manual for the diagnosis of IBD, with data from the experience of specialists in Amazonas, comparing with data from the relevant world literature; identify and analyze clinical, laboratory, imaging and endoscopic findings adopted by specialist doctors with experience for the diagnosis of inflammatory bowel diseases in Amazonas; confront the data found with the relevant literature and develop a manual for the diagnosis of inflammatory bowel diseases to be used in primary care of the Unified Health System of Amazonas. METHOD: A qualitative, prospective and non-probabilistic study, using the Delphi method, in which electronic questionnaires were prepared containing direct questions about definition, clinical status, physical examination, complementary exams and diagnostic procedures to physicians specialized in gastroenterology, coloproctology and digestive tract surgery. , with experience in inflammatory bowel diseases and who care for these patients in the Unified Health System of Amazonas. RESULTS: Of the 18 specialists who agreed to participate, 17 completely answered the questionnaires, being 6 gastroenterologists, 5 coloproctologists and 6 digestive system surgeons. In the first round of questionnaires, 30 objective questions were elaborated, in 10 of them it was only allowed to choose one option and in the others more than one alternative could be chosen. The percentage accepted as consensus was 60%, and this consensus was reached in 21 questions. A second round was necessary with 19 questions for cases where there was no consensus and to finish off the others. CONCLUSIONS: The view of specialists from Amazonas on clinical, laboratory, imaging and endoscopic findings in patients with IBD was compared with the specialized literature, resulting in the creation of a manual compatible with the reality of the local SUS. The preparation of the manual is in the final stage of preparation for registration and publication.