1. Graduate Program of Health Sciences; Federal University of Maranhão; Maranhão Brazil
2. Department of Gastroenterology; University of Sao Paulo School of Medicine; São Paulo Brazil
3. Maranhão Clinical Research Center; University Hospital of the Federal University of Maranhão; Maranhão Brazil
4. Department of Nursing; Federal University of Maranhão; Maranhão Brazil
5. Department of Medicine; Federal University of Maranhão; Maranhão Brazil