WorldWideScience

Sample records for active ulcerative colitis

  1. Types of Ulcerative Colitis

    ... Colitis? > Types of Ulcerative Colitis Types of Ulcerative Colitis Email Print + Share If you are diagnosed with ... abdomen may occur in active disease. Left-sided Colitis Continuous inflammation that begins at the rectum and ...

  2. Ulcerative Colitis

    ... or worsen symptoms. Who is more likely to develop ulcerative colitis? Ulcerative colitis can occur in people ... any age. However, it is more likely to develop in people between the ages of 15 and ...

  3. Ulcerative colitis - discharge

    Inflammatory bowel disease - ulcerative colitis - discharge; Ulcerative proctitis - discharge; Colitis - discharge ... were in the hospital because you have ulcerative colitis. This is a swelling of the inner lining ...

  4. Evaluation of false remission in ulcerative colitis and the need for a revised disease activity index

    Alaa Elgamal

    2014-01-01

    Conclusion About 70% of our patients with ulcerative colitis in clinical remission had an active disease. Clinical remission in ulcerative colitis can be best expressed as true and false remission depending on histological grading in a revised ulcerative colitis disease activity index. Some inflammatory markers can be useful for the detection of true remission.

  5. HLA-DR expression and disease activity in ulcerative colitis

    Poulsen, L O; Elling, P; Sørensen, Flemming Brandt

    1986-01-01

    In 12 patients with active ulcerative colitis (UC) the rectal epithelial cells were analyzed for HLA-DR antigens by an immunohistochemical technique. The clinical, rectoscopic, and histologic stages were also determined. The investigations were carried out at the beginning of the study and 2 weeks...

  6. Andrographis paniculata Extract (HMPL-004) for Active Ulcerative Colitis

    Sandborn, William J; Targan, Stephan R; Byers, Vera S; Rutty, Dean A; Mu, Hua; Zhang, Xun; Tang, Tom

    2013-01-01

    OBJECTIVES: Andrographis paniculata has in vitro inhibitory activity against TNF-α, IL-1β and NF-κB. A pilot study of A. paniculata extract (HMPL-004) suggested similar efficacy to mesalamine for ulcerative colitis. METHODS: A randomized, double-blind, placebo-controlled trial evaluated the efficacy of A. paniculata extract (HMPL-004) in 224 adults with mild-to-moderate ulcerative colitis. Patients were randomized to A. paniculata extract (HMPL-004) 1,200 mg or 1,800 mg daily or placebo for 8 weeks. RESULTS: In total, 45 and 60% of patients receiving A. paniculata 1,200 mg and 1,800 mg daily, respectively, were in clinical response at week 8, compared with 40% of those who received placebo (P=0.5924 for 1,200 mg vs. placebo and P=0.0183 for 1,800 mg vs. placebo). In all, 34 and 38% of patients receiving A. paniculata 1,200 mg and 1,800 mg daily, respectively, were in clinical remission at week 8, compared with 25% of those who received placebo (P=0.2582 for 1,200 mg vs. placebo and P=0.1011 for 1,800 mg vs. placebo). Adverse events developed in 60 and 53% of patients in the A. paniculata 1,200 mg and 1,800 mg daily groups, respectively, and 60% in the placebo group. CONCLUSIONS: Patients with mildly to moderately active ulcerative colitis treated with A. paniculata extract (HMPL-004) at a dose of 1,800 mg daily were more likely to achieve clinical response than those receiving placebo. PMID:23044768

  7. Evaluation of inflammatory activity in Crohn's disease and ulcerative colitis

    Eduardo Garcia Vilela; Henrique Osvaldo da Gama Torres; Fabiana Paiva Martins; Maria de Lourdes de Abreu Ferrari; Marcella Menezes Andrade; Aloísio Sales da Cunha

    2012-01-01

    Crohn's disease and ulcerative colitis evolve with a relapsing and remitting course.Determination of infiammatory state is crucial for the assessment of disease activity and for tailoring therapy.However,no simple diagnostic test for monitoring intestinal inflammation is available.Noninvasive markers give only indirect assessments of disease activity.Histopathological or endoscopical examinations accurately assess inflammatoryactivity,but they are invasive,time consuming and expensive and therefore are unsuitable for routine use.Imaging procedures are not applicable for ulcerative colitis.The usefulness of ultrasound and Doppler imaging in assessing disease activity is still a matter of discussion for Crohn's disease,and an increased interest in computed tomography enterograph (CTE) has been seen,mainly because it can delineate the extent and severity of bowel wall inflammation,besides detecting extraluminal findings.Until now,the available data concerning the accuracy of magnetic resonance enterography in detecting disease activity is less than CTE.Due to this,clinical activity indices are still commonly used for both diseases.

  8. Topical Rosiglitazone Treatment Improves Ulcerative Colitis by Restoring Peroxisome Proliferator-Activated Receptor-gamma Activity

    Pedersen, G.; Brynskov, Jørn

    2010-01-01

    and functional activity in human colonic epithelium and explored the potential of topical treatment with rosiglitazone (a PPAR gamma ligand) in patients with ulcerative colitis. METHODS: Spontaneous and rosiglitazone-mediated PPAR gamma and adipophillin expression (a gene transcriptionally activated by PPAR...... gamma) were measured by reverse transcriptase PCR in colonic biopsies and isolated epithelial cells from patients with ulcerative colitis and controls. Fourteen patients with active distal ulcerative colitis were randomized to either rosiglitazone (4 mg) or mesalazine (1 g) enema treatment once daily...... in epithelial cells from inflamed mucosa in vitro. Rosiglitazone enema treatment was well tolerated and reduced the Mayo ulcerative colitis score from 8.9 to 4.3 (P

  9. Genetics Home Reference: ulcerative colitis

    ... Understand Genetics Home Health Conditions ulcerative colitis ulcerative colitis Enable Javascript to view the expand/collapse boxes. Download PDF Open All Close All Description Ulcerative colitis is a chronic disorder that affects the digestive ...

  10. Application of fecal calprotectin and myeloperoxidase in evaluation of disease activity of ulcerative colitis

    柏明见

    2013-01-01

    Objective To explore the clinical value of fecal calprotectin and myeloperoxidase in evaluation of ulcerative colitis(UC) activity.Methods Specimens of serum and feces over the same period were collected from

  11. Surgery for Crohn's Disease and Ulcerative Colitis

    ... Crohn's Disease & Ulcerative Colitis Go Back Surgery for Crohn's Disease & Ulcerative Colitis Email Print + Share ( Disclaimer: Surgery information ... helps you to learn what to expect. About Crohn’s disease and ulcerative colitis Crohn’s disease and ulcerative colitis ...

  12. Characteristic endoscopic findings and risk factors for cytomegalovirus-associated colitis in patients with active ulcerative colitis

    Yutaka Hirayama; Takafumi Ando; Yoshiki Hirooka; Osamu Watanabe; Ryoji Miyahara; Masanao Nakamura; Takeshi Yamamura; Hidemi Goto

    2016-01-01

    AIM: To identify characteristic endoscopic findings and risk factors for cytomegalovirus(CMV)-associated colitis in patients with active ulcerative colitis(UC).METHODS: A total of 149 UC patients admitted to the Department of Gastroenterology, Nagoya University Hospital, from January 2004 to December 2013 with exacerbation of UC symptoms were enrolled in this retrospective study. All medical records, including colonoscopy results, were reviewed. CMV infection was determined by the presence of CMV antigen, CMV inclusion bodies in biopsy specimens, or positive specific immunohistochemical staining for CMV. Multivariate analysis was used to identify independent risk factors for CMV colitis.RESULTS: Multivariate analysis indicated independent associations with the extent of disease(pancolitis) anduse of > 400 mg corticosteroids for the previous 4 wk. In contrast, no association was seen with sex, age at UC diagnosis, immunomodulator use, or infliximab use. Punched-out ulceration was also significantly associated with CMV infection in patients with active UC(odds ratio = 12.672, 95%CI: 4.210-38.143).CONCLUSION: Identification of a total corticosteroid dose > 400 mg for 4 wk, extensive colitis and a specific endoscopic finding of punched-out ulcer might facilitate the more rapid diagnosis and timely initiation of antiviral therapy for CMV-associated colitis in patients with active UC.

  13. Pseudomembranous colitis complicating ulcerative colitis.

    Kawaratani, Hideto; Tsujimoto, Tatsuhiro; Toyohara, Masahisa; Kin, Kenichi; Taniguchi, Tomoyasu; Shirai, Yasuyo; Ikenaka, Yasuhide; Nakayama, Masaki; Fujii, Hisao; Fukui, Hiroshi

    2010-10-01

    Clostridium difficile toxin (CD toxin) causes antibiotic-associated colitis, or pseudomembranous colitis (PMC). Although CD toxin is sometimes found in the stools of patients with ulcerative colitis (UC), UC is rarely complicated by PMC. We report herein a case of PMC complicating UC, and present a review of the literature. A 71-year-old woman was diagnosed as having UC of the left colon, and treated with prednisolone and mesalazine. Later, however, lumbar spinal stenosis was also detected. After surgery for lumbar spinal stenosis, she suffered postoperative infection of the lumbar region. After 3-week treatment with antibiotics, she developed diarrhea, bloody stools, and abdominal pain. Colonoscopy revealed PMC of the cecum, ascending colon, sigmoid colon, and rectum. Stools were positive for CD toxin. As cefotiam hydrochloride, levofloxacin hydrate (LVFX), and prednisolone were suspected as the causative agents, she was treated with 1.5 g vancomycin (VCM) daily for 2 weeks without ceasing LVFX. Her symptoms improved, and colonoscopy confirmed resolution of PMC. The possibility of PMC should be considered in UC patients treated with antibiotics, immunosuppressive agents or corticosteroids who complain of gastrointestinal symptoms. These patients should be thoroughly investigated by several modalities, including colonoscopy and CD toxin testing.

  14. Active and passive smoking behaviour and cessation plans of patients with Crohn's disease and ulcerative colitis

    van der Heide, Frans; Dijkstra, Arie; Albersnagel, Frans A.; Kleibeuker, Jan H.; Dijkstra, Gerard

    2010-01-01

    Background: Smoking is a remarkable risk factor in inflammatory bowel disease (IBD), with negative effects on Crohn's disease (CD) and positive effects on ulcerative colitis (UC). This makes different changes in smoking behaviour after diagnosis between CD and UC likely. Changes in active smoking, c

  15. Attenuated apoptosis response to Fas-ligand in active ulcerative colitis

    Seidelin, J.B.; Nielsen, Ole Haagen

    2008-01-01

    BACKGROUND: From mainly carcinoma cell line studies, apoptosis has been thought to play a major role in the pathogenesis of ulcerative colitis (UC). Apoptosis has been suggested to be due to a Fas ligand / Fas receptor interaction, but has never been studied in cells from patients with active UC...

  16. Ulcerative colitis in infancy

    Md Rukunuzzaman

    2011-01-01

    Full Text Available Ulcerative colitis (UC is a chronic idiopathic inflammatory disorder of colon. Frequency of UC is gradually increasing over few years worldwide. Prevalence is 35 to 100/100 000 people in USA, 1% of them are infants. UC develops in a genetically predisposed individual with altered intestinal immune response. An eight-month-old girl presented with loose bloody stool, growth failure, and moderate pallor. The girl was diagnosed as a case of UC by colonoscopy and biopsy. Treatment was thereafter started with immunosuppressive drugs. After initial induction therapy with parenteral steroid and infliximab, the patient is now on remission with azathioprine and mesalamine. UC is rare in Bangladesh, especially in children, and it is rarer during infancy. Several conditions like infective colitis, allergic colitis, Meckel′s diverticulitis, Crohn′s disease, etc. may mimic the features of UC. So, if a child presents with recurrent bloody diarrhea, UC should be considered as differential diagnosis.

  17. Ulcerative Colitis in Infancy

    Md Rukunuzzaman; A. S. M. Bazlul Karim

    2011-01-01

    Ulcerative colitis (UC) is a chronic idiopathic inflammatory disorder of colon. Frequency of UC is gradually increasing over few years worldwide. Prevalence is 35 to 100/100 000 people in USA, 1% of them are infants. UC develops in a genetically predisposed individual with altered intestinal immune response. An eight-month-old girl presented with loose bloody stool, growth failure, and moderate pallor. The girl was diagnosed as a case of UC by colonoscopy and biopsy. Treatment was thereafter ...

  18. Identification of symptom domains in ulcerative colitis that occur frequently during flares and are responsive to changes in disease activity

    Wang Sijian

    2008-09-01

    Full Text Available Abstract Background Ulcerative colitis disease activity is determined by measuring symptoms and signs. Our aim was to determine which symptom domains are frequent and responsive to change in the evaluation of disease activity, which are those defined by three criteria: 1 they occur frequently during flares; 2 they improve during effective therapy for ulcerative colitis; and 3 they resolve during remission. Methods Twenty-eight symptom domains, 16 from standard indices and 12 novel domains identified by ulcerative colitis patient focus groups, were evaluated. Sixty subjects with ulcerative colitis were surveyed, rating each symptom on the three criteria with a 100 mm Visual Analogue Scale. Frequent and responsive symptoms were defined a priori as those whose median Visual Analogue Scale rating for all 3 criteria was significantly greater than 50. Results Thirteen of the 28 symptom domains were identified as both frequent in ulcerative colitis flares and responsive to changes in disease activity. Seven of these 13 symptom domains were novel symptoms derived from ulcerative colitis patient focus groups including stool mucus, tenesmus, fatigue, rapid postprandial bowel movements, and inability to differentiate liquid or gas from solid stool when rectal urgency occurs. Ten of the 16 symptom domains from standard indices were either infrequent or unresponsive to changes in disease activity. Conclusion Only some of the symptoms of ulcerative colitis that are important to patients are included in standard indices, and several symptoms currently measured are not frequent or responsive to change in ulcerative colitis patients. Development of survey measures of these symptom domains could significantly improve the assessment of disease activity in ulcerative colitis.

  19. Attenuated apoptosis response to Fas-ligand in active ulcerative colitis

    Seidelin, Jakob B; Nielsen, Ole H

    2008-01-01

    From mainly carcinoma cell line studies, apoptosis has been thought to play a major role in the pathogenesis of ulcerative colitis (UC). Apoptosis has been suggested to be due to a Fas ligand / Fas receptor interaction, but has never been studied in cells from patients with active UC. The aim...... was to investigate both the spontaneous and the cell death receptor ligand-induced apoptosis in UC....

  20. Exacerbation of Bloody Diarrhea as a Side Effect of Mesalamine Treatment of Active Ulcerative Colitis

    Yuichi Shimodate; Kunihiro Takanashi; Eriko Waga; Tomoki Fujita; Shinichi Katsuki; Masafumi Nomura

    2011-01-01

    Mesalamine has been used as the first-line therapy for the treatment of ulcerative colitis (UC) because of its efficacy and fewer side effects. However, earlier study showed that mesalamine occasionally causes diarrhea. We are presenting a patient with active UC in whom bloody diarrhea accompanied by abdominal pain and fever occurred and the symptoms were aggravated after administration of mesalamine. In order to clarify the reason of symptoms aggravation, drug lymphocyte stimulation test and...

  1. Blockade of leukotriene production by a single oral dose of MK-0591 in active ulcerative colitis

    Hillingsø, Jens; Kjeldsen, J; Laursen, L S;

    1995-01-01

    dialysis fluid, ex vivo biosynthesis of LTB4 in whole blood, and urinary excretion of leukotriene E4 (LTE4) from 16 patients with mild to moderately active distally located ulcerative colitis were measured by use of radioimmunoassays in a double-blind, placebo-controlled parallel-design study before...... was unchanged. In whole blood, MK-0591 decreased ex vivo biosynthesis of LTB4 (p LTE4 was reduced by more than 85% (p

  2. Open label trial of granulocyte apheresis suggests therapeutic efficacy in chronically active steroid refractory ulcerative colitis

    Wolfgang Kruis; Robert L(o)fberg; Axel Dignass; Elisabeth Steinhagen-Thiessen; Julia Morgenstern; Joachim M(o)ssner; Stephan Schreiber; Maurizio Vecchi; Alberto Malesci; Max Reinshagen

    2005-01-01

    AIM:To study the efficacy, safety, and feasibility of a granulocyte adsorptive type apheresis system for the treatment of patients with chronically active ulcerative colitis despite standard therapy.METHODS: An open label multicenter study was carried out in 39 patients with active ulcerative colitis (CAI6-8) despite continuous use of steroids (a minimum total dose of 400 mg prednisone within the last 4 wk).Patients received a total of five aphereses using a granulocyte adsorptive technique (Adacolumn(R), Otsuka Pharmaceutical Europe, UK). Assessments at wk 6 and during follow-up until 4 mo comprised clinical (CAI) and endoscopic (EI) activity index, histology, quality of life(IBDQ), and laboratory tests.RESULTS: Thirty-five out of thirty-nine patients were qualified for intent-to-treat analysis. After the apheresis treatment at wk 6, 13/35 (37.1%) patients achieved clinical remission and 10/35 (28.6%) patients had endoscopic remission (CAI<4, EI<4). Quality of life (IBDQ) increased significantly (24 points, P<0.01)at wk 6. Apheresis could be performed in all but one patient. Aphereses were well tolerated, only one patient experienced anemia.CONCLUSION: In patients with steroid refractory ulcerative colitis, five aphereses with a granulocyte/monocyte depleting filter show potential short-term efficacy. Tolerability and technical feasibility of the procedure are excellent.

  3. Pas de Deux: Active Ulcerative Colitis in an HIV-Positive Patient

    David C Pearson

    1996-01-01

    Full Text Available A 40-year-old male who was found to be human immunodeficiency virus-positive when he presented with bloody diarrhea in 1986 is described. Clinical, laboratory, endoscopic and histological findings were all compatible with ulcerative colitis, and stool cultures were repeatedly negative for pathogens. Colitis was initially mild and controlled with intermittent oral aminosalicylic acid products. Since 1993 he has had more significant symptoms requiring prednisone up to 40 mg/day. Repeat colonoscopy disclosed pancolitis and biopsies did not show evidence of cytomegalovirus infection. He has not had an acquired immune deficiency syndrome-defining illness. CD4 cells fell below normal as his colitis worsened. This case raises questions about immune regulation in ulcerative colitis because the patient has active disease in addition to a reduced number of T helper cells. It also presents a difficult management problem because the patient has a limited life expectancy and is reluctant to accept colectomy, and further immunosuppressive therapy may be dangerous.

  4. Ulcerative colitis flare with splenic ven thrombosis.

    Bozkurt, Huseyin Sancar; Kara, Banu; Citil, Serdal

    2015-01-01

    Patients with ulcerative colitis (UC) have an increased risk of thromboembolic events. Here, we present a 28-year-old man with active ulcerative pancolitis presenting via splenic vein thrombosis and left renal superior infarct that was not associated with a surgical procedure.

  5. Assessment of the influence of the inflammatory process on the activation of blood platelets and morphological parameters in patients with ulcerative colitis (colitis ulcerosa

    Halina Kemona

    2011-04-01

    Full Text Available Ulcerative colitis (colitis ulcerosa is a non-specific inflammatory bowel disease of unknown etiology. The symptoms which are observed in the course of ulcerative colitis are: an increase in the number of leukocytes and blood platelets, an increase in the concentration of IL-6 and anemia. Blood platelets are the key element, linking the processes of hemostasis, inflammation and the repair of damaged tissues. Activation of blood platelets is connected with changes in their shape and the occurrence of the reaction of release. P-selectin appears on the surfaces of activated blood platelets and the concentration level of soluble P-selectin increases in the blood plasma. The aim of this study was to define whether the increased number of blood platelets in patients with ulcerative colitis accompanies changes in their activation and morphology. A total of 16 subjects with ulcerative colitis and 32 healthy subjects were studied. Mean platelet count, morphological parameters of platelets and MPC were measured using an ADVIA 120 hematology analyzer. Concentrations of sP-selectin and IL-6 in serum were marked by immunoassay (ELISA. MPC, concentration of sP-selectin and IL-6 were significantly higher in subjects with ulcerative colitis compared to those in the healthy group. There was a decrease of MPV in patients with ulcerative colitis, which is statistically significant. Chronic inflammation in patients with ulcerative colitis causes an increase in the number of blood platelets, a change in their morphology and activation. Decreased MPV value reflects activation and the role blood platelets play in the inflammatory process of the mucous membrane of the colon. A high concentration of sP-selectin, which is a marker of blood platelet activation, demonstrates their part in the inflammatory process. The increase in the concentration of sP-selectin correlated positively with the increase in concentration of IL-6. This is why it may be a useful marker

  6. Amebic and cytomegalovirus colitis mimic ulcerative colitis

    Meng-Tzu Weng

    2016-06-01

    Full Text Available Here we present a 50-year-old man who suffered from progressively bloody diarrhea for 2 months. A colonoscopy revealed pancolonic mucosal inflammation, ulceration, and spontaneous bleeding. Ulcerative colitis was initially diagnosed and sulfasalazine was prescribed. Hypoalbuminemia and renal function deterioration developed 1 year later. Steroids were prescribed for suspected nephrotic syndrome. His bloody diarrhea and abdominal symptoms worsened after steroid use. Progressive sepsis and acute renal function deterioration also developed. Positive human immunodeficiency virus (HIV antibody was found during routine hemodialysis screening. An episode of colon perforation occurred and surgery was performed. The resected colon showed amoeba, cytomegalovirus, and fungal infection. The patient died of sepsis. In this report, we discuss how to diagnose ulcerative colitis. It is important to exclude infection before using an immunosuppressive agent.

  7. Profermin is efficacious in patients with active ulcerative colitis--a randomized controlled trial

    Krag, Aleksander; Munkholm, Pia; Israelsen, Hans;

    2013-01-01

    Profermin is developed for the dietary management of ulcerative colitis (UC). It consists of water, fermented oats, barley malt, lecithin, and Lactobacillus plantarum 299v. The aim of this study was to assess the clinical efficacy of Profermin.......Profermin is developed for the dietary management of ulcerative colitis (UC). It consists of water, fermented oats, barley malt, lecithin, and Lactobacillus plantarum 299v. The aim of this study was to assess the clinical efficacy of Profermin....

  8. Assessment of the influence of the inflammatory process on the activation of blood platelets and morphological parameters in patients with ulcerative colitis (colitis ulcerosa

    Beata Polińska

    2011-04-01

    Full Text Available Ulcerative colitis (colitis ulcerosa is a non-specific inflammatory bowel disease of unknown etiology. Thesymptoms which are observed in the course of ulcerative colitis are: an increase in the number of leukocytes andblood platelets, an increase in the concentration of IL-6 and anemia. Blood platelets are the key element, linkingthe processes of hemostasis, inflammation and the repair of damaged tissues. Activation of blood platelets is connectedwith changes in their shape and the occurrence of the reaction of release. P-selectin appears on the surfacesof activated blood platelets and the concentration level of soluble P-selectin increases in the blood plasma. The aimof this study was to define whether the increased number of blood platelets in patients with ulcerative colitisaccompanies changes in their activation and morphology. A total of 16 subjects with ulcerative colitis and 32healthy subjects were studied. Mean platelet count, morphological parameters of platelets and MPC were measuredusing an ADVIA 120 hematology analyzer. Concentrations of sP-selectin and IL-6 in serum were marked byimmunoassay (ELISA. MPC, concentration of sP-selectin and IL-6 were significantly higher in subjects with ulcerativecolitis compared to those in the healthy group. There was a decrease of MPV in patients with ulcerativecolitis, which is statistically significant. Chronic inflammation in patients with ulcerative colitis causes an increase inthe number of blood platelets, a change in their morphology and activation. Decreased MPV value reflects activationand the role blood platelets play in the inflammatory process of the mucous membrane of the colon. A highconcentration of sP-selectin, which is a marker of blood platelet activation, demonstrates their part in the inflammatoryprocess. The increase in the concentration of sP-selectin correlated positively with the increase in concentrationof IL-6. This is why it may be a useful marker of the activity of

  9. Plasma matrix metalloproteinase-1 and tissue inhibitor of metalloproteinase-1 as biomarkers of ulcerative colitis activity

    Alicja Wiercinska-Drapalo; Jerzy Jaroszewicz; Robert Flisiak; Danuta Prokopowicz

    2003-01-01

    AIM: Overexpression of mucosal metalloproteinases (MMP)has been demonstrated recently in inflammatory boweldisease. Their activity can be counterbalanced by the tissueinhibitor of metalloproteinases (TIMP). The aim of this studywas to evaluate the effect of ulcerative colitis (UC) on MMP-1 and TTMP-1 plasma concentrations, as two possiblebiomarkers of the disease activity.METHODS: MMP-1 and TIMP-1 plasma concentrations weremeasured with an enzyme immunoassay in 16 patients withendoscopically confirmed active UC.RESULTS: Plasma concentrations of both MMP-11 (13.7±0.2ng/ml) and TIMP-L (799±140 ng/ml) were significantlyelevated in UC patients in comparison to healthy controls(11.9±0.9 ng/ml and 220±7 ng/ml respectively). There wasno correlation between TIMP-1 and MMP-1 concentrations(r=-0.02). TIMP-1 levels revealed significant positivecorrelations with scored endoscopic degree of mucosai injury,disease activity index and clinical activity index values aswell as C-reactive protein concentration. There was nocorrelation between MMP-1 and laboratory, clinical orendoscopic indices of the disease activity.CONCLUSION: These results confirm the role of both MMP-1 and TIMP-1 in the pathogenesis of ulcerative colitis.However only TIMP-1 can be useful as a biomarker of thedisease activity, demonstrating association with clinical andendoscopic pictures.

  10. Aberrant activation of nuclear factor of activated T cell 2 in lamina propria mononuclear cells in ulcerative colitis

    Tsung-Chieh Shih; Sen-Yung Hsieh; Yi-Yueh Hsieh; Tse-Chin Chen; Chien-Yu Yeh; Chun-Jung Lin; Deng-Yn Lin; Cheng-Tang Chiu

    2008-01-01

    AIM: To investigate the role of nuclear factor of activated T cell 2 (NFAT2), the major NFAT protein in peripheral T cells, in sustained T cell activation and intractable inflammation in human ulcerative colitis (UC).METHODS: We used two-dimensional gel-electrophoresis, immunohistochemistry, double immunohistochemical staining, and confocal microscopy to inspect the expression of NFAT2 in 107, 15, 48 and 5 cases of UC, Crohn's disease (CD), non-specific colitis, and 5 healthy individuals, respectively.RESULTS: Up-regulation with profound nucleo-translocation/activation of NFAT2 of lamina propria mononuclear cells (LPMC) of colonic mucosa was found specifically in the affected colonic mucosa from patients with UC, as compared to CD or NC (P < 0.001, Kruskal-Wallis test). Nucleo-translocation/activation of NFAT2 primarily occurred in CD8+T, but was less prominent in CD4+ T cells or CD20+B cells. It was strongly associated with the disease activity, including endoscopic stage (t = 0.2145, P = 0.0281) and histologic grade (t = 0.4167, P < 0.001).CONCLUSION: We disclose for the first time the nucleo-translocation/activatin of NFAT2 in lamina propria mononuclear cells in ulcerative colitis. Activation of NFAT2 was specific for ulcerative colitis and highly associated with disease activity. Since activation of NFAT2 is implicated in an auto-regulatory positive feedback loop of sustained T-cell activation and NFAT proteins play key roles in the calcium/calcineurin signaling pathways, our results not only provide new insights into the mechanism for sustained intractable inflammation, but also suggest the calcium-calcineurin/NFAT pathway as a new therapeutic target for ulcerative colitis.

  11. Management of pediatric ulcerative colitis

    Turner, Dan; Levine, Arie; Escher, Johanna C

    2012-01-01

    Pediatric ulcerative colitis (UC) shares many features with adult-onset disease but there are some unique considerations; therefore, therapeutic approaches have to be adapted to these particular needs. We aimed to formulate guidelines for managing UC in children based on a systematic review (SR......) of the literature and a robust consensus process. The present article is a product of a joint effort of the European Crohn's and Colitis Organization (ECCO) and the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN)....

  12. Infliximab to treat severe ulcerative colitis

    Dídia Bisamra Cury; Marcelo de Souza Cury; Geraldo Vinicius Hemerly Elias; Sender Jankiel Mizsputen

    2009-01-01

    A 48-year-old female with severe ulcerative colitis refractory to conventional therapy was referred to our facility for management. The patient showed extensive ulcerative colitis since the age of 20 years and had failed therapy with 5-aminosalicylic acid agents and azathioprine. The disease remained active despite treatment with steroids and cyclosporine. The clinical and endoscopic parameters were consistent with severe disease. Infectious precipitants were ruled out. Given the severity of the disease and in order to avoid a colectomy, we started the patient on infliximab therapy. A dramatic clinical and endoscopic response was observed and she remained in remission at the end of a 1-year follow-up period. We discuss findings in the literature regarding the use of infliximab therapy in patients with ulcerative colitis who have failed steroids and cyclosporine.

  13. Activation of nuclear factor kappaB in colonic mucosa from patients with collagenous and ulcerative colitis

    Jørgensen, V.L.; Perner, A.; Hansen, A.

    2005-01-01

    Expression of inducible nitric oxide synthase (iNOS) is greatly upregulated in the colonic mucosa of patients with collagenous and ulcerative colitis. As the transcription factor nuclear factor kappaB (NFkappaB) is a major inducer of iNOS gene expression, we compared activation and transcriptional...

  14. Mucosal healing in ulcerative colitis

    Seidelin, Jakob Benedict; Coskun, Mehmet; Nielsen, Ole Haagen

    2013-01-01

    Ulcerative colitis (UC) is a colonic inflammatory condition with a substantial impact on the quality of life of affected persons. The disease carries a cumulative risk of need of colectomy of 20-30% and an estimated cumulative risk of colorectal cancer of 18% after 30 years of disease duration. W...

  15. Mucosal healing in ulcerative colitis

    Seidelin, Jakob Benedict; Coskun, Mehmet; Nielsen, Ole Haagen

    2013-01-01

    Ulcerative colitis (UC) is a colonic inflammatory condition with a substantial impact on the quality of life of affected persons. The disease carries a cumulative risk of need of colectomy of 20-30% and an estimated cumulative risk of colorectal cancer of 18% after 30 years of disease duration...

  16. [Ulcerative colitis and cytomegalovirus infection].

    Tárraga Rodríguez, I; Ferreras Fernández, P; Vicente Gutiérrez, M; de Arriba, J J; García Mouriño, M L

    2003-02-01

    Colitis ulcerous and citomegalovirus infection association have been reported in medical literature in sometimes, althougth this prevalence have lately increased. We report a case record of this association and do a review of this subject. It is not clear what factors are involved in this association, being necessary hore studies to know them.

  17. Bacterial colonization of colonic crypt mucous gel and disease activity in ulcerative colitis.

    Rowan, Fiachra

    2012-02-01

    OBJECTIVE: To optimize total bacterial 16S rRNA quantification in microdissected colonic crypts in healthy controls and patients with ulcerative colitis (UC) and to characterize the findings with disease activity. BACKGROUND: Microscopic and molecular techniques have recently converged to allow bacterial enumeration in remote anatomic locations [eg, crypt-associated mucous gel (CAMG)]. The aims of this study were to combine laser capture microdissection (LCM) and 16S rRNA-based quantitative polymerase chain reaction (qPCR) to determine total bacterial copy number in CAMG both in health and in UC and to characterize the findings with disease activity. METHODS: LCM was used to microdissect CAMG from colonic mucosal biopsies from controls (n = 20) and patients with acute (n = 10) or subacute (n = 10) UC. Pan-bacterial 16S rRNA copy number per millimeter square in samples from 6 locations across the large bowel was obtained by qPCR using Desulfovibrio desulfuricans as a reference strain. Copy numbers were correlated with the UC disease activity index (UCDAI) and the simple clinical colitis activity index (SCCAI). RESULTS: Bacterial colonization of CAMG was detectable in all groups. Copy numbers were significantly reduced in acute UC. In subacute colitis, there was a positive correlation between copy number and UCDAI and SCCAI in the ascending, transverse and sigmoid colon. CONCLUSIONS: This study describes a sensitive method of quantitatively assessing bacterial colonization of the colonic CAMG. A positive correlation was found between CAMG bacterial load and subacute disease activity in UC, whereas detectable bacterial load was reduced in acute UC.

  18. Confocal laser endomicroscopy in ulcerative colitis

    Karstensen, John Gásdal; Săftoiu, Adrian; Brynskov, Jørn

    2016-01-01

    was to correlate colonic confocal laser endomicroscopy (CLE) in ulcerative colitis with histopathology and macroscopic appearance before and after intensification of medical treatment. METHODS: Twenty-two patients with ulcerative colitis in clinical relapse and 7 control subjects referred for colonoscopy were...... colitis compared with inactive ulcerative colitis...... is an emerging endoscopic technique that reproducibly identifies mucosal changes in ulcerative colitis. With the exception of crypt changes, endomicroscopic features appear to improve slowly with time after medical treatment. ( CLINICAL TRIAL REGISTRATION NUMBER: NCT01684514.)....

  19. Ulcerative colitis six years after colon cancer: only a coincidence?

    Sakellakis, Minas; Makatsoris, Thomas; Gkermpesi, Maria; Peroukidis, Stavros; Kalofonos, Haralabos

    2014-01-01

    The association between inflammatory bowel disease and colorectal cancer is well known. Ulcerative colitis is a risk factor for the development of colorectal cancer, and this risk increases with the activity and duration of bowel inflammation. Here we describe the case of a 52-year-old man who developed ulcerative colitis 6 years after the diagnosis and treatment of colon cancer. Although this could be a coincidence, there could be additional possibilities, like pre-existence of quiescent colitis, late effect of therapy, or maybe the existence of common pathogenetic factors contributing to the development of ulcerative colitis and colorectal cancer. PMID:24855393

  20. Ciprofloxacin and probiotic Escherichia coli Nissle add-on treatment in active ulcerative colitis

    Petersen, Andreas Munk; Mirsepasi, Hengameh; Halkjær, Sofie Ingdam;

    2014-01-01

    BACKGROUND AND AIM: Ulcerative colitis (UC) is a chronic inflammatory bowel disease. The probiotic bacterium Escherichia coli Nissle 1917 (EcN) has been used to maintain and induce clinical remission in UC. Our aim was to test the effect of Ciprofloxacin and/or orally administered EcN as add...

  1. Atypical disease phenotypes in pediatric ulcerative colitis

    Levine, Arie; de Bie, Charlotte I; Turner, Dan

    2013-01-01

    Definitive diagnosis of pediatric ulcerative colitis (UC) may be particularly challenging since isolated colitis with overlapping features is common in pediatric Crohn's disease (CD), while atypical phenotypes of UC are not uncommon. The Paris classification allows more accurate phenotyping...

  2. Antiviral treatment in patients with cytomegalovirus positive ulcerative colitis

    Kadir; Ozturk

    2014-01-01

    Cytomegalovirus(CMV) is a common virus in patients with ulcerative colitis receiving immunosuppressive drugs. Many studies suggested that CMV infection is an exacerbating factor in patients with ulcerative colitis. The role of CMV in exacerbations of ulcerative colitis has been discussed. One of studies starting this discussion is an article entitled "CMV positive ulcerative colitis: A single center experience and literature review" by Kopylov et al. However, we think that there are some points that should be emphasized about the study. Especially, the small number of patients in the study has led to meaningless results. Large controlled prospective trials are needed to clarify the benefit of antiviral therapy for active ulcerative colitis patients.

  3. Ulcerative colitis after Cytomegalovirus Infection

    Mohammad Aminianfar

    2014-06-01

    Full Text Available A 21 years old man has been complained of bloody diarrhea, liquid stool containing blood, pus, and fecal matter and crampy abdominal pain from four monthes ago. Ulcerative colitis relies upon the patient's history, clinical symptoms, sigmoidoscopic appearance and histology of colonic biopsy specimens. Treatment of patient started with high dose dexamethasone and prednisolone, asacole, suppository, metronidazole. Patient’s condition not improved and patient admitted in hospital. High dose prednisolone, azathioprine, sulfasalazine and folic acid were given.

  4. Current treatment of ulcerative colitis

    Johannes Meier; Andreas Sturm

    2011-01-01

    Ulcerative colitis (UC) is a chronic disease featuring recurrent inflammation of the colonic mucosa. The goal of medical treatment is to rapidly induce a steroid-free remission while at the same time preventing complications of the disease itself and its treatment. The choice of treatment depends on severity, localization and the course of the disease. For proctitis, topical therapy with 5-aminosalicylic acid (5-ASA) compounds is used. More extensive or severe disease should be treated with oral and local 5-ASA compounds and corticosteroids to induce remission. Patients who do not respond to this treatment require hospitalization. Intravenous steroids or, when refractory, calcineurin inhibitors (cyclosporine, tacrolimus), tumor necrosis factor-α antibodies (infliximab) or immunomodulators (azathioprine, 6-mercaptopurine) are then called for. Indications for emergency surgery include refractory toxic megacolon, perforation, and continuous severe colorectal bleeding. Close collaboration between gastroenterologist and surgeon is mandatory in order not to delay surgical therapy when needed. This article is intended to give a general, practice- orientated overview of the key issues in ulcerative colitis treatment. Recommendations are based on published consensus guidelines derived from national and international guidelines on the treatment of ulcerative colitis.

  5. Current treatment of ulcerative colitis

    JohannesMeier; AndreasSturm

    2011-01-01

    Ulcerative colitis (UC) is a chronic disease featuring re- current inflammation of the colonic mucosa. The goal of medical treatment is to rapidly induce a steroid-free remission while at the same time preventing complica- tions of the disease itself and its treatment. The choice of treatment depends on severity, localization and the course of the disease. For proctitis, topical therapy with 5-aminosalicylic acid (5-ASA) compounds is used. More extensive or severe disease should be treated with oral and local 5-ASA compounds and corticosteroids to induce remission. Patients who do not respond to this treatment require hospitalization. Intravenous steroids or, when refractory, calcineurin inhibitors (cyclosporine, tacrolimus), tumor necrosis factor-α antibodies (infliximab) or immunomodulators (azathioprine, 6-mercaptopurine) are then called for. Indications for emergency surgery include refractory toxic megacolon, perforation, and continuous severe colorectal bleeding. Close collaboration between gastroenterologist and surgeon is mandatory in order not to delay surgical therapy when needed. This article is intended to give a general, practice-orientated overview of the key issues in ulcerative colitis treatment. Recommendations are based on published consensus guidelines derived from national and international guidelines on the treatment of ulcerative colitis.

  6. Ulcerative colitis six years after colon cancer: only a coincidence?

    Sakellakis M

    2014-04-01

    Full Text Available Minas Sakellakis,1 Thomas Makatsoris,1 Maria Gkermpesi,2 Stavros Peroukidis,1 Haralabos Kalofonos11Division of Oncology, Department of Medicine, 2Department of Pathology, University, Hospital of Patras, Patras, GreeceAbstract: The association between inflammatory bowel disease and colorectal cancer is well known. Ulcerative colitis is a risk factor for the development of colorectal cancer, and this risk increases with the activity and duration of bowel inflammation. Here we describe the case of a 52-year-old man who developed ulcerative colitis 6 years after the diagnosis and treatment of colon cancer. Although this could be a coincidence, there could be additional possibilities, like pre-existence of quiescent colitis, late effect of therapy, or maybe the existence of common pathogenetic factors contributing to the development of ulcerative colitis and colorectal cancer.Keywords: ulcerative, colitis, colorectal, cancer, inflammation

  7. Clinical management of severe active ulcerative colitis in the TNF-a inhibitors era

    Andrea Calafiore

    2013-12-01

    Full Text Available Ulcerative colitis (UC is a chronic inflammation of the coli mucosa clinically characterized by bloody diarrhea, abdominal pain and other systemic symptoms. The onset, as well as subsequent relapses, may occur with varying degrees of clinical and endoscopic activity and extent of disease. The clinical and endoscopic activity varies from mild to severe, while the extent of disease, without interruption, may involve from the rectum up to the entire colon. The severe form, when not properly and promptly treated, can be life-threatening and may determine various complications requiring urgent surgical treatment. Early recognition of severe forms, their treatment and patient monitoring can reduce morbidity and mortality, and improve surgical outcome. Since the 1950s, systemic corticosteroids have been the first-line treatment in severe active UC. Today, appropriate patient monitoring, and recognition of clinical, radiological and laboratory findings indicative of steroid failure guide the clinician in the use of immunomodulatory drugs or suggest indications for surgery. The aim of our study is to review the more recent data and guidelines that could be useful in clinical practice for the management of severe UC.

  8. Crohn's Disease and Ulcerative Colitis: Emotional Factors

    ... IS THE CAUSE OF ULCERATIVE COLITIS AND CROHN’S DISEASE? The origin of IBD is still unknown. It is possible that a combination of factors may be the underlying cause of Crohn’s disease and ulcerative colitis. Researchers theorize that IBD patients ...

  9. Microheterogeneity of acute phase proteins in patients with ulcerative colitis

    Marian Grzymis(l)awski; Katarzyna Derc; Magdalena Sobieska; Krzysztof Wiktorowicz

    2006-01-01

    AIM: To estimate the serum α1-antichymotrypsin (ACT),α1-acid glycoprotein (AGP) and transferrin (Tf) concentrations and to evaluate the microheterogeneity of these acute phase proteins in patients with ulcerative colitis. METHODS: Twenty-seven patients with ulcerative colitis (UC) and 17 healthy control subjects were studied. The patients were categorised as severe (n = 9), moderate (n = 10) and mild groups (n = 8) using Truelove and Witts'classification of ulcerative colitis. Microheterogeneity of ACT, AGP and Tf was analysed by crossed immunoaffinity electrophoresis (CIAE) with concanavalin A. In all serum samples standard electrophoresis of serum proteins was performed, iron (Fe) concentration, total iron binding capacity (TIBC) and C-reactive protein (CRP) were also measured.RESULTS: Our patients suffering from ulcerative colitis had significantly higher serum ACT and AGP concentrations and lower serum transferrin concentration in comparison to healthy subjects. Changes in concentrationsof acute phase proteins were dependent on the activityof the inflammatory process. The glycosylation patterns of transferrin were related to the inflammation status. We also observed the correlation between ACT and AGP concentrations, patterns of transferrin glycosylation and changes in standard protein electrophoresis or blood cell count.CONCLUSION: The glycosylation patterns of transferrin obtained from patients suffering from ulcerative colitis are highly branched and sialylated compared with those obtained from healthy subjects. In contrast, the glycosylation patterns of transferrin do not differ according to the activity index of ulcerative colitis. The microheterogeneity patterns of AGP and ACT are similar in ulcerative colitis patients and healthy subjects.

  10. Faecal mucus degrading glycosidases in ulcerative colitis and Crohn's disease.

    Rhodes, J M; Gallimore, R; Elias, E; Allan, R N; Kennedy, J F

    1985-08-01

    Because the normal faecal flora includes bacteria which can produce mucus-digesting glycosidases, it follows that increased digestion of colonic mucus by these bacterial enzymes could be important in the pathogenesis of ulcerative colitis. Faecal activities of potential mucus-degrading glycosidases have therefore been assayed in samples from patients with inflammatory bowel disease and normal controls. The enzymes alpha-D-galactosidase, beta-D-galactosidase, beta-NAc-D-glucosaminidase alpha-L-fucosidase and neuraminidase were assayed. Considerable glycosidase activity was present in most faecal samples. Similar activities of all the enzymes assayed were found in faeces from patients with ulcerative colitis, Crohn's disease and normal controls and there was no significant correlation with disease activity. These results imply that relapse of ulcerative colitis is not initiated by increased degradation of colonic mucus by faecal glycosidases but do not exclude a role for bacterial mucus degradation in the pathogenesis of ulcerative colitis.

  11. Exacerbation of Bloody Diarrhea as a Side Effect of Mesalamine Treatment of Active Ulcerative Colitis

    Yuichi Shimodate

    2011-04-01

    Full Text Available Mesalamine has been used as the first-line therapy for the treatment of ulcerative colitis (UC because of its efficacy and fewer side effects. However, earlier study showed that mesalamine occasionally causes diarrhea. We are presenting a patient with active UC in whom bloody diarrhea accompanied by abdominal pain and fever occurred and the symptoms were aggravated after administration of mesalamine. In order to clarify the reason of symptoms aggravation, drug lymphocyte stimulation test and rechallenge trial with mesalamine were performed. The results indicated the possibility that aggravation was related to allergic reaction and was dose-dependent. Furthermore, we examined colonoscopic views but there was no remarkable change in before and after rechallenge trial. Based on the above result, the patient was diagnosed with mesalamine intolerance. In order to differentiate whether the exacerbation of bloody diarrhea is due to the side effects of the mesalamine or a true relapse of UC, taking careful history before and after increasing mesalamine dosage as well as being aware of side effects of mesalamine are required. Clinicians should be aware of diarrhea as a side effect of mesalamine particularly after onset of mesalamine formulation, change in mesalamine formulation, or change in mesalamine dose.

  12. Intestinal microbiota and ulcerative colitis.

    Ohkusa, Toshifumi; Koido, Shigeo

    2015-11-01

    There is a close relationship between the human host and the intestinal microbiota, which is an assortment of microorganisms, protecting the intestine against colonization by exogenous pathogens. Moreover, the intestinal microbiota play a critical role in providing nutrition and the modulation of host immune homeostasis. Recent reports indicate that some strains of intestinal bacteria are responsible for intestinal ulceration and chronic inflammation in inflammatory bowel diseases (IBD) such as ulcerative colitis (UC) and Crohn's disease (CD). Understanding the interaction of the intestinal microbiota with pathogens and the human host might provide new strategies treating patients with IBD. This review focuses on the important role that the intestinal microbiota plays in maintaining innate immunity in the pathogenesis and etiology of UC and discusses new antibiotic therapies targeting the intestinal microbiota.

  13. Clinical value of fecal calprotectin in determining disease activity of ulcerative colitis

    Jun-Ying Xiang; Qin Ouyang; Guo-Dong Li; Nan-Ping Xiao

    2008-01-01

    AIM:To investigate possibility and clinical application of fecal calprotectin in determining disease activity of ulcerative colitis (UC).METHODS: The enzyme-linked immunosorbent assay(ELISA) was used to measure the concentrations of calprotectin in feces obtained from 66 patients with UC and 20 controls. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), acid glycoprotein (AGP) were also measured and were compared with calprotectin in determining disease activity of UC. The disease activity of UC was also determined by the Sutherland criteria.RESULTS: The fecal calprotectin concentration in the patients with active UC was significantly higher than that in the inactive UC and in the controls (402.16±48.0 μg/g vs 35.93±3.39 μg/g, 11.5±3.42 μg/g, P < 0.01). The fecal calprotectin concentration in the inactive UC group was significantly higher than that in the control group (P < 0.05). A significant difference was also found in the patients with active UC of mild, moderate and severe degrees. The area under the curve of the receiver operating characteristics (AUCROC) was 0.975, 0.740, 0.692 and 0.737 for fecal calprotectin, CRP, ESR and AGP,respectively. There was a strong correlation between the fecal calprotectin concentration and the endoscopic gradings for UC (r = 0.866, P < 0.001).CONCLUSION: Calprotectin in the patient's feces can reflect the disease activity of UC and can be used as a rational fecal marker for intestinal inflammation in clinical practice. This kind of marker is relatively precise, simple and noninvasive when compared with other commonly-used markers such as CRP, ESR and AGR.

  14. Plasma interleukin-18 reflects severity of ulcerative colitis

    Alicja Wiercinska-Drapalo; Robert Flisiak; Jerzy Jaroszewicz; Danuta Prokopowicz

    2005-01-01

    AIM: The aim of this study was to evaluate the association between ulcerative colitis activity and plasma or mucosal concentrations of interleukin (IL)-18.METHODS:Il-18 concentrations were measured in plasma and mucosal samples from 15 patients with active ulcerative colitis (UC).RESULTS: The mean plasma concentration of IL-18 measured in all patients (422±88 pg/mL) doubled the mean value in healthy controls (206±32 pg/mL); however,the difference was not statistically significant. Plasma IL-18 levels revealed a significant positive correlation with scored endoscopic degree of mucosal injury, disease activity index, clinical activity index and C-reactive protein concentration. The mean concentration of plasma IL-18 was significantly higher in patients with severe ulcerative colitis (535±115 pg/mL) than in patients with mild ulcerative colitis (195±41 pg/mL), and in healthy controls.Although the mucosal mean IL-18 concentration in severe ulcerative colitis (2 523±618 pg/mg protein) doubled values observed in mild one (1 347±308 pg/mg protein), there was no statistically significant difference.CONCLUSION: Plasma IL-18 can be considered as a surrogate marker helpful in evaluation of ulcerative colitis activity.

  15. Increased Expression and Cellular Localization of Spermine Oxidase in Ulcerative Colitis and Relationship to Disease Activity

    Hong, Shih-Kuang S.; Chaturvedi, Rupesh; Blanca Piazuelo, M.; Coburn, Lori A.; Williams, Christopher S.; Delgado, Alberto G.; Casero, Robert A.; Schwartz, David A.; Wilson, Keith T.

    2010-01-01

    Background Polyamines are important in cell growth and wound repair, but have also been implicated in inflammation-induced carcinogenesis. Polyamine metabolism includes back-conversion of spermine to spermidine by the enzyme spermine oxidase (SMO), which produces hydrogen peroxide that causes oxidative stress. In ulcerative colitis (UC), levels of spermine are decreased compared to spermidine. Therefore, we sought to determine if SMO is involved in UC. Methods Colon biopsies and clinical information from subjects undergoing colonoscopy for evaluation of UC or colorectal cancer screening were utilized from 16 normal controls and 53 UC cases. Histopathologic disease severity was graded and the Mayo Disease Activity Index (DAI) and endoscopy subscore assessed. SMO mRNA expression was measured in frozen biopsies by Taq-Man-based real-time polymerase chain reaction (PCR). Formalin-fixed tissues were used for SMO immunohistochemistry. Results There was a 3.1-fold upregulation of SMO mRNA levels in UC patients compared to controls (P = 0.044), and a 3.7-fold increase in involved left colon versus paired uninvolved right colon (P < 0.001). With worsening histologic injury in UC there was a progressive increase in SMO staining of mononuclear inflammatory cells. There was a similar increase in SMO staining with worsening endoscopic disease severity and strong correlation with the DAI (r = 0.653, P < 0.001). Inflammatory cell SMO staining was increased in involved left colon versus uninvolved right colon. Conclusions SMO expression is upregulated in UC tissues, deriving from increased levels in mononuclear inflammatory cells. Dysregulated polyamine homeostasis may contribute to chronic UC by altering immune responses and increasing oxidative stress. PMID:20127992

  16. Best practice in the management of mild-to-moderately active ulcerative colitis and achieving maintenance of remission using mesalazine

    Munkholm, P.; Michetti, P.; Probert, C.S.;

    2010-01-01

    Optimizing treatment goals in ulcerative colitis requires recognizing the needs of patients. It is increasingly recognized that adapting treatment strategies aligned with patient needs can improve patient compliance and consequently minimize relapse rates. Tailoring of treatment strategies can im...

  17. PET/CT colonography: a novel non-invasive technique for assessment of extent and activity of ulcerative colitis

    Das, Chandan J.; Sharma, Raju [All India Institute of Medical Sciences, Department of Radiodiagnosis, New Delhi (India); Makharia, Govind K.; Tiwari, Rajeew P. [All India Institute of Medical Sciences, Department of Gastroenterology and Human Nutrition, New Delhi (India); Kumar, Rakesh; Kumar, Rajender; Malhotra, Arun [All India Institute of Medical Sciences, Department of Nuclear Medicine, New Delhi (India)

    2010-04-15

    Extent of involvement and activity of ulcerative colitis (UC) is best evaluated by colonoscopy. Colonoscopy however carries risk during acute exacerbation. We investigated the utility of PET/CT colonography for assessment of extent and activity of UC. Within a 1-week window, 15 patients with mild to moderately active UC underwent colonoscopy and PET/CT colonography 60 min after injection of 10 mCi of {sup 18}F-fluorodeoxyglucose (FDG). PET activity score based on the amount of FDG uptake and endoscopic mucosal activity in seven colonic segments of each patient was recorded. The mean maximum standardized uptake value (SUV{sub max}) of seven segments was compared with activity in liver. A PET activity grade of 0, 1, 2 or 3 was assigned to each region depending upon their SUV{sub max} ratio (colon segment to liver). The extent of disease was left-sided colitis in five and pancolitis in ten. The mean Ulcerative Colitis Disease Activity Index (UCDAI) was 7.6. The number of segments involved as per colonoscopic evaluation and PET/CT colonography was 67 and 66, respectively. There was a good correlation for extent evaluation between the two modalities (kappa 55.3%, p = 0.02). One patient had grade 0 PET activity, nine had grade 2 and five had grade 3 PET activity. In six patients, there was one to one correlation between PET activity grades with that of endoscopic grade. One patient showed activity in the sacroiliac joint suggesting active sacroiliitis. PET/CT colonography is a novel non-invasive technique for the assessment of extent and activity of the disease in patients with UC. (orig.)

  18. Meta-analysis using individual patient data : efficacy and durability of topical alicaforsen for the treatment of active ulcerative colitis

    Vegter, S.; Tolley, K.; Waterworth, T. Wilson; Jones, H.; Jones, S.; Jewell, D.

    2013-01-01

    Background The antisense ICAM-1 inhibitor alicaforsen has been studied in four phase 2 studies in ulcerative colitis (UC). Recruited patients varied as to the extent of their colitis and in the severity of disease at entry. Aim To investigate the efficacy of alicaforsen enema in specific UC populati

  19. Intestinal microecology in rats with ulcerative colitis

    韩晓霞

    2013-01-01

    Objective To study the abundance and diversity ofthe gut flora in rats with dextran sulfate sodium(DSS)-induced ulcerative colitis(UC)to provide new knowledge about the pathogenesis of this disease.Methods Twenty-six

  20. Desulfovibrio bacterial species are increased in ulcerative colitis.

    Rowan, Fiachra

    2012-02-01

    BACKGROUND: Debate persists regarding the role of Desulfovibrio subspecies in ulcerative colitis. Combined microscopic and molecular techniques enable this issue to be investigated by allowing precise enumeration of specific bacterial species within the colonic mucous gel. The aim of this study was to combine laser capture microdissection and quantitative polymerase chain reaction to determine Desulfovibrio copy number in crypt-associated mucous gel in health and in acute and chronic ulcerative colitis. METHODS: Colonic mucosal biopsies were harvested from healthy controls (n = 19) and patients with acute (n = 10) or chronic (n = 10) ulcerative colitis. Crypt-associated mucous gel was obtained by laser capture microdissection throughout the colon. Pan-bacterial 16S rRNA and Desulfovibrio copy number\\/mm were obtained by polymerase chain reaction at each locus. Bacterial copy numbers were interrogated for correlation with location and disease activity. Data were evaluated using a combination of ordinary linear methods and linear mixed-effects models to cater for multiple interactions. RESULTS: Desulfovibrio positivity was significantly increased in acute and chronic ulcerative colitis at multiple levels within the colon, and after normalization with total bacterial signal, the relative Desulfovibrio load was increased in acute colitis compared with controls. Desulfovibrio counts did not significantly correlate with age, disease duration, or disease activity but interlevel correlations were found in adjacent colonic segments in the healthy control and chronic ulcerative colitis groups. CONCLUSION: The presence of Desulfovibrio subspecies is increased in ulcerative colitis and the data presented suggest that these bacteria represent an increased percentage of the colonic microbiome in acute ulcerative colitis.

  1. The economics of adalimumab for ulcerative colitis.

    Xie, Feng

    2015-06-01

    Ulcerative colitis is a chronic inflammatory disease, characterized by diffuse mucosal inflammation in the colon. Adalimumab, as a TNF-α blocker, offers a safe and efficacious treatment option for patients with moderate to severe ulcerative colitis and refractory or intolerant to conventional medications; however, its cost-effectiveness profile has not yet been well established. Future economic evaluations should choose appropriate comparators in the context of target-reimbursement decision making and focus on cost-effectiveness over a long time horizon.

  2. Effect of probiotics on pro-inflammatory cytokines and NF-κB activation in ulcerative colitis

    Sahar; K; Hegazy; Mohamed; M; El-Bedewy

    2010-01-01

    AIM:To demonstrate the therapeutic effect of probiotics in patients with ulcerative colitis(UC),and their effect on inflammatory mediators and nuclear factor(NF)κB activation in these patients.METHODS:Thirty patients with mild to moderate UC were randomly classified into two groups:sulfasalazine group,who received sulfasalazine 2400 mg/d;and probiotic group,who received sulfasalazine 2400 mg/d with probiotic.The patients were investigated before and after 8 wk of treatment with probiotic(Lactobacillus delbr...

  3. Endoscopic findings can predict the efficacy of leukocytapheresis for steroid-naive patients with moderately active ulcerative colitis

    Yasushi Umehara; Masatoshi Kudo; Masanori Kawasaki

    2008-01-01

    AIM:To investigate the therapeutic usefulness of leukocytapheresis (LCAP;Cellsoba) in steroid-naive patients with moderately active ulcerative colitis (UC).METHODS:Eighteen steroid-naive patients with moderately active UC received one LCAP session every week for five consecutive weeks.RESULTS:The remission rate 8 weeks after the last LCAP session was 61.1% (11/18).All three patients with deep ulcers showed worsening after LCAP.For the remaining 15 patients,who had erosions or geographic ulcers,the average clinical activity index (CAI) score dropped significantly from 9.4 to 3.8eight weeks after the last LCAP session (t=4.89,P=0.001).The average C-reactive protein (CRP) levels before and after LCAP were 1.2 mg/dL and 1.0 mg/dL,respectively.Of the patients with erosions,geographic ulcers,and deep ulcers,100% (9/9),33.3% (2/6),and 0% (0/3) were in remission 8 weeks after the last LCAP session,respectively (x2=7.65,P < 0.005).Fortyeight weeks after the last LCAP session,the remission rates for patients with erosions and geographic ulcers were 44.4% (4/9) and 16.7% (1/6),respectively.Only one patient suffered a mild adverse event after LCAP (nausea).CONCLUSION:LCAP is a useful and safe therapy for steroid-naive UC patients with moderate disease activity.Moreover,the efficacy of the treatment can be predicted on the basis of endoscopic findings.

  4. Funcionalidad de la glicoproteína P linfocitaria en la colitis ulcerosa P-glycoprotein functional activity in peripheral blood lymphocytes in ulcerative colitis

    Catalina M. Cortada

    2009-10-01

    Full Text Available La glicoproteína gp-P, codificada por el MDR1 es una bomba de eflujo transmembrana capaz de movilizar una gran cantidad de fármacos de uso frecuente. Se expresa en la cara luminal del epitelio intestinal, en linfocitos y otros tejidos con función de barrera. MDR1 ha sido postulado como gen candidato en la colitis ulcerosa. El objetivo del presente trabajo fue evaluar la función de la gp-P en linfocitos aislados de sangre periférica de pacientes con colitis en actividad (n = 27 clasificados clínicamente como refractarios (n=16 o respondedores (n = 11 al tratamiento. Se estudió el eflujo de rodamina 123, sustrato de la glicoproteína P, en ausencia y presencia del inhibidor verapamilo (100 μM determinando la fluorescencia intracelular por citometría de flujo. Los resultados se expresaron evaluando el comportamiento de dos marcadores que corresponden al % de células que contienen máxima (M1/mínima (M2 concentración del colorante, reflejando inactividad/actividad de la bomba. Utilizando el test de Kruskal-Wallis y post test de Dunn, se observaron diferencias significativas entre refractarios versus respondedores (p P-glycoprotein (P-gp, encoded by MDR-1, is a transmembrane efflux pump that has been involved in relevant clinical drug transport. It is expressed in lymphocytes, luminal epithelium of colon and other tissues with barrier function. MDR1 was proposed as a candidate gene for ulcerative colitis. The aim of the present work was to investigate the role of P-gp in therapeutic response of ulcerative colitis by studying its functionality in lymphocytes isolated from peripheral blood. Samples were taken from 27 patients with active colitis classified clinically in refractory (n = 16 and responders (n = 11 to treatment. Rhodamine 123 (a fluorescent P-glycoprotein substrate efflux was studied by flow cytometry as absence and presence of an inhibitor (verapamil, 100 μM. Data were expressed evaluating the behaviour of two markers defined

  5. Drug therapy for ulcerative colitis

    Chang-Tai Xu; Shu-Yong Meng; Bo-Rong Pan

    2004-01-01

    Ulcerative colitis (UC) is an inflammatory destructive disease of the large intestine occurred usually in the rectum and lower part of the colon as well as the entire colon. Drug therapy is not the only choice for UC treatment and medical management should be as a comprehensive whole.Azulfidine, Asacol, Pentasa, Dipentum, and Rowasa all contain 5-aminosalicylic acid (5-ASA), which is the topical anti-inflammatory ingredient. Pentasa is more commonly used in treating Crohn's ileitis because Pentasa capsules release more 5-ASA into the small intestine than Asacol tablets. Pentasa can also be used for treating mild to moderate UC. Rowasa enemas are safe and effective in treating ulcerative proctitis and proctosigmoiditis. The sulfafree 5-ASA agents (Asacol, Pentasa, Dipentum and Rowasa) have fewer side effects than sulfa-containing Azulfidine. In UC patients with moderate to severe disease and in patients who failed to respond to 5-ASA compounds,systemic (oral) corticosteroids should be used. Systemic corticosteroids (prednisone, prednisolone, cortisone, etc.)are potent and fast-acting drugs for treating UC, Crohn's ileitis and ileocolitis. Systemic corticosteroids are not effective in maintaining remission in patients with UC.Serious side effects can result from prolonged corticosteroid treatment. To minimize side effects, corticosteroids should be gradually reduced as soon as the disease remission is achieved. In patients with corticosteroid-dependent or unresponsive to corticosteroid treatment, surgery or immunomodulator is considered. Immunomodulators used for treating severe UC include azathioprine/6-MP,methotrexate, and cyclosporine. Integrated traditional Chinese and Western medicine is safe and effective in maintaining remission in patients with UC.

  6. Management and treatment of distal ulcerative colitis

    Andrea Calafiore

    2013-12-01

    Full Text Available Ulcerative colitis (UC is a chronic inflammatory condition that is confined to the colonic mucosa. Its main symptoms include diarrhea, rectal bleeding and abdominal pain. Approximately two-thirds of UC patients have disease confined distal to the splenic flexure, which can be treated effectively with topical therapy. This means the active drug can be delivered directly to the site of inflammation, limiting the systemic absorption and potential side effects. Topical treatment with aminosalicylates is the most effective approach in the treatment of these forms, provided that the formulation reaches the upper margin of the disease. Given this, the suppository formulation is the treatment of choice for proctitis and distal sigmoiditis. Thanks to their proximal spread, enemas, foams and gels represent the treatment of choice for proctosigmoiditis and for distal ulcerative colitis. Oral aminosalicylates are less effective than topical therapies in patients with active disease, while the combination of topical and oral treatment is more effective in patients refractory to topical or oral mono-therapy. Topically administered aminosalicylates play an important role in the maintenance of remission, but the long-term adhesion to therapy is poor. For this reason, the oral formulation is the first-line therapy in the maintenance of remission. Refractory patients can be treated with topical steroids or systemic steroids and TNF-alpha inhibitors in severe forms.

  7. Soluble ST2: A new and promising activity marker in ulcerative colitis

    David Díaz-Jiménez; Lucía E Nú(n)ez; Caroll J Beltrán; Enzo Candia; Cristóbal Suazo; Manuel álvarez-Lobos; María-Julieta González; Marcela A Hermoso; Rodrigo Quera

    2011-01-01

    AIM: To correlate circulating soluble ST2 (sST2) levels with the severity of ulcerative colitis (UC) and serum levels of pro-inflammatory cytokines,and to demonstrate the predictive power of sST2 levels for differentiation between active and inactive UC. METHODS: We recruited 153 patients: 82 with UC,26 with Crohn's disease (CD) and 43 disease controls [non-inflammatory bowel disease (IBD)]. Subjects were excluded if they had diagnosis of asthma,autoimmune diseases or hypertension. The serum levels of sST2 and pro-inflammatory cytokines [pg/mL;median (25th-75th)] as well as clinical features,endoscopic and histological features,were subjected to analyses. The sST2 performance for discrimination between active and inactive UC,non-IBD and healthy controls (HC) was determined with regard to sensitivity and specificity,and Spearman's rank correlation coefficient (r ). To validate the method,the area under the curve (AUC) of receiver-operator characteristic (ROC) was determined (AUC,95% CI) and the total ST2 content of the colonic mucosa in UC patients was correlated with circulating levels of sST2. RESULTS: The serum sST2 value was significantly higher in patients with active [235.80 (90.65-367.90) pg/mL] rather than inactive UC [33.19 (20.04-65.32) pg/mL],based on clinical,endoscopic and histopathological characteristics,as well as compared with non-IBD and HC (P < 0.001). The median level of sST2 in CD patients was 54.17 (35.02-122.0) pg/mL,significantly higher than that of the HC group only (P < 0.01). The cutoff was set at 74.87 pg/mL to compare active with inactive UC in a multicenter cohort of patients. Values of sensitivity,specificity,and ability to correctly classify UC,according to activity,were 83.33%,83.33% and 83.33%,respectively. The AUC of the ROC curve to assess the ability of this molecule to discriminate between active vs inactive UC was 0.92 (0.86-0.97,P < 0.0001). The serum levels of sST2 in patients with UC significantly correlated with endoscopic

  8. Infliximab and complications after colectomy in patients with ulcerative colitis

    Bregnbak, David; Mortensen, Christian; Bendtsen, Flemming

    2012-01-01

    Infliximab treatment may increase the risk of subsequent postoperative complications in patients with ulcerative colitis. The main purpose of the present study therefore was to assess postoperative complications in patients who have undergone colectomy for ulcerative colitis with and without...

  9. Vedolizumab as induction and maintenance therapy for ulcerative colitis

    Feagan, Brian G; Rutgeerts, Paul; Sands, Bruce E

    2013-01-01

    Gut-selective blockade of lymphocyte trafficking by vedolizumab may constitute effective treatment for ulcerative colitis.......Gut-selective blockade of lymphocyte trafficking by vedolizumab may constitute effective treatment for ulcerative colitis....

  10. Golimumab in unresponsive ulcerative colitis

    Lippert E

    2014-05-01

    Full Text Available Elisabeth Lippert, Martina Müller, Claudia Ott University Hospital Regensburg, Department of Internal Medicine I, Regensburg, Germany Abstract: Ulcerative colitis (UC is a chronic inflammation mainly affecting the colon mucosa. It predominantly occurs in younger patients. Until recently, the main goals in the treatment of UC were to temper the symptoms, such as diarrhea, pain, and weight loss, by using mesalazine and steroids. With newer medications, such as immunomodulators (thiopurines and the biologics providing blockade of tumor necrosis factor (TNF, the goals of the therapy in UC have changed to long-term remission and mucosal healing. The first available anti-TNF therapy in UC included infusion therapy with infliximab every few weeks. In 2012, subcutaneously administered adalimumab gained approval for the treatment of UC in Germany. In patients with a mild disease, therapy with mesalazine, orally or topically, can be sufficient. In patients with moderate to severe disease, therapy with azathioprine or anti-TNF is often required to reach disease control; however, this is only efficient in about two-thirds of patients. Some patients either show no response or a lost response while on treatment. So, further medical options are warranted in the treatment of UC. With golimumab, a new approach in the treatment of mild to moderate UC recently became available in Germany and is a promising new option in the therapy regimen for patients with UC. Keywords: anti-TNF, biological therapy, inflammatory bowel disease

  11. Combination therapy using fexofenadine, disodium cromoglycate, and a hypoallergenic amino acid-based formula induced remission in a patient with steroid-dependent, chronically active ulcerative colitis.

    Raithel, M; Winterkamp, S; Weidenhiller, M; Müller, S; Hahn, E G

    2007-07-01

    Corticosteroids and 5-aminosalicylic acid are the primary standard therapy for inflammatory bowel disease. Recent immunologic data implicate an involvement of mast cell activation followed by increased histamine secretion and elevated tissue concentrations of histamine in the pathogenesis of ulcerative colitis. In the present case, the clinical course of a 35-year-old man with steroid-dependent chronic active ulcerative colitis, who did not respond to high-dose steroids, antibiotics, or azathioprine during 3 years, is reported. Clinical disease activity and established serological markers were recorded during 6 weeks of unsuccessful therapy and during the next 6 weeks, as a new nonsedative antihistaminergic drug, a mast cell stabilizer, and an hypoallergenic diet were implemented in addition to conventional therapy. Induction of remission was achieved within 2 weeks after treatment with fexofenadine, disodium cromoglycate, and an amino acid-based formula. Clinical disease activity, stool frequency, leukocytes, c-reactive protein, and orosomucoid levels in serum decreased rapidly. Daily steroid administration could be gradually reduced along with 6 weeks of this treatment. This report suggests that histamine and mast cell activity may be important pathophysiological factors responsible for persistent clinical and mucosal inflammatory activity in ulcerative colitis despite the use of steroids. In ulcerative colitis, patients unresponsive to conventional treatment, therapeutic considerations should also include an antiallergic approach when further signs of atopy or intestinal hypersensitivity are present.

  12. Characteristics and therapeutic efficacy of sulfasalazine in patients with mildly and moderately active ulcerative colitis

    Qi-Kui Chen; Zhong-Lin Yu; Shi-Zheng Yuan; Zhuo-Fu Wen; Ying-Qiang Zhong; Cu-Jun Li; Hui-Sheng Wu; Can-Rong Mai; Peng-Yan Xie; Yu-Min Lu

    2005-01-01

    AIM: To investigate the characteristics and short-term efficacy of sulfasalazine (SASP) in patients with mildly and moderately active ulcerative colitis (UC).METHODS: Two hundred and twenty-eight patients with mildly and moderately active UC were recruited, 106patients in 1993-1995, and 122 patients in 2000-2002,they were assigned as the 1990s group (n = 106) and the 2000s group (n = 122), prospectively. The general characteristics, clinical manifestations, colonoscopic and histological data were compared between the two groups.The short-term efficacy and safety of SASP 3 g per d were evaluated.RESULTS: Between 2000s and 1990s groups, the gender ratio of men to women was 1:1.18 and 1:1.04, 57.4%and 50.9% of the patients were between 30 and 49 years old. The gender ratio and age of UC patients were not significantly different. The total course of 50.0% and 37.1% of UC patients was less than 1 year (P<0.05), 10.6% and 31.2% of the cases had a duration of more than 5 years (P<0.05) in 2000s and 1990s groups, respectively. The most common clinical type was first episode in 2000s group and chronic relapse in 1990s group. The patients showed a higher frequency of abdominal pain and tenderness in 1990s group than in 2000s group. Erosions were found in 84.4% and 67.9% of patients in 2000s and 1990s groups (P<0.05). Rough and granular mucosa (67.9%vs43.4%, P<0.05)and polyps (47.2% vs 32.8%, P<0.05)were identified in 1990s group more than in 2000s group.There were no significant differences in clinical, colonoscopic and histological classifications. After SASP (1 g thrice per d) treatment for 6 wk, the clinical, colonoscopic and histological remission rates were 71.8%, 21.8% and 16.4%,respectively. In 79 patients with clinical remission, 58.2%and 67.1% remained grade 1 in colonoscopic and histological findings, respectively. The overall effects in first episode type (complete remission in 10, 18.9%, partial remission in 28, 52.8%, and improvement in 9, 17.0%) were

  13. Increased expression of T-cell KV1.3 and KCa3.1 channels in the inflamed intestinal wall from patients with active ulcerative colitis

    Hansen, Lars Koch; Larsen, Dorte; Sadda, Veeranjaneyulu;

    INTRODUCTION: T-cell KV1.3 and KCa3.1 channels have been proposed to be important effector proteins during T-cell activation and also in autoimmune disease by controlling T-cell motility, cytokine production, and proliferation. The role of KV1.3 channels in ulcerative colitis (UC) has not been...

  14. Amyloid Goiter Secondary to Ulcerative Colitis

    Bunyamin Aydin

    2016-01-01

    Full Text Available Diffuse amyloid goiter (AG is an entity characterized by the deposition of amyloid in the thyroid gland. AG may be associated with either primary or secondary amyloidosis. Secondary amyloidosis is rarely caused by inflammatory bowel diseases. Secondary amyloidosis is relatively more common in the patients with Crohn’s disease, whereas it is highly rare in patients with ulcerative colitis. Diffuse amyloid goiter caused by ulcerative colitis is also a rare condition. In the presence of amyloid in the thyroid gland, medullary thyroid cancer should be kept in mind in the differential diagnosis. Imaging techniques and biochemical tests are not very helpful in the diagnosis of secondary amyloid goiter and the definitive diagnosis is established based on the histopathologic analysis and histochemical staining techniques. In this report, we present a 35-year-old male patient with diffuse amyloid goiter caused by secondary amyloidosis associated with ulcerative colitis.

  15. Best practice in the management of mild-to-moderately active ulcerative colitis and achieving maintenance of remission using mesalazine

    Munkholm, P.; Michetti, P.; Probert, C.S.;

    2010-01-01

    Optimizing treatment goals in ulcerative colitis requires recognizing the needs of patients. It is increasingly recognized that adapting treatment strategies aligned with patient needs can improve patient compliance and consequently minimize relapse rates. Tailoring of treatment strategies can...... improve not only patient quality of life, and decrease the number harmed by adverse events from more potent drugs, but can also save valuable healthcare costs by avoiding high-cost treatment interventions associated with acute ulcerative colitis. This review will consider several elements of mesalazine...

  16. Extraintestinal Helminth Infection Limits Pathology and Proinflammatory Cytokine Expression during DSS-Induced Ulcerative Colitis: A Role for Alternatively Activated Macrophages and Prostaglandins.

    Ledesma-Soto, Yadira; Callejas, Blanca E; Terrazas, César A; Reyes, Jose L; Espinoza-Jiménez, Arlett; González, Marisol I; León-Cabrera, Sonia; Morales, Rosario; Olguín, Jonadab E; Saavedra, Rafael; Oghumu, Steve; Satoskar, Abhay R; Terrazas, Luis I

    2015-01-01

    Chronic inflammation of the intestinal mucosa is characteristic of inflammatory bowel diseases such as ulcerative colitis and Crohn's disease. Helminth parasites have developed immunomodulatory strategies that may impact the outcome of several inflammatory diseases. Therefore, we investigated whether Taenia crassiceps infection is able to decrease the inflammatory effects of dextran sulfate sodium- (DSS-) induced ulcerative colitis in BALB/c and C57BL/6 mice. Preinfection significantly reduced the manifestations of DSS-induced colitis, as weight loss and shortened colon length, and decreased the disease activity index independently of the genetic background of the mice. Taenia infection decreased systemic levels of proinflammatory cytokines while increasing levels of IL-4 and IL-10, and the inflammatory infiltrate into the colon was also markedly reduced. RT-PCR assays from colon showed that T. crassiceps-infected mice displayed increased expression of Arginase-1 but decreased expression of iNOS compared to DSS-treated uninfected mice. The percentages of T regulatory cells were not increased. The adoptive transfer of alternatively activated macrophages (AAMФs) from infected mice into mice with DSS-induced colitis reduced the severity of colon inflammation. Administration of indomethacin abrogated the anticolitic effect of Taenia. Thus, T. crassiceps infection limits the pathology of ulcerative colitis by suppressing inflammatory responses mechanistically associated with AAMФs and prostaglandins.

  17. Status of colitis-associated cancer in ulcerative colitis

    Tetsushi Kinugasa; Yoshito Akagi

    2016-01-01

    Surgical therapy for ulcerative colitis(UC) depends on the medical therapy administered for the patient’s condition. UC is a benign disease. However, it has been reported that the rare cases of cancer in UC patients are increasing, and such cases have a worse prognosis. Recently, surgical therapy has greatly changed, there has been quite an increase in the number of UC patients with high-grade dysplasia and/or cancer. These lesions are known as colitis-associated cancer(CAC). The relationship between inflammation and tumorigenesis is well-established, and in the last decade, a great deal of supporting evidence has been obtained from genetic, pharmacological, and epidemiological studies. Inflammatory bowel disease, especially UC, is an important risk factor for the development of colon cancer. We should determine the risk factors for UC patients with cancer based on a large body of data, and we should attempt to prevent the increase in the number of such patients using these newly identified risk factors in the near future. Actively introducing the surgical treatment in addition to medical treatment should be considered. Several physicians should analyze UC from their unique perspectives in order to establish new clinically relevant diagnostic and treatment methods in the future. This article discusses CAC, including its etiology, mechanism, diagnosis, and treatment in UC patients.

  18. Diverticular colitis of the ascending colon preceding the onset of ulcerative colitis

    Maeshiro, Tatsuji; Hokama, Akira; Kinjo, Tetsu; Fujita, Jiro

    2014-01-01

    We present a case of diverticular colitis of the ascending colon preceding the onset of ulcerative colitis. A 58-year-old man presented with positive faecal occult blood test. Colonoscopy disclosed diverticular colitis of the ascending colon. After a year's follow-up, typical ulcerative colitis developed and diverticular colitis improved. Diverticular colitis is a newly established disorder of chronic segmental mucosal inflammation affected by diverticular disease. There is increasing recogni...

  19. Ulcerative Colitis associated with Sclerosing Cholangitis and Autoimmune Hepatitis

    Hoduț Andrei

    2013-04-01

    Full Text Available Introduction: Ulcerative colitis is a chronic intestinal inflammation, part of inflammatory bowel disease, which also includes Crohn’s disease. Both have extraintestinal manifestations, but those that tend to occur more commonly with ulcerative colitis include chronic active hepatitis, pyoderma gangrenosum and ankylosing spondylitis. Many individuals present with overlapping non-diagnostic features of more than one of these conditions that is referred to in the literature as autoimmune overlap syndrome. Sclerosing cholangitis associated with IBD is often referred to as overlap syndrome.

  20. Cerebral Arterial Thrombosis in Ulcerative Colitis

    Giovanni Casella

    2013-01-01

    Full Text Available Thrombosis, mainly venous, is a rare and well-recognized extraintestinal manifestation of inflammatory bowel disease (IBD. We describe a 25-year-old Caucasian man affected by ulcerative colitis and sclerosing cholangitis with an episode of right middle cerebral arterial thrombosis resolved by intraarterial thrombolysis. We perform a brief review of the International Literature.

  1. Manipulation of enteric flora in ulcerative colitis

    Mario Guslandi

    2005-01-01

    @@ TO THE EDITOR Reviewing the available therapeutic options in the medical treatment of ulcerative colitis, Xu et al.[1], have omitted to mention an important aspect in the pharmacological management of the disease, namely the possibility to promote clinical and endoscopic improvement by manipulating the enteric flora.

  2. Golimumab for the treatment of ulcerative colitis

    Lowenberg, M.; Boer, N. de; Hoentjen, F.

    2014-01-01

    The introduction of therapeutic antibodies against tumor necrosis factor (TNF) had a major impact on the treatment of ulcerative colitis (UC). Infliximab and adalimumab are powerful agents that are used for remission induction and maintenance therapy in UC and have an acceptable safety profile. Howe

  3. Microarray Assisted Gene Discovery in Ulcerative Colitis

    Brusgaard, Klaus

    Inflammatory Bowel disease (IBD) is a condition characterised by chronic recidivous inflammation of the bowel and intestine. IBD includes chron´s disease (CD) and ulcerative colitis (UC). The combined prevalence of CD and UC are app. 1 in 500 in the general Caucasian population. In 25% of the cases...

  4. Neutrophil Extracellular Traps in Ulcerative Colitis

    Bennike, Tue Bjerg; Carlsen, Thomas Gelsing; Ellingsen, Torkell

    2015-01-01

    BACKGROUND: The etiology of the inflammatory bowel diseases, including ulcerative colitis (UC), remains incompletely explained. We hypothesized that an analysis of the UC colon proteome could reveal novel insights into the disease etiology. METHODS: Mucosal colon biopsies were taken by endoscopy...

  5. IL-33 is upregulated in colonocytes of ulcerative colitis

    Seidelin, J.B.; Bjerrum, J.T.; Coskun, Mehmet

    2010-01-01

    , airway inflammation and arthritis in animal models. We now report IL-33 to be produced by colonic epithelial cells in humans and it is highly upregulated in ulcerative colitis (UC). Little mRNA expression was found in control subjects (N=9), whereas patients with UC in remission (N=7) and active UC (N=9...

  6. Psychological status in Iranian patients with ulcerative colitis and its relation to disease activity and quality of life

    Tabatabaeian, Mahshid; Afshar, Hamid; Roohafza, Hamid Reza; Daghaghzadeh, Hamed; Feizi, Awat; Sharbafchi, Mohammad Reza; Tabatabaeian, Maryam; Naji, Fateme; Adibi, Peyman

    2015-01-01

    Background: Psychological profile of inflammatory bowel disease patients is not well studied in Iran. We investigated the psychological status of Iranian patients with ulcerative colitis (UC) and its relationship with disease activity and quality of life (QOL). Materials and Methods: A cross-sectional study was conducted on adult UC patients. The Lichtiger Colitis Activity Index, Hospital Anxiety and Depression Scale, General Health Questionnaire-12, and WHOQOL-BREF, were completed by the patients. Results: From 120 studied patients, 35 (29.2%), 48 (40.0%), and 46 (38.3%) had significant anxiety, depression, and psychological distress, respectively. Anxiety, depression, and psychological distress were strongly correlated with disease activity (r = 0.357 to 0.439, P < 0.01). Disease activity was negatively correlated with all QOL dimensions (r = −0.245 to −0.550, P < 0.01). Anxiety, depression, and psychological distress were also negatively correlated with all QOL domains (r = −0.356 to −0.789, P < 0.01). In the regression models, anxiety was independently associated with active disease (β = 4.150, P = 0.049). Furthermore, disease activity was associated with the physical health (β = −0.371, P < 0.001). For almost all of the QOL domains, depression and psychological distress were independent predictors (β = −0.296 to −0.453, P < 0.001). Conclusion: Anxiety, depression, and psychological distress are highly frequent in UC patients of our society and are strongly associated with disease activity. Depression and psychological distress are important predictors of poor QOL in these patients. Further prospective studies, as well as clinical trials, are warranted in this regard. PMID:26600833

  7. Psychological status in Iranian patients with ulcerative colitis and its relation to disease activity and quality of life

    Mahshid Tabatabaeian

    2015-01-01

    Full Text Available Background: Psychological profile of inflammatory bowel disease patients is not well studied in Iran. We investigated the psychological status of Iranian patients with ulcerative colitis (UC and its relationship with disease activity and quality of life (QOL. Materials and Methods: A cross-sectional study was conducted on adult UC patients. The Lichtiger Colitis Activity Index, Hospital Anxiety and Depression Scale, General Health Questionnaire-12, and WHOQOL-BREF, were completed by the patients. Results: From 120 studied patients, 35 (29.2%, 48 (40.0%, and 46 (38.3% had significant anxiety, depression, and psychological distress, respectively. Anxiety, depression, and psychological distress were strongly correlated with disease activity (r = 0.357 to 0.439, P < 0.01. Disease activity was negatively correlated with all QOL dimensions (r = −0.245 to −0.550, P < 0.01. Anxiety, depression, and psychological distress were also negatively correlated with all QOL domains (r = −0.356 to −0.789, P < 0.01. In the regression models, anxiety was independently associated with active disease (β = 4.150, P = 0.049. Furthermore, disease activity was associated with the physical health (β = −0.371, P < 0.001. For almost all of the QOL domains, depression and psychological distress were independent predictors (β = −0.296 to −0.453, P < 0.001. Conclusion: Anxiety, depression, and psychological distress are highly frequent in UC patients of our society and are strongly associated with disease activity. Depression and psychological distress are important predictors of poor QOL in these patients. Further prospective studies, as well as clinical trials, are warranted in this regard.

  8. Efficacy and Safety of Adalimumab in Moderately to Severely Active Cases of Ulcerative Colitis: A Meta-Analysis of Published Placebo-Controlled Trials

    Zhang, Zong Mei; Li, Wei; Jiang, Xue Liang

    2016-01-01

    Background/Aims To evaluate the efficacy and safety of adalimumab (ADA) in moderately to severely active ulcerative colitis (UC) patients who are unresponsive to traditional therapy. Methods Electronic databases, including the PubMed, Embase, and Cochrane databases, were searched to April 20, 2014. UC-related randomized controlled trials (RCTs) that compared ADA with placebo were eligible. Review Manager 5.1 was used for data analysis. Results This meta-analysis included three RCTs. ADA was c...

  9. Histiocytic ulcerative colitis in a French bulldog.

    Tanaka, Hiroshi; Nakayama, Masanari; Takase, Katsuaki

    2003-03-01

    A 9-month-old French bulldog was referred for signs of chronic large bowel diarrhea. The dog had an increased frequency of defecation, tenesmus and hematochezia. Flexible colonoscopy showed hyperemia, irregularities and ulcerations with multifocal hemorrhages in the mucosa from the descending colon to the proximal rectum. Multiple colonic biopsies were characterized by infiltrations of PAS positive histiocytes in the lamina propria. A diagnosis of histiocytic ulcerative colitis (HUC) was made, and the animal showed only minimal improvement, although it was treated with nutritional and medical therapies. This is the second case of HUC in French bulldog, a breed which has ancestral relations to Boxer dogs.

  10. Ileal pouch surgery for ulcerative colitis

    Simon P Bach; Neil J Mortensen

    2007-01-01

    Ulcerative colitis (UC) is a relapsing and remitting disease characterised by chronic mucosal and submucosal inflammation of the colon and rectum.Treatment may vary depending upon the extent and severity of inflammation. Broadly speaking medical treatments aim to induce and then maintain remission.Surgery is indicated for inflammatory disease that is refractory to medical treatment or in cases of neoplastic transformation. Approximately 25% of patients with UC ultimately require colectomy. Ileal pouch-anal anastomosis (IPAA) has become the standard of care for patients with ulcerative colitis who ultimately require colectomy. This review will examine indications for IPAA, patient selection, technical aspects of surgery,management of complications and long term outcome following this procedure.

  11. Sulfasalazine-Induced Pancytopenia in Ulcerative Colitis

    NS Neki

    2016-09-01

    Full Text Available Sulfasalazine is a well-established disease-modifying agent. It is commonly used in the treatment of rheumatic disorders and inflammatory bowel disease. The most frequently reported adverse effects are gastrointestinal effects, headache, dizziness and rash; myelosuppression can also occur. Patients treated with sulfasalazine can develop thrombocytopenia which is immune mediated. We report a case of ulcerative colitis that was on sulfasalazine subsequently developing thrombocytopenia.

  12. Associations between diet and disease activity in ulcerative colitis patients using a novel method of data analysis

    Curno Richard

    2005-02-01

    Full Text Available Abstract Background The relapsing nature and varying geographical prevalence of ulcerative colitis (UC implicates environmental factors such as diet in its aetiology. Methods In order to determine which foods might be related to disease activity in UC a new method of dietary analysis was developed and applied. Eighty-one UC patients were recruited at all stages of the disease process. Following completion of a 7 d diet diary, clinical assessment including a sigmoidoscopic examination (scale 0 (normal mucosa to 6 (very active disease was conducted. Food weights for each person were adjusted (divided by the person's calorific intake for the week. Each food consumed was given a food sigmoidoscopy score (FSS calculated by summing the products of the (adjusted weight of food consumed and sigmoidoscopy score for each patient and occurrence of food and dividing by the total (adjusted weight of the food consumed by all 81 patients. Thus, foods eaten in large quantities by patients with very active disease have high FSSs and vice versa. Foods consumed by Results High FSS foods were characterized by high levels of the anti-thiamin additive sulfite (Mann-Whitney, p Conclusions The dietary analysis method described provides a new tool for establishing relationships between diet and disease and indicates a potentially therapeutic diet for UC.

  13. Antineutrophil cytoplasmic autoantibodies in ulcerative colitis

    Vodjgani M

    2000-10-01

    Full Text Available Antineutrophil cytoplasmic autoanibodies (ANCA were detecte in patients with certain autoimmune vascular disease such as Wegner’s granulomatosis, polyarthrits nodosa and systemic luuc erythematous. Indirect immunofluorescence (IIF technique was employed to detec these autoantibodies.ANCA have been recently detected in some forms of inflammatory bowel disease (IBD, ulcerative colitis (U.C. Crohn’s disease (C.D and primary sclerosing cholangitis (PSC. By IIF method, two general patterns of ANCA were seen: a cytoplasmic (C-ANCA and perinuclear form (P-ANCA. In this study we evaluated the presece of ANCA in 52 U.C. patients and 69 matched normal control group by IIF technique, and it’s relationship with disease activity. Site of colon involvement and, lesion extent. The results showed that all control group were ANCA negative, but 58% of patients had ANCA, and most cases (70% had C- ANCA. The obtained results also revealed that there was no relationship between ANCA and disease activity

  14. Disease Severity and Immune Activity Relate to Distinct Interkingdom Gut Microbiome States in Ethnically Distinct Ulcerative Colitis Patients

    Jordan S. Mar

    2016-08-01

    Full Text Available Significant gut microbiota heterogeneity exists among ulcerative colitis (UC patients, though the clinical implications of this variance are unknown. We hypothesized that ethnically distinct UC patients exhibit discrete gut microbiotas with unique metabolic programming that differentially influence immune activity and clinical status. Using parallel 16S rRNA and internal transcribed spacer 2 sequencing of fecal samples (UC, 30; healthy, 13, we corroborated previous observations of UC-associated bacterial diversity depletion and demonstrated significant Saccharomycetales expansion as characteristic of UC gut dysbiosis. Furthermore, we identified four distinct microbial community states (MCSs within our cohort, confirmed their existence in an independent UC cohort, and demonstrated their coassociation with both patient ethnicity and disease severity. Each MCS was uniquely enriched for specific amino acid, carbohydrate, and lipid metabolism pathways and exhibited significant luminal enrichment of the metabolic products of these pathways. Using a novel ex vivo human dendritic cell and T-cell coculture assay, we showed that exposure to fecal water from UC patients caused significant Th2 skewing in CD4+ T-cell populations compared to that of healthy participants. In addition, fecal water from patients in whom their MCS was associated with the highest level of disease severity induced the most dramatic Th2 skewing. Combined with future investigations, these observations could lead to the identification of highly resolved UC subsets based on defined microbial gradients or discrete microbial features that may be exploited for the development of novel, more effective therapies.

  15. Relationship between Ulcerative Colitis and Lung Injuries

    Zhi-peng Tang; Jia-wei Wu; Yan-cheng Dai; Ya-li Zhang; Rong-rong Bi

    2015-01-01

    Objective To explore the relationship between ulcerative colitis (UC) and lung injuries by assessing their clinical manifestations and characteristics. Methods From July 2009 to April 2012, 91 UC patients presenting to Longhua Hospital who met the established inclusion and exclusion criteria were enrolled in this retrospective study. According to the scores of disease activity index, the patients were divided into the mild, moderate, and severe groups. Meanwhile, the records of pulmonary symptoms, chest X-ray image, and pulmonary function were reviewed. Results Sixty-eight (74.7%) patients had at least 1 pulmonary symptom, such as cough (38.5%), shortness of breath (27.5%), and expectoration (17.6%). And 77 (84.6%) had at least 1 ventilation abnormality. Vital capacity value was significantly lower in the severe group than that in the mild group (91.82%±10.38%vs. 98.92%±12.12%, P Conclusions Lung injury is a common extraintestinal complication of UC. According to the theory in Traditional Chinese Medicine that the lung and large intestine are related, both the lungs and large intestine should be treated simultaneously.

  16. HSF2 expression in ulcerative colitis lesion tissue

    Li-Rong Zeng; Peng-Fei Chen; Wen-Bin Wei

    2016-01-01

    Objective:To study the expression of HSF2 in ulcerative colitis lesion tissue and its value for diagnosis and assessment of the disease.Methods:A total of 40 cases with ulcerative colitis were included for study and divided into remission stage, mild activity stage, moderate activity stage and severe activity stage by Sutherland disease activity index. Lesion tissue and normal tissue were collected to detect HSFs, NOX1, ROS, COX2, PGE2, IL-6, JAK2, STAT3, TLRs and SOCSs contents.Results: HSF2 contents in lesion tissue were higher than those in normal tissue, and HSF1, HSF3 and HSF4 contents were not different from those of normal tissue; TLR2, TLR4, TLR5, MyD88, NF-kB, NOX1, ROS, COX2, PGE2, IL-6, JAK2 and STAT3 contents in lesion tissue were higher than those in normal tissue and positively correlated with HSF2 content; SOCS2 and SOCS3 contents in lesion tissue were lower than those in normal tissue and negatively correlated with HSF2 content, and SOCS1, SOCS4, SOCS5, SOCS6 and SOCS7 contents were not different from those of normal tissue.Conclusions:HSF2 expression abnormally increases in ulcerative colitis lesion tissue and is closely related to the activity of the disease, and HSF2 can regulate the expression of inflammatory signal molecules, TLRs and SOCSs to enhance inflammatory response.

  17. Leukocyte apheresis in the management of ulcerative colitis

    Helmy Ahmed

    2009-01-01

    Full Text Available Ulcerative colitis is a chronic inflammatory disease that affects the colon and rectum. Its pathogenesis is probably multifactorial including the influx of certain cytokines into the colonic mucosa, causing disease activity and relapse. The hypothesis of removing such cytokines from the circulation by leukocytapheresis was implemented to reduce disease activity, maintain remission, and prevent relapse. Many recent reports not only in Japan, but also in the West, have highlighted its beneficial effects in both adult and pediatric patients. Large placebo-controlled studies are needed to confirm the available data in this regard. In this article, we shed some light on the use of leukocyte apheresis in the management of autoimmune diseases, especially ulcerative colitis.

  18. Dr.Dong Demao's Experience in Treating Chronic Ulcerative Colitis

    徐凌云

    2004-01-01

    @@ Chronic ulcerative colitis (chronic non-specific ulcerative colitis) is a kind of non-specific inflammation occurred in the colonic mucosa layers. As a lingering and troublesome condition that often attacks people aged 20-40, it is characterized by recurrent diarrhea, abdominal pain, pus- and mucus-stained stools in clinic.

  19. Acupuncture Treatment for 76 Cases of Ulcerative Colitis

    2005-01-01

    @@ Ulcerative colitis is also called nonspecific chronic ulcerative colitis. The author of this essay has treated 76 such cases with acupuncture and obtained satisfactory therapeutic effect. Meanwhile, the results were compared with 45 cases treated with azulfidine.A report follows.

  20. Pathogenesis and biomarkers of carcinogenesis in ulcerative colitis

    Thorsteinsdottir, Sigrun; Gudjonsson, Thorkell; Nielsen, Ole Haagen

    2011-01-01

    One of the most serious complications of ulcerative colitis is the development of colorectal cancer. Screening patients with ulcerative colitis by standard histological examination of random intestinal biopsy samples might be inefficient as a method of cancer surveillance. This Review focuses...... on the current understanding of the pathogenesis of ulcerative colitis-associated colorectal cancer and how this knowledge can be transferred into patient management to assist clinicians and pathologists in identifying patients with ulcerative colitis who have an increased risk of colorectal cancer. Inflammation....... Although progress has been made in the understanding of inflammation-driven carcinogenesis, markers based on these findings possess insufficient sensitivity or specificity to be usable as reliable biomarkers for risk of colorectal cancer development in patients with ulcerative colitis. However, screening...

  1. How does disease location affect acute phase reactants in ulcerative colitis?

    Serkan Ipek

    2015-07-01

    Conclusion: CRP, ESR, WBC, PLT counts and albumin levels are of limited value in determining disease activity in ulcerative colitis patients, especially in those with proctitis. [Int J Res Med Sci 2015; 3(7.000: 1589-1593

  2. Crohn's Disease and Ulcerative Colitis: A Guide for Teachers and Other School Personnel

    ... a clinical trial of experimental treatments. Interactive Disease Tracker Use GI Buddy to keep a daily log ... or a private dorm room. Participation in physical activities Young people with Crohn’s disease or ulcerative colitis ...

  3. Safety and efficacy of Profermin(R) to induce remission in ulcerative colitis

    Krag, Aleksander; Israelsen, Hans; von Ryberg, Bjørn;

    2012-01-01

    AIM: To test the efficacy and safety of Profermin(R) in inducing remission in patients with active ulcerative colitis (UC). METHODS: The study included 39 patients with mild to moderate UC defined as a Simple Clinical Colitis Activity Index (SCCAI) > 4 and < 12 (median: 7.5), who were treated ope...

  4. Cellular and Molecular Immunopathogenesis of Ulcerative Colitis

    Suzhen Zhang; Xuhui Zhao; Dechun Zhang

    2006-01-01

    Ulcerative colitis (UC) is an inflammatory disease of the rectal and colonic mucosa and seems to result from a complex series of interactions between susceptibility genes, the environment and the immune system. Various components of the mucosal immune system are implicated in the immunopathogenesis of UC. Evidence from animal models also suggests that an altered immune response to the commensal microflora of the host plays a central role in the development of UC. So in this review, we elucidate the cells and molecules which are implicated in the immunopathogenesis of the disease from four aspects: antigens in the intestine, dendritic cells, toll like receptors and NF-κB in the UC.

  5. Encapsulated mesalamine granules (Apriso) for ulcerative colitis.

    2009-05-18

    Apriso (Salix) is a new formulation of mesalamine (5-aminosalicylic acid; 5-ASA) approved by the FDA for maintenance of remission in mild to moderate ulcerative colitis (UC). Mesalamine is a locally acting antiinflammatory agent that is widely used both to maintain and induce remission in inflammatory bowel disease. Various mesalamine formulations have been developed to target drug delivery to areas of the small intestine and colon. Most of these agents require frequent dosing and have a high pill burden. The newest products--Lialda, introduced in 2007, and now Apriso--can be dosed once daily.

  6. Nutritional follow-up of patients with ulcerative colitis during periods of intestinal inflammatory activity and remission

    Juliana Ripoli

    2010-03-01

    Full Text Available CONTEXT: Ulcerative colitis is an inflammatory bowel disease involving superficial inflammation of the mucosa of the colon, rectum, and anus, sometimes including the terminal ileum. When in clinical activity, the disease is characterized by various daily evacuations containing blood, mucus and/or pus alternating periods of remission. OBJECTIVE: To compare nutritional parameters (dietary, biochemical and anthropometric among patients with ulcerative colitis followed up on an outpatient basis over a period of 1 year and during periods of intestinal inflammatory activity and remission. METHODS: Sixty-five patients were studied over a period of 1 year and divided into two groups: group 1 with inflammatory disease activity (n = 24, and group 2 without disease activity (n = 41. Anthropometric measures, biochemical parameters, quantitative food intake, and qualitative food frequency were analyzed. RESULTS: A significant reduction in body mass index and weight and in the intake of energy, proteins, lipids, calcium, iron and phosphorus was observed in the group with inflammatory activity (group 1 when compared to the period of clinical remission. The most affected food groups were cereals, legumes, oils, and fats. In contrast, in group 2 significant differences in triceps and sub scapular skin fold thickness, total protein, hemoglobin and hematocrit were observed between the first and final visit. Calcium and vitamin B6 intake, as well as the consumption of legumes, meat and eggs, and sugar and sweets, was significantly higher than on the first visit. CONCLUSION: Patients with ulcerative colitis followed up on an outpatient basis tend to be well nourished. However, the nutritional aspects studied tend to worsen during the period of inflammatory disease activity.CONTEXTO: A retocolite ulcerativa inespecífica compreende uma das doenças inflamatórias intestinais, com características de inflamação superficial da mucosa do cólon, reto, ânus, podendo

  7. Golimumab for the treatment of ulcerative colitis

    Löwenberg M

    2014-03-01

    Full Text Available Mark Löwenberg,1 Nanne KH de Boer,2 Frank Hoentjen3 1Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands; 2Department of Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, the Netherlands; 3Inflammatory Bowel Disease Center, Radboud University Medical Center, Nijmegen, the Netherlands Abstract: The introduction of therapeutic antibodies against tumor necrosis factor (TNF had a major impact on the treatment of ulcerative colitis (UC. Infliximab and adalimumab are powerful agents that are used for remission induction and maintenance therapy in UC and have an acceptable safety profile. However, a proportion of UC patients for whom therapy with anti-TNF agents is indicated fail or become intolerant to treatment with infliximab or adalimumab. Hence, there remains an unmet need for novel anti-TNF agents. Golimumab (Simponi®, a human anti-TNF antibody that is administered by monthly subcutaneous injections, is the most recently introduced TNF blocker for the treatment of UC. Here, we will discuss recent literature on clinical efficacy and safety of golimumab induction and maintenance treatment in patients with UC. Furthermore, we will discuss the positioning of golimumab for UC in current treatment algorithms. Keywords: ulcerative colitis, UC, antitumor necrosis factor, TNF, antibodies, golimumab

  8. Diagnosis and classification of ulcerative colitis.

    Conrad, Karsten; Roggenbuck, Dirk; Laass, Martin W

    2014-01-01

    Ulcerative colitis (UC) is a chronic relapsing inflammatory bowel disease (IBD) characterised by superficial mucosal ulceration, rectal bleeding, diarrhoea, and abdominal pain. In contrast to Crohn's disease (CrD), UC is restricted to the colon and the inflammation is limited to the mucosal layer. Classic UC affects the colon in a retrograde and continuous fashion starting from the rectum and extending proximally. Dependent on the anatomic extent of involvement, UC can be classified as proctitis, left-sided colitis, or pancolitis. Inflammatory arthropathies and primary sclerosing cholangitis (PSC) are the most common and clinically most important extraintestinal manifestations of UC. The aetiopathogenesis of UC is incompletely understood, but immune-mediated mechanisms are responsible for dysregulated immune responses against intraluminal antigens in genetically predisposed individuals. The diagnosis is based on the history, as well as clinical, radiological, endoscopic and histological features. Autoantibodies, mainly antineutrophil cytoplasmic antibodies (ANCA) and anti-goblet cell antibodies (GAB) may be helpful in the early diagnosis of UC and in differentiating it from CrD.

  9. INTERLEUKIN-6, INTERLEUKIN-8 AND TUMOR NECROSIS FACTOR-α EXPRESSION IN ULCERATIVE COLITIS

    李琪佳; 宫恩聪; 刘叔平; 鄂文

    2001-01-01

    Objectve To study the new insight into the pathogenesis of ulcerative colitis. Methods Interleukin-6 (IL-6), Interleukin-8 (IL-8) and tumor necrosis factor-α(TNF-α) mRNA expression were assessed in the intestinal mucosa of active (n=32) and inactive (n=18) phase using in situ hybridization. Immunohistochemistry for different leukocyte subsets was performed in biopsy specimens of the intestinal mucosa from 50 patients with ulcerative colitis and 5 healthy controls.

  10. Infliximab-associated alveolitis after treatment for severe left-sided ulcerative colitis.

    Veerappan, Sundaram G

    2012-02-01

    Here we describe a patient with ulcerative colitis who developed alveolitis after infliximab therapy. With earlier case reports of development of alveolitis in rheumatoid arthritis patients after infliximab infusion, the temporal relationship between the infliximab therapy and the development of alveolitis in this case, raises the possibility that the two might be causally related. With an increasing trend towards treating moderate to severely active ulcerative colitis patients with infliximab as a rescue therapy, clinicians should be aware of this potentially serious complication.

  11. Golimumab: clinical update on its use for ulcerative colitis.

    Gilardi, D; Fiorino, G; Allocca, M; Bravatà, I; Danese, S

    2015-03-01

    Monoclonal antibodies directed against tumor necrosis factor alpha (anti-TNF-α agents) have dramatically changed the therapeutical approach to inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis. A new anti-TNF drug, golimumab, has recently been approved for patients with moderate to severe ulcerative colitis. Its efficacy has been demonstrated by preclinical and clinical studies and the drug showed an efficacy and safety profile in line with the other anti-TNF agents, such as infliximab and adalimumab. This review gives an overview on golimumab in the treatment of moderate to severe ulcerative colitis.

  12. Clinical Effects of a Topically Applied Toll-like Receptor 9 Agonist in Active Moderate-to-Severe Ulcerative Colitis

    Atreya, Raja; Bloom, Stuart; Scaldaferri, Franco; Gerardi, Viviana; Admyre, Charlotte; Karlsson, Åsa; Knittel, Thomas; Kowalski, Jan; Lukas, Milan; Löfberg, Robert; Nancey, Stephane; Petryka, Robert; Rydzewska, Grazyna; Schnabel, Robert; Seidler, Ursula; Neurath, Markus F.

    2016-01-01

    Background and Aims: Toll-like receptors [TLRs] are potential drug targets for immunomodulation. We determined the safety and efficacy of the TLR-9 agonist DNA-based immunomodulatory sequence 0150 [DIMS0150] in ulcerative colitis [UC] patients refractory to standard therapy. Methods: In this randomized, double-blind, placebo-controlled trial, 131 patients with moderate-to-severe active UC were randomized to receive two single doses of the oligonucleotide DIMS0150 [30 mg] or placebo administered topically during lower GI endoscopy at baseline and Week 4. The primary endpoint was clinical remission, defined as Clinical Activity Index [CAI] ≤4, at Week 12. Secondary endpoints included mucosal healing and symptomatic remission of key patient-reported outcomes [absence of blood in stool and weekly stool frequency <35]. Results: There was no statistical significant difference between the groups in the induction of clinical remission at Week 12, with 44.4% in the DIMS0150 group vs. 46.5% in the placebo group. However, the proportion of patients who achieved symptomatic remission was 32.1% in the DIMS0150 group vs. 14.0% in the placebo group at Week 4 [p = 0.020], and 44.4% vs. 27.9% at Week 8 [p = 0.061]. More patients on DIMS0150 compared with those on placebo had mucosal healing [34.6% vs. 18.6%; p = 0.09] and histological improvement regarding the Geboes score [30.9% vs. 9.3%; p = 0.0073] at Week 4. Significantly more patients on DIMS0150 were in clinical remission with mucosal healing at Week 4: 21% vs. 4.7% in the placebo group [p = 0.02]. DIMS0150 was well tolerated, and no safety signals compared with placebo were evident. Conclusions: Therapy with the topically applied TLR-9 agonist DIMS0150 is a promising and well-tolerated novel therapeutic option for treatment-refractory, chronic active UC patients, warranting further clinical trials. PMID:27208386

  13. Association between oral 5-ASA adherence and health care utilization and costs among patients with active ulcerative colitis

    Mitra Debanjali

    2012-09-01

    Full Text Available Abstract Background Observational cohort study to assess the association between adherence to oral 5-aminosalicylates (5-ASAs and all-cause costs and health care utilization among patients with active ulcerative colitis (UC in the United States. Methods Retrospective analysis of insurance claims from June 1997 to August 2006 in the LifeLink Database. Patient criteria: aged 18 or older with one or more claim(s between June 1997 and August 2005 for a UC diagnosis and at least one oral 5-ASA prescription on or after the first observed UC diagnosis; continuous enrollment for at least 6 months prior to and 12 months following 5-ASA initiation (index date. As a proxy for active disease, patients needed to have at least two UC-specific non-pharmacy claims, at least 30 days of 5-ASA treatment and at least one corticosteroid prescription within the 12-month post-index period. Cumulative exposure to oral 5-ASAs over the 12-month period was calculated using the medication possession ratio (MPR. Patients with an MPR of at least 0.80 were classified as adherent. All-cause medical and pharmacy resource utilization and costs were computed over the 12-month post-index period and compared between adherent and nonadherent patients. Results 1,693 UC patients met study inclusion criteria: 72% were nonadherent to 5-ASA treatment (n = 1,217 and 28% were adherent (n = 476 in the 12-month study period. Compared with nonadherent patients, adherent patients had 31% fewer hospitalizations (P = 0.0025 and 34% fewer emergency department admissions (P = 0.0016. Adherent patients had 25% more pharmacy prescriptions overall (P P P = 0.0002. After adjusting for covariates, total all-cause costs were 29% higher for nonadherent patients than for adherent patients (mean [95% confidence interval]: $13,465 [$13,094, $13,835] vs $17,339 [$17,033, $17,645]. Conclusions Approximately three-quarters of patients with active UC were not adherent with their

  14. Interleukin-6 induces S100A9 expression in colonic epithelial cells through STAT3 activation in experimental ulcerative colitis.

    Min Jeoung Lee

    Full Text Available BACKGROUND: Intestinal epithelium is essential for maintaining normal intestinal homeostasis; its breakdown leads to chronic inflammatory pathologies, such as inflammatory bowel diseases (IBDs. Although high concentrations of S100A9 protein and interleukin-6 (IL-6 are found in patients with IBD, the expression mechanism of S100A9 in colonic epithelial cells (CECs remains elusive. We investigated the role of IL-6 in S100A9 expression in CECs using a colitis model. METHODS: IL-6 and S100A9 expression, signal transducer and activator of transcription 3 (STAT3 phosphorylation, and infiltration of immune cells were analyzed in mice with dextran sulfate sodium (DSS-induced colitis. The effects of soluble gp130-Fc protein (sgp130Fc and S100A9 small interfering (si RNA (si-S100A9 on DSS-induced colitis were evaluated. The molecular mechanism of S100A9 expression was investigated in an IL-6-treated Caco-2 cell line using chromatin immunoprecipitation assays. RESULTS: IL-6 concentrations increased significantly in the colon tissues of DSS-treated mice. sgp130Fc or si-S100A9 administration to DSS-treated mice reduced granulocyte infiltration in CECs and induced the down-regulation of S100A9 and colitis disease activity. Treatment with STAT3 inhibitors upon IL-6 stimulation in the Caco-2 cell line demonstrated that IL-6 mediated S100A9 expression through STAT3 activation. Moreover, we found that phospho-STAT3 binds directly to the S100A9 promoter. S100A9 may recruit immune cells into inflamed colon tissues. CONCLUSIONS: Elevated S100A9 expression in CECs mediated by an IL-6/STAT3 signaling cascade may play an important role in the development of colitis.

  15. Extraintestinal manifestations in Crohn's disease and ulcerative colitis

    Isene, Rune; Bernklev, Tomm; Høie, Ole

    2015-01-01

    BACKGROUND: In chronic inflammatory bowel disease (IBD) (Crohn's disease [CD] and ulcerative colitis [UC]), symptoms from outside the gastrointestinal tract are frequently seen, and the joints, skin, eyes, and hepatobiliary area are the most usually affected sites (called extraintestinal...

  16. A Review of Qingchang Shuan for Treatment of Ulcerative Colitis

    DAI Yan-cheng; TANG Zhi-peng; MA Gui-tong; GONG Yu-ping; LIU Wen; ZHANG Ya-li; WANG Xin-zhong

    2010-01-01

    @@ Qingchang Shuan(清肠栓)is a commonly used Chinese herbal suppository for treatment of ulcerative colitis(UC).It has the effects of clearing away heat and toxic materials, and promoting tissue regeneration by removing blood stasis.

  17. Clostridium difficile Infection Worsens the Prognosis of Ulcerative Colitis

    María E Negrón

    2014-01-01

    Full Text Available BACKGROUND: The impact of Clostridium difficile infections among ulcerative colitis (UC patients is well characterized. However, there is little knowledge regarding the association between C difficile infections and postoperative complications among UC patients.

  18. Achilles tendinitis as a rare extraintestinal manifestation of ulcerative colitis.

    Zenda, Takahiro; Araki, Ichiro; Nakamiya, Otoyuki; Tokuumi, Yuji; Shimada, Yuka; Komai, Keigo; Taniuchi, Yukie

    2016-06-01

    Patients with inflammatory bowel disease often have extraintestinal manifestations (EIMs) involving almost all organ systems, but little has been reported on Achilles tendinitis. Herein, we present a unique case of Achilles tendinitis, which manifested shortly after initiation of mesalazine therapy for ulcerative colitis. A 26-year-old Japanese woman with bloody diarrhea and abdominal cramps lasting for 7 days was referred to our hospital. The Lichtiger clinical activity index (CAI) score was 9 at the first visit. Based on the clinical symptoms and examination results, she was diagnosed with ulcerative pancolitis in the active phase, and treatment with mesalazine (2.4 g/day) and probiotics was initiated. Her symptoms resolved within 7 days of treatment (CAI 3). However, she then developed bilateral Achilles tendinitis without any apparent cause. The Achilles tendinitis subsided with conservative management within 2 weeks, despite continuation of mesalazine therapy. This case instructively suggests that Achilles tendinitis should be noted as an EIM of ulcerative colitis.

  19. Acute respiratory distress syndrome associated with severe ulcerative colitis

    Shiho; Sagara; Yasuo; Horie; Yumiko; Anezaki; Hideaki; Miyazawa; Masahiro; Iizuka

    2010-01-01

    Various extraintestinal manifestations including pulmonary abnormalities have been reported in patients with ulcerative colitis. Acute respiratory distress syndrome (ARDS) is a serious and fatal pulmonary manifestation. We have experienced a 67-year-old male patient with ARDS associated with a severe type of ulcerative colitis (UC). Severe dyspnea symptoms occurred during the treatment of UC in a previous hospital and the patient was transferred to our hospital on June 27, 2007. Both blood and sputa culture...

  20. Ulcerative colitis Presenting as leukocytoclastic vasculitis of skin

    Sabiye Akbulut; Ersan Ozaslan; Firdevs Topal; Levent Albayrak; Burcak Kayhan; Cumali Efe

    2008-01-01

    A number of cutaneous changes are known to occur in the course of inflammatory bowel diseases (IBD),including pyoderma gangrenosum, erythema nodosum,perianal disease, erythematous eruptions, urticaria, and purpura. However, occurrence of skin manifestations prior to the development of ulcerative colitis is a rare occasion. Here, we report a case of ulcerative colitis associated with leukocytoclastic vasculitis in which the intestinal symptoms became overt 8 mo after the development of skin lesions.

  1. Relationship and significance between anti-β2-glycoprotein I antibodies and platelet activation state in patients with ulcerative colitis

    Yan-Hang Gao; Pu-Jun Gao; Chun-Guang Wang; Xiao-Cong Wang; Yun-Feng Piao

    2008-01-01

    AIM:To study the relationship between anti-β2-glycoproteinⅠ(aβ2GPⅠ) antibodies and platelet activation state in patients with ulcerative colitis (UC)and its significance.METHODS:Peripheral blood samples were collected from 56 UC patients (34 males and 22 females,aged 43.5 years,range 21-66 years),including 36 at active stage and 20 at remission stage,and 25 sex-and age-matched controls.The level of aβ2GPⅠwas measured by ELISA.The platelet activation markers,platelet activation complex-I (PAC- I) and P-selectin (CD62P) were detected by flow cytometry.RESULTS:The A value for IgG aβzGPⅠin the active UC group was 0.61±0.13,significantly higher than that in the remittent UC and control groups (0.50±0.13 and 0.22±0.14,P<0.01).There was a significant difference between the two groups (P<0.01).The A value for IgM aβ2GPⅠin the active and remittent UC groups was 0.43±0.13 and 0.38±0.12,significantly higher than that in the control group (0.20±0.12,P<0.01).However,there was no significant difference between the two groups (P>0.05).The PAC-I positive rate for the active and remittent UC groups was 30.6%±7.6% and 19.6%±7.8% respectively,significantly higher than that for the control group (6.3%±1.7%,P<0.01).There was a significant difference between the two groups (P<0.01).The CD62P positive rate for the active and remittent UC groups was 45.0%±8.8% and 31.9%±7.8% respectively,significantly higher than that for the control group (9.2%±2.7%,P<0.01).There was a significant difference between the two groups (P<0.01).In the active UC group,the more severe the state of illness was,the higher the A value for IgG aβ2GPⅠwas,and the positive rate for PAC-I and CD62P was positively correlated with the state of illness (Faβ2GPⅠ= 3.679,P<0.05;FPAC-I (%) = 5.346,P<0.01;and FCD62P (%) = 5.418,P<0.01).Meanwhile,in the same state of illness,the A value for IgG aβ2GPⅠwas positively correlated to the positive rates for PAC-I and CD62P

  2. [Faecal lactate as a disease activity index of ulcerative colitis: application to assessment of efficacy in the treatment with total parenteral nutrition].

    Nakamura, M

    1989-08-01

    I investigated changes of faecal short-chain fatty acids (SCFA) in 52 hospitalized patients with ulcerative colitis (UC) who had bloody diarrhoea (severe and moderate colitis). The results suggest that molar ratios of faecal lactate could be helpful to monitor the disease activity of UC patients. Faecal SCFA output correlated directly with faecal output. This finding reflected an increase in output of lactate and acetate. In severe colitis, concentrations of faecal lactate were increased, whereas those of faecal major components of SCFA (acetate, propionate and n-buty-rate) were markedly reduced. Further, faecal lactate concentrations were increased in cases with bloody diarrhoea and reduced in those with formed stool. Patients were divided into two groups according with their treatments: patients treated with total parenteral nutrition (TPN) or low-residue UC diet. The molar ratio of faecal lactate in the TPN group was reduced below 2% in four weeks, whereas that in the UC diet group was reduced into the 2% mark in eight weeks. These findings support that patients in the former group were more rapidly induced into remission.

  3. [Ulcerative colitis initial presentation with multiple extra-intestinal manifestations].

    Marques, M Raquel; Oliveira, Susana; Gorjão Clara, J P

    2010-01-01

    Multiple extraintestinal diseases are present in 0.3- 4.5 % of inflammatory bowel disease patients. A 39-year-old woman was admitted with a 3 months history of cervicalgia with functional incapacity, asthenia, tibio-tarsal bilateral arthritis and bloody diarrhoea. She had ferropenic anemia, SR-120 mm, creatinine clearance-42 mL/min, proteinuria-1.2 g/24h. Colonoscopy with biopsy showed active ulcerative rectossigmoiditis. She had bilateral sacroileitis more pronounced at the right side which was suggestive of ankylosing spondylitis. HLA B27 was positive. Because of colestasis, colangio-MRI and CPRE were done and were suggestive of primary sclerosing colangitis. Renal disease was interpreted as an analgesic nephropathy versus glomerulonephritis associated with ulcerative colitis. Cardiac ecodoppler showed pericardial thickening with a thin pericardial effusion. Full improvement of gastrointestinal complaints was observed with 5-ASA topic enemas, sulfassalazine, corticosteroids and azathioprine and full remission of ankylosing spondylitis with adalimumab. This case illustrates extraintestinal wide involvement as the initial presentation of ulcerative colitis, remarking its systemic nature.

  4. Radical induction theory of ulcerative colitis

    Jay Pravda

    2005-01-01

    To propose a new pathogenesis called Radical Induction to explain the genesis and progression of ulcerative colitis (UC). UC is an inflammatory bowel disease. Colonic inflammation in UC is mediated by a buildup of white blood cells (WBCs) within the colonic mucosal lining; however,to date there is no answer for why WBCs initially enter the colonic mucosa to begin with. A new pathogenesis termed "Radical Induction Theory" is proposed to explain this and states that excess un-neutralized hydrogen peroxide, produced within colonic epithelial cells as a result of aberrant cellular metabolism, diffuses through cell membranes to the extracellular space where it is converted to the highly damaging hydroxyl radical resulting in oxidative damage to structures comprising the colonic epithelial barrier. Once damaged, the barrier is unable to exclude highly immunogenic fecal bacterial antigens from invading the normally sterile submucosa. This antigenic exposure provokes an initial immune response of WBC infiltration into the colonic mucosa. Once present in the mucosa,WBCs are stimulated to secrete toxins by direct exposure to fecal bacteria leading to mucosal ulceration and bloody diarrhea characteristic of this disease.

  5. Complement activation capacity in plasma before and during high-dose prednisolone treatment and tapering in exacerbations of Crohn's disease and ulcerative colitis

    Baatrup Gunnar

    2005-09-01

    Full Text Available Abstract Background Ulcerative colitis (UC and Crohn's disease (CD are characterized by intestinal inflammation mainly caused by a disturbance in the balance between cytokines and increased complement (C activation. Our aim was to evaluate possible associations between C activation capacity and prednisolone treatment. Methods Plasma from patients with exacerbations of UC (n = 18 or CD (n = 18 were collected before and during high dose prednisolone treatment (1 mg/kg body weight and tapering. Friedman's two way analysis of variance, Mann-Whitney U test and Wilcoxon signed-rank sum test were used Results Before treatment, plasma from CD patients showed significant elevations in all C-mediated analyses compared to the values obtained from 38 healthy controls (p Conclusion Our findings indicate that C activation capacity is up-regulated significantly in plasma from CD patients. The decreases observed after prednisolone treatment reflect a general down-regulation in immune activation.

  6. Ulcerative colitis flair induced by mesalamine suppositories hypersensitivity.

    Ding, Hao; Liu, Xiao-Chang; Mei, Qiao; Xu, Jian-Ming; Hu, Xiang-Yang; Hu, Jing

    2014-04-07

    Mesalamine suppositories have been used widely for the treatment of distal ulcerative colitis and considered to be safer than systemic administration for its limited systemic absorption. However, previous studies have shown that mesalamine suppository occasionally causes severe hypersensitivity reactions including fever, rashes, colitis exacerbation and acute eosinophilic pneumonia. Here we present a 25-year-old woman with ulcerative colitis with bloody diarrhea accompanied by abdominal pain and fever which were aggravated after introduction of mesalamine suppositories. In light of symptom exacerbation of ulcerative colitis, increased inflammatory injury of colon mucosa shown by colonoscopy and elevated peripheral eosinophil count after mesalamine suppositories administration, and the Naranjo algorithm score of 10, the possibility of hypersensitivity reaction to mesalamine suppositories should be considered, warning us to be aware of this potential reaction after administration of mesalamine formulations even if it is the suppositories.

  7. Long-term efficacy and safety of once-daily mesalazine granules for the treatment of active ulcerative colitis.

    Böhm, Stephan Karl; Kruis, Wolfgang

    2014-01-01

    In 1977, 5-aminosalicylic acid (5-ASA) was discovered as a therapeutically active moiety of sulfasalazine (SASP) and was launched for topical and oral therapy of ulcerative colitis (UC) in 1984. As a first-step, delivery systems had to be developed to protect 5-ASA against absorption in the upper gastrointestinal tract, resulting in different and competing strategies (azo compounds, controlled release, and pH-dependent release). In a second step, at the beginning of the new century, coinciding with the expiration of patent protection for the first 5-ASA formulations, two component composite release mechanisms (pH-dependent and controlled release) were developed. Furthermore, the drug was formulated as granules instead of tablets, allowing higher unit strengths compared with tablets. Neither Salofalk Granu-Stix(®), nor MMX 5-ASA, nor Pentasa(®) granules have initially been developed for once-daily (OD) dosing. A review of the achievements of 20 years of 5-ASA development has demonstrated that 5-ASA has equal efficacy compared with SASP at best, that there are no measurable differences in efficacy between various 5-ASA preparations, and that in a group of patients tolerating SASP, adverse event profiles of SASP and 5-ASA did not differ significantly, with SASP being the far cheaper substance. Therefore, drug adherence came into focus as a new goal for improving UC therapy. Although adherence is a complex and multifactorial construct, a simple dosing schedule may contribute to higher drug adherence and better efficacy of treatment. Simultaneously, the US 5-ASA market, estimated to be worth US$1.4 billion, is expected to grow continuously. Naturally, this very competitive market is not only driven by scientific progress but also by commercial interests. Thus, patents for minor changes to the formulation may serve as protection against drug companies trying to launch generic versions. Randomized controlled trials performed on OD dosing in induction of remission have

  8. Long-term efficacy and safety of once-daily mesalazine granules for the treatment of active ulcerative colitis

    Böhm SK

    2014-09-01

    Full Text Available Stephan Karl Böhm,1 Wolfgang Kruis2 1Kantonsspital Baselland, Medizinische Universitätsklinik, Bruderholz, Switzerland; 2Evangelisches Krankenhaus Kalk, University of Cologne, Cologne, Germany Abstract: In 1977, 5-aminosalicylic acid (5-ASA was discovered as a therapeutically active moiety of sulfasalazine (SASP and was launched for topical and oral therapy of ulcerative colitis (UC in 1984. As a first-step, delivery systems had to be developed to protect 5-ASA against absorption in the upper gastrointestinal tract, resulting in different and competing strategies (azo compounds, controlled release, and pH-dependent release. In a second step, at the beginning of the new century, coinciding with the expiration of patent protection for the first 5-ASA formulations, two component composite release mechanisms (pH-dependent and controlled release were developed. Furthermore, the drug was formulated as granules instead of tablets, allowing higher unit strengths compared with tablets. Neither Salofalk Granu-Stix®, nor MMX 5-ASA, nor Pentasa® granules have initially been developed for once-daily (OD dosing. A review of the achievements of 20 years of 5-ASA development has demonstrated that 5-ASA has equal efficacy compared with SASP at best, that there are no measurable differences in efficacy between various 5-ASA preparations, and that in a group of patients tolerating SASP, adverse event profiles of SASP and 5-ASA did not differ significantly, with SASP being the far cheaper substance. Therefore, drug adherence came into focus as a new goal for improving UC therapy. Although adherence is a complex and multifactorial construct, a simple dosing schedule may contribute to higher drug adherence and better efficacy of treatment. Simultaneously, the US 5-ASA market, estimated to be worth US$1.4 billion, is expected to grow continuously. Naturally, this very competitive market is not only driven by scientific progress but also by commercial interests

  9. Treatment of severe steroid refractory ulcerative colitis

    Gert Van Assche; Séverine Vermeire; Paul Rutgeerts

    2008-01-01

    Although systemic steroids are highly efficacious in ulcerative colitis (UC),failure to respond to steroids sUll poses an important challenge to the surgeon and physician alike. Even if the life Lime risk of a fulminant UC flare is only 20%, this condition is potentially life threatening and should be managed in hospital. If patients fail 3 to 5 d of intravenous corticosteroids and optimal supportive care, they should be considered for any of three options: intravenous cyclosporine (2 mg/kg for 7 d, and serum level controlled),infliximab (5 mg/kg N,0-2-6 wk) or total colectomy.The choice between these three options is a medicalsurgical decision based on clinical signs, radiological and endoscopic findings and blood analysis (CRP, serum albumin).Between 65 and 85% of patients will initially respond to cyclosporine and avoid colectomy on the short term. Over 5 years only 50% of initial responders avoid colectomy and outcomes are better in patients naive to azathioprine (bridging strategy).The data on infliximab as a medical rescue in fulminant colitis are more limited although the efficacy of this anti tumor necrosis factor (TNF) monoclonal antibody has been demonstrated in a controlled trial. Controlled data on the comparative efficacy of cyclosporine and infliximab are not available at this moment. Both drugs are immunosuppressants and are used in combination with steroids and azathioprine, which infers a risk of serious, even fatal, opportunistic infections. Therefore,patients not responding to these agents within 5-7 d should be considered for colectomy and responders should be closely monitored for infections.

  10. Colonic production of nitric oxide gas in ulcerative colitis, collagenous colitis and uninflamed bowel

    Perner, Anders; Lassen, Inge Nordgaard; Matzen, Peter;

    2002-01-01

    with ulcerative colitis, 10 patients with collagenous colitis and 20 controls with uninflamed mucosa. METHODS: The tip of a Teflon tube was placed in the caecum during colonoscopy. Subsequently, argon was infused at a constant rate for 70-180 min. Argon and NO in gas sampled from the rectum were measured...

  11. Noninvasive evaluation of active pan-ulcerative colitis with multiple strictures using Fluorine-18-Fluorodeoxyglucose positron emission tomography/computed tomography.

    Santhosh, Sampath; Bhattacharya, Anish; Rana, Surinder Singh; Bhasin, Deepak Kumar; Gupta, Rajesh; Mittal, Bhagwant Rai

    2016-01-01

    Ulcerative colitis (UC) is an inflammatory bowel disease characterized by waxing and waning inflammation that changes in severity and extent and may progress to neoplasia, especially in the presence of strictures. When patients have nonnegotiable strictures or severe inflammation with ulcers, colonoscopy is difficult and carries the risk of perforation. The authors present a patient with pan-UC with multiple strictures, in whom fluorodeoxyglucose positron emission tomography/computed tomography was used to noninvasively evaluate the extent and severity of the disease.

  12. Management of acute severe ulcerative colitis

    Saurabh; Kedia; Vineet; Ahuja; Rakesh; Tandon

    2014-01-01

    The management strategy of acute severe ulcerative colitis has evolved over the past decade from being entirely restricted to twin choices of intravenous steroids or colectomy to include colon rescue therapies like cyclosporin as well as infliximab. However it still remains a medical emergency requiring hospitalization and requires care from a multidisciplinary team comprising of a gastroenterologist and a colorectal surgeon. The frame shift in management has been the emphasis on time bound decision making with an attempt to curtail the mortality rate to below 1%. Intravenous corticosteroids are the mainstay of therapy. Response to steroids should be assessed at day 3 of admission and partial/non-responders should be considered for alternative medical therapy/surgery. Medical rescue therapies include intravenous cyclosporin and infliximab. Cyclosporin is administered in a dose of 2 mg/kg per day and infliximab is administered as a single dose intravenous infusion of 5 mg/kg. Approximately 75% patients have short term and 50% patients have long term response to cyclosporin. Long term response to cyclosporin is improved in patients who are thiopurine na?ve and are started on thiopurines on day 7. Infliximab also has a response rate of approximately 70% in short term and 50% in long term. Both cyclosporin and infliximab are equally efficacious medical rescue therapies as demonstrated in a recent randomized control trial. Patientsnot responding to infliximab or cyclosporin should be considered for colectomy.

  13. Optimal management of steroid-dependent ulcerative colitis

    Khan HMW

    2015-11-01

    Full Text Available Hafiz M Waqas Khan,1 Faisal Mehmood,1 Nabeel Khan2 1Department of Medicine, King Edward Medical University, Lahore, Pakistan; 2Section of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia VA Medical Center, Philadelphia, PA, USA Abstract: Ulcerative colitis (UC is a chronic inflammatory condition that is variable in both extent and severity of disease as well as response to therapy. Corticosteroids (CSs were the first drugs used in the management of UC and are still used for induction of remission. However, because of their extensive side-effect profile, they are not utilized for maintenance of remission. In view of this, CS-free remission has become an important end point while evaluating therapeutic agents used in the management of UC. This review highlights the results of various studies conducted to evaluate the efficacy of different medications to attain CS-free remission in the setting of active UC. The drugs reviewed include established agents such as thiopurines, methotrexate, infliximab, adalimumab, vedolizumab, golimumab, and newer experimental agents, and if all else fails, colectomy will be performed. The efficacy of these drugs is evaluated individually. Our aim is to provide a synopsis of the work done in this field to date. Keywords: ulcerative colitis, steroid dependent, thiopurines, MTX, adalimumab, infliximab

  14. Initial experience with golimumab in clinical practice for ulcerative colitis

    Luisa Castro-Laria

    Full Text Available Background: Golimumab is a TNF-blocking agent indicated as a second-line therapy in ulcerative colitis. Purpose: To research the effectiveness and safety of golimumab in patients with ulcerative colitis in clinical practice. Methods: Retrospective study of the effectiveness and safety of golimumab in patients with ulcerative colitis. All patients received golimumab 200 mg subcutaneously at week 0, and golimumab 100 mg subcutaneously at week 2. After the induction treatment, each patient received 50 mg sc. every 4 weeks in patients with body weight less than 80 kg, and 100 mg every 4 weeks in patients with body weight greater than or equal to 80 kg. Results: Study of a group of 23 ulcerative colitis patients, 7 of whom were naive to any anti-TNF therapy, and 16 patients who had previously been treated with an anti-TNF agent other than golimumab (non-naive patients. The average treatment time with golimumab was 14.3 weeks. Globally, withdrawal of corticosteroids was observed in 74% of cases. Clinical response was observed in 85.5% of patients who had not received biological treatment previously, and in patients who had previously received biological treatment the response rate was 75%. Conclusions: In this short study, golimumab seems to be an alternative treatment in naive and non-naive anti-TNF ulcerative colitis patients. It is also a safe therapy, given that there were no adverse effects in the patients studied.

  15. Selective blockade of leukotriene production by a single dose of the FPL 64170XX 0.5% enema in active ulcerative colitis

    Kjeldsen, J; Laursen, L S; Hillingsø, Jens

    1995-01-01

    5-Lipoxygenase products of arachidonic acid metabolism are thought to play a central role in the secondary amplification of the inflammatory response of several inflammatory diseases, including ulcerative colitis. FPL 64170XX is a selective inhibitor of the enzyme 5-lipoxygenase. Concentrations o...

  16. Epithelial-specific ETS-1 (ESE1/ELF3) regulates apoptosis of intestinal epithelial cells in ulcerative colitis via accelerating NF-κB activation.

    Li, Liren; Miao, Xianjing; Ni, Runzhou; Miao, Xiaobing; Wang, Liang; Gu, Xiaodan; Yan, Lijun; Tang, Qiyun; Zhang, Dongmei

    2015-06-01

    Epithelial-specific ETS-1 (ESE1), also named as ELF3, ERT and ESX, belonging to the ETS family of transcription factors, exerts multiple activities in inflammation, epithelial differentiation and cancer development. Previous data demonstrated that ESE1 synergizes with NF-κB to induce inflammation and drive tumor progress, and the nuclear translocation of ESE1 promotes colon cells apoptosis. However, the expression and biological functions of ESE1 in ulcerative colitis (UC) remain unclear. In this study, we reported for the first time that ESE1/ELF3 was over-expressed in intestinal epithelial cells (IECs) of patients with UC. In DSS-induced colitis mouse models, we observed the up-regulation of ESE1/ELF3 accompanied with the elevated levels of IEC apoptotic markers (active caspase-3 and cleaved PARP) and NF-κB activation indicators [phosphorylated NF-κB p65 subunit (p-p65) and p-IκB] in colitis IECs. Increased co-localization of ESE1/ELF3 with active caspase-3 (and p-p65) in IECs of the DSS-induced colitis group further indicated the possible involvement of ESE1/ELF3 in NF-κB-mediated IEC apoptosis in UC. Employing the TNF-α-treated HT-29 cells as an IEC apoptosis model, we confirmed the positive correlation of ESE1/ELF3 with NF-κB activation and caspase-dependent IEC apoptosis in vitro. Immunoprecipitation and immunofluorescence assay revealed the physical interaction and increased nuclear translocation of ESE1/ELF3 and the NF-κB p65 subunit in TNF-α-treated HT-29 cells. Knocking ESE1/ELF3 down by siRNA significantly alleviated TNF-α-induced NF-κB activation and cellular apoptosis in HT-29 cells. Taken together, our data suggested that ESE1/ELF3 may promote the UC progression via accelerating NF-κB activation and thus facilitating IEC apoptosis.

  17. Evolution of Collagenous Colitis into Severe and Extensive Ulcerative Colitis

    Hugh J Freeman

    2007-01-01

    Full Text Available Collagenous colitis is an inflammatory mucosal disorder of the colon with distinctive histopathological features, including a thickened subepithelial collagen layer. The clinical course is usually benign, but serious complications, including death, may occur. In the present report, a 69-year-old woman with watery diarrhea and collagenous colitis developed bloody diarrhea that was refractory to treatment medications, including corticosteroids and azathioprine. Endoscopic and histopathological studies showed a focal neutrophilic inflammatory process that progressed to a diffuse and extensive form of colitis, eventually requiring total proctocolectomy. Careful histological review of the resected colon showed no evidence of persistent collagenous colitis. These findings suggest an important need for continued long-term follow-up of patients with collagenous colitis because superimposed and serious colonic complications may occur, including a severe and extensive pancolitis refractory to medications and necessitating total proctocolectomy.

  18. Pathogenesis and biomarkers of carcinogenesis in ulcerative colitis

    Thorsteinsdottir, Sigrun; Gudjonsson, Thorkell; Nielsen, Ole Haagen;

    2011-01-01

    One of the most serious complications of ulcerative colitis is the development of colorectal cancer. Screening patients with ulcerative colitis by standard histological examination of random intestinal biopsy samples might be inefficient as a method of cancer surveillance. This Review focuses......-driven mechanisms of DNA damage, including the generation and effects of reactive oxygen species, microsatellite instability, telomere shortening and chromosomal instability, are reviewed, as are the molecular responses to genomic stress. We also discuss how these mechanisms can be translated into usable biomarkers....... Although progress has been made in the understanding of inflammation-driven carcinogenesis, markers based on these findings possess insufficient sensitivity or specificity to be usable as reliable biomarkers for risk of colorectal cancer development in patients with ulcerative colitis. However, screening...

  19. Surveillance issues in inflammatory bowel disease: ulcerative colitis.

    Provenzale, D; Onken, J

    2001-02-01

    This review article on the surveillance of patients with ulcerative colitis provides an overview of the criteria for evaluating screening and surveillance programs and applies the criteria to the available evidence to determine the effectiveness of the surveillance of patients with ulcerative colitis. We examine the clinical outcomes associated with surveillance, the additional clinical time required to confirm the diagnosis of dysplasia and cancer, compliance with surveillance and follow-up, and the effectiveness of the individual components of a surveillance program, including colonoscopy and pathologist's interpretation. The disability associated with colectomy is considered, as are the cost and acceptability of surveillance programs. Patients with long-standing ulcerative colitis are at risk for developing colorectal cancer. Recommended surveillance colonoscopy should be supported. New endoscopic and histopathologic techniques to improve the identification of high-risk patients may enhance the effectiveness and cost-effectiveness of surveillance practices.

  20. Inherited determinants of Crohn's disease and ulcerative colitis phenotypes

    Cleynen, Isabelle; Boucher, Gabrielle; Jostins, Luke

    2016-01-01

    BACKGROUND: Crohn's disease and ulcerative colitis are the two major forms of inflammatory bowel disease; treatment strategies have historically been determined by this binary categorisation. Genetic studies have identified 163 susceptibility loci for inflammatory bowel disease, mostly shared...... between Crohn's disease and ulcerative colitis. We undertook the largest genotype association study, to date, in widely used clinical subphenotypes of inflammatory bowel disease with the goal of further understanding the biological relations between diseases. METHODS: This study included patients from 49...... centres in 16 countries in Europe, North America, and Australasia. We applied the Montreal classification system of inflammatory bowel disease subphenotypes to 34,819 patients (19,713 with Crohn's disease, 14,683 with ulcerative colitis) genotyped on the Immunochip array. We tested for genotype...

  1. Crohn's-like complications in patients with ulcerative colitis after total proctocolectomy and ileal pouch-anal anastomosis.

    Goldstein, N S; Sanford, W W; Bodzin, J H

    1997-11-01

    Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) has become an established surgical procedure for ulcerative colitis. Occasional patients who have undergone IPAA develop persistent or recurrent episodes of pouchitis (chronic pouchitis), from which a subset also develop gastrointestinal and systemic complications that are identical to those seen in Crohn's disease. These complications include enteric stenoses or fistulas in the pouch or pouch inlet segment, perianal fistulas or abscesses, pouch fistulas, arthritis, iridocyclitis, and pyoderma gangrenosum. The development of Crohn's-like gastrointestinal complications in a patient with chronic pouchitis frequently engenders concern that the pathologist misinterpreted the proctocolectomy specimen as ulcerative colitis instead of Crohn's disease. We describe eight patients who developed chronic pouchitis and Crohn's-like complications after IPAA and total proctocolectomy. In each case, concern was voiced about misinterpretation of the proctocolectomy specimen as ulcerative colitis instead of Crohn's disease after the development of the Crohn's-like complications. Preoperatively, all eight patients had characteristic clinical, radiographic, and pathologic features of ulcerative colitis. Review of the pathology specimens indicated that all eight had ulcerative colitis. Crohn's-like complications are most likely related to chronic pouchitis, which probably is a form of recrudescent ulcerative colitis within the novel environment of the pouch. A diagnosis of Crohn's disease after IPAA surgery should only be made when reexamination of the original proctocolectomy specimen shows typical pathologic features of Crohn's disease, Crohn's disease arises in parts of the gastrointestinal tract distant from the pouch, pouch biopsies contain active enteritis with granulomas, or excised pouches show the characteristic features of Crohn's disease, including granulomas. There were no histologic differences in the total

  2. Pedal Gangrenous Changes in the Digits of an Adolescent With Ulcerative Colitis: A Case Report.

    Bhoola, Prashant H; Shtofmakher, Garry; Bahri, Ankur; Patel, Ankur A; Barlizo, Sharon R; Trepal, Michael

    2016-01-01

    Ulcerative colitis is an autoimmune inflammatory disease of the colon and is occasionally associated with thrombosis. We report the case of an adolescent with ulcerative colitis who presented with bilateral gangrenous toes without signs of ascending cellulitis. Radiographs indicated the presence of bilateral and erosive changes in the distal phalanges. The vascular team referred the patient for podiatric intervention for distal vasculitis and thrombosis of the digital vessels. Transphalangeal amputations were performed, and postoperative antibiotics were initiated. The surgical sites healed uneventfully, and the patient was able to resume daily activities. Thrombosis of the foot in the context of ulcerative colitis is a rare, but serious, complication that can lead to serious comorbidities, including amputation.

  3. Clinical Observations on Acupuncture Treatment of Ulcerative Colitis

    YANG Shun-yi

    2003-01-01

    Purpose To observe the curative effect of acupuncture on ulcerative colitis. Methods and Results Sixty-two patients with ulcerative colitis were treated mainly by needle-warming moxibustion at Lower He-Sea points and Front-mu points, with the cooperation of syndomic differentiation-based selection of acupoints and oral administration of patent Chinese medicine. After treatment the total effective rate was 91.94% and T cell subgroups returned nearly to normal. Conclusion This treatment method can help the internal environment of human immune system to tend to balance.

  4. Effects of topical ropivacaine on eicosanoids and neurotransmitters in the rectum of patients with distal ulcerative colitis

    Hillingsø, Jens; Kjeldsen, J; Schmidt, P T;

    2002-01-01

    BACKGROUND: Topical administration of lidocaine has been suggested to have beneficial clinical effects in patients with active ulcerative colitis, but the mechanism of action, if any, remains obscure. As local anaesthetics may exert anti-inflammatory actions through their inhibition of nervous......: These findings reveal no evidence of anti-inflammatory actions by ropivacaine in active ulcerative colitis and thus provide no rationale for topical treatment with local anaesthetics....

  5. Two for One: Coexisting Ulcerative Colitis and Crohn’s Disease

    Grant I Chen

    2002-01-01

    Full Text Available Three cases of coexisting ulcerative colitis and Crohn’s disease are presented. In the first case, the patient had a long-standing history of ulcerative proctitis before developing Crohn’s colitis. In the two remaining cases, the patients presented initially with Crohn’s disease of the ileum and, subsequent to resection, developed ulcerative colitis. Well-documented cases of patients diagnosed with both ulcerative colitis and Crohn’s disease are rare. The literature on such cases is reviewed, and the controversy over whether ulcerative colitis and Crohn’s disease are two distinct diseases is explored.

  6. Lansoprazole-associated collagenous colitis: Diffuse mucosal cloudiness mimicking ulcerative colitis

    Mitsuro Chiba; Takeshi Sugawara; Haruhiko Tozawa; Hidehiko Tsuda; Toru Abe; Takuo Tokairin; Iwao Ono; Eriko Ushiyama

    2009-01-01

    There have only been a few reports on lansoprazoleassociated collagenous colitis. Colonic mucosa of collagenous colitis is known to be endoscopically normal. We present a case of collagenous colitis where the mucosa showed diffuse cloudiness mimicking ulcerative colitis. A 70-year-old woman developed watery diarrhea four to nine times a day. She had interstitial pneumonia at 67 and reflux esophagitis at 70 years. Lansoprazole 30 mg/d had been prescribed for reflux esophagitis for nearly 6 mo. Lansoprazole was withdrawn due to its possible side effect of diarrhea. Colonoscopy disclosed diffuse cloudiness of the mucosa which suggested ulcerative colitis. Consequently sulfasalazine 2 g/d was started. The patient's diarrhea dramatically disappeared on the following day. However, biopsy specimens showed subepithelial collagenous thickening and infiltration of inflammatory cells in the lamina propria, confirming the diagnosis of collagenous colitis. One month after sulfasalazine therapy was initiated, colonoscopic and histological abnormalities resolved completely. Five months later the diarrhea recurred. The findings on colonoscopy and histology were the same as before, confirming a diagnosis of collagenous colitis relapse. We found that the patient had begun to take lansoprazole again 3 mo ahead of the recent diarrhea. Withdrawal of lansoprazole promptly resolved the diarrhea. Endoscopic and histological abnormalities were also completely resolved, similar to the first episode. Retrospectively, the date of commencement of sulfasalazine and discontinuation of lansoprazole in the first episode was found to be the same. We conclude that this patient had lansoprazole-associated collagenous colitis.

  7. [Management of severe ulcerative colitis: An up-to-date].

    Hernández-Rocha, Cristian; Ibáñez, Patricio; Molina, María Elena; Klaassen, Julieta; Valenzuela, Andrea; Candia, Roberto; Bellolio, Felipe; Zúñiga, Álvaro; Miguieles, Rodrigo; Miquel, Juan Francisco; Chianale, José; Álvarez-Lobos, Manuel

    2017-01-01

    Ulcerative Colitis (UC) is a chronic inflammatory disease involving the colon, with alternating periods of remission and activity. Exacerbations can be severe and associated with complications and mortality. Diagnosis of severe UC is based on clinical, biochemical and endoscopic variables. Patients with severe UC must be hospitalized. First line therapy is the use of intravenous corticoids which achieve clinical remission in most patients. However, 25% of patients will be refractory to corticoids, situation that should be evaluated at the third day of therapy. In patients without response, cytomegalovirus infection must be quickly ruled out to escalate to second line therapy with biological drugs or cyclosporine. Total colectomy must not be delayed if there is no response to second line therapy, if there is a contraindication for second line therapies or there are complications such as: megacolon, perforation or massive bleeding. An active management with quick escalation on therapy allows to decrease the prolonged exposure to corticoids, reduce colectomy rates and its perioperative complications.

  8. Primary biliary cirrhosis and ulcerative colitis: A case report and review of literature

    Wen-Bin Xiao; Yu-Lan Liu

    2003-01-01

    AIM: To summarize the characteristics of patients suffered from primary biliary cirrhosis associated with ulcerative colitis.METHODS: To report a new case and review the literature.RESULTS: There were 18 cases (including our case) of primary biliary cirrhosis complicated with ulcerative colitis reported in the literature. Compared with classical primary biliary cirrhosis, the patients were more often males and younger similar. The bowel lesions were usually mild with proctitis predominated. While ulcerative colitis was diagnosed before primary biliary cirrhosis in 13 cases, the presentation of primary biliary cirrhosis was earlier than that of ulcerative colitis in our new case reported here. The prevalence of primary biliary cirrhosis among patients of ulcerative colitis was almost 30 times higher than in general population.CONCLUSION: Association of primary biliary cirrhosis with ulcerative colitis is rare. It should be considered in the differential diagnosis of hepatobiliary disease in patients with ulcerative colitis, and vice versa.

  9. Effects of topical ropivacaine on eicosanoids and neurotransmitters in the rectum of patients with distal ulcerative colitis

    Hillingsø, J G; Kjeldsen, J; Schmidt, P T;

    2002-01-01

    reflexes, we have studied the local effects of a single rectal dose of ropivacaine gel on rectal concentrations of eicosanoids and neurotransmittors in patients with relapsing ulcerative colitis. METHODS: In a randomized, double-blind, placebo-controlled study, concentrations of leukotriene B4, thromboxane...... changes in concentrations of eicosanoids or neuropeptides were observed after ropivacaine or placebo administration. Baseline concentrations of all neuropeptides, except somatostatin, were significantly lower in active ulcerative colitis than in controls with non-inflamed colon. CONCLUSIONS...

  10. Biologics for the treatment of pyoderma gangrenosum in ulcerative colitis

    Arivarasan, K; Bhardwaj, Vaishali; Sud, Sukrit; Sachdeva, Sanjeev

    2016-01-01

    Pyoderma gangrenosum (PG) is an uncommon extra-intestinal manifestation of inflammatory bowel disease (IBD). Despite limited published literature, biologics have caused a paradigm shift in the management of this difficult-to-treat skin condition. The clinical data and outcomes of three patients with active ulcerative colitis and concurrent PG treated with biologics (infliximab two and adalimumab one) are reviewed in this report. Biologics were added because of the sub-optimal response of the colonic symptoms and skin lesions to parenteral hydrocortisone therapy. All three patients showed a dramatic response to the addition of the biologics. In view of the rapid healing of the skin lesions, superior response rate, and the additional benefit of improvement in the underlying colonic disease following treatment, anti-tumor necrosis factor blockers should be considered as a first line therapy in the management of PG with underlying IBD. PMID:27799888

  11. Florid urticarial vasculitis heralding a flare up of ulcerative colitis.

    Boules, Evon; Lyon, Calum

    2014-12-22

    A 75-year-old man with ulcerative colitis (UC) and diet controlled diabetes mellitus presented with a 3-week history of slightly itchy, red plaques on both lower limbs ascending gradually to cover the trunk and arms. One week later, he developed a flare up of his UC. Routine blood tests showed modest drop in haemoglobin (122 g/L) and C reactive protein (85 mg/L). Serology was remarkable for high antiproteinase 3 (c-ANCA). Serum electrophoresis showed a mildly positive paraprotein band (γ region). Stool culture was negative. Urine analysis showed proteinuria. Skin biopsy showed features of urticarial vasculitis (UV). He underwent a flexible sigmoidoscopy after the flare up showed mildly active UC. The patient was given hydrocortisone for 7 days and then prednisolone. Both rash and UC subsided. Electrophoresis was repeated 4 weeks later showing normal pattern. Prednisolone has been gradually reduced. Although rare, UV can be considered as one of the skin manifestations of UC.

  12. Sulfate-reducing bacteria colonize pouches formed for ulcerative colitis but not for familial adenomatous polyposis.

    Duffy, M

    2012-02-03

    PURPOSE: Ileal pouch-anal anastomosis remains the "gold standard" in surgical treatment of ulcerative colitis and familial adenomatous polyposis. Pouchitis occurs mainly in patients with a background of ulcerative colitis, although the reasons for this are unknown. The aim of this study was to characterize differences in pouch bacterial populations between ulcerative colitis and familial adenomatous pouches. METHODS: After ethical approval was obtained, fresh stool samples were collected from patients with ulcerative colitis pouches (n = 10), familial adenomatous polyposis (n = 7) pouches, and ulcerative colitis ileostomies (n = 8). Quantitative measurements of aerobic and anaerobic bacteria were performed. RESULTS: Sulfate-reducing bacteria were isolated from 80 percent (n = 8) of ulcerative colitis pouches. Sulfate-reducing bacteria were absent from familial adenomatous polyposis pouches and also from ulcerative colitis ileostomy effluent. Pouch Lactobacilli, Bifidobacterium, Bacteroides sp, and Clostridium perfringens counts were increased relative to ileostomy counts in patients with ulcerative colitis. Total pouch enterococci and coliform counts were also increased relative to ileostomy levels. There were no significant quantitative or qualitative differences between pouch types when these bacteria were evaluated. CONCLUSIONS: Sulfate-reducing bacteria are exclusive to patients with a background of ulcerative colitis. Not all ulcerative colitis pouches harbor sulfate-reducing bacteria because two ulcerative colitis pouches in this study were free of the latter. They are not present in familial adenomatous polyposis pouches or in ileostomy effluent collected from patients with ulcerative colitis. Total bacterial counts increase in ulcerative colitis pouches after stoma closure. Levels of Lactobacilli, Bifidobacterium, Bacteroides sp, Clostridium perfringens, enterococci, and coliforms were similar in both pouch groups. Because sulfate-reducing bacteria are

  13. Resveratrol abrogates adhesion molecules and protects against TNBS-induced ulcerative colitis in rats.

    Abdallah, Dalaal M; Ismael, Naglaa R

    2011-11-01

    Resveratrol, a polyphenol compound with anti-inflammatory properties, has been previously evaluated for its beneficial effects in several ulcerative colitis models. However, the current study elucidates the effect of resveratrol on adhesion molecules, as well as its antioxidant efficacy in a trinitrobenzene sulfonic acid (TNBS)-induced ulcerative-colitis model. Colitis was induced by rectal instillation of TNBS, followed by daily per os administration of either sulphasalazine (300 mg/kg) or resveratrol (2 and 10 mg/kg) for 7 days. Administration of resveratrol decreased the ulcerative area and colon mass index; these effects were further supported by the reduction in colon inflammation grades, as well as histolopathological changes, and reflected by the stalling of body mass loss. The anti-inflammatory effects of resveratrol were indicated by lowered myeloperoxidase activity, and by suppressing ICAM-1 and VCAM-1 levels in the colon and serum. In addition, it restored a reduced colonic nitric oxide level and reinstated its redox balance, as evidenced by the suppression of lipid peroxides and prevention of glutathione depletion. The anti-ulcerative effect of the higher dose of resveratrol was comparable with those of sulphasalazine. The study confirms the anti-ulcerative effect of resveratrol in TNBS-induced experimental colitis via reduction of neutrophil infiltration, inhibition of adhesive molecules, and restoration of the nitric oxide level, as well as the redox status.

  14. CCR9 Antagonists in the Treatment of Ulcerative Colitis

    Pirow Bekker

    2015-01-01

    Full Text Available While it has long been established that the chemokine receptor CCR9 and its ligand CCL25 are essential for the movement of leukocytes into the small intestine and the development of small-intestinal inflammation, the role of this chemokine-receptor pair in colonic inflammation is not clear. Toward this end, we compared colonic CCL25 protein levels in healthy individuals to those in patients with ulcerative colitis. In addition, we determined the effect of CCR9 pharmacological inhibition in the mdr1a−/− mouse model of ulcerative colitis. Colon samples from patients with ulcerative colitis had significantly higher levels of CCL25 protein compared to healthy controls, a finding mirrored in the mdr1a−/− mice. In the mdr1a−/− mice, CCR9 antagonists significantly decreased the extent of wasting and colonic remodeling and reduced the levels of inflammatory cytokines in the colon. These findings indicate that the CCR9:CCL25 pair plays a causative role in ulcerative colitis and suggest that CCR9 antagonists will provide a therapeutic benefit in patients with colonic inflammation.

  15. Clinical characteristics and treatment outcomes of severe ulcerative colitis

    詹翔

    2014-01-01

    Objective To explore the clinical characteristics and medicine treatment of patients with severe ulcerative colitis(UC),the efficacy of rescue treatment in patients with glucocorticoid(GCS)resistant severe UC,and the clinical risk factors in patients with GCS-refractory severe UC.Methods From January 2001 to December 2012,

  16. Scintigraphic evaluation of pouch function in patients with ulcerative colitis

    Kjær, Mie Dilling; Simonsen, Jane Angel; Hvidsten, Svend

    scintigraphic intestinal transit time, scintigraphic defecography and any association with QoL, and pouch function. Method A cross-sectional study including 20 patients with ulcerative colitis and an IPAA. Scintigraphic transit time was determined after oral administration of a Tc-99m-labelled omelette...

  17. Increased Risk of Gallstone Disease Following Colectomy for Ulcerative Colitis

    Mark-Christensen, Anders; Brandsborg, Søren; Laurberg, Søren

    2017-01-01

    following colectomy and IPAA.Methods:Individuals who had a colectomy were identified from a national cohort of patients with ulcerative colitis (UC), and controls without colectomy were sampled from within the same cohort, matching on gender, calendar year, and year of birth. We used Cox regression...

  18. Scintigrapfic evaluation of pouch function in patients with ulcerative colitis

    Kjær, Mie Dilling; Hvidsten, Svend; Simonsen, Jane Angel

    with QoL and pouch function. Method It is a cross-sectional study including 20 patients with ulcerative colitis and an IPAA. Scintigraphic transit time was determined after oral administration of a Tc-99m-labelled omelette. Defecography was performed with instillation of a radioactive labelled paste...

  19. Ulcerative colitis: ultrastructure of interstitial cells in myenteric plexus

    Rumessen, J J; Vanderwinden, J-M; Horn, T

    2010-01-01

    Interstitial cells of Cajal (ICC) are key regulatory cells in the gut. In the colon of patients with severe ulcerative colitis (UC), myenteric ICC had myoid ultrastructural features and were in close contact with nerve terminals. In all patients as opposed to controls, some ICC profiles showed...

  20. Metabonomics of human fecal extracts characterize ulcerative colitis, Crohn's disease and healthy individuals

    Bjerrum, Jacob Tveiten; Wang, Yulan; Hao, Fuhua

    2015-01-01

    This study employs spectroscopy-based metabolic profiling of fecal extracts from healthy subjects and patients with active or inactive ulcerative colitis (UC) and Crohn's disease (CD) to substantiate the potential use of spectroscopy as a non-invasive diagnostic tool and to characterize the fecal...

  1. Second Korean guidelines for the management of ulcerative colitis

    Choi, Chang Hwan; Moon, Won; Kim, You Sun; Kim, Eun Soo; Lee, Bo-In; Jung, Yunho; Yoon, Yong Sik; Lee, Heeyoung; Park, Dong Il

    2017-01-01

    Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by a relapsing and remitting course. The direct and indirect costs of the treatment of UC are high, and the quality of life of patients is reduced, especially during exacerbation of the disease. The incidence and prevalence of UC in Korea are still lower than those of Western countries, but have been rapidly increasing during the past decades. Various medical and surgical therapies, including biologics, are currently used for the management of UC. However, many challenging issues exist, which sometimes lead to differences in practice between clinicians. Therefore, the IBD study group of the Korean Association for the Study of Intestinal Diseases established the first Korean guidelines for the management of UC in 2012. This is an update of the first guidelines. It was generally made by the adaptation of several foreign guidelines as was the first edition, and encompasses treatment of active colitis, maintenance of remission, and indication of surgery for UC. The specific recommendations are presented with the quality of evidence and classification of recommendations. PMID:28239313

  2. [Medical therapy of inflammatory bowel diseases: ulcerative colitis].

    Lakatos, László; Lakatos, Péter László

    2007-06-24

    There are fewer significant changes in the medical therapy of ulcerative colitis (UC) compared to Crohn's disease. The most important factors that determine therapy are disease extent and severity. 5-aminosalicylates (5-ASA) constitute the treatment of choice in mild-to-moderate UC. The efficacy of new compounds (e.g. mesalazine) is only mildly improved compared to sulphasalazine; however, their use has become more frequent due to a more favorable side effects profile. Topical medication is more effective in proctitis and distal colitis, and the combination of topical and orally-administered drugs is superior to oral therapy alone also in extensive disease. Thus, this latter regimen should be considered for cases where the escalation of treatment is required. Systemic steroids still represent the first line therapy in acute, severe UC, while in patients who do not respond to steroids, cyclosporine and infliximab should be considered as a second line therapy and as alternatives for colectomy. Maintenance treatment is indicated in all UC cases. 5-ASA compounds are suggested as first line maintenance therapy with the optimal dose still being under investigation. Topical compounds are effective also for maintenance in distal colitis or proctitis, if accepted by the patients. Immunosuppressives, especially azathioprine, should be considered in chronically active, steroid dependent or resistant patients. According to recent publications, azathioprine is almost equally effective in UC and CD. The question of chemoprevention is important during maintenance. There are increasing data supporting the notion that aminosalicylates may lower the risk for UC-associated colorectal cancer. The most important changes in the management of UC are the more frequent use of topical aminosalicylates and azathioprine, the availability of infliximab in severe UC, and increasing use of aminosalicylates for chemoprevention of colorectal carcinoma. Furthermore, adequate attention is needed to

  3. Therapeutic Efficacy of pH-Dependent Release Formulation of Mesalazine on Active Ulcerative Colitis Resistant to Time-Dependent Release Formulation: Analysis of Fecal Calprotectin Concentration

    Kousaku Kawashima

    2014-01-01

    Full Text Available Purpose. Few reports have compared the clinical efficacy of a pH-dependent release formulation of mesalazine (pH-5-ASA with a time-dependent release formulation (time-5-ASA. We examined whether pH-5-ASA is effective for active ulcerative colitis (UC in patients resistant to time-5-ASA. Methods. We retrospectively and prospectively analyzed the efficacy of pH-5-ASA in mildly to moderately active UC patients in whom time-5-ASA did not successfully induce or maintain remission. The clinical efficacy of pH-5-ASA was assessed by clinical activity index (CAI before and after switching from time-5-ASA. In addition, the efficacy of pH-5-ASA on mucosal healing (MH was evaluated in a prospective manner by measuring fecal calprotectin concentration. Results. Thirty patients were analyzed in a retrospective manner. CAI was significantly reduced at both 4 and 8 weeks after switching to pH-5-ASA. In the prospective study (n=14, administration of pH-5-ASA also significantly reduced CAI scores at 4 and 8 weeks in these patients who were resistant to time-5-ASA. In addition, fecal calprotectin concentration was significantly decreased along with improvement in CAI after switching to pH-5-ASA. Conclusions. Our results suggest that pH-5-ASA has clinical efficacy for mildly to moderately active patients with UC in whom time-5-ASA did not successfully induce or maintain remission.

  4. Clinical evaluation of {sup 99m}Tc-HMPAO labeled leukocyte imaging in ulcerative colitis

    Saitoh, Yasuhiro; Aburano, Tamio; Takashio, Tetsuya; Shuke, Noriyuki; Ayabe, Tokiyoshi; Nomura, Masashi; Kohgo, Yutaka; Ishikawa, Yukio; Satoh, Junichi [Asahikawa Medical Coll., Hokkaido (Japan)

    1996-07-01

    Inflammatory imaging using {sup 99m}Tc-HMPAO-labeled mixed leukocytes was assessed for use in treating 11 cases diagnosed as ulcerative colitis: 10 cases with total colitis and 1 with left-sided colitis. They consisted of 8 patients with relapse-remitting type and 3 with chronic continuous type. Radionuclide abdominal images were obtained at 1 hr, 4 hr and 24 hr after intravenous injection of 200 MBq prepared {sup 99m}Tc leukocytes. Obvious colonic activity noted at 4 hr served as the basis for positive comparative criterion in the present study. The diagnostic efficacy of radionuclide imaging was compared with endoscopic findings (based on Matts` classification) and the clinical manifestations as reference. The sensitivity and specificity of this imaging were 83.3% and 85.7%, respectively, these values being consistent with endoscopic findings and clinical manifestations at sites of disease activity. All of positive images changed to negative after treatment by leukocyte apheresis or glucocorticoid. Based on these results, {sup 99m}Tc leukocyte imaging can be used to accurately evaluate severity and treatment response in ulcerative colitis. Leukocytes may be closely related to the pathogenesis of ulcerative colitis. (author)

  5. Effect of Changyuning in treating active ulcerative colitis%肠愈宁治疗活动期溃疡性结肠炎疗效观察

    谢晶日; 陆振华; 刘朝霞

    2012-01-01

    [目的]观察肠愈宁颗粒治疗活动期溃疡性结肠炎(UC)的临床疗效.[方法]60例患者随机分为2组各30例,治疗组予以中药肠愈宁颗粒口服,10g,早晚分服;对照组予口服美沙拉嗪1.0 g/次,4次/d.8周为1个疗程.观察2组患者治疗后主要临床症状、结肠镜下黏膜改善情况及临床疗效.[结果]治疗组总有效率为93.3%,对照组90.0%,2组比较差异无统计学意义(P>0.05).临床症状改善情况2组比较差异亦无统计学意义(P>0.05).[结论]肠愈宁颗粒治疗活动期UC疗效显著,与西药美沙拉嗪相当,值得临床推广应用.%[Objective]to observe the clinical curative effect of Changyuning in the treatment of active ulcerative colitis. [Methods]Sixty cases were randomly divided into the treatment group and control group,30 cases in each group. The treatment group were treated with oral Chinese medicine Changyuning Particles 10g twice a day, while the control group were given oral Mesalamine 1. 0 g four times daily. After 8 weeks' treatment,main clinical symptoms,mucous changes as well as the clinical efficacy were observed in both groups. [ResuIts]The total effective rate was 93. 3% in the treatment group and 90.0% in the control group, showing no significant difference(P> 0.05). There was no remarkable difference in clinical symptoms between the two groups (P> 0. 05). [Conclusion]Changyuning has similar effect to Mesalamine in treating active ulcerative colitis,and worth more wide clinical application.

  6. Assessment of Disease‐Related Therapeutic Protein Drug‐Drug Interaction for Etrolizumab in Patients With Moderately to Severely Active Ulcerative Colitis

    Wei, Xiaohui; Kenny, Jane R.; Dickmann, Leslie; Maciuca, Romeo; Looney, Caroline

    2016-01-01

    Abstract The efficacy and safety of etrolizumab, a humanized IgG1 mAb, were evaluated in patients with ulcerative colitis (UC) in a phase 2 study (EUCALYPTUS). The current study assessed the risk of therapeutic protein drug‐drug interaction (TP‐DDI) of etrolizumab on CYP3A activity in patients with UC. Literature review was performed to compare serum proinflammatory cytokine levels and pharmacokinetic (PK) parameters of CYP3A substrate drugs between patients with inflammatory bowel disease (IBD) and healthy subjects. Treatment effect of etrolizumab on CYP3A activity was evaluated by measuring colonic CYP3A4 mRNA expression and serum C‐reactive protein (CRP) in EUCALYPTUS patients. Literature data suggested similar levels between IBD patients and healthy subjects for serum proinflammatory cytokines and PK parameters of CYP3A substrate drugs. Additionally, treatment with etrolizumab did not change colonic CYP3A4 mRNA expression or serum CRP levels in UC patients. In conclusion, our results indicate a low TP‐DDI risk for etrolizumab in UC patients, particularly on medications metabolized by CYP3A. PMID:26412221

  7. A case of interstitial pneumonitis in a patient with ulcerative colitis treated with azathioprine

    Ferenc Nagy; Tamas Molnar; Eva Makula; Ildiko Kiss; Peter Milassin; Eva Zollei; Laszlo Tiszlavicz; Janos Lonovics

    2007-01-01

    The early hypersensitivity reaction and late bone marrow depression are well-known side-effects of azathioprine,whereas interstitial pneumonia is a rare complication.A 40-year old male patient had been treated with azathioprine in consequence of extensive ulcerative colitis for 10 years. He then complained of 7 d of fever,cough and catarrhal signs, without symptoms of active colitis. Opportunistic infections were ruled out. The chest X-ray, CT and lung biopsy demonstrated the presence of interstitial inflammation. Azathioprine therapy was discontinued as a potential source of the pulmonary infiltrate. In response to steroid therapy, and intensive care, the pulmonary infiltrate gradually decreased within 4 wk. Three months later, his ulcerative colitis relapsed,and ileo-anal pouch surgery was performed. In cases of atypical pneumonia, without a proven infection,azathioprine-associated interstitial pneumonitis may be present, which heals after withdrawal of the drug.

  8. Inter-observer agreement in the assessment of endoscopic findings in ulcerative colitis

    de Lange Thomas

    2004-05-01

    Full Text Available Abstract Background Endoscopic findings are essential in evaluating the disease activity in ulcerative colitis. The aim of this study was to evaluate how endoscopists assess individual endoscopic features of mucosal inflammation in ulcerative colitis, the inter-observer agreement, and the importance of the observers' experience. Methods Five video clips of ulcerative colitis were shown to a group of experienced and a group of inexperienced endoscopists. Both groups were asked to assess eight endoscopic features and the overall mucosal inflammation on a visual analogue scale. The following statistical analyses were used; Contingency tables analysis, kappa analysis, analysis of variance, Pearson linear correlation analysis, general linear models, and agreement analysis. All tests were carried out two-tailed, with a significance level of 5%. Results The inter-observer agreement ranged from very good to moderate in the experienced group and from very good to fair in the inexperienced group. There was a significantly better inter-observer agreement in the experienced group in the rating of 6 out of 9 features (p A correlation was seen between all the observed endoscopic features in both groups of endoscopists. Among experienced endoscopists, a set of four endoscopic variables ("Vascular pattern", "Erosions", "Ulcerations" and Friability" explained 92% of the variation in EAI. By including "Granularity" in these set 91% of the variation in EAI was explained in the group of inexperienced endoscopists. Conclusion The inter-observer agreement in the rating of endoscopic features characterising ulcerative colitis is satisfactory in both groups of endoscopists but significantly higher in the experienced group. The difference in the mean score between the two groups is only significant for "ulcerations". The endoscopic variables "Vascular pattern", "Erosions", "Ulcerations" and Friability" explained the overall endoscopic activity index. Even though the

  9. Keratinocyte growth factor gene therapy ameliorates ulcerative colitis in rats

    Chun-Jie Liu; Ji-De Jin; Tong-De Lv; Zu-Ze Wu; Xiao-Qin Ha

    2011-01-01

    AIM: To investigate the effect of keratinocyte growth factor (KGF) gene therapy in acetic acid-induced ulcerative colitis in rat model. METHODS: The colitis of Sprague-Dawley rats was induced by intrarectal infusion of 1 mL 5% (v/v) acetic acid. Twenty-four hours after exposed to acetic acid, rats were divided into three experimental groups: control group, attenuated Salmonella typhimurium Ty21a strain (SP) group and SP strain carrying human KGF gene (SPK) group, and they were separately administered orally with 10% NaHCO3, SP or SPK. Animals were sacrificed and colonic tissues were harvested respectively on day 3, 5, 7 and 10 after administration. Weights of rats, colonic weight/ length ratio and stool score were evaluated. Histological changes of colonic tissues were examined by hematoxylin and eosin (HE) staining method. The expression of KGF, KGF receptor (KGFR) and TNF-α were measured either by enzyme-linked immunosorbent assay or Western blotting. Immunohistochemistry was used to detect the cellular localization of KGFR and Ki67. In addition, superoxide dismutase (SOD) activity and malondialdehyde (MDA) contents in the homogenate were measured. RESULTS: Body weight and colonic weight/length ratio were declined in SPK group compared with SP and control groups (body weight: 272.78 ± 17.92 g vs 243.72 ± 14.02 g and 240.68 ± 12.63 g, P < 0.01; colonic weight/length ratio: 115.76 ± 7.47 vs 150.32 ± 5.99 and 153.67 ± 5.50 mg/cm, P < 0.01). Moreover, pathological changes of damaged colon were improved in SPK group as well. After administration of SPK strain, KGF expression increased markedly from the 3rd d, and remained at a high level till the 10th d. Furthermore, KGFR expression and Ki67 expression elevated, whereas TNF-α expression was inhibited in SPK group. In the group administered with SPK, SOD activity increased significantly (d 5: 26.18 ± 5.84 vs 18.12 ± 3.30 and 18.79 ± 4.74 U/mg, P < 0.01; d 7: 35.48 ± 3.35 vs 22.57 ± 3.44 and 21.69 ± 3.94 U

  10. Colonic production of nitric oxide gas in ulcerative colitis, collagenous colitis and uninflamed bowel

    Perner, A; Nordgaard, I; Matzen, P;

    2002-01-01

    Nitric oxide (NO) produced in excess by the inflamed human colon is generally considered a pathway of mucosal damage. In an attempt to quantify colonic mucosal production of NO in various forms of colitis we performed 'steady-state' gas perfusion of whole colon in 11 patients with ulcerative coli...

  11. Severe ulcerative colitis: At what point should we define resistance to steroids?

    Maria Esteve; Javier P Gisbert

    2008-01-01

    Corticoesteroids are still the first-line treatment for active ulcerative colitis more than 50 years after the publication of trials assessing their beneficial effect, with about a 50% remission rate in cases of severe disease. The mortality related to severe attacks of ulcerative colitis has decreased dramatically, to less than 1%, in experienced centers, due to the appropriate use of intensive therapeutic measures (intravenous steroids, fluids and electrolytes, artificial nutritional support, antibiotics, etc),along with timely decision-making about second-line medical therapy and early identification of patients requiring colectomy. One of the most difficult decisions in the management of severe ulcerative colitis is knowing for how long corticosteroids should be administered before deciding that a patient is a non-responder. Studies assessing the outcome of acute attacks after steroid initiation have demonstrated that, n steroid-sensitive patients, the response generally occurs early on, in the first days of treatment. Different indexes to predict treatment failure, when applied on the third day of treatment, have demonstrated a high positive predictive value for colectomy. In contrast to this resolute approach, which is the most widely accepted, other authors have suggested that in some patients a complete and prolonged response to steroids may take longer. Either way, physicians taking care of these patients need to recognize that severe ulcerative colitis may be life-threatening, and they need to be careful with excessively prolonged medical treatment and delayed surgery.

  12. Anti-inflammatory effects of nicotine in obesity and ulcerative colitis

    Kirchgessner Annette

    2011-08-01

    Full Text Available Abstract Cigarette smoke is a major risk factor for a number of diseases including lung cancer and respiratory infections. Paradoxically, it also contains nicotine, an anti-inflammatory alkaloid. There is increasing evidence that smokers have a lower incidence of some inflammatory diseases, including ulcerative colitis, and the protective effect involves the activation of a cholinergic anti-inflammatory pathway that requires the α7 nicotinic acetylcholine receptor (α7nAChR on immune cells. Obesity is characterized by chronic low-grade inflammation, which contributes to insulin resistance. Nicotine significantly improves glucose homeostasis and insulin sensitivity in genetically obese and diet-induced obese mice, which is associated with suppressed adipose tissue inflammation. Inflammation that results in disruption of the epithelial barrier is a hallmark of inflammatory bowel disease, and nicotine is protective in ulcerative colitis. This article summarizes current evidence for the anti-inflammatory effects of nicotine in obesity and ulcerative colitis. Selective agonists for the α7nAChR could represent a promising pharmacological strategy for the treatment of inflammation in obesity and ulcerative colitis. Nevertheless, we should keep in mind that the anti-inflammatory effects of nicotine could be mediated via the expression of several nAChRs on a particular target cell.

  13. Mesalamine treatment mimicking relapse in a child with ulcerative colitis

    Iva Hojsak; Ana M Pavić; Sanja Kolaček

    2014-01-01

    Background: There are reports on mesalamine-induced bloody diarrhea mimicking ulcerative colitis (UC) relapse, mostly in adults. Methods: Herein we present a case of a child with UC who developed relapse of hemorrhagic colitis related to mesalamine. Results: A 10-year-old girl developed severe symptoms mimicking UC relapse 3 weeks after introduction of mesalamine therapy. After mesalamine was withdrawn, her symptoms improved, but deteriorated again during the challenge of mesalamine despite concomitant use of corticosteroids. Conclusion: This is the fi rst case report on such a young child during the concomitant use of corticosteroids.

  14. Paradoxical regulation of ChAT and nNOS expression in animal models of Crohn's colitis and ulcerative colitis

    Winston, John H.; Li, Qingjie; Sarna, Sushil K.

    2013-01-01

    Morphological and functional changes in the enteric nervous system (ENS) have been reported in inflammatory bowel disease. We examined the effects of inflammation on the expression of choline acetyltransferase (ChAT) and nNOS in the muscularis externae of two models of colonic inflammation, trinitrobenzene sulfonic acid (TNBS)-induced colitis, which models Crohn's disease-like inflammation, and DSS-induced colitis, which models ulcerative Colitis-like inflammation. In TNBS colitis, we observe...

  15. Ulcerative colitis and Crohn's disease: factor XIII, inflammation and haemostasis.

    Seitz, R; Leugner, F; Katschinski, M; Immel, A; Kraus, M; Egbring, R; Göke, B

    1994-01-01

    An important role has been ascribed to plasma factor XIII (FXIII) in inflammation and wound healing. FXIII is necessary for fibrin stabilization and interacts with connective tissue and adhesive proteins and cells. In a prospective study, FXIII activity and parameters of coagulation, fibrinolysis and inflammation, were determined in patients with ulcerative colitis (UC; 13 active, 22 moderate) and Crohn's disease (CD; 36 active, 45 moderate). FXIII levels were lower in active than in moderate UC and CD, and were < 70% of normal values in 7/13 patients with active UC, and in 7/36 patients with active CD, although the median values did not fall below the normal range. FXIII was somewhat higher in active UC patients responding to therapy. The FXIII levels were widely scattered, and low values appear to be due to greatly enhanced turnover. A correlation between FXIII and the systemic levels of markers of activation of haemostasis and inflammation was lacking, but there was a correlation with the extent of bowel involvement. FXIII levels were lower in the patients with involvement beyond the sigmoid colon in CU (p = 0.0045), and both small and large bowel segments in CD (p = 0.0223) patients. This points to local consumption and/or loss of FXIII within the inflamed tissue, and provides an argument for FXIII substitution in the treatment of acute episodes of inflammatory bowel diseases.

  16. Relationship and significance between anti-β2-glycoproteinI antibodies and platelet activation state in patients with ulcerative colitis

    Gao, Yan-Hang; Gao, Pu-Jun; Wang, Chun-Guang; Wang, Xiao-Cong; Piao, Yun-Feng

    2008-01-01

    AIM: To study the relationship between anti-β2-glycoprotein I (aβ2GPI) antibodies and platelet activation state in patients with ulcerative colitis (UC) and its significance. METHODS: Peripheral blood samples were collected from 56 UC patients (34 males and 22 females, aged 43.5 years, range 21-66 years), including 36 at active stage and 20 at remission stage, and 25 sex-and age-matched controls. The level of aβ2GPI was measured by ELISA. The platelet activation markers, platelet activation complex-I (PAC-I) and P-selectin (CD62P) were detected by flow cytometry. RESULTS: The A value for IgG aβ2GPI in the active UC group was 0.61 ± 0.13, significantly higher than that in the remittent UC and control groups (0.50 ± 0.13 and 0.22 ± 0.14, P 0.05). The PAC-I positive rate for the active and remittent UC groups was 30.6% ± 7.6% and 19.6% ± 7.8% respectively, significantly higher than that for the control group (6.3% ± 1.7%, P FPAC-I (%) = 5.346, P < 0.01; and FCD62P (%) = 5. 418, P < 0.01). Meanwhile, in the same state of illness, the A value for IgG aβ2GPI was positively correlated to the positive rates for PAC-I and CD62P. CONCLUSION: aβ2GPI level, platelet activation state and their relationship of them are closely correlated with the pathogenesis and development of UC. PMID:18205270

  17. Mouse model of ulcerative colitis using trinitrobenzene sulfonic acid

    Irfan Ahmad Rather

    2015-12-01

    Full Text Available Animal model of intestinal inflammation is of paramount significance that aids in discerning the pathologies underlying ulcerative colitis and Crohn’s disease, the two clinical presentations of inflammatory bowel disease. The 2,4,6-trinitrobenzene sulfonic acid (TNBS colitis model represents one such intestinal inflammation-prototype that is generated in susceptible strains of mice through intra-rectal instillation of compound TNBS. In this paper, we demonstrate the experimental induction of TNBS-mediated colitis in a susceptible strain of ICR mice. This can be done by the following steps: a acclimation, b induction and c observation. TNBS-mouse model provides the information in shortest possible time and simultaneously represents a cost effective and highly reproducible model method of studying the pathogenesis of inflammatory bowel disease.

  18. [Recent advances in medical and surgical treatment of ulcerative colitis].

    Sugita, Akira; Koganei, Kazutaka; Tatsumi, Kenji; Futatsuki, Ryo; Kuroki, Hirosuke; Yamada, Kyoko; Arai, Katsuhiko; Fukushima, Tsuneo

    2015-03-01

    Recent advances in both medical and surgical treatment of ulcerative colitis have been remarkable. Changes in medical treatment are mainly good results of therapy with the anti-TNF-α antibody, tacrolimus, and those in surgical treatment are an expansion of the surgical indications to include patients with intractable disease, such as treatment refractoriness and chronic corticosteroid dependence, by a better postoperative clinical course after pouch surgery, improred selection of surgical procedures and the timing of surgery in elderly patients. To offer the optimal treatment for patients with ulcerative colitis, new medical therapies should be analyzed from the standpoint of the efficacy and limitations of effect. Long postoperative clinical course of surgical patients including colitic cancer, prevention of postoperative complications should be also analyzed.

  19. Treatment tactics in patient with rectal cancer complicating ulcerative colitis

    Yu. A. Barsukov

    2012-01-01

    Full Text Available A successful treatment of a young patient with a 15-year anamnesis of ulcerative colitis, who has been diagnosed with rectal cancer, is presented in this case report. A non-standard surgical intervention has been performed following all principles of oncologic surgery. A subtotal colectomy has been performed with ultra-low anterior resection of rectum. Ascendoanal anastomosis has been performed forming the neo-rectum. There were no complications in postoperative period. Considering disease stage (T3N1M0 adjuvant XELOX was administered for 6 months along with 2 cycles of prophylactic treatment with 5-aminosalycilic acid. During 2-years follow-up there are no signs of rectal cancer and ulcerative colitis progression. After pelvic electrostimulation defecation frequency decreased to 3–4 times per day, a patient has complete social rehabilitation.

  20. Repeated fecal microbiota transplantation in a child with ulcerative colitis.

    Shimizu, Hirotaka; Arai, Katsuhiro; Abe, Jun; Nakabayashi, Kazuhiko; Yoshioka, Takako; Hosoi, Kenji; Kuroda, Makoto

    2016-08-01

    We report the case of an 11-year-old girl with ulcerative colitis refractory to conventional therapy, who was subsequently treated successfully with repeated fecal microbiota transplantation (FMT). The patient was steroid dependent despite several infliximab treatments, and colectomy was proposed to improve quality of life. After repeated FMT, she was able to maintain remission with on minimal dose of steroid. Although her fecal microbiota was dysbiotic before FMT, it was restored to a similar pattern as the donor after repeated FMT.

  1. Managing Ulcerative Colitis – The Guidelines and Beyond

    Mitchell RKL Lie

    2013-11-01

    Full Text Available Management guidelines offer clinicians clear, evidence-based and often succinct treatment advice. For ulcerative colitis these guidelines describe the use of 5-ASA, corticosteroids, thiopurines, cyclosporine, and anti-TNFα therapies. However, guidelines do have some drawbacks, mainly a lack of concrete advice concerning patients resistant to these aforementioned therapies. This review gives a short overview of current guidelines and addresses treatment alternatives for conventional therapies.

  2. Specific endoscopic features of ulcerative colitis complicated by cytomegalovirus infection

    Hideyuki; Suzuki; Jun; Kato; Motoaki; Kuriyama; Sakiko; Hiraoka; Kenji; Kuwaki; Kazuhide; Yamamoto

    2010-01-01

    AIM:To identify specific colonoscopic findings in patients with ulcerative colitis (UC) complicated by cyto-megalovirus (CMV) infection.METHODS: Among UC patients who were hospitalized due to exacerbation of symptoms, colonoscopic findings were compared between 15 CMV-positive patients and 58 CMV-negative patients. CMV infection was determined by blood test for CMV antigenemia. Five aspects of mucosal changes were analyzed (loss of vascular pattern, erythema, mucosal edema, easy bleeding, and mucinous exuda...

  3. Differential diagnosis problem of pulmonary changes in ulcerative colitis

    Đurić Mirna

    2010-01-01

    Full Text Available Introduction. Inflammatory intestinal diseases are often accompanied with extraintestinal and even pulmonary manifestations. The treatment of these intestinal diseases includes sulphasalazine and mesalazine, which may have undesirable allergic and other side effects, including hypersensitive pneumonitis. Case report. Having performed colonoscopy due to abdominal pains and mushy stools, the diagnosis of ulcerous colitis was established in a 20-year old female patient and the treatment with mesalazine initiated. However, the patient developed slimy and bloody stools, slightly increased body temperature, dry cough and bilateral lung lesions. The bronchological exploration established interstitial and organizing pneumonia. Despite the treatment with antibiotics, corticosteroids and mesalazine, dry cough, fever and bloody stools persisted, accompanied with bilateral inhomogeneous lesions of the pulmonary parenchyma. Upon discontinuation of the treatment with mesalazine, clinical symptoms and pulmonary lesions disappeared. Conclusion. The differential diagnosis of pulmonary lesions in patients with ulcerous colitis may be a problem. In the reported case, pulmonary lesions were interpreted as interstitial pneumonitis accompanying ulcerous colitis. However, they are most probably a consequence of allergic response to mesalazine.

  4. Granulocytes and monocytes apheresis induces upregulation of TGFβ1 in patients with active ulcerative colitis: A possible involvement of soluble HLA-I.

    Contini, Paola; Negrini, Simone; Bodini, Giorgia; Trucchi, Cecilia; Ubezio, Gianluca; Strada, Paolo; Savarino, Vincenzo; Ghio, Massimo

    2017-02-01

    Granulocyte and monocyte apheresis has been used in different immune-mediated disorders, mainly inflammatory bowel diseases. The removal of activated leukocytes and several additional immunomodulatory mechanisms have been so far suggested to explain the anti-inflammatory effects of the treatment. Recent data indicate that, during centrifugation based apheresis, sHLA-I adsorbed to plastic circuits is able to induce TGFβ1 production in activated leukocytes. On these bases, the present study was aimed at analyzing if this model could be applied to a noncentrifugation based apheresis, such as granulocyte and monocyte apheresis. Ten patients with ulcerative colitis were enrolled. Every patient received 5 weekly apheresis treatments. Cellulose acetate beads removed from the column post-GMA were stained by fluorescent anticlass I mAb and examined by fluorescent microscope. Moreover, sFasL plasma concentration, TGFβ1 plasma levels, and the percentage of TGFβ1 positive neutrophils were evaluated before and immediately after each single apheresis. Immunofluorescent images revealed a homogeneous layer of a sHLA-I adsorbed to the surface of the beads recovered following the procedure. sFasL plasma concentration progressively increased both following the procedures and during inter-procedure periods. Consistently, also TGFβ1 plasma levels and the percentage of TGFβ1 positive neutrophils increased during the procedures with a meaningful relationship with sFasL plasma levels. Taken together, these findings suggest that the immunosuppressive effects attributed to granulocyte and monocyte apheresis might depend, at least in part, on the sensitivity of activated leucocytes to the bioactivity of sHLA-I molecules. J. Clin. Apheresis 32:49-55, 2017. © 2016 Wiley Periodicals, Inc.

  5. Autoimmunity in ulcerative colitis: humoral and cellular immune response bytropomyosin in ulcerative colitis

    Xin Geng; Masato Taniguchi; Hui Hui Dai; JJ-C Lin; Jim Lin; Kiron Moy Das

    2000-01-01

    AIM Autoimmunity has been emphasized in the pathogenesis of ulcerative colitis (UC). We reported thattropomyosin (TM) or TM related protein is a putative autoantigen in UC. In human fibroblast, at least 8isoforms of TM have been identified with molecular weight range from 30kD to 40kD, depending upon theisoforms, and human TM isoforms (hTM5) has been found the main isoform in human intestinal epithelialcells. In this study, hTM5 was used as a putative auto-antigen for the humoral and T cell immune responses inpatients with UC, Crohn's disease (CD) and healthy subjects (HS) as controls.METHODS Anti-bTM antibody was examined by enzyme-linked immunosorbent assay using human sera(UC 59, CD 28, HS 26) against hTM isoforms. The IFN-γ production by peripheral blood T cells followingstimulation by recombinant hTM5 was analyzed by ELISPOT assay.RESULTS Anti-hTM5 antibody (IgG1) was detected in 15/59 (25.4%) patients with UC, 3/28 (10.γ%)with CD, and 3/26 (11.5%) of HS. The OD value in UC was significantly higher than in CD and HS groups(P < 0.05; P < 0.01 respectively). Western blot analysis demonstrated immunoreactivity against hTM5 inseveral UC sera. ELISPOT assay demonstrated that IFN-γ production is significantly higher in UC (7/18),39.0%), compared with CD (0/8, 0%) and HS (0/7, 0%), (P<0.05).CONCLUSION A significantly higher immune response to hTM5 was present in UC compared to CD andHS. Further studies of the hTM5/peptides may provide immuno-biochemical mechanism of autoimmuneprocess in UC.

  6. Exploring the ameliorative potential of Punica granatum in dextran sulfate sodium induced ulcerative colitis in mice.

    Singh, Kavinder; Jaggi, Amteshwar Singh; Singh, Nirmal

    2009-11-01

    The present study was designed to investigate the ameliorative potential of Punica granatum in dextran sulfate sodium (DSS) induced ulcerative colitis. DSS (2%) was administered orally in drinking water for 7 days to induce ulcerative colitis. The extent and severity of ulceration was analysed macroscopically, histopathologically and using a disease activity index. Myeloperoxidase (MPO), a specific marker of inflammation; histamine, a marker of mast cell degranulation; superoxide anion generation and, lipid peroxides were analysed. Administration of DSS resulted in a significant development of ulceration in the colon along with a rise in histamine, MPO activity and oxidative stress. Treatment with Punica granatum extract and its ellagic acid rich fraction (100 mg/kg and 200 mg/kg p.o.) significantly attenuated DSS-induced colonic inflammation along with attenuation of histamine, MPO and oxidative stress. The antiulcerative effect of Punica granatum extract and its ellagic acid rich fraction were comparable to sulphasalazine (100 mg/kg, p.o.) and sodium cromoglycate (40 mg/kg i.p). It is concluded that Punica granatum has a potential for ameliorating DSS-induced colitis and its ellagic acid rich fraction may be responsible for this effect. Further, the antiulcerative effects may be attributed to mast cell stabilizing, antiinflammatory and antioxidant actions.

  7. Biomarkers in the management of ulcerative colitis: a brief review

    Hussain, Shabnum

    2011-01-01

    Full Text Available Several attempts have been made in the last two decades to investigate ulcerative colitis (UC patients during the natural course of the disease so as to identify appropriate surrogate markers of disease activity. Most patients with quiescent inflammatory bowel disease have low grade inflammation and it is possible that relapse occurs only once the inflammatory process crosses a critical intensity. Since inflammation is a continuous process, its direct assessment may provide us a quantitative pre-symptomatic measure of imminent relapse. If substantial, it may allow targeted treatment early, to avert relapse or formulate newer therapeutic strategies to maintain symptomatic remission. It is clinically very important to identify these patients at a subclinical stage, noninvasively, by various biomarkers. Biomarkers help to gain an objective measurement of disease activity as symptoms are often subjective. Biomarkers also help to avoid invasive procedures which are often a burden to the patient and the health care system. If an ideal biomarker existed for UC, it would greatly facilitate the work of the gastroenterologist treating these patients. Both “classical” and “emerging” biomarkers of relevance for UC have been studied, but the quest for an ideal biomarker still continues. In this brief review we describe various biomarkers of clinical importance.

  8. 5-ASA in ulcerative colitis: Improving treatment compliance

    Cosimo Prantera; Marina Rizzi

    2009-01-01

    5-aminosalicylic acid (5-ASA) compounds are a highly effective treatment for ulcerative colitis (UC). While UC patient compliance in clinical studies is over 90%, only 40% of patients in every day life take their prescribed therapy. Adherence to medication has been emphasized recently by a Cochrane meta-analysis that has suggested that future trials of 5-ASA in UC should look at patient compliance rather than drug efficacy. Better compliance can be obtained by reducing the number of tablets and times of administration. Given that the 5-ASA formulations have different delivery systems that split the active moiety in various regions of the intestine, it is particularly important that an adequate dose of the drug arrives at the inflamed part of the colon. 5-ASA Multi matrix (MMx) is a novel, high strength (1.2 g), oral formulation designed for once-daily dosing. It releases the active moiety throughout the colon. Different studies with this compound have shown that it is as effective as 5-ASA enema in the treatment of mild-to-moderate, left-sided UC, and is comparable to a pH-dependent, delayed release 5-ASA (Asacol(R)), even if given once daily. Recently, the effectiveness in the acute phase of UC has been confirmed also in maintenance. In conclusion, at present, 5-ASA MMx seems theoretically the best agent for maintaining patient compliance, and consequently, treatment effectiveness.

  9. Stereomicroscopic examination of stained rectal biopsies in ulcerative colitis and Crohn's disease

    Poulsen, Steen Seier

    1980-01-01

    Rectal biopsy samples from 22 healthy control subjects, 54 patients with ulcerative colitis, and 34 with Crohn's disease with involvement of the colon or rectum were investigated in a stereomicroscopic study. Samples were stained as whole mounts with Alcian Green before the stereomicroscopic...... the stereomicroscopic findings and the clinical disease activity, the sigmoidoscopic findings, and the histologic activity. Apart from the stereomicroscopic observation of small superficial erosions in one fourth of the biopsies, no changes of diagnostic value were observed in Crohn's disease....

  10. Extraintestinal pathogenic Escherichia coli are associated with intestinal inflammation in patients with ulcerative colitis

    Mirsepasi-Lauridsen, Hengameh C; Halkjaer, Sofie Ingdam; Mortensen, Esben Munk;

    2016-01-01

    E. coli of the phylogenetic group B2 harbouring Extra intestinal Pathogenic Escherichia coli (ExPEC) genes are frequently seen as colonizers of the intestine in patients with active ulcerative colitis (UC). In this study, we describe the influence of E. coli Nissle (EcN) B2 as add-on treatment to...... scores in comparison to patients colonized with E. coli A and D (p treatment of UC patients with E. coli Nissle (B2) does not promote clinical remission and active UC patients colonized with E. coli B2 have an increased intestinal inflammation.......E. coli of the phylogenetic group B2 harbouring Extra intestinal Pathogenic Escherichia coli (ExPEC) genes are frequently seen as colonizers of the intestine in patients with active ulcerative colitis (UC). In this study, we describe the influence of E. coli Nissle (EcN) B2 as add-on treatment...

  11. Altered colonic mucosal Polyunsaturated Fatty Acid (PUFA derived lipid mediators in ulcerative colitis: new insight into relationship with disease activity and pathophysiology.

    Mojgan Masoodi

    Full Text Available OBJECTIVES: Ulcerative colitis (UC is a relapsing inflammatory disorder of unconfirmed aetiology, variable severity and clinical course, characterised by progressive histological inflammation and with elevation of eicosanoids which have a known pathophysiological role in inflammation. Therapeutic interventions targetting eicosanoids (5-aminosalicylates (ASA are effective first line and adjunctive treatments in mild-moderate UC for achieving and sustaining clinical remission. However, the variable clinical response to 5-ASA and frequent deterioration in response to cyclo-oxygenase (COX inhibitors, has prompted an in depth simultaneous evaluation of multiple lipid mediators (including eicosanoids within the inflammatory milieu in UC. We hypothesised that severity of inflammation is associated with alteration of lipid mediators, in relapsing UC. DESIGN: Study was case-control design. Mucosal lipid mediators were determined by LC-MS/MS lipidomics analysis on mucosal biopsies taken from patients attending outpatients with relapsing UC. Univariate and multivariate statistical analyses were used to investigate the association of mucosal lipid mediators, with the disease state and severity graded histologically. RESULTS: Levels of PGE2, PGD2, TXB2, 5-HETE, 11-HETE, 12-HETE and 15-HETE are significantly elevated in inflamed mucosa and correlate with severity of inflammation, determined using validated histological scoring systems. CONCLUSIONS: Our approach of capturing inflammatory mediator signature at different stages of UC by combining comprehensive lipidomics analysis and computational modelling could be used to classify and predict mild-moderate inflammation; however, predictive index is diminished in severe inflammation. This new technical approach could be developed to tailor drug treatments to patients with active UC, based on the mucosal lipid mediator profile.

  12. Epidemiology and gene markers of ulcerative colitis in the Chinese

    Jun Yun; Chang-Tai Xu; Bo-Rong Pan

    2009-01-01

    Inflammatory bowel disease (IBD) includes two similar yet distinct conditions called ulcerative colitis (UC) and Crohn's disease (CD). These diseases affect the digestive system and cause the inflammation of intestinal tissue, form sores and bleed easily. Most children with IBD arediagnosed in late childhood and adolescence. However, both UC and CD have been reported as early as in infancy. Most information pertaining to the epidemiology of IBD is based upon adult studies. Symptoms include abdominal pain, cramping, fatigue and diarrhea. Genetic factors play a significant role in determining IBD susceptibility. Epidemiological data support a genetic contribution to the pathogenesis of IBD. Recently, numerous new genes have been identified as being involved in the genetic susceptibility to IBD: TNF- 308A, CARD15 ( NOD2), MIF-173, N-acetyltransferase 2 ( NAT2), NKG2D (natural killer cell 2D), STAT6 (signal transducer and activator of transcription 6), CTLA-4 (cytotoxic T lymphocyte antigen-4), MICA-MICB (major histocompatibility complex A and B), HLA-DRB1, HLA class-?, IL-18, IL-4, MICA-A5, CD14, TLR4, Fas-670, p53 and NF-kB. The characterization of these novel genes has the potential to identify therapeutic agents and aid clinical assessment of phenotype and prognosis in patients with IBD (UC and CD).

  13. Prevalence and importance of amebic infestation in patients with ulcerative colitis in two regions in Turkey.

    Soylu, Aliye; Dolapcioglu, Can; Alis, Halil; Dolay, Kemal; Yasar, Nurgul; Boduroglu, Omer; Cildas, Aydin; Bolukbas, Fusun F; Bolukbas, Cengiz

    2009-06-01

    We investigated the prevalence of amebiasis in patients with ulcerative colitis residing in two geographical regions with different socioeconomic status and climatic conditions, and its effect on the age of onset, duration, localization, and activity of disease. Ninety patients from a high socioeconomic location (group I) and 28 cases from a low socioeconomic location (group II) were enrolled. Median age at disease onset was significantly higher in group I compared with in group II. Prevalence of amebiasis in group I was significantly lower than in group II. A considerably number of patients with amebiasis in group I had a history of travel to the cities with a lower socioeconomic level, mainly located in the east of Turkey. There was a strong relationship between presence of amebiasis and history of travel to eastern parts of Turkey among residents from the northwestern part of Turkey. Median age and age at time of diagnosis were significantly lower in patients with amebiasis compared with those without infection. In patients with mild disease activity, prevalence of amebiasis was significantly lower compared with those with moderate or severe disease activity. In conclusion, prevalence of amebiasis was markedly higher in the southeast compared to the northwest of Turkey. Travel to regions with low socioeconomic status may be considered a risk factor for amebiasis in patients with ulcerative colitis. Amebiasis enhances disease activity in ulcerative colitis.

  14. Primary sclerosing cholangitis in patients with ulcerative colitis: two case reports

    Kwon, Se Hwan; Lee, Dong Ho; Choi, Dong Sik; Ko, Young Tae [Kyunghee University Hospital, Seoul (Korea, Republic of)

    1999-02-01

    Primary sclerosing cholangitis, a chronic cholestatic liver disease, is uncommon and is characterized by inflammation and fibrosis of the bile ducts. It frequently occurs in association with ulcerative colitis. We describe two cases of primary sclerosing cholangitis in patients with ulcerative colitis.

  15. Efficacy of Adalimumab as a long term maintenance therapy in ulcerative colitis.

    McDermott, Edel

    2013-03-01

    Adalimumab is a recombinant human IgG1 monoclonal antibody to TNF-alpha. There are limited data with regard to its efficacy in ulcerative colitis. We report experience of adalimumab in ulcerative colitis in a single centre with a focus on the ability of this agent to maintain response and avoid colectomy in the medium to long-term.

  16. Treatment of acute ulcerative colitis with infliximab, a retrospective study from three Danish hospitals

    Mortensen, Christian; Caspersen, Sarah; Christensen, Niels Lyhne

    2011-01-01

    In acute steroid-refractory ulcerative colitis, rescue therapy with infliximab has become a therapeutic option in patients facing colectomy. Data on efficacy and safety in this setting are sparse.......In acute steroid-refractory ulcerative colitis, rescue therapy with infliximab has become a therapeutic option in patients facing colectomy. Data on efficacy and safety in this setting are sparse....

  17. Overall and cause-specific mortality in ulcerative colitis

    Jess, Tine; Gamborg, Michael; Munkholm, Pia

    2007-01-01

    OBJECTIVES: It remains debated whether patients with ulcerative colitis (UC) are at greater risk of dying and whether a possible alteration in mortality can be attributed to specific causes of death. We aimed to clarify this issue by conducting a meta-analysis of population-based inception cohort...... studies on overall and cause-specific mortality in patients with UC. METHODS: The MEDLINE search engine and abstracts from international conferences were searched for relevant literature by use of explicit search criteria. STATA meta-analysis software was used to calculate pooled risk estimates (SMR...... estimate was 1.1 (95% confidence interval [CI] 0.9-1.2, P= 0.42). However, greater risk of dying was observed during the first years of follow-up, in patients with extensive colitis, and in patients from Scandinavia. Metaregression analysis showed an increase in SMR by increasing cohort size. UC...

  18. Diet in the Aetiology of Ulcerative Colitis: A European Prospective Cohort Study

    Hart, Andrew R; Luben, Robert; Olsen, Anja;

    2008-01-01

    Background/Aims: The causes of ulcerative colitis are unknown, although it is plausible that dietary factors are involved. Case-control studies of diet and ulcerative colitis are subject to recall biases. The aim of this study was to examine the prospective relationship between the intake...... was supplied and the subjects were followed up for the development of ulcerative colitis. Each incident case was matched with four controls and dietary variables were divided into quartiles. Results: A total of 139 subjects with incident ulcerative colitis were identified. No dietary associations were detected......, apart from a marginally significant positive association with an increasing percentage intake of energy from total polyunsaturated fatty acids (trend across quartiles OR = 1.19 (95% CI = 0.99-1.43) p = 0.07). Conclusions: No associations between ulcerative colitis and diet were detected, apart from...

  19. Increased levels of homocysteine in patients with ulcerative colitis

    Sabiye; Akbulut; Emin; Altiparmak; Firdevs; Topal; Ersan; Ozaslan; Metin; Kucukazman; Ozlem; Yonem

    2010-01-01

    AIM: To investigate serum levels of homocysteine (Hcys) and the risk that altered levels carry for thrombosis development in ulcerative colitis (UC) patients. METHODS: 55 UC patients and 45 healthy adults were included. Hcys, vitamin B12 and folic acid levels were measured in both groups. Clinical history and thrombo- embolic events were investigated. RESULTS: The average Hcys level in the UC patients was 13.3 ± 1.93 μmmol/L (range 4.60-87) and was higher than the average Hcys level of the control group whi...

  20. [Anti-TNF-alpha therapy in ulcerative colitis].

    Lakatos, Péter László; Lakatos, László

    2008-05-18

    The most important factors that determine treatment strategy in ulcerative colitis (UC) are disease extent and severity. Orally-topically administered 5-aminosalicylates (5-ASA) remain the treatment of choice in mild-to-moderate UC. In contrast, the treatment of refractory (to steroids, azathioprine or 5-ASA) and fulminant cases is still demanding. New evidence supports a role for infliximab induction and/or maintenance therapy in these subgroup of patients leading to increased remission and decreased colectomy rates. The aim of this paper is to review the rationale for the use of TNF-alpha inhibitors in the treatment of UC.

  1. Anal transition zone in the surgical management of ulcerative colitis

    Jennifer Holder-Murray; Alessandro Fichera

    2009-01-01

    Preservation of the anal transition zone has long been a significant source of controversy in the surgical management of ulcerative colitis. The two techniques for restorative proctocolectomy and ileal pouch anal anastomosis (RPC IPAA) in common practice are a stapled anastomosis and a handsewn anastomosis;these techniques differ in the amount of remaining rectal mucosa and therefore the presence of the anal transition zone following surgery. Each technique has advantages and disadvantages in long-term functional outcomes, operative and postoperative complications, and risk of neoplasia. Therefore, we propose a selective approach to performing a stapled RPC IPAA based on the presence of dysplasia in the preoperative endoscopic evaluation.

  2. Effects of topical ropivacaine on eicosanoids and neurotransmitters in the rectum of patients with distal ulcerative colitis

    Hillingsø, J.G.; Kjeldsen, J.; Schmidt, P.T.;

    2002-01-01

    reflexes, we have studied the local effects of a single rectal dose of ropivacaine gel on rectal concentrations of eicosanoids and neurotransmittors in patients with relapsing ulcerative colitis.Methods: In a randomized, double-blind, placebo-con trolled study, concentrations of leukotriene B-4...... changes in concentrations of eicosanoids or neuropeptides were observed after ropivacaine or placebo administration. Baseline concentrations of all neuropeptides, except somatostatin, were significantly lower in active ulcerative colitis than in controls with non-inflamed colon.Conclusions: These findings...

  3. The Impact of Endoscopic Inflammation and Mucosal Healing on Health-related Quality of Life in Ulcerative Colitis Patients

    Theede, Klaus; Kiszka-Kanowitz, Marianne; Nordgaard-Lassen, Inge;

    2015-01-01

    BACKGROUND: Health-related quality of life [HRQoL] is impaired in ulcerative colitis and is correlated to clinical disease activity. The recent shift towards more objective treatment goals like mucosal healing generates a need for evaluating the association between endoscopic disease activity......], and HRQoL by the Short Inflammatory Bowel Disease Questionnaire [SIBDQ] and Short Health Scale [SHS]. RESULTS: A total of 110 patients, 71% with active disease, had a median SCCAI score of 3 and a median MES score of 1. Patients in clinical remission had a mean SIBDQ of 60 and SHS of 6. HRQoL decreased......, mucosal healing and HRQoL. METHODS: In this cross-sectional study, patients with either active or inactive ulcerative colitis underwent sigmoidoscopy. Clinical disease activity was assessed by the Simple Clinical Colitis Activity Index [SCCAI], endoscopic inflammation by the Mayo Endoscopic Subscore [MES...

  4. Enteric microbiota leads to new therapeutic strategies for ulcerative colitis.

    Chen, Wei-Xu; Ren, Li-Hua; Shi, Rui-Hua

    2014-11-14

    Ulcerative colitis (UC) is a leading form of inflammatory bowel disease that involves chronic relapsing or progressive inflammation. As a significant proportion of UC patients treated with conventional therapies do not achieve remission, there is a pressing need for the development of more effective therapies. The human gut contains a large, diverse, and dynamic population of microorganisms, collectively referred to as the enteric microbiota. There is a symbiotic relationship between the human host and the enteric microbiota, which provides nutrition, protection against pathogenic organisms, and promotes immune homeostasis. An imbalance of the normal enteric microbiota composition (termed dysbiosis) underlies the pathogenesis of UC. A reduction of enteric microbiota diversity has been observed in UC patients, mainly affecting the butyrate-producing bacteria, such as Faecalibacterium prausnitzii, which can repress pro-inflammatory cytokines. Many studies have shown that enteric microbiota plays an important role in anti-inflammatory and immunoregulatory activities, which can benefit UC patients. Therefore, manipulation of the dysbiosis is an attractive approach for UC therapy. Various therapies targeting a restoration of the enteric microbiota have shown efficacy in treating patients with active and chronic forms of UC. Such therapies include fecal microbiota transplantation, probiotics, prebiotics, antibiotics, helminth therapy, and dietary polyphenols, all of which can alter the abundance and composition of the enteric microbiota. Although there have been many large, randomized controlled clinical trials assessing these treatments, the effectiveness and safety of these bacteria-driven therapies need further evaluation. This review focuses on the important role that the enteric microbiota plays in maintaining intestinal homeostasis and discusses new therapeutic strategies targeting the enteric microbiota for UC.

  5. A subset of ulcerative colitis with positive proteinase-3antineutrophil cytoplasmic antibody

    Jin Xu; Chuan-Hua Yang; Xiao-Yu Chen; Xu-Hang Li; Min Dai; Shu-Dong Xiao

    2008-01-01

    A small subset of patients with active ulcerative colitis is non-responsive to major known non-biological therapies.We reported 5 patients with positive serum proteinase-3 antineutrophil cytoplasmic antibody (PR3-ANCA) and tried to (1) identify the common clinical features of these patients; (2) investigate the efficacy of a novel therapy using a Chinese medicine compound; and (3) attract more gastroenterologists to be engaged in further study of this subset of patients. The common manifestations of disease in these 5 patients included recurrent bloody diarrhea and inflammatory lesions involving the entire colorectal mucosa. Initial treatment with intravenous methylprednisolone successfully induced remission.Four of these 5 patients were steroid-dependence,and immunosuppressants, such as azathioprine and cyclophosphamide, were ineffective. In 3 patients,only the particular Chinese medicine compound could induce and maintain remission. One patient underwent colectomy. No vascular inflammatory lesions were found by histopathological examination. Although more cases are needed for confirmation, our study indicates that ulcerative colitis with positive PR3-ANCA may belong to a subtype of refractory ulcerative colitis. The particular Chinese medicine compound used in our study is by far the most effective in the management of these patients,with additional advantages of having no noticeable sideeffects and less financial burden.

  6. Isotretinoin and ulcerative colitis: A case report and review of the literature

    Ioannis; Papaconstantinou; Anastasios; Stefanopoulos; Aspasia; Papailia; Christos; Zeglinas; Ioannis; Georgopoulos; Spyridon; Michopoulos

    2014-01-01

    This case report describes a case of ulcerative colitisthe onset of which occurred after the use of isotreti-noin for acne treatment. Our patient, a healthy maleyoung adult, after several months of isotretinoin use,developed gastrointestinal disorders and after thoroughmedical workup was diagnosed with ulcerative colitis.The literature regarding a possible correlation betweenisotretinoin use and ulcerative colitis is scarce. Never-theless, recent epidemiological studies have shed morelight on this possible association.

  7. Recent advances in the management of distal ulcerative colitis

    Ioannis; E; Koutroubakis

    2010-01-01

    The most frequent localization of ulcerative colitis(UC) is the distal colon.In treating patients with active distal UC,efficacy and targeting of the drug to the distal colon are key priorities.Oral and rectal 5-aminosalicylic acid(5-ASA) preparations represent the first line therapy of mild-to-moderate distal UC for both induction and maintenance treatment.It has been reported that many UC patients are not adherent to therapy and that noncompliant patients had a 5-fold risk of experiencing a relapse.These findings led to the introduction of oncedaily oral regimens of 5-ASA as better therapeutic options in clinical practice due to improved adherence.New formulations of mesalazine,including the multimatrix delivery system,and mesalazine granules,which allow once-daily administration,have been developed.They have been demonstrated to be efficacious in inducing and maintaining remission in mild-to-moderate distal UC in large clinical trials.However,existing data for distal UC are rather insufficient to make a comparison between new and classical 5-ASA formulations.It seems that the new formulations are at least as effective as classical oral 5-ASA formulations.Other treatment options,in the case that 5-ASA therapy is not effective,include systemic corticosteroids,thiopurines(azathioprine or 6-mercaptopurine),cyclosporine,infliximab and surgery.The combination of a prompt diagnostic work-up,a correct therapeutic approach and an appropriate follow-up schedule is important in the management of patients with distal UC.This approach can shorten the duration of symptoms,induce a prolonged remission,improve patient’s quality of life,and optimize the use of health resources.

  8. The Role of Fecal Calprotectin in Investigating Pediatric Ulcerative Colitis

    Fatih Ünal

    2012-12-01

    Full Text Available Introduction: Fecal calprotectin (FCP can be found in high concentrations in inflammatory bowel disease due to the increase in leucocyte turnover in intestinal wall or increase of migration of neutrophils into the lumen. In this study, we aimed to determine the FCP values of the ulcerative colitis (UC patients at the time of diagnosis and to investigate the applicability and effectiveness of this non-invasive method in the diagnosis of the disease, routinely.Materials and Methods: A total of 19 patients with UC (10 females, 9 males, age: 11.5±3.5 years old whoose stool samples collected during the diagnosis period and 20 healthy controls (10 female, 10 male, age: 10.3±4.5 years old were included in the study. Stool samples were collected for FCP analysis by ELISA method at the time of diagnosis and before the treatment period.Results: FCP values of the UC group were statistically higher than the control group. FCP values of the UC and control groups were 398.4 µg/gr stool (56.7-2450 and 19.4 µg/gr stool (2-81, respectively (p0.05. High CRP values (89.4%, elevation of erythrocyte sedimentation rate (84.2%, leukocytosis (73.6%, thrombocytosis (68.4%, anemia (89.4%, and hypoalbuminemia (52.6% were found.Conclusions: FCP values of the UC patients were found to be statistically higher than the control group, and increase in FCP values has been observed with increasing disease activity. Therefore, we believe that the determination of FCP could be useful at the time of diagnosis and during follow-up of the patients with UC. (Journal of Current Pediatrics 2012; 10: 80-4

  9. Concomitant herpes simplex virus colitis and hepatitis in a man with ulcerative colitis

    Phadke, Varun K.; Friedman-Moraco, Rachel J.; Quigley, Brian C.; Farris, Alton B.; Norvell, J. P.

    2016-01-01

    Abstract Background: Herpesvirus infections often complicate the clinical course of patients with inflammatory bowel disease; however, invasive disease due to herpes simplex virus is distinctly uncommon. Methods: We present a case of herpes simplex virus colitis and hepatitis, review all the previously published cases of herpes simplex virus colitis, and discuss common clinical features and outcomes. We also discuss the epidemiology, clinical manifestations, diagnosis, and management of herpes simplex virus infections, focusing specifically on patients with inflammatory bowel disease. Results: A 43-year-old man with ulcerative colitis, previously controlled with an oral 5-aminosalicylic agent, developed symptoms of a colitis flare that did not respond to treatment with systemic corticosteroid therapy. One week later he developed orolabial ulcers and progressive hepatic dysfunction, with markedly elevated transaminases and coagulopathy. He underwent emergent total colectomy when imaging suggested bowel micro-perforation. Pathology from both the colon and liver was consistent with herpes simplex virus infection, and a viral culture of his orolabial lesions and a serum polymerase chain reaction assay also identified herpes simplex virus. He was treated with systemic antiviral therapy and made a complete recovery. Conclusions: Disseminated herpes simplex virus infection with concomitant involvement of the colon and liver has been reported only 3 times in the published literature, and to our knowledge this is the first such case in a patient with inflammatory bowel disease. The risk of invasive herpes simplex virus infections increases with some, but not all immunomodulatory therapies. Optimal management of herpes simplex virus in patients with inflammatory bowel disease includes targeted prophylactic therapy for patients with evidence of latent infection, and timely initiation of antiviral therapy for those patients suspected to have invasive disease. PMID:27759636

  10. Ulcerative Colitis and Its Association with Salmonella Species

    Manish Kumar Tripathi

    2016-01-01

    Full Text Available Ulcerative colitis (UC is characterized by presence of ulcer in colon and bloody diarrhea. The present study explores the possibility of association between Salmonella and ulcerative colitis. The present study comprised 59 cases of UC, 28 of colon cancer (CC, 127 of irritable bowel syndrome (IBS, and 190 of healthy control. The serological study was done by Widal and Indirect Haemagglutination Assay (IHA for ViAb. Nested PCR was performed targeting fliC, staA, and stkG gene for Typhi and Paratyphi A, respectively. A total of 15.3% patients were positive for Salmonella “O” antigen among them 18.6% UC, 35.5% CC, 12.6% IBS, and 15.3% healthy control. A total of 36.9% patients were positive for “H” antigen including 39.0%, 57.1%, and 67.7% UC, CC, and IBS, respectively. About 1.73% show positive agglutination for AH antigen including 3.4%, 3.6%, and 1.6%, UC, CC, and IBS. A total of 10.89% were positive for ViAb. While 6.8% of UC, 10.7% of CC, 11.0% of IBS, and 12.1% of healthy subjects were positive for the antibody, the PCR positivity rates for Salmonella specific sequences were 79.7% in UC, 53.6% in CC, 66.1% in IBS, and 16.3% in healthy controls. The present study suggested that higher prevalence of Salmonella might play important role in etiopathogenesis of UC, IBS, and CC.

  11. Ulcerative Colitis and Its Association with Salmonella Species

    Tripathi, Manish Kumar; Pratap, Chandra Bhan; Dixit, Vinod K.; Singh, Tej Bali; Shukla, Sunit K.; Jain, Ashok K.; Nath, Gopal

    2016-01-01

    Ulcerative colitis (UC) is characterized by presence of ulcer in colon and bloody diarrhea. The present study explores the possibility of association between Salmonella and ulcerative colitis. The present study comprised 59 cases of UC, 28 of colon cancer (CC), 127 of irritable bowel syndrome (IBS), and 190 of healthy control. The serological study was done by Widal and Indirect Haemagglutination Assay (IHA) for ViAb. Nested PCR was performed targeting fliC, staA, and stkG gene for Typhi and Paratyphi A, respectively. A total of 15.3% patients were positive for Salmonella “O” antigen among them 18.6% UC, 35.5% CC, 12.6% IBS, and 15.3% healthy control. A total of 36.9% patients were positive for “H” antigen including 39.0%, 57.1%, and 67.7% UC, CC, and IBS, respectively. About 1.73% show positive agglutination for AH antigen including 3.4%, 3.6%, and 1.6%, UC, CC, and IBS. A total of 10.89% were positive for ViAb. While 6.8% of UC, 10.7% of CC, 11.0% of IBS, and 12.1% of healthy subjects were positive for the antibody, the PCR positivity rates for Salmonella specific sequences were 79.7% in UC, 53.6% in CC, 66.1% in IBS, and 16.3% in healthy controls. The present study suggested that higher prevalence of Salmonella might play important role in etiopathogenesis of UC, IBS, and CC. PMID:26904116

  12. [A case of steroid resistant autoimmune hemolytic anemia in ulcerative colitis].

    Choi, Hyun Jong; Hong, Su Jin; Kim, Young Jee; Ko, Bong Min; Lee, Moon Sung; Shim, Chan Sup; Kim, Hyun Jung; Hong, Dae Sik

    2008-02-01

    Autoimmunity is thought to play a central role in the pathogenesis of inflammatory bowel disease and associated extraintestinal manifestations. Autoimmune hemolytic anemia associated with ulcerative colitis is a rare occurrence. No more than 50 cases have been described in the international literatures, and only 2 cases reported in Korea. A 29-year-old woman who was diagnosed as ulcerative colitis two years ago was complicated with autoimmune hemolytic anemia, and did not respond to steroid therapy. Ultimately, total colectomy and splenectomy were carried out for the treatment of ulcerative colitis and hemolytic anemia. After the operation, anemia was resolved. We present the case with a review of literature.

  13. Effectiveness of infliximab in the treatment of perianal fistulas in ulcerative colitis: report of two cases.

    de la Piscina, Patricia Ramírez; Duca, Ileana; Estrada, Silvia; Spicakova, Katerina; Calderón, Rosario; Urtasun, Leire; Marra-López, Carlos; Salvador, Marta; Delgado, Elvira; Campos, Francisco García

    2013-01-01

    Ulcerative colitis is a chronic inflammatory bowel disease of unknown etiopathogenesis and increasing incidence in recent years. Perianal complications of ulcerative colitis are rare and seem to be associated with higher extent of inflammation and a more severe course of the disease. The cases of two male patients with severe corticoid-dependent ulcerative colitis of protracted clinical course who developed perianal fistulas and abscesses successfully treated with infliximab are reported. Treatment with infliximab was followed by perianal fistula closure with marked improvement in the quality of life over 2-year follow-up period.

  14. Development and Improvement of Simple Colonic Mucosal Ulcer during Treatment of Severe Ulcerative Colitis with Tacrolimus

    Ayumi Ito

    2017-03-01

    Full Text Available Diarrhea, melena, and lower abdominal pain developed in a male in his 20s and colonoscopy showed pancolitis-type severe ulcerative colitis (UC. Treatment was initiated with 4,000 mg of 5-aminosalicylic acid and 60 mg/day of prednisolone, but the symptoms and inflammatory reaction worsened with prednisolone dose reduction. Tacrolimus was added to the treatment, which subsequently induced remission. Serial colonoscopies during the treatment showed improvement in ulcer and mucosal edema throughout the entire large intestine, but a new solitary round ulcer appeared at the end of the ileum. Since no signs of Behçet’s disease were noted, it was considered as a simple ulcer, a complication of UC. Tacrolimus treatment was continued based on continued improvement in clinical features and colonic mucosa, excluding the end of the ileum. Colonoscopy at 6 months after initiation of tacrolimus showed healing of the large intestinal mucosa, although mild congestion was still noted. The solitary round ulcer at the end of the ileum improved to a small erosion. We report the improvement of a simple ulcer that developed during tacrolimus treatment.

  15. Azathioprine, mucosal healing in ulcerative colitis, and the chemoprevention of colitic cancer: a clinical-practice-based forecast.

    Actis, Giovanni C; Pellicano, Rinaldo; David, Ezio; Sapino, Anna

    2010-03-01

    The development of colorectal cancer in ulcerative colitis is a function of disease duration, with the risk approaching 14% at 25 years. Colitic cancer has become an issue in the last decades, as the availability of effective immune suppressors has reduced resort to curative colectomies. Scrutiny of the available drug options for ulcerative colitis has generated solid evidence of a chemopreventive role of mesalamines. Recent studies on the thiopurines azathioprine and mercaptopurine have unraveled the ability of these drugs to reduce inflammation and influence adaptive immunity by enhancing apoptosis. This evidence, speaking in favor of a chemopreventive role of thiopurines, has not been supported until recently by clinical studies. By contrast, endoscopic and clinical data in our hands have continued to suggest such a role: of a cohort of ulcerative colitis patients treated with azathioprine for 17 years, those on active treatment had no mucosal inflammation on endoscopy and overall none in this cohort developed cancer. This retrospective data have now been validated by cutting-edge information from a prospective nationwide study from an independent group which found a significant chemopreventive effect of azathioprine in those with extended long-standing colitis. Combination of our single-center experience with the data from this large study strongly indicates that the immune modulatory properties of thiopurines can translate into clinically meaningful anti-cancer activity in colitis. These results are likely to influence the medical choices of inflammatory bowel disease caregivers in the decades to come.

  16. Hospitalized ulcerative colitis patients have an elevated risk of thromboembolic events

    Jennifer Y Wang; Jonathan P Terdiman; Eric Vittinghoff; Tracy Minichiello; Madhulika G Varma

    2009-01-01

    AIM: To compare thromboembolism rates between hospitalized patients with a diagnosis of ulcerative colitis and other hospitalized patients at high risk for thromboembolism. To compare thromboembolism rates between patients with ulcerative colitis undergoing a colorectal operation and other patients undergoing colorectal operations. METHODS: Data from the National Hospital Discharge Survey was used to compare thromboembolism rates between (1) hospitalized patients with a discharge diagnosis of ulcerative colitis and those with diverticulitis or acute respiratory failure, and (2) hospitalized patients with a discharge diagnosis of ulcerative colitis who underwent colectomy and those with diverticulitis or colorectal cancer who underwent colorectal operations. RESULTS: Patients diagnosed with ulcerative colitis had similar or higher rates of combined venous thromboembolism (2.03%) than their counterparts with diverticulitis (0.76%) or respiratory failure (1.99%), despite the overall greater prevalence of thromboembolic risk factors in the latter groups. Discharged patients with colitis that were treated surgically did not have significantly different rates of venous or arterial thromboembolism than those with surgery for diverticulitis or colorectal cancer. CONCLUSION: Patients with ulcerative colitis who do not undergo an operation during their hospitalization have similar or higher rates of thromboembolism than other medical patients who are considered to be high risk for thromboembolism.

  17. Oat β-glucan ameliorates dextran sulfate sodium (DSS)-induced ulcerative colitis in mice.

    Liu, Bo; Lin, Qinlu; Yang, Tao; Zeng, Linna; Shi, Limin; Chen, Yaya; Luo, Feijun

    2015-11-01

    Ulcerative colitis is a major inflammatory bowel disease (IBD), characterized by inflammation within the gastrointestinal tract through chronic or relapsing immune system activation. The aim of this study is to investigate the potential protective effect of oat β-glucan (βG) against colitis induced by DSS in mice. Eighty mice were randomly divided into the control group (no DSS, no βG), DSS group (DSS only), DSS + L-βG group (DSS plus 500 mg per kg βG), and DSS + H-βG group (DSS plus 1000 mg per kg βG). Compared with the DSS group, administration of βG significantly reduced clinical symptoms with less weight loss, diarrhea and shortening of the colon, the severity of colitis was significantly inhibited as evidenced by the reduced disease activity index (DAI) and degree of histological damage in colon. Moreover, treatment with βG not only decreased myeloperoxidase activity (MPO), and nitric oxide (NO) and malondialdehyde (MDA) levels, but also inhibited mRNA and protein expression of pro-inflammatory factors such as TNF-α, IL-1β, IL-6 and iNOS. This suggests that oat βG in diet might exhibit an anti-inflammatory function against colitis through inhibition of expression of pro-inflammatory factors.

  18. Budesonide for ulcerative colitis Budesonida en el tratamiento de la colitis ulcerosa

    I. Marín-Jiménez

    2006-05-01

    Full Text Available In this review, we examined studies published on oral and topical formulations of budesonide (Entocort® and Budenofalk®, in Spain: Entocord® and Intestifalk® for the treatment of ulcerative colitis. This glycocorticosteroid has a potent local action and an important first-pass liver metabolism. It has proven successful over the last years as a controlled-release formulation. It obtained results similar to prednisolone, without the latter's significant suppression of plasma cortisol. Many publications exist on the effects of oral budesonide for the treatment of Crohn's disease (CD. These have led to the registration of this drug for the treatment of CD. Studies on oral formulations of budesonide for the treatment of ulcerative colitis (UC are scarce. After reviewing published evidence, we suggest the conduction of controlled trials for the treatment of UC to obtain evidence-based efficacy and safety results in order to benefit patients with this form of inflammatory bowel disease (IBD.En esta revisión repasamos los estudios publicados hasta la fecha con las formulaciones orales y las preparaciones tópicas rectales de budesonida (Entocort® y Budenofalk®, en España Entocord® e Intestifalk® para el tratamiento de la colitis ulcerosa. Este glucocorticosteroide de una elevada acción tópica y un importante metabolismo de primer paso hepático se ha utilizado en los últimos años como una formulación de liberación controlada, proporcionando resultados similares a la prednisolona pero sin suprimir de forma apreciable los niveles de cortisol plasmático. Aunque se han publicado muchos estudios sobre los efectos de la budesonida oral para el tratamiento de la enfermedad de Crohn, los estudios sobre esta misma forma galénica de administración de budesonida para el tratamiento de los pacientes con colitis ulcerosa son escasos. Después de revisar los trabajos publicados al respecto, se sugiere la necesidad de realizar un estudio controlado

  19. Clinical value analysis of routine ultrasound combined with endoscopic ultrasonography in judging ulcerative colitis

    Jing-Mei Tuo; Zhi-Hong Han

    2016-01-01

    Objective:To study the clinical value of routine ultrasound combined with endoscopic ultrasonography in judging ulcerative colitis.Methods: A total of 60 cases of patients with ulcerative colitis were collected as observation group of research and 60 cases of healthy volunteers were collected as control group of research. Intestinal wall thickness was detected by white light endoscopy, abdominal intestinal ultrasound and endoscopic ultrasonography; TNF-α, IL-1β, IL-4 and IL-10 contents were detected by Elisa kit; Th1, Th2, Th17 and Treg ratios were detected by flow cytometry.Results: (1) intestinal wall thickness: intestinal wall thickness of both active UC patients and quiescent UC patients was significantly higher than that of control group, intestinal wall thickness of active UC patients was significantly higher than that of quiescent UC patients and the higher the degree of activity, the higher the intestinal wall thickness; (2) inflammatory mediators: TNF-α and IL-1β contents in intestinal mucosa of active UC patients were higher than those of quiescent UC patients and positively correlated with intestinal wall thickness; IL-4 and IL-10 contents were lower than those of quiescent UC patients and negatively correlated with intestinal wall thickness; (3) T cell contents: Th1 and Th17 cell contents in intestinal mucosa of active UC patients were higher than those of quiescent UC patients and positively correlated with intestinal wall thickness; Th2 and Treg cell contents in intestinal mucosa of active UC patients were lower than those of quiescent UC patients and negatively correlated with intestinal wall thickness.Conclusion: Routine ultrasound combined with endoscopic ultrasonography can accurately determine the severity of ulcerative colitis; measured intestinal wall thickness is closely correlated with the degree of inflammation and abnormal immune response.

  20. Refractory ulcerative colitis accompanied with cytomegalovirus colitis and multiple liver abscesses:A case report

    Takuya Inoue; Ken Toshina; Takashi Nishikawa; Norihiro Hamamoto; Ken Nakagawa; Ken-Ichi Katsu; Ichiro Hirata; Yutaro Egashira; Kumi Ishida; Ken Kawakami; Eijiro Morita; Naoko Murano; Shingo Yasumoto; Mitsuyuki Murano

    2005-01-01

    Various hepato-biliary complications are an increased incidence in patients with inflammatory bowel disease,and portal bacteremia is well documented in patients with ulcerative colitis (UC). However, few reports mention UC in association with liver abscesses. Recently, there are several reports describing cytomegalovirus (CMV) infection in association with disease exacerbation and steroid refractoriness in patients with UC. Here we present a case of refractory UC accompanied with multiple liver abscesses and CMV colitis. The patient, a 72-year-old male, with a five-year history of repeated admissions to our hospital for UC, presented with an exacerbation of his UC.Sigmoidoscopy performed on admission suggested that his UC was exacerbated, then he was given prednisolone and mesalazine orally, and betamethasone enemas.However, he had exacerbated symptoms. Repeat sigmoidoscopy revealed multiple longitudinal ulcers and pseudopolyps in the rectosigmoid colon. Although immunohistochemical staining of biopsy specimens and the serum testing for antigenemia were negative on admission and after the repeat sigmoidoscopy, they became histologically positive for CMV. Nonetheless, the patient developed spiking fevers, soon after ganciclovir was administered. Laboratory studies revealed an increased white cell count with left shift, and Enterococcus fecalis grew in blood cultures. An abdominal computed tomography (CT) scan was obtained and the diagnosis of liver abscesses associated with UC was made, based on CT results. The hepatic abscesses were successfully treated with intravenous meropenem for 6 wk, without further percutaneous drainage. To our knowledge, this is the first reported case of multiple liver abscesses that develop during UC exacerbation complicated by CMV colitis.

  1. Vedolizumab for the Treatment of Adults with Moderate-to-Severe Active Ulcerative Colitis: An Evidence Review Group Perspective of a NICE Single Technology Appraisal.

    Essat, Munira; Tappenden, Paul; Ren, Shijie; Bessey, Alice; Archer, Rachel; Wong, Ruth; Lobo, Alan; Hoque, Sami

    2016-03-01

    As part of its single technology appraisal (STA) process, the National Institute for Health and Care Excellence (NICE) invited the manufacturer of vedolizumab (Takeda UK) to submit evidence of the clinical effectiveness and cost effectiveness of vedolizumab for the treatment of patients with moderate-to-severe active ulcerative colitis (UC). The Evidence Review Group (ERG) produced a critical review of the evidence for the clinical effectiveness and cost effectiveness of the technology, based upon the company's submission to NICE. The evidence was derived mainly from GEMINI 1, a Phase 3, multicentre, randomised, double-blinded, placebo-controlled study of the induction and maintenance of clinical response and remission by vedolizumab (MLN0002) in patients with moderate-to-severe active UC with an inadequate response to, loss of response to or intolerance of conventional therapy or anti-tumour necrosis factor (TNF)-α. The clinical evidence showed that vedolizumab performed significantly better than placebo in both the induction and maintenance phases. In the post hoc subgroup analyses in patients with or without prior anti-TNF-α therapy, vedolizumab performed better then placebo (p value not reported). In addition, a greater improvement in health-related quality of life was observed in patients treated with vedolizumab, and the frequency and types of adverse events were similar in the vedolizumab and placebo groups, but the evidence was limited to short-term follow-up. There were a number of limitations and uncertainties in the clinical evidence base, which warrants caution in its interpretation--in particular, the post hoc subgroup analyses and high dropout rates in the maintenance phase of GEMINI 1. The company also presented a network meta-analysis of vedolizumab versus other biologic therapies indicated for moderate-to-severe UC. However, the ERG considered that the results presented may have underestimated the uncertainty in treatment effects, since fixed

  2. Beclomethasone dipropionate enema in ulcerative colitis: Is it safe?

    Luboshitzky, Rafael; Rachelis, Zoia; Nussensone, Elchanan; Ishay, Avraham

    2009-06-02

    Objective: To evaluate the pituitary-adrenal axis (PA axis) reserve in patients with ulcerative colitis (UC) treated with steroid enemas, we performed 1mug ACTH test.Methods: Patients with UC (n=8) given beclomethasone dipropionate enema (Betnesol) for 4 weeks. Fasting serum cortisol and the response at 30 and 60 minutes following an IV 1mug ACTH injection were determined after 2 weeks of Betnesol enemas. Patients were retested, one month after discontinuation of enemas.Results: Fasting and peak cortisol responses to ACTH were suppressed in six patients. Additional patient had suppressed fasting cortisol and another patient had blunted response to ACTH. One month off Betnesol enema, basal and peak cortisol response to ACTH were normal in all but one patient.Conclusion: Betnesol enemas are associated with severe suppression of the PA axis in almost all patients. Caution is required in patients with UC after withdrawal of rectal steroids as adrenal insufficiency can occur.

  3. An Unusual Association between Chronic Pancreatitis and Ulcerative Colitis

    Surya Prakash Bhatt

    2008-01-01

    Full Text Available Episodes of acute pancreatitis have been described during the course of ulcerative colitis and most of them are due to cholelithiasis or drugs. Idiopathic pancreatitis has rarely been associated with inflammatory bowel disease (IBD. We describe one such case. A 35-year-old male presented in 2001 with a ten year history of recurrent episodes of diarrhea without blood and mucus in the stools. Four years ago, he developed an episode of mild acute pancreatitis. At that time, the serum amylase level was three times the upper normal limit. He was treated conservatively. A month later, he was found to be diabetic and was put on insulin. He was non-alcoholic and there was no history of any chronic drug use. There was no similar family history.

  4. [Hepatobiliary diseases in Crohn disease and ulcerative colitis].

    Kruis, W

    1987-02-01

    Hepatobiliary diseases are certainly not very frequent extraintestinal complications of chronic intestinal inflammatory diseases, however, they are an important prognostic factor. 2% of patients with ulcerative colitis develop liver cirrhosis but 10% of those die as a direct result of liver failure. Other associated severe hepatobiliary diseases include primary sclerosing cholangitis, carcinoma of the bile duct and amyloidosis. The present review attempts to divide the associated hepatobiliary diseases into three groups. 1. those that are the result of therapy. 2. those that are the result of the pathophysiological mechanisms of the underlying disease and 3. those of unknown etiological origin. This division might serve not only for a better understanding of the various mechanisms but should have some impact on therapeutic regimens.

  5. Strongyloides stercoralis infestation in a patient with severe ulcerative colitis

    Ghoshal Uday

    2006-03-01

    Full Text Available Asymptomatic infestation with Strongyloides stercoralis, common in the tropics, may result in potentially fatal hyperinfection during treatment with immunosuppressive drugs used to treat patients with severe ulcerative colitis (UC. Hence, importance of early recognition and treatment of this nematode in patients with UC before starting immunosuppressive drugs can not be overemphasized. We report a 23-yrs old man with UC who presented with acute severe attack. Since his UC did not respond to intravenous hydrocortisone over 6 days, oral cyclosporine was started on 7th day after repeating stool microscopy, which revealed larvae of Strongyloides stercoralis. Duodenal aspirate also confirmed presence of multiple larvae. He responded to treatment for Strongyloides stercoralis , continuation of hydrocortisone and cyclosporine. Importance of early diagnosis of infestation with Strongyloides stercoralis while on treatment with immunosuppressive drugs for severe UC is emphasized. Difficulties in diagnosis and management of Strongyloides stercoralis infestation in patients with UC are discussed.

  6. Once-daily mesalamine granules for ulcerative colitis.

    Lawlor, Garrett; Ahmed, Awais; Moss, Alan C

    2010-07-01

    Mesalamine extended-release capsules (Apriso [Salix Pharmaceuticals, Raleigh, NC, USA]) are the first once-daily mesalamine preparation approved by the US FDA for the maintenance of remission of ulcerative colitis (UC). Each mesalamine extended-release capsule contains granules of a mesalamine-polymer matrix that are coated with a pH-sensitive resin. This design begins releasing mesalamine (0.375 g) once the pH is more than 6 in the ileum and colon. Two clinical trials have reported that mesalamine extended-release capsules (1.5 g/day) maintained remission in 79% of patients with UC who were in clinical remission. Reported adherence with mesalamine extended-release capsules once daily was high (>90%) in these studies. This article examines the efficacy and safety of mesalamine extended-release capsules in the maintenance of remission in patients with UC.

  7. Ulcerative colitis and steroid-responsive, diffuse interstitial lung disease

    Balestra, D.J.; Balestra, S.T.; Wasson, J.H.

    1988-07-01

    The authors describe a patient with ulcerative colitis and extracolonic manifestations in whom diffuse interstitial pulmonary disease developed that was responsive to glucocorticoid therapy one year after total proctocolectomy. The patient presented in December 1983 with a subacute course marked by cough and progressive exertional dyspnea, abnormal chest examination results, and a chest roentgenogram that revealed diffuse interstitital and alveolar infiltrates. A transbronchial biopsy specimen revealed a polymorphic interstitial infiltrate, mild interstitial fibrosis without apparent intraluminal fibrosis, and no vasculitis, granulomas, or significant eosinophilic infiltration. Within one week of the initiation of daily high-dose steroid therapy, the patient's symptoms dramatically improved; chest roentgenogram and forced vital capacity (60%) improved at a slower rate. All three measures deteriorated when alternate-day prednisone therapy was started but once again improved until the patient was totally asymptomatic, chest roentgenograms were normal, and forced vital capacity was 80% of the predicted value 2 1/2 years later.

  8. Early aggressive therapy for severe extensive ulcerative colitis

    De-Jun Cui

    2009-01-01

    The current ulcerative colitis (UC) treatment algorithm involves a step-up therapeutic strategy, mainly aiming at inducing and maintaining its clinical remission.Although this therapeutic strategy may seem to be cost-efficient and reduce the risk of side effects,recent trials and case reports have shown that topdown therapy using infliximab induces a rapid clinical response, enhances patient quality of life, promotes mucosal healing, reduces surgeries and indirect cost of treatment for patients with severe UC. Moreover,since long-term treatment with infliximab is safe and well tolerated, early aggressive top-down therapeutic strategy may be a more effective approach, at least in a subgroup of severe extensive UC patients.

  9. Ulcerative colitis in a Nigerian girl: A case report

    Senbanjo Idowu O

    2012-10-01

    Full Text Available Abstract Background Ulcerative colitis (UC is uncommon in the tropics and sub-tropics. We report a case of UC in a 7 year old girl whose parents were both Nigerians. This report is to alert healthcare professionals in sub-Saharan Africa that UC is not a rare health problem, especially in children. Case presentation The patient presented with frequent passage of blood stained stool, abdominal pain and significant weight loss. The diagnosis was entertained after she was investigated for common causes of chronic diarrhea in our setting and the findings were negative. The patient symptoms abated after she was commenced on steroid therapy. Conclusion Under-diagnosis and misdiagnosis may account for a dearth of information on UC in African children.

  10. Crohn's disease, ulcerative colitis, and measles vaccine in an English population, 1979–1998

    Seagroatt, V.; Goldacre, M

    2003-01-01

    Study objectives: To study the hospitalised incidence of Crohn's disease (CD) and ulcerative colitis (UC) from 1979 to 1998; and to determine whether the introduction of the measles vaccination programme was associated with an increase in the young.

  11. Expression of apoptosis related proteins during malignant progression in chronic ulcerative colitis

    C.J. van der Woude (Janneke); H. Moshage; M. Homan; J.H. Kleibeuker (Jan); P.L.M. Jansen (Peter); H. van Dekken (Herman)

    2005-01-01

    textabstractBACKGROUND: Chronic ulcerative colitis (CUC) is associated with increased risk of developing colon cancer through a dysplasia (intraepithelial neoplasia)-carcinoma sequence. AIMS: To investigate the expression of apoptosis and inflammatory related proteins in CUC. METHO

  12. Regulation of antiapoptotic and cytoprotective pathways in colonic epithelial cells in ulcerative colitis

    Seidelin, Jakob B

    2015-01-01

    Ulcerative colitis is an inflammatory bowel disease involving the colon resulting in bloody diarrhea and increased risk of colorectal cancer in certain patient subgroups. Increased apoptosis in the epithelial cell layer causes increased permeability, especially during flares; this leads...

  13. Infective Endocarditis Presented as a Right Atrium Mass in a Patient with Ulcerative Colitis

    Ali Asghar Moeinipour

    2015-01-01

    Full Text Available Involvement of the heart is infrequently seen in irritable bowel syndrome (IBD. We present a case of severe acute infective endocarditis diagnosed as ulcerative colitis in further workup.

  14. Treatment with diammonium glycyrrhizinate down-regulates M30 expression in ulcerative colitis in rats

    原皓

    2013-01-01

    Objective To assess the therapeutic effect of diammonium glycyrrhizinate(DG) on2,4,6-trinitro-benzene sulfonic acid(TNBS)-induced ulcerative colitis in rats and to explore the underlying mechanisms by

  15. Open versus laparoscopic (assisted) ileo pouch anal anastomosis for ulcerative colitis and familial adenomatous polyposis

    Ali, Usama Ahmed; Keus, Frederik; Heikens, Joost T.; Bemelman, Willem A.; Berdah, Stephane V.; Gooszen, H. G.; van Laarhoven, Cees J. H. M.

    2009-01-01

    Background Restorative proctocolectomy with ileo pouch anal anastomosis (IPAA) is the main surgical treatment for patients with ulcerative colitis (UC) and familial adenomatous polyposis (FAP). With the advancements of minimal-invasive surgery this demanding operation is increasingly being performed

  16. Metabonomics in Ulcerative Colitis: Diagnostics, Biomarker Identification, And Insight into the Pathophysiology

    Bjerrum, Jacob T; Nielsen, Ole H; Hao, Fuhua;

    2010-01-01

    Nuclear magnetic resonance (NMR) spectroscopy and appropriate multivariate statistical analyses have been employed on mucosal colonic biopsies, colonocytes, lymphocytes, and urine from patients with ulcerative colitis (UC) and controls in order to explore the diagnostic possibilities, define new ...

  17. Concordance of ulcerative colitis in monozygotic twin sisters

    Madoka Horiya; Masatomo Mori; Satoru Kakizaki; Katsunobu Teshigawara; Yuki Kikuchi; Tetsu Hashida; Yoshio Tomizawa; Tomohiro Iida; Takashige Masuo; Hitoshi Takagi

    2005-01-01

    The etiology of inflammatory bowel disease is multifacto rial and appears to combine both genetic and environmental factors. We experienced here a rare occurrence of woman monozygotic twins with ulcerative colitis (UC). A 45-year-old woman (the elder monozygotic twin) was admitted to our hospital because of bloody diarrhea occurring over 10 times per day, abdominal pain and fever. She was diagnosed as UC at the age of 22, and repeated the relapse and remission. She was diagnosed as relapse of UC and total colitis type. Her younger monozygotic twin sister also suffered from UC at the age of 22. Human leukocyte antigen was examined serologically with DNA type in both patients. DRB1*1502, which was previously shown to be dominant in Japanese patients with UC, was not observed in this case. Although the concordance in monozygotic twin in UC is reported to be 6.3-18.8%, the concordant case like this is relatively rare. We report this rare case of UC and the previously reported cases are also discussed.

  18. Fulminant ulcerative colitis associated with steroid-resistant minimal change disease and psoriasis: A case report

    2007-01-01

    A 43-year-old Chinese patient with a history of psoriasis developed fulminant ulcerative colitis after immunosuppressive therapy for steroid-resistant minimal change disease was stopped. Minimal change disease in association with inflammatory bowel disease is a rare condition. We here report a case showing an association between ulcerative colitis, minimal change disease,and psoriasis. The possible pathological link between 3 diseases is discussed.

  19. Remission induction and maintenance effect of probiotics on ulcerative colitis: A meta-analysis

    2010-01-01

    AIM:To evaluate the induction of remission and main-tenance effects of probiotics for ulcerative colitis.METHODS: Information was retrieved from MEDLINE, EMBASE, and the Cochrane Controlled Trials Register. The induction of remission and promotion of mainte-nance were compared between probiotics treatment and non-probiotics treatment in ulcerative colitis.RESULTS: Thirteen randomized controlled studies met the selection criteria. Seven studies evaluated the remission rate, and eight studies estimated the re...

  20. Fulminant ulcerative colitis associated with steroid-resistant minimal change disease and psoriasis: A case report

    Lok, Ka-Ho; Hung, Hiu-Gong; Yip, Wai-Man; Li, Kin-Kong; Li, Kam-Fu; Szeto, Ming-Leung

    2007-01-01

    A 43-year-old Chinese patient with a history of psoriasis developed fulminant ulcerative colitis after immunosuppressive therapy for steroid-resistant minimal change disease was stopped. Minimal change disease in association with inflammatory bowel disease is a rare condition. We here report a case showing an association between ulcerative colitis, minimal change disease, and psoriasis. The possible pathological link between 3 diseases is discussed.

  1. Fulminant ulcerative colitis associated with steroid-resistant minimal change disease and psoriasis: a case report.

    Lok, Ka-Ho; Hung, Hiu-Gong; Yip, Wai-Man; Li, Kin-Kong; Li, Kam-Fu; Szeto, Ming-Leung

    2007-08-07

    A 43-year-old Chinese patient with a history of psoriasis developed fulminant ulcerative colitis after immunosuppressive therapy for steroid-resistant minimal change disease was stopped. Minimal change disease in association with inflammatory bowel disease is a rare condition. We here report a case showing an association between ulcerative colitis, minimal change disease, and psoriasis. The possible pathological link between 3 diseases is discussed.

  2. Distal Ulcerative Colitis Refractory to Rectal Mesalamine: Role of Transdermal Nicotine versus Oral Mesalamine

    Mario Guslandi; Roberto Frego; Edi Viale; Pier Alberto Testoni

    2002-01-01

    BACKGROUND: Distal ulcerative colitis usually responds to treatment with rectal mesalamine, but the management of refractory cases is poorly defined.AIM: To evaluate the possible therapeutic benefit of transdermal nicotine versus oral mesalamine.PATIENTS AND METHODS: Thirty patients with left-sided ulcerative colitis unresponsive to treatment with a mesalamine 4 g enema at bedtime were randomly allocated to additional therapy with either transdermal nicotine 15 mg daily or oral mesalamine 800...

  3. Management of difficult-to-treat patients with ulcerative colitis: focus on adalimumab

    Armuzzi A; Pugliese D; Nardone OM; Guidi L

    2013-01-01

    Alessandro Armuzzi, Daniela Pugliese, Olga Maria Nardone, Luisa Guidi IBD Unit, Complesso Integrato Columbus, Catholic University, Rome, Italy Abstract: The treatment of ulcerative colitis has changed over the last decade, with the introduction of biological drugs. This article reviews the currently available therapies for ulcerative colitis and the specific use of these therapies in the management of patients in different settings, particularly the difficult-to-treat patients. The focus of ...

  4. Refractory ulcerative colitis complicated by cytomegalovirus infection successfully treated with valganciclovir

    Tiziana Larussa

    2012-11-01

    Full Text Available Cytomegalovirus (CMV infection is widespread in the general population. In patients with severe and/or steroid-refractory ulcerative colitis (UC, local reactivation of CMV can be detected in actively inflamed colonic tissue in approximately 30% of cases. However, the role of CMV in patients with UC is not clearly understood. There is evidence to show a possible role in exacerbating a colitis flare, whereas other studies describe CMV as an innocent bystander. We report the case of a patient with severe UC complicated by CMV infection who did not respond to conventional therapy. A complete diagnostic panel for CMV diagnosis, including tissue polymerase chain reaction and immunohistochemistry, was carried out. Three-week therapy with oral valganciclovir resulted in dramatic clinical and endoscopic improvement. Timing of diagnosis and treatment of CMV infection complicating UC is crucial in order to recognize the organ-disease and plan appropriate treatment.

  5. Leclercia adecarboxylata Bacteremia in a Patient with Ulcerative Colitis

    Amir Kashani

    2014-01-01

    Full Text Available Patients with inflammatory bowel disease (IBD are a high risk population for bacteremia. Derangement in the mucosal architecture of the gastrointestinal (GI tract and frequent endoscopic interventions in immunocompromised individuals are considered primary causes. Isolation of opportunistic microorganisms from the bloodstream of IBD patients has been increasingly reported in recent years. Leclercia adecarboxylata is a ubiquitous, aerobic, motile, gram-negative bacillus. The human GI tract is known to harbor this rarely pathogenic microorganism. There are only a few case reports of bacteremia with this microorganism; the majority are either polymicrobial or associated with immunocompromised patients. We describe a case of monomicrobial L. adecarboxylata bacteremia in a 43-year-old female who presented with bloody diarrhea. Colonoscopy revealed diffuse colonic mucosal inflammation with numerous ulcers, and histopathology revealed crypt abscesses. Following an episode of rectal bleeding, two sets of blood cultures grew L. adecarboxylata, which was treated with intravenous ceftriaxone. After a complicated hospital course, she was eventually diagnosed with ulcerative colitis and enteropathic arthritis, treated with intravenous methylprednisolone, mesalamine, and infliximab which resulted in resolution of her symptoms. In our previously immunocompetent patient, derangement of the gut mucosal barrier was the likely cause of bacteremia, yet performing endoscopic intervention may have contributed to bacterial translocation.

  6. Immune thrombocytopenic purpura in ulcerative colitis: a case report and systematic review

    Subhash Chandra

    2014-04-01

    Full Text Available Over 100 extraintestinal manifestations are reported in ulcerative colitis (UC. A commonly reported hematological manifestation is autoimmune hemolytic anemia. On rare occasions, immune thrombocytopenic purpura (ITP has been reported with UC. The presence of thrombocytopenia can complicate the clinical scenario as the number of bloody bowel movements is an important indicator of disease activity in UC. A proposed theory for this association is antigenic mimicry between a platelet surface antigen and bacterial glycoprotein. We are reporting a case of UC and associated ITP managed successfully with anti-TNF therapy. We also performed a systemic review of case reports and a case series reporting this association.

  7. Anti-inflammatory activity of probiotic Bifidobacterium:Enhancement of IL-10 production in peripheral blood mononuclear cells from ulcerative colitis patients and inhibition of IL-8 secretion in HT-29 cells

    Akemi Imaoka; Tatsuichiro Shima; Kimitoshi Kato; Shigeaki Mizuno; Toshiki Uehara; Satoshi Matsumoto; Hiromi Setoyama; Taeko Hara; Yoshinori Umesaki

    2008-01-01

    AIM: To determine the anti-inflammatory activity of probiotic Bifidobacteria in Bifidobacteria-fermented milk (BFM) which is effective against active ulcerative colitis (UC) and exacerbations of UC, and to explore the immunoregulatory mechanisms.METHODS: Peripheral blood mononuclear cells (PBMNC)from UC patients or HT-29 cells were co-cultured with heat-killed probiotic bacteria or culture supernatant of Bifidobacterium breve strain Yakult (BbrY) or Bifidobacterium bifidum strain Yakult (BbiY) to estimate the amount of IL-10 or IL-8 secreted.RESULTS: Both strains of probiotic Bifidobacteria contained in the BFM induced IL-10 production in PBMNC from UC patients, though BbrY was more effective than BbiY.Conditioned medium (CM) and DNA of both strains inhibited IL-8 secretion in HT-29 cells stimulated with TNF-α, whereas no such effect was observed with heatkilled bacteria.The inhibitory effect of CM derived from BbiY was greater than that of CM derived from BbrY.DNAs of the two strains had a comparable inhibitory activity against the secretion of IL-8.CM of BbiY induced a repression of IL-8 gene expression with a higher expression of IκB-ζ mRNA 4 h after culture of HT-29 cells compared to that in the absence of CM.CONCLUSION: Probiotic Bifidobacterium strains in BFM enhance IL-10 production in PBMNC and inhibit IL-8 secretion in intestinal epithelial cells, suggesting that BFM has anti-inflammatory effects against ulcerative colitis.

  8. Clinical investigation of 41 patients with ischemic colitis accompanied by ulcer

    Satohiro Matsumoto; Kenichiro Tsuji; Satoshi Shirahama

    2007-01-01

    AIM: To investigate the relationship among the presence of ulcer lesions, underlying disease, and clinical course in patients with ischemic colitis.METHODS: The subjects were 41 patients (10 male and 31 female; mean age 70 years) with ischemic colitis who were admitted to and received treatment in our hospital from 2000 to 2006. We compared their characteristics and analyzed the mean lengths of admission and fasting for 9 patients with ulcer lesions (ulcer group) and 32 without (non-ulcer group).RESULTS: The groups with presence and absence of ulcer differed significantly only in white blood cell (WBC)count. Lengths of fasting and admission were 7.9 d and 17.9 d for the ulcer group and 4.4 d and 10.7 d for the non-ulcer group, respectively, and significantly longer in the ulcer group (P = 0.0057 and 0.0001). There was no correlation between presence of ulcer and presence of underlying diseases.CONCLUSION: Lengths of fasting and admission were significantly longer in patients with ischemic colitis with ulcer than for those without ulcer.

  9. Protective Effect of Amphipterygium adstringens Extract on Dextran Sulphate Sodium-Induced Ulcerative Colitis in Mice

    Mario Rodriguez-Canales

    2016-01-01

    Full Text Available Amphipterygium adstringens is an endemic species in Mexico commonly known as “cuachalalate.” Healers to treat gastritis, gastric ulcers, and gastrointestinal cancer have traditionally used the bark. We investigated the effects of alcoholic extract of A. adstringens (AaEE in DSS-induced colitis in mice. The protective effect of AaEE was determined at 200 mg/kg by oral gavage for 10 days. We determine the effect of AaEE on clinical features (disease activity index, antioxidants, anti-inflammatory, and immunomodulatory activities in relation to the activity of SOD, CAT, and GPx, levels of proinflammatory cytokines, and changes both macroscopic and microscopic of the colonic mucosa. AaEE significantly reduced the inflammation of colon and significantly increased SOD and GPx activities. AaEE also significantly decreased TNF-α, IFN-γ, and IL-1β cytokine levels compared to DSS-treated mice and reduced both infiltration of inflammatory cells and the mucosal damage in colon. The results suggested the protective potential of AaEE in DSS-induced colitis and this might be attributed to its phytochemicals compounds that have been found to induce a wide spectrum of activities such as reduction in oxidative stress, suppression of inflammation, modulating numerous signal transduction pathways, and induction of apoptosis. The findings of this study suggest that AaEE has substantial potential for the treatment of inflammatory colitis.

  10. Protective Effect of Amphipterygium adstringens Extract on Dextran Sulphate Sodium-Induced Ulcerative Colitis in Mice

    Rodriguez-Canales, Mario; Jimenez-Rivas, Ruben; Canales-Martinez, Maria Margarita; Garcia-Lopez, Ana Judith; Rivera-Yañez, Nelly; Nieto-Yañez, Oscar; Ledesma-Soto, Yadira; Sanchez-Torres, Luvia Enid; Rodriguez-Sosa, Miriam; Terrazas, Luis Ignacio

    2016-01-01

    Amphipterygium adstringens is an endemic species in Mexico commonly known as “cuachalalate.” Healers to treat gastritis, gastric ulcers, and gastrointestinal cancer have traditionally used the bark. We investigated the effects of alcoholic extract of A. adstringens (AaEE) in DSS-induced colitis in mice. The protective effect of AaEE was determined at 200 mg/kg by oral gavage for 10 days. We determine the effect of AaEE on clinical features (disease activity index), antioxidants, anti-inflammatory, and immunomodulatory activities in relation to the activity of SOD, CAT, and GPx, levels of proinflammatory cytokines, and changes both macroscopic and microscopic of the colonic mucosa. AaEE significantly reduced the inflammation of colon and significantly increased SOD and GPx activities. AaEE also significantly decreased TNF-α, IFN-γ, and IL-1β cytokine levels compared to DSS-treated mice and reduced both infiltration of inflammatory cells and the mucosal damage in colon. The results suggested the protective potential of AaEE in DSS-induced colitis and this might be attributed to its phytochemicals compounds that have been found to induce a wide spectrum of activities such as reduction in oxidative stress, suppression of inflammation, modulating numerous signal transduction pathways, and induction of apoptosis. The findings of this study suggest that AaEE has substantial potential for the treatment of inflammatory colitis. PMID:27635116

  11. Genetically determined high activity of IL-12 and IL-18 in ulcerative colitis and TLR5 in Crohns disease were associated with non-response to anti-TNF therapy

    Bank, S; Andersen, P S; Burisch, Johan

    2017-01-01

    Anti-tumour necrosis factor-α (TNF-α) is used for treatment of severe cases of inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC). However, one-third of the patients do not respond to the treatment. A recent study indicated that genetically determined hi...

  12. Significant Differences Between Crohn's Disease and Ulcerative Colitis Regarding the Impact of Body Mass Index and Initial Disease Activity on Responsiveness to Azathioprine: Results from a European Multicenter Study in 1,176 Patients

    M.H. Holtmann; F. Krummenauer; C. Claas; K. Kremeyer; D. Lorenz; O. Rainer; I. Vogel; U. Boecker; S. Boehm; C. Buening; R. Duchmann; G. Gerken; H. Herfarth; N. Luegering; W. Kruis; M. Reinshagen; J Schmidt; A. Stallmach; J. Stein; A. Sturm; P.R. Galle; D.W. Hommes; G. D'Haens; P. Rutgeerts; M.F. Neurath

    2010-01-01

    In a survey comprising 1,176 patients with inflammatory bowel disease (IBD) we recently showed that azathioprine (AZA) beyond 4 years is beneficial in ulcerative colitis (UC) patients and in a subset of Crohn's disease (CD) patients. Here, we show for the first time that azathioprine responsiveness

  13. Lycopene, Lutein and Zeaxanthin May Reduce Faecal Blood, Mucus and Pus but not Abdominal Pain in Individuals with Ulcerative Colitis

    Głąbska, Dominika; Guzek, Dominika; Zakrzewska, Paulina; Włodarek, Dariusz; Lech, Gustaw

    2016-01-01

    Background: The main symptom of ulcerative colitis is diarrhoea, which is often accompanied by painful tenesmus and faecal blood and mucus. It sometimes co-occurs with abdominal pain, fever, feeling of fatigue, loss of appetite and weight loss. Some dietary factors have been indicated as important in the treatment of ulcerative colitis. The aim of the study was to analyse the association between retinoid intake (total vitamin A, retinol, β-carotene, α-carotene, β-cryptoxanthin, lycopene, lutein and zeaxanthin) and ulcerative colitis symptoms (abdominal pain, faecal blood, faecal mucus, faecal pus) in individuals with ulcerative colitis in remission. Methods: Assessment of diet was based on self-reported data from each patient’s dietary records taken over a period of three typical, random days (2 weekdays and 1 day of the weekend). Results: A total of 56 individuals with ulcerative colitis in remission (19 males and 37 females) were recruited for the study. One in every four individuals with ulcerative colitis in remission was characterised as having inadequate vitamin A intake. Higher lycopene, lutein and zeaxanthin intakes in individuals with ulcerative colitis in remission were associated with lower faecal blood, mucus and pus but not with lower incidence of abdominal pain. Higher carotene intake in individuals with ulcerative colitis in remission may contribute to higher incidence of faecal mucus. Conclusions: Optimising intake of specific retinoids may enhance disease control in individuals with ulcerative colitis. Prospective studies, including patient reported and objective outcomes, are required to confirm this. PMID:27706028

  14. Computed tomography of Crohn`s disease and ulcerative colitis; Computertomographische Morphologie von Morbus Crohn und Colitis ulcerosa

    Klein, H.M. [Klinik fuer Radiologische Diagnostik der RWTH, Aachen (Germany); Wein, B. [Klinik fuer Radiologische Diagnostik der RWTH, Aachen (Germany); Adam, G. [Klinik fuer Radiologische Diagnostik der RWTH, Aachen (Germany); Ruppert, D. [Klinik fuer Radiologische Diagnostik der RWTH, Aachen (Germany); Guenther, R.W. [Klinik fuer Radiologische Diagnostik der RWTH, Aachen (Germany)

    1995-07-01

    We analysed the CT examinations of 109 patients with 197 involved bowel locations. 81 patients suffered from Crohn`s disease, 28 from ulcerative colitis. Diagnosis was based on the combination of clinical, endoscopic and histopathologic findings. Three radiologists evaluated the CT series concerning the presence of morphologic changes analogous to conventional radiographic findings. In Crohn`s disease, we found irregular outer contours in 26% of cases. The bowel wall was thickened in 82%. In acute phases, the bowel wall was thickened in 100%. Abscess and fistula as complications of inflammatory disease were present in 26 and 14% respectively. In ulcerative colitis, a target sign of the bowel wall was present in 40%, whereas in Crohn`s disease a homogeneous wall density was present in all but two cases. Reduced attenuation due to submucosal fat deposits was found in 16% and mucosal tunneling in 27% of cases with ulcerative colitis. Even if severe mucosal destructions were found, the outer contour of the gut was smooth and regular in 95% of the ulcerative colitis cases. CT can provide additional information on acuity, extent and complications in inflammatory bowel disease. In combination with conventional radiographic findings a three-step classification for Crohn`s disease and ulcerative colitis (early changes, acute and chronic phase) can be proposed. (orig./MG) [Deutsch] Wir untersuchten computertomographisch 109 Patienten mit 197 erkrankten Darmsegmenten. 81 Patienten litten an M. Crohn und 28 an Colitis ulcerosa. Die Diagnose wurde durch Kombination klinischer, endoskopischer, radiologischer und bioptischer Befunde gesichert. Drei Radiologen bewerteten die Computertomographien und verglichen die Ergebnisse mit den konventionell-radiologischen Befunden. Bei den Patienten mit M. Crohn fanden wir in 26% der Faelle eine irregulaere aeussere Darmwand. Eine Darmwandverdickung lag in 82% vor und fand sich regelmaessig in Darmabschnitten mit floriden Veraenderungen

  15. IL-22+ CD4+ T cells are associated with therapeutic trichuris trichiura infection in an ulcerative colitis patient.

    Broadhurst, Mara J; Leung, Jacqueline M; Kashyap, Vikram; McCune, Joseph M; Mahadevan, Uma; McKerrow, James H; Loke, P'ng

    2010-12-01

    Ulcerative colitis, a type of inflammatory bowel disease, is less common in countries endemic for helminth infections, suggesting that helminth colonization may have the potential to regulate intestinal inflammation in inflammatory bowel diseases. Indeed, therapeutic effects of experimental helminth infection have been reported in both animal models and clinical trials. Here, we provide a comprehensive cellular and molecular portrait of dynamic changes in the intestinal mucosa of an individual who infected himself with Trichuris trichiura to treat his symptoms of ulcerative colitis. Tissue with active colitis had a prominent population of mucosal T helper (T(H)) cells that produced the inflammatory cytokine interleukin-17 (IL-17) but not IL-22, a cytokine involved in mucosal healing. After helminth exposure, the disease went into remission, and IL-22-producing T(H) cells accumulated in the mucosa. Genes involved in carbohydrate and lipid metabolism were up-regulated in helminth-colonized tissue, whereas tissues with active colitis showed up-regulation of proinflammatory genes such as IL-17, IL-13RA2, and CHI3L1. Therefore, T. trichiura colonization of the intestine may reduce symptomatic colitis by promoting goblet cell hyperplasia and mucus production through T(H)2 cytokines and IL-22. Improved understanding of the physiological effects of helminth infection may lead to new therapies for inflammatory bowel diseases.

  16. [Treatment of patients with severe glucocorticoid-refractory ulcerative colitis: cyclosporine or infliximab?

    Lowenberg, M.; Boer, N.K. de; Dewint, P.; Hoentjen, F.

    2013-01-01

    - Cyclosporine and infliximab are so-called 'rescue-therapies' as last resort for the treatment of patients with severe glucocorticoid-refractory ulcerative colitis.- A recent study found that cyclosporine and infliximab are similar in terms of efficacy in the treatment of patients with severe ulcer

  17. A case of ulcerative colitis presenting as pyoderma gangrenosum and lung nodule

    Xin Li

    2014-02-01

    Full Text Available Pyoderma gangrenosum is a phenomenon of cutaneous ulceration where etiology is not well understood. About half of the cases have an associated extracutanoeus manifestation or associated systemic diseases. Most commonly associated systemic disorders include inflammatory bowel disease, hematologic malignancies, autoimmune arthritis, and vasculitis. We are reporting a case where pyoderma gangrenosum has presenting features for ulcerative colitis.

  18. ERK controls epithelial cell death receptor signalling and cellular FLICE-like inhibitory protein (c-FLIP) in ulcerative colitis

    Seidelin, Jakob Benedict; Coskun, Mehmet; Vainer, Ben

    2013-01-01

    Intestinal epithelial cell (IEC) death signalling through the Fas receptor is impaired in active ulcerative colitis (UC). This is possibly due to the activation of cytoprotective pathways resulting in limitation of the tissue injury secondary to inflammation. We hypothesized that inflammatory...... the resistance to receptor mediated epithelial apoptosis in active UC. Oncogenic c-FLIP could promote propagation of DNA-damaged IECs and contribute to cancer development in UC....

  19. Indications and Contraindications to Reconstructive Surgery in Ulcerative Colitis

    David Johnston

    1995-01-01

    Full Text Available Surgical treatment is often needed for patients with ulcerative colitis because of toxic dilation, intractability or risk of cancer. Precise diagnosis is vital to exclude Crohn's disease and infective colitis, although patients with `indeterminate' colitis often do well after reconstructive surgery. Restorative proctocolectomy, in which the anal sphincter is preserved and a pelvic ileal reservoir is used as a substitute for the rectum, is the standard surgical procedure, supplanting panproctocolectomy with ileostomy. Ileorectal anastomosis should also be considered, but is only suitable for patients with relative rectal sparing, and meticulous sigmoidoscopic follow-up is essential. For toxic dilation, colectomy with ileostomy and mucous fistula is recommended, proctectomy and reconstruction being deferred until the patient is fitter. For most patients, the entire colon and rectum are removed and a pelvic ileal reservoir is anastomosed to the anus. Many types of reservoir have been proposed, but randomized trials are few, and it seems that the J pouch is as good as the S or W pouches, and technically is simpler. The operative mortality of restorative proctocolectomy worldwide has been about 1%, thanks largely to the routine use of a temporary defunctioning ileostomy. A one-stage procedure without ileostomy is permissible if the patient is relatively fit and the surgeon is in attendance for 10 days after operation, but omission of the ileostomy certainly increases the risk to life and the postoperative morbidity, and should thus not be done in debilitated patients or in those on high dose steroids. Resection of the mucosal lining of the anal canal above the dentate line (`mucosal proctectomy' was formerly routine, but leads to diminished sphincter pressure and sensation, such that preservation of the entire motor and sensory sphincteric complex is now advocated by many authors. Omission of mucosal stripping renders the procedure technically

  20. Defensin expression in chronic pouchitis in patients with ulcerative colitis or familial adenomatous polyposis coli

    Karlheinz Kiehne; Gabriele Brunke; Franziska Wegner; Tomas Banasiewicz; Ulrich R F(o)lsch; Karl-Heinz Herzig

    2006-01-01

    AIM:Pouchitis develops in ileoanal pouches in up to 50% of patients with ulcerative colitis during the first 10years after pouch surgery while being rare in patients after proctocolectomy for familial adenomatous polyposis coii (FAP) syndrome. Defensins are major components of the innate immune system and play a significant role in gastrointestinal microbial homeostasis. Pouch defensin and cytokine expression were correlated with states of pouch inflammation to study their role in pouchitis.METHODS:Patients with ulcerative colitis and FAP syndrome were stratified into groups with pouches after surgery, pouches without or with pouchitis. Biopsies from terminal ileum from a healthy intestine or from normal terminal ileum of patients with ulcerative colitis served as controls, mRNA from pouches and controls was analysed for defensin and cytokine expression.RESULTS: Expression of defensins was increased in all pouches immediately after surgery, compared to ileum of controls. Initially, pouches in ulcerative colitis revealed higher defensin expression than FAP pouches. Defensin expression declined in both patient groups and increased again slightly in pouchitis in patients with ulcerative colitis. FAP pouches without pouchitis had strong expression of β-defensin hBD-1, while all other defensins remained at low levels. Cytokine expression in ulcerative colitis pouches was high, while FAP pouches showed moderately elevated cytokines only after surgery.CONCLUSION: Development of pouchitis correlates with decreased defensin expression in ulcerative colitis in addition to high expression of cytokines. The low incidence of pouchitis in FAP pouches correlates with increased expression of hBD-1 β- defensin in association with low cytokine levels.

  1. Adalimumab induction therapy for ulcerative colitis with intolerance or lost response to infliximab: An open-label study

    Laurent Peyrin-Biroulet; Cécils Laclotte; Xavier Roblin; Marc-André Bigard

    2007-01-01

    AIM: To evaluate the efficacy of adalimumab induction therapy in patients with ulcerative colitis who previously responded to infliximab and then lost response or became intolerant.METHODS: Ten patients with ulcerative colitis were enrolled in a 4-wk open-label trial. The patients received a loading dose of 160 mg adalimumab at wk 0 followed by 80 mg at wk 2. The primary efficacy measure was clinical improvement at wk 4, as defined by a decrease in clinical activity index (CAI) of more than 4.RESULTS: Four of 10 patients (40%) benefited from subsequent adalimumab therapy; one patient achieved remission (CAI < 4) and 3 had clinical improvement at wk 4. 6 patients had no response (60%); 2 of 6 (33.3%) subsequently underwent colectomy. This was accompanied by a decrease in median CRP concentration from 16.8 mg/mL at baseline to 3.85 mg/mL at wk 4, excluding two patients who underwent colectomy after two infusions of adalimumab. Among the 6 patients with severe colitis (CAI > 12) at baseline, none achieved remission and only one patient had clinical improvement at wk 4.CONCLUSION: The small advantage of adalimumab in patients with mild to moderate ulcerative colitis and lost response or intolerance to infliximab needs to be confirmed in randomised, double-blind, placebocontrolled trials.

  2. Antibiotic-responsive histiocytic ulcerative colitis in 9 dogs.

    Hostutler, Roger A; Luria, Brian J; Johnson, Susan E; Weisbrode, Steven E; Sherding, Robert G; Jaeger, Jordan Q; Guilford, W Grant

    2004-01-01

    Canine histiocytic ulcerative colitis (HUC) is characterized by colonic inflammation with predominantly periodic acid-Schiff (PAS)-positive macrophages. The inflammation results in colonic thickening, ulcerations, and distortion of normal glandular architecture. Resultant clinical signs consist of chronic large bowel diarrhea, tenesmus, and marked weight loss, and the disease frequently results in euthanasia. Conventional therapy consists of some combination of prednisone, azathioprine, sulfasalazine, and metronidazole. Nine dogs (8 Boxers and 1 English Bulldog) with histologic confirmation of HUC were treated with antibiotic therapy (either with enrofloxacin alone or in combination with metronidazole and amoxicillin). Clinical signs, physical examination findings, laboratory abnormalities, and the histologic severity of the disease were evaluated. Four of the 9 dogs had been treated previously with conventional therapy and had failed to respond favorably; then, these dogs were placed on antibiotic therapy (enrofloxacin, n = 1; enrofloxacin, metronidazole, and amoxicillin, n = 3) and had resolution of clinical signs within 3-12 days. Five dogs were treated solely with antibiotic therapy (enrofloxacin, n = 1; enrofloxacin and metronidazole, n = 1; enrofloxacin, metronidazole, and amoxicillin, n = 3), and clinical signs resolved in 2-7 days. Repeated biopsy specimens were obtained from 5 dogs after treatment, and all showed marked histologic improvement. The increase in body weight after treatment was statistically significant (P = .01). Three dogs currently are not on any treatment and have had resolution of clinical signs for up to 14 months. These observations suggest that an infectious agent responsive to antibiotics plays an integral role in the clinical manifestation of canine HUC, and they support the use of antibiotics in its treatment.

  3. Evaluation of large intestinal mucosa regeneration in ulcerative colitis using linear measurements

    Đolai Matilda

    2005-01-01

    Full Text Available Ulcerative colitis is a chronic inflammatory condition characterized by three phases: active, regression and remission phase. The active phase is followed by atrophy of the large intestinal mucosa. Although its evaluation is sometimes difficult, quantification of ceratin mucosal parameters can be used as an accessory method. The aim of the study was to determine the parameters of linear micrometry in order to estimate the regeneration of the large intestinal mucosa in ulcerative colitis, and to evaluate the efficiency of this method in everyday work. The measurements were performed on routine bioptic samples after qualitative histologic analysis and determination of the type and stage of the disease. The measurements were carried out to determine: the number of crypts per unit length, the height of crypt epithelium, diameter of crypts, their lumen and interstices; also, the quotient between the diameters of crypts and interstices was calculated. The analysis of the measured parameters points to presence and degree of regeneration and/or atrophy of mucosa, particularly by following the parameters of crypt epithelium. Linear measurements can be used in estimation of regeneration and atrophy of large intestinal mucosa. .

  4. Anti-inflammatory effect of Diammonium Glycyrrhizinate in a rat model of ulcerative colitis

    Hao Yuan; Wan-Sheng Ji; Ke-Xiang Wu; Jian-Xin Jiao; Liang-Hua Sun; Yong-Tang Feng

    2006-01-01

    AIM: To explore the anti-inflammatory mechanism of Diammonium Glycyrrhizinate in a rat model of ulcerative colitis induced by acetic acid.METHODS: Spragur-Dawley female rats were divided into four groups: Diammonium Glycyrrhizinate group,dexamethasone group, acetic acid control and normal control group. Colonic inflammation was evaluated by disease activity index, gross morphologic damage,histological injury and colonic myeloperoxidase activity.Immunohistochemistry was used to detect the expression of NF-κB, TNF-α and ICAM-1 in colonic mucosa.RESULTS: Compared to the acetic acid control, both Diammonium Glycyrrhizinate and dexamethasone showed a significant anti-inflammatory effect (P<0.01).The expression of NF-κB, TNF-α and ICAM-1 in colonic mucosa was significantly lower in the Diammonium Glycyrrhizinate group and dexamethasone group than in the acetic acid group.CONCLUSION: Diammonium Glycyrrhizinate could reduce inflammatory injury in a rat model of ulcerative colitis. This may occur via suppression of NF-κB, TNF-α and ICAM-1 in colonic mucosa.

  5. Hyperhomocysteinemia in ulcerative colitis is related to folate levels

    Petros Zezos; Georgia Papaioannou; Nikolaos Nikolaidis; Themistoclis Vasiliadis; Olga Giouleme; Nikolaos Evgenidis

    2005-01-01

    AIM: To study the prevalence and clinical significance of hyperhomocysteinemia (hHcys), an independent factor for arterial and venous thrombosis, in a group of patients with ulcerative colitis (UC).METHODS: Fasting homocysteine (Hcys), folate, and vitamin B12 serum levels were measured in 40 UC patients and 50 healthy controls. Clinical data regarding UC were gathered.RESULTS: Median serum Hcys levels in UC patients were similar to those in controls (12.26 μmol/L vs 12.32 μmol/L), but the prevalence of hHcys was higher in UC patients than in controls (30% vs 10%, P= 0.028). UC significantly increased the risk of hHcys (adjusted odds ratio: 4.125;95% CI: 1.26-13.44). Multivariate regression analysis showed that male sex, folate and vitamin B12 deficiency or lower serum values were significant independent predictors of higher Hcys levels in UC patients (r2 = 0.4; P<0.001).CONCLUSION: hHcys is common in UC patients and it is related to folate and vitamin B12 deficiency or lower serum values. It would be reasonable for patients with UC to receive folate and vitamin B complex supplements as a prophylactic measure.

  6. Ulcerative colitis and Crohn's disease tissue cytotoxins

    McLaren, L.C.; Gitnick, G.

    1982-06-01

    Bowel-wall tissue filtrates from patients with inflammatory bowel disease produce cytopathic effects in tissue culture. The cytopathic effects inducers have been reported to have the characteristics of a small RNA virus. Clostridium difficile toxin also produces cytopathic effects and has been found in the stools of patients with Crohn's disease and ulcerative colitis. The present study concerns the further characterization of the cytopathic inducers in tissues of inflammatory bowel disease patients. It was found that they are nonsedimentable at 148,000 g for 2 h and resistant to inactivation by UV light. They are proteins that are distinct from C. difficile toxin and are unique cytotoxins which are associated with the early cytopathic effects observed in Riff-free chick embryo and rabbit ileum cell cultures. These results suggest that the early cytopathic effects previously described are not produced by a virus. They do not explain the delayed cytopathic effects seen in rabbit ileum or WI-38 cells.

  7. Resolution of Severe Ulcerative Colitis with the Specific Carbohydrate Diet

    Birgit N. Khandalavala

    2015-08-01

    Full Text Available A 73-year-old female of Asian origin was diagnosed with ulcerative colitis (UC after initial gastrointestinal symptoms of abdominal pain and bloody diarrhea. She had a relatively benign course over the subsequent 12 years. In 2009, she had increased left-sided abdominal pain, bloody diarrhea and progressive weight loss, due to a severe exacerbation. In spite of a variety of standard treatments, her condition continued to decline with a significant impact on normal life and functioning. In December of 2010, repeat colonoscopy and microscopy confirmed pancolitis, without diverticulitis. The Specific Carbohydrate Diet (SCD was initiated due to failure of conventional therapies. Following this highly restricted diet, within a period of 3-6 months, improvement was noted, and within a year, no abdominal pain or diarrhea were present, and she returned to her baseline functioning and career. Two years later, repeat colonoscopy showed resolution of the pancolitis, confirmed with microscopic evaluation. Successful use of the SCD in children with UC has been documented. We describe previously unreported, highly beneficial results with both symptomatic and clinical improvement and complete remission of UC in an adult female with the SCD.

  8. Clinical manifestations and outcomes in severe ulcerative colitis

    YANG Xuesong; YAO Wei; LIU Wenbin; LI Jun; LU Yumin

    2007-01-01

    In order to evaluate the clinical manifestations and outcomes of severe ulcerative colitis (UC),we retrospectively reviewed 41 patients with severe UC from 144 consecutively hospitalized UC cases from 1988 to 2004.Data recorded included onset,symptoms,signs,laboratory results,endoscopic,radiologic and pathologic findings,the clinical treatment process and follow-up.Of these severe cases,92.7%(38/41)had pancolitis.Clinically,36.9%(15/41)were categorized as first onset type,36.9%(15/41)were chronic persistent and 26.8%(11/41)were chronic recurrent.Steroids played a main role in the remission of severe UC(61.0%).Thirty-one cases(75.6%) were relieved by drug therapy.Seven cases(17.1%) progressed to the need for operation.An early age of onset,pancolitis,low hemoglobin and serum albumin levels,and the need for intravenous steroids tended to be associated with the need for surgery.In conclusion,most of the severe UC patients respond well to drug therapy,but for individuals who are unresponsive to drug therapy,or for those depending on steroids,after a reasonable duration of treatment,the necessity for surgery should be considered.

  9. Herbal medicine in the treatment of ulcerative colitis

    Fei Ke

    2012-01-01

    Full Text Available Ulcerative colitis (UC is a refractory, chronic, and nonspecific disease occurred usually in the rectum and the entire colon. The etiopathology is probably related to dysregulation of the mucosal immune response toward the resident bacterial flora together with genetic and environmental factors. Several types of medications are used to control the inflammation or reduce symptoms. Herbal medicine includes a wide range of practices and therapies outside the realms of conventional Western medicine. However, there are limited controlled evidences indicating the efficacy of traditional Chinese medicines, such as aloe vera gel, wheat grass juice, Boswellia serrata, and bovine colostrum enemas in the treatment of UC. Although herbal medicines are not devoid of risk, they could still be safer than synthetic drugs. The potential benefits of herbal medicine could lie in their high acceptance by patients, efficacy, relative safety, and relatively low cost. Patients worldwide seem to have adopted herbal medicine in a major way, and the efficacy of herbal medicine has been tested in hundreds of clinical trials in the management of UC. The evidences on herbal medicine are incomplete, complex, and confusing, and certainly associated with both risks and benefits. There is a need for further controlled clinical trials of the potential efficacy of herbal medicine approaches in the treatment of UC, together with enhanced legislation to maximize their quality and safety.

  10. Herbal medicine in the treatment of ulcerative colitis.

    Ke, Fei; Yadav, Praveen Kumar; Ju, Liu Zhan

    2012-01-01

    Ulcerative colitis (UC) is a refractory, chronic, and nonspecific disease occurred usually in the rectum and the entire colon. The etiopathology is probably related to dysregulation of the mucosal immune response toward the resident bacterial flora together with genetic and environmental factors. Several types of medications are used to control the inflammation or reduce symptoms. Herbal medicine includes a wide range of practices and therapies outside the realms of conventional Western medicine. However, there are limited controlled evidences indicating the efficacy of traditional Chinese medicines, such as aloe vera gel, wheat grass juice, Boswellia serrata, and bovine colostrum enemas in the treatment of UC. Although herbal medicines are not devoid of risk, they could still be safer than synthetic drugs. The potential benefits of herbal medicine could lie in their high acceptance by patients, efficacy, relative safety, and relatively low cost. Patients worldwide seem to have adopted herbal medicine in a major way, and the efficacy of herbal medicine has been tested in hundreds of clinical trials in the management of UC. The evidences on herbal medicine are incomplete, complex, and confusing, and certainly associated with both risks and benefits. There is a need for further controlled clinical trials of the potential efficacy of herbal medicine approaches in the treatment of UC, together with enhanced legislation to maximize their quality and safety.

  11. Magnetic resonance colonography in severe attacks of ulcerative colitis

    Savoye-Collet, C.; Roset, J.B.; Koning, E.; Dacher, J.N. [Rouen University Hospital Charles Nicolle, Radiology Department - QUANTIF - LITIS EA 4108, Rouen (France); Charpentier, C.; Hommel, S.; Lerebours, E.; Savoye, G. [Rouen University Hospital Charles Nicolle, Gastroenterology Department - ADEN U 1073, Rouen (France)

    2012-09-15

    To evaluate the ability of MR colonography (MRC) to detect lesions in severe attacks of ulcerative colitis (UC) and to assess its concordance with rectosigmoidoscopy. Eighteen patients underwent MRC and rectosigmoidoscopy. MRC consisted of a water-filled colonic procedure followed by T1/T2w images. Image quality was recorded. Inflammatory lesions and the existence of signs of severity were analysed. We calculated MR accuracy in the diagnosis of inflammatory lesions, as well as per segment and per patient concordance depending on the presence or absence of severe lesions. The MR image quality of the 108 segments was satisfactory. Endoscopy was used to study 36 segments (rectum and sigmoid). MRC had a positive predictive value of 100% and a sensitivity of 64% in the diagnosis of inflammatory lesions. Concordance for the diagnosis of severe lesions was excellent for the rectum (k = 0.85) and good for the sigmoid (k = 0.64). MRC diagnosed signs of severity in all patients affected at endoscopy. MRC also disclosed signs of severity located higher in the colon in four patients with nonsevere lesions at rectosigmoidoscopy. MRC can accurately diagnose inflammatory lesions in severe attacks of UC and significantly correlates with rectosigmoidoscopy in the diagnosis of severe lesions. (orig.)

  12. Incidence of ulcerative colitis in Central Greece: A prospective study

    Spiros D. Ladas; Elias Mallas; Konstantinos Giorgiotis; Georgios Karamanolis; Dimitrios Trigonis; Apostolos Markadas; Vana Sipsa; Sotirios A. Raptis

    2005-01-01

    AIM: To study the incidence of ulcerative colitis UC in the prefecture of Trikala, Central Greece.METHODS: A prospective and population basedepidemiological study of UC from 1990 to the end of 1994was conducted. Trikala is a semirural prefecture of Central Greece with a population of 138 946 (census 1991). Three gastroenterologists (one hospital based, two private doctors)of the prefecture participated in this study.RESULTS: During the study period, 66 new histologically verified cases of UC were recorded. The mean annual incidence of the disease in 1990-1994 was 11.2 per 105inhabitants (95%CI: 8.7-14.3). There was no difference between men and women (annual incidence: 10.5 and 12.0 per 105 inhabitants respectively), either among urban,semirural or rural populations (annual incidence: 11.7,17.1 and 9.9 per 105 inhabitants respectively). The majority (56%) of the patients never smoked and a quarter were ex-smokers. About a half of all cases had proctitis.CONCLUSION: UC is common in Central Greece and its incidence is similar to that in North-Western European countries.

  13. Developments in the treatment of moderate to severe ulcerative colitis: focus on adalimumab

    Freeman HJ

    2013-11-01

    Full Text Available Hugh J FreemanDepartment of Medicine (Gastroenterology, University of British Columbia, Vancouver, BC, Canada Abstract: In selected patients with moderate to severe active ulcerative colitis who have failed to respond or are poorly responsive to standard pharmacologic forms of treatment with corticosteroids and immunosuppressive agents, therapy with a biological agent may be considered. While infliximab is an established tumor necrosis factor blocker and has a longer history of clinical use, adalimumab is an alternative in the same class and may be employed as an initial biological agent, if indicated for treatment of the disease. Adalimumab may have special appeal to stable users able to self-inject in a home setting rather than a centralized infusion center. Short-term adverse effects have been limited, but long-term adverse events can be serious and remain less well defined. Recently, another agent, subcutaneous golimumab, has also been reported to induce and maintain clinical response and remission in clinical trials, but a large experience has not been accumulated to date in clinical practice. In the future, other biological agents with novel and distinct mechanisms of therapeutic action may become available. Keywords: ulcerative colitis, anti-tumor necrosis factor inhibitors, biological therapy, infliximab, adalimumab

  14. Steroid-refractory ulcerative colitis and associated primary sclerosing cholangitis treated with infliximab

    Duca, Ileana; Ramírez de la Piscina, Patricia; Estrada, Silvia; Calderón, Rosario; Spicakova, Katerina; Urtasun, Leire; Marra-López, Carlos; Zabaleta, Salvador; Bengoa, Raquel; Marcaide, María Asunción; García-Campos, Francisco

    2013-01-01

    Primary sclerosing cholangitis is an infrequent extraintestinal manifestation of ulcerative colitis. Damage to bile ducts is irreversible and medical therapies to prevent progression of the disease are usually ineffective. We describe a patient with long-standing ulcerative colitis, which was refractory to corticosteroid therapy who developed primary sclerosing cholangitis (biochemical stage II/IV) in the course of his pancolitis. Treatment with infliximab (5 mg/kg as an induction dose followed by maintenance doses every two months) was indicated because of steroid-dependent disease associated to primary sclerosing cholangitis as well as sacroiliitis and uveitis and previous episode of severe azathioprine-related hepatic toxicity. At present, after two years of follow-up, the patient is asymptomatic with normal liver tests and complete resumption of daily life activities. This case draws attention to the usefulness of anti-tumor necrosis factor-alpha therapy for the management of primary sclerosing cholangitis as extraintestinal manifestation of inflammatory bowel disease. PMID:23382642

  15. Sulphomucin expression in ileal pouches: emerging differences between ulcerative colitis and familial adenomatous polyposis pouches.

    Bambury, Niamh

    2012-02-03

    PURPOSE: We characterized the expression of sialomucin and sulphomucin in pouches fashioned for familial adenomatous polyposis and ulcerative colitis. We correlated sulphomucin expression with bacterial colonization and mucosal inflammation. METHODS: Ethical approval and informed consent were obtained. Mucosal biopsies from 9 patients with familial adenomatous polyposis and 12 with ulcerative colitis were obtained. Sulphomucin levels were assessed by using the high iron-diamine stain. Mucous gel layer composition was correlated with villous height, crypt depth, and total mucosal thickness. Mucous gel layer composition was correlated with acute and chronic inflammatory infiltrates. Colonization by a panel of seven bacterial species (including sulphate reducing bacteria) was established and correlated with sulphomucin levels. RESULTS: High-iron-diamine positivity (i.e., sulphomucin expression) was greater in ulcerative colitis pouch mucous gel (2.083 +\\/- 0.5 vs. 0.556 +\\/- 0.4, P = 0.003). Sulphomucin expression correlated with reduced crypt depth, villous height, and total mucosal thickness. In the ulcerative colitis group, chronic inflammatory infiltrate scores were significantly greater for high-iron-diamine-positive patients. Colonization by sulphate reducing bacteria was increased in high-iron-diamine-positive patients. CONCLUSIONS: Sulphomucin expression is increased in the mucous gel layer of the ulcerative colitis pouch compared with that of the familial adenomatous polyposis pouch. Sulphomucin expression is associated with colonization by sulphate-reducing bacteria and increased chronic inflammation.

  16. Palisaded Granulomatous Dermatitis Associated with Ulcerative Colitis: A Comprehensive Literature Review

    Cohen, Philip R

    2017-01-01

    Palisaded granulomatous dermatitis is an uncommon pathologic condition potentially associated with several disorders. These include drugs, inflammatory bowel disease, multiple myelomas, rheumatoid arthritis, and systemic lupus erythematosus. An illustrative case of a man with palisaded granulomatous dermatitis who subsequently developed ulcerative colitis is described, and the characteristics of other individuals with ulcerative colitis-associated palisaded granulomatous dermatitis are reviewed. PubMed was used to search the following terms: palisaded, interstitial, granulomatous, dermatitis, ulcerative colitis, and neutrophilic. Papers were obtained and references were reviewed. Ulcerative colitis-associated palisaded granulomatous dermatitis is uncommon. Palisaded granulomatous dermatitis-associated ulcerative colitis has been reported in four individuals. The palisaded granulomatous dermatitis appeared from six years prior to diagnosis to 19 years following diagnosis of the patient’s gastrointestinal disease. In addition to individual and grouped papular lesions on the elbows, the morphology of palisaded granulomatous dermatitis can also present as indurated linear plaques overlying the metacarpophalangeal (MCP) joints and proximal fingers.  PMID:28168136

  17. Delayed-Release Oral Mesalamine 4.8 g/day (800 mg tablets Compared with 2.4 g/day (400 mg tablets for the Treatment of Mildly to Moderately Active Ulcerative Colitis: The ASCEND I Trial

    Stephen B Hanauer

    2007-01-01

    Full Text Available BACKGROUND: Delayed-release oral mesalamine 2.4 g/day to 4.8 g/day has been shown to be effective in treating mildly to moderately active ulcerative colitis (UC, but it is unknown whether an initial dose of 4.8 g/day is more effective than 2.4 g/day in patients with mildly to moderately active UC and in the subgroup with moderate disease.

  18. Cerebral venous thrombosis and heparin-induced thrombocytopenia in an 18-year old male with severe ulcerative colitis

    Gudrun Scheving Thorsteinsson; Maria Magnussson; Lena M Hallberg; Nils Gunnar Wahlgren; Fredrik Lindgren; Petter Malmborg; Thomas H Casswall

    2008-01-01

    The risk of thromboembolism is increased in inflammatory bowel disease and its symptoms may be overlooked. Furthermore, its treatment can be complex and is not without complications. We describe a case of an adolescent boy who developed a cerebral sinus venous thrombosis during a relapse of his ulcerative colitis and who, while on treatment with heparin,developed heparin-induced thrombocytopenia (HIT).The treatment was then switched to fondaparinux, a synthetic and selective inhibitor of activated factor x.

  19. Meta-analysis identifies 29 additional ulcerative colitis risk loci, increasing the number of confirmed associations to 47

    Anderson, Carl A; Boucher, Gabrielle; Lees, Charlie W

    2011-01-01

    Genome-wide association studies and candidate gene studies in ulcerative colitis have identified 18 susceptibility loci. We conducted a meta-analysis of six ulcerative colitis genome-wide association study datasets, comprising 6,687 cases and 19,718 controls, and followed up the top association s...

  20. Meta-analysis identifies 29 additional ulcerative colitis risk loci, increasing the number of confirmed associations to 47

    Anderson, Carl A.; Boucher, Gabrielle; Lees, Charlie W.; Franke, Andre; D'Amato, Mauro; Taylor, Kent D.; Lee, James C.; Goyette, Philippe; Imielinski, Marcin; Latiano, Anna; Lagace, Caroline; Scott, Regan; Amininejad, Leila; Bumpstead, Suzannah; Baidoo, Leonard; Baldassano, Robert N.; Barclay, Murray; Bayless, Theodore M.; Brand, Stephan; Buening, Carsten; Colombel, Jean-Frederic; Denson, Lee A.; De Vos, Martine; Dubinsky, Marla; Edwards, Cathryn; Ellinghaus, David; Fehrmann, Rudolf S. N.; Floyd, James A. B.; Florin, Timothy; Franchimont, Denis; Franke, Lude; Georges, Michel; Glas, Juergen; Glazer, Nicole L.; Guthery, Stephen L.; Haritunians, Talin; Hayward, Nicholas K.; Hugot, Jean-Pierre; Jobin, Gilles; Laukens, Debby; Lawrance, Ian; Lemann, Marc; Levine, Arie; Libioulle, Cecile; Louis, Edouard; McGovern, Dermot P.; Milla, Monica; Montgomery, Grant W.; Morley, Katherine I.; Mowat, Craig; Ng, Aylwin; Newman, William; Ophoff, Roel A.; Papi, Laura; Palmieri, Orazio; Peyrin-Biroulet, Laurent; Panes, Julian; Phillips, Anne; Prescott, Natalie J.; Proctor, Deborah D.; Roberts, Rebecca; Russell, Richard; Rutgeerts, Paul; Sanderson, Jeremy; Sans, Miquel; Schumm, Philip; Seibold, Frank; Sharma, Yashoda; Simms, Lisa A.; Seielstad, Mark; Steinhart, A. Hillary; Targan, Stephan R.; van den Berg, Leonard H.; Vatn, Morten; Verspaget, Hein; Walters, Thomas; Wijmenga, Cisca; Wilson, David C.; Westra, Harm-Jan; Xavier, Ramnik J.; Zhao, Zhen Z.; Ponsioen, Cyriel Y.; Andersen, Vibeke; Torkvist, Leif; Gazouli, Maria; Anagnou, Nicholas P.; Karlsen, Tom H.; Kupcinskas, Limas; Sventoraityte, Jurgita; Mansfield, John C.; Kugathasan, Subra; Silverberg, Mark S.; Halfvarson, Jonas; Rotter, Jerome I.; Mathew, Christopher G.; Griffiths, Anne M.; Gearry, Richard; Ahmad, Tariq; Brant, Steven R.; Chamaillard, Mathias; Satsangi, Jack; Cho, Judy H.; Schreiber, Stefan; Daly, Mark J.; Barrett, Jeffrey C.; Parkes, Miles; Annese, Vito; Hakonarson, Hakon; Radford-Smith, Graham; Duerr, Richard H.; Vermeire, Severine; Weersma, Rinse K.; Rioux, John D.

    2011-01-01

    Genome-wide association studies and candidate gene studies in ulcerative colitis have identified 18 susceptibility loci. We conducted a meta-analysis of six ulcerative colitis genome-wide association study datasets, comprising 6,687 cases and 19,718 controls, and followed up the top association sign

  1. Effects of moxibustion on heat-shock protein 70 expression in the spinal cord and colonic mucosa in a rat model of ulcerative colitis

    Li Qi; Yin Shi; Luyi Wu; Jingping Mu; Linying Tan; Xiaopeng Ma; Huirong Liu; Shifen Xu; Huangan Wu

    2010-01-01

    Pathological changes in the colon are closely associated with the spinal cord, and innervation of spinal cord can regulate cellular functions. Our previous studies verified that moxibustion protects and restores the colonic mucosa, but the mechanisms of action remain unknown. The present study observed the effects of moxibustion and salicylazosulfapyridine on expression of heat-shock protein 70 (HSP70) and its mRNA in the spinal cord and colonic mucosa of ulcerative colitis rats. Results demonstrated that moxibustion and salicylazosulfapyridine increased HSP70 mRNA expression in the spinal cord and colonic mucosa of ulcerative colitis rats. The decreased transcriptional activity of HSP70 in the spinal cord and colonic mucosa might participate in damage to the colonic mucosa in ulcerative colitis rats. Moxibustion exerted protective effects on colonic mucosa by up-regulating HSP70 transcriptional activity in the spinal cord and colonic mucosa.

  2. Retrospective Evaluation of Cases Diagnosed with Ulcerative Colitis

    Gülseren Şahin

    2012-04-01

    Full Text Available In­tro­duc­ti­on: Inflammatory bowel disease (IBD is a chronic inflammatory disease of the gastrointestinal canal characterised by remissions and exacerbations. This study aimed to make a retrospective evaluation of clinical and laboratory findings of patients being monitored with a diagnosis of IBD.Materials and Methods: Medical records of 18 patients with a diagnosis of IBD and 7 years of follow-up at our pediatric gastroenterology departments were investigated with respect to demographic data, complaints on presentation and accompanying diseases. Unusual findings from physical examination, endoscopic findings, histopathological findings and the applied treatments were examined.Results: The 18 patients (10 female, 8 male included in this study had a mean age of 13.6±2.9 years and the mean time from onset of symptoms to diagnosis was 6.9±4.5 months. Seventeen patients were diagnosed with ulcerative colitis and 1 patient with intermediate colitis. There was a positive family history of the disease in 2 patients (11%. At the time of diagnosis, the most common complaints on presentation were found to be abdominal pain (100%, bloody diarrhea (94.5% and tenesmus (44.4%. The most frequent laboratory findings were CRP positivity (89%, increased sedimentation rate (83.3% and iron-deficient anaemia (77.7%. On colonoscopy, pancolitis involvement (66.6% was most frequently encountered. Accompanying diseases to IBD were found to be familial Mediterranean fever (FMF (11%, celiac disease (5.5% and Heliobacter pylori gastritis (5.5%. One patient (5.5% who did not respond to medical treatment for pancolitis involvement underwent a colectomy. Discussion: The number of diagnoses of IBD in childhood is gradually increasing. Nonetheless, it can be difficult to define diseases with non-specific symptoms and this may cause a delay in diagnosis. Because of the association of autoimmune diseases with IBD, despite appropriate therapy, diseases with no remission

  3. Extraintestinal pathogenic Escherichia coli are associated with intestinal inflammation in patients with ulcerative colitis

    Mirsepasi-Lauridsen, Hengameh C.; Halkjaer, Sofie Ingdam; Mortensen, Esben Munk; Lydolph, Magnus C.; Nordgaard-Lassen, Inge; Krogfelt, Karen Angeliki; Petersen, Andreas Munk

    2016-01-01

    E. coli of the phylogenetic group B2 harbouring Extra intestinal Pathogenic Escherichia coli (ExPEC) genes are frequently seen as colonizers of the intestine in patients with active ulcerative colitis (UC). In this study, we describe the influence of E. coli Nissle (EcN) B2 as add-on treatment to conventional therapies in patients with active UC. For this study one hundred active UC patients were randomized to ciprofloxacin or placebo for 1 week followed by EcN or placebo for 7 weeks. Stool samples were collected at weeks 0, 1, 8, 12, where E. coli were characterized and fecal calprotectin was measured. We showed that in the active UC patient group receiving Placebo/EcN, fewer patients reached remission, in comparison to the patient group receiving Placebo/placebo (p intestinal inflammation. PMID:27686530

  4. Linear IgA dermatosis associated with ulcerative colitis: complete and sustained remission after total colectomy.

    Vargas, Thiago Jeunon de Sousa; Fialho, Mônica; Santos, Luiza Tavares dos; Rodrigues, Palmira Assis de Jesus Barreto; Vargas, Ana Luisa Bittencourt Sampaio Jeunon; Sousa, Maria Auxiliadora Jeunon

    2013-01-01

    Linear IgA dermatosis has been increasingly associated with inflammatory bowel diseases, particularly ulcerative colitis. A 13-year-old male patient with an 11-month history of ulcerative colitis developed vesicles, pustules and erosions on the skin of the face, trunk and buttocks and in the oral mucosa. The work-up revealed a neutrophil-rich sub-epidermal bullous disease and linear deposition of IgA along the dermoepidermal junction, establishing the diagnosis of linear IgA dermatosis. The patient experienced unsatisfactory partial control of skin and intestinal symptoms despite the use of adalimumab, mesalazine, prednisone and dapsone for some months. After total colectomy, he presented complete remission of skin lesions, with no need of medications during two years of follow-up. A review of previously reported cases of the association is provided here and the role of ulcerative colitis in triggering linear IgA dermatosis is discussed.

  5. Crohn's disease but not chronic ulcerative colitis induces the expression of PAI-1 in enteric neurons

    Laerum, O.D.; Illemann, M.; Skarstein, A.

    2008-01-01

    OBJECTIVES: Chronic inflammation of the intestinal wall is the common characteristic of Crohn's disease and ulcerative colitis; disorders, which in some cases can be difficult to distinguish. The inflammation also affects the local neuronal plexuses of the enteric nervous system. It is known...... by immunohistochemical techniques. RESULTS: PAI-1 was found in a subset of neurons primarily located in the submucosal plexus of the small and large intestine in 24 of 28 cases (86%) with Crohn's disease, but in none of 17 cases with chronic ulcerative colitis and other severe inflammatory conditions in the intestinal....... CONCLUSIONS: PAI-1-positive neurons in inflammatory bowel disease are linked to chronic inflammation in Crohn's disease, implying PAI-1 as a potential parameter for the differential diagnosis between Crohn's disease and ulcerative colitis. The findings also suggest that PAI-1 in neurons is related to pain...

  6. Ulcerative colitis amongst the Saudis: Six-year experience from Al-Madinah region

    Khan Hamid

    1996-01-01

    Full Text Available Ulcerative Colitis is now being recognized amongst the Arabs. After consideration of the clinical, endoscopic and histopathological data, 80 Saudi patients out of 1,182, were diagnosed as ulcerative colitis. There were 47 males and 33 females. The age ranged between two and 90 years (mean 36.5 years. Endoscopically, the disease was limited to the rectum in 22.5%, rectum and sigmoid in 30%, extended up to the splenic flexure in 27.5% and beyond the splenic flexure in 20% of the patients. Our data supports the recent observation that ulcerative colitis is not uncommon in this part of the world. There are differences in the extent of disease and the presence of local complications, between our patients and those in the high incidence areas.

  7. Proctocolectomy and ileostomy to pouch surgery for ulcerative colitis.

    Hultén, L

    1998-04-01

    The development of continence-preserving and sphincter-preserving procedures for operation of ulcerative colitis has a long and interesting history. Reported clinical results on the continent ileostomy (Kock pouch) and the pelvic pouch procedure have often been enthusiastic; and when confronted with the options patients have mostly been in no doubt in selecting "the best operation." However, even if the continent ileostomy and subsequently restorative proctocolectomy were great innovations, it is by no means obvious that they should be recommended as the first choice for all patients. For patients old enough to join in a responsible discussion the pros and cons of the various operations available today must first be carefully described and a decision reached that reasonably meets the patient's wishes and that seems to the surgeon to be soundly based. When comparing the postoperative morbidity, long-term outcome, and quality of life assessment of the options, such a decision is in fact far from easy. Thus panproctocolectomy and ileostomy for ulcerative colitis can be considered a comparatively safe, predictable operation that can cure the patient and allow a short hospital stay, a quick recovery, and rehabilitation. It should also enable the patient to be free of hospital supervision after a year or so. Although there is a major change in body image and sexual disturbances may occur, the operation is in fact still the yardstick by which the other options should be compared. Despite the great attraction of rectum- and sphincter-preserving operations, there will always be patients for whom panproctocolectomy and a conventional end-ileostomy is the superior alternative. The ileal pouch operations are technically demanding and should probably best be restricted to specialist centers even in the future. Complications, if they arise, are often serious, and the hospital stay is often counted in weeks. The functional result may be good, but defects in continence are common

  8. What strategies do ulcerative colitis patients employ to facilitate adherence?

    Kawakami, Aki; Tanaka, Makoto; Naganuma, Makoto; Maeda, Shin; Kunisaki, Reiko; Yamamoto-Mitani, Noriko

    2017-01-01

    Background Overall, 30%–45% of patients with ulcerative colitis (UC) are non-adherent and have difficulties taking their medications; this non-adherence increases the risk of clinical relapse 1.4- to 5.5-fold. This study aimed to clarify the strategies patients employ to facilitate adherence and determine whether the strategies had an impact on good adherence. Methods This was a cross-sectional survey using a self-administered questionnaire and review of medical records. Patients diagnosed as having UC and attending one of the outpatient clinics of four urban hospitals from June 2009 to December 2012 were enrolled. A questionnaire was developed to identify the strategies patients employ to facilitate adherence and then administered to patients with UC. Adherence to 5-aminosalicylic acid was calculated, and univariate and multiple logistic regression analyses were performed to determine the strategies that were associated with good adherence. Results The final analyses included 671 participants (mean age 40.2 years; 54.3% males). The valid response rate was 96.9%; 186 (27.7%) participants were classified as non-adherent, the mean adherence rate being 86.1% (standard deviation [SD] 17.9). Seven strategies that patients employ to facilitate adherence were identified, the following two being significantly associated with good adherence: “I keep my medicines where I eat meals” and “I keep each day’s medicine in a pill case or something similar to make sure I have taken them”. Conclusion The identified strategies might be used to develop a program to improve medication adherence in patients with UC. PMID:28203059

  9. Neuroendocrine carcinomas arising in ulcerative colitis: coincidences or possible correlations?

    Grassia, Roberto; Bodini, Paolo; Dizioli, Paolo; Staiano, Teresa; Iiritano, Elena; Bianchi, Guglielmo; Buffoli, Federico

    2009-09-07

    Patients with inflammatory bowel disease (IBD) are at increased risk of colorectal malignancies. Adenocarcinoma is the commonest type of colorectal neoplasm associated with ulcerative colitis (UC) and Crohn's disease, but other types of epithelial and non-epithelial tumors have also been described in inflamed bowel. With regards to non-epithelial malignancies, lymphomas and sarcomas represent the largest group of tumors reported in association with IBD, especially in immunosuppressed patients. Carcinoids and in particular neuroendocrine neoplasms other than carcinoids (NENs) are rare tumors and are infrequently described in the setting of IBD. Thus, this association requires further investigation. We report two cases of neoplasms arising in mild left-sided UC with immunohistochemical staining for neuroendocrine markers: a large cell and a small cell neuroendocrine carcinoma of the rectum. The two patients were different in age (35 years vs 77 years) and disease duration (11 years vs 27 years), and both had never received immunosuppressant drugs. Although the patients underwent regular endoscopic and histological follow-up, the two neoplasms were locally advanced at diagnosis. One of the two patients developed multiple liver metastases and died 15 mo after diagnosis. These findings confirm the aggressiveness and the poor prognosis of NENs compared to colorectal adenocarcinoma. While carcinoids seem to be coincidentally associated with IBD, NENs may also arise in this setting. In fact, long-standing inflammation could be directly responsible for the development of pancellular dysplasia involving epithelial, goblet, Paneth and neuroendocrine cells. It has yet to be established which IBD patients have a higher risk of developing NENs.

  10. Impact of lipoprotein lipase gene polymorphisms on ulcerative colitis

    Toshihito Kosaka; Taizou Shiraishi; Masatoshi Watanabe; Takayuki Yamamoto; Ai Nakahara; Takahiko Katoh; Junji Yoshino; Kazuo Inui; Takao Wakabayashi; Kazumu Okushima; Takashi Kobayashi; Hironao Miyoshi; Yuta Nakamura; Shigekazu Hayashi

    2006-01-01

    AIM: To examine the influence of lipoprotein lipase (LPL)gene polymorphism in ulcerative colitis (UC) patients.METHODS: Peripheral blood was obtained from 131 patients with UC and 106 healthy controls for DNA extraction. We determined LPL gene polymorphisms affecting the enzyme at Ser447stop, as well as Hind Ⅲ and Pvu Ⅱ polymorphisms using PCR techniques. PCR products were characterized by PCR-RFLP and direct sequencing.Polymorphisms were examined for association with clinical features in UC patients. Genotype frequencies for LPL polymorphisms were also compared between UC patients and controls.RESULTS: In patients with onset at age 20 years or younger, C/G and G/G genotypes for Ser447stop polymorphism were more prevalent than C/C genotype (OR= 3.13, 95% CI = 0.95-10.33). Patients with H+/- or H-/-genotype for HindⅢ polymorphism also were more numerous than those with H+/+ genotype (OR = 2.51, 95%CI = 0.85-7.45). In the group with H+/+ genotype for HindⅢ polymorphism, more patients had serum triglyceride concentrations over 150 mg/dL than patients with H+/- or H-/- genotype (P < 0.01, OR = 6.46, 95% CI =1.39-30.12). Hypertriglycemia was also more prevalent in patients with P+/+ genotypes for Pvu Ⅱ polymorphism (P< 0.05, OR = 3.0, 95% CI = 1.06-8.50). Genotype frequency for LPL polymorphism did not differ significantly between UC patients and controls.CONCLUSION: Ser447stop and HindⅢ LPL polymorphisms may influence age of onset of UC, while HindⅢand PvuⅡ polymorphisms influence serum triglyceride in UC patients.

  11. Evaluation of 5 versus 10 granulocyteaphaeresis sessions in steroid-dependent ulcerative colitis: A pilot, prospective, multicenter, randomized study

    Elena Ricart; Maria Esteve; Montserrat Andreu; Francesc Casellas; David Monfort; Miquel Sans; Natalia Oudovenko; Raúl Lafuente; Julián Panés

    2007-01-01

    AIM: To evaluate the efficacy of 5 compared to 10 granulocyteaphaeresis sessions in patients with active steroid-dependent ulcerative colitis.METHODS: In this pilot, prospective, multicenter randomized trial, 20 patients with moderately active steroid-dependent ulcerative colitis were randomized to 5 or 10 granulocyteaphaeresis sessions. The primary objective was clinical remission at wk 17. Secondary measures included endoscopic remission and steroid consumption.RESULTS: Nine patients were randomized to 5 granulocyteaphaeresis sessions (group 1) and L1 patients to 10 granulocyteaphaeresis sessions (group 2). At wk 17, 37.5% of patients in group 1 and 45.45% of patients in group 2 were in clinical remission. Clinical remission was accompanied by endoscopic remission in all cases.Eighty-six percent of patients achieving remission were steroid-free at wk 17. Daily steroid requirements were significantly lower in group 2. Eighty-nine per cent of patients remained in remission during a one year follow-up. One serious adverse event, not related to the study therapy, was reported.CONCLUSION: Granulocyteaphaeresis is safe and effective for the treatment of steroid-dependent ulcerative colitis. In this population, increasing the number of aphaeresis sessions is not associated with higher remission rates, but affords a significant steroid-sparing effect.

  12. Observation on the efficacy of combined treatment of Chinese and Western medicine in active ulcerative colitis%中西医结合治疗活动期溃疡性结肠炎的疗效

    鲍良生; 孔梅

    2011-01-01

    目的:探讨中西医结合[千喜片+水杨酸柳氮磺胺吡啶片(SASP)+泼尼松]治疗活动期溃疡性结肠炎(UC)的疗效.方法:将70例活动期UC患者按随机数字表法平均分为治疗组(予以千喜片+ SASP+泼尼松治疗)和对照组(予以SASP+泼尼松治疗),治疗1个疗程后,观察两组临床疗效和不良反应.结果:治疗组显效率明显高于对照组(P<0.05),有统计学意义;治疗组总有效率与对照组无统计学意义(P>0.05),治疗组不良反应发生率与对照组比无统计学意义(P>0.05).结论:SASP加糖皮质激素基础上加用中成药千喜片治疗活动期UC的显效率明显优于使用SASP加糖皮质激素的疗效,值得临床推广.%Objective ;To observe the effect of integrated Chinese-western therapy ( Qiangxipian tablet + salicylic acid tablets sulfasalazine (SASP) + prednisone) for ulcerative colitis ( UC) in active phase. Methods: Seventy patients with active UC patients were evenly allocated to treatment group ( Qiangxipian tablet + salicylic acid tablets sulfasalazine (SASP) + prednisone) and control group (salicylic acid sulfasalazine SASP tablets (SASP) + prednisone) at random. The two groups were observed for the clinical efficacy and adverse reactions after one course of therapy. Results-.The curative rate was significantly higher in the treatment group than that of the controls ( P 0. 05 ). Conclusion: Qiangxipian tablet + SASP + prednisone is superior to SASP + prednisone therapy for ulcerative colitis in active phase and worthy of wider clinical use.

  13. Cytomegalovirus infection in severe ulcerative colitis patients undergoing continuous intravenous cyclosporine treatment in Japan

    Masaaki Minami; Michio Ohta; Teruko Ohkura; Takafumi Ando; Naoki Ohmiya; Yasumasa Niwa; Hidemi Goto

    2007-01-01

    AIM: To investigate active cytomegalovirus (CMV) infection following the cyclosporine A (CyA) treatment of steroid-refractory ulcerative colitis (UC).METHODS: Twenty-three patients with severe UC not responding to steroid therapy (male 14, and female 9)enrolled at Nagoya University Hospital from 1999 to 2005. They received continuous intravenous infusion of CyA (average 4 mg/kg per day) for 1 mo. Serum and colonic biopsy samples were collected before CyAtreatment and 4 d, 10 d, 20 d, and 30 d after treatment.Patients were evaluated for CMV by using serology (IgM antibody by ELISA), quantitative real-time PCR for CMV DNA, and histopathological assessment of hematoxylin and eosin (HE)-stained colonic biopsies. CMV infection was indicated by positive results in any test.RESULTS: No patients had active CMV infection before CyA treatment. Eighteen of 23 UC patients treated with CyA were infected with active CMV (IgM antibody in 16/23 patients, 69.6%; CMV DNA in 18/23 patients,78.2%; and inclusion bodies in 4/23 patients, 17.3%).There was no difference in the active CMV-infection rate between males and females. Active CMV infection was observed after approximately 8 d of CyA treatment,leading to an exacerbation of colitis. Fifteen of these 18 patients with active CMV infection (83.3%) required surgical treatment because of severe deteriorating colitis.Treatment with ganciclovir rendered surgery avoidable inthree patients.CONCLUSION: Our results suggest that active CMV infection in severe UC patients treated with CyA is associated with poor outcome. Further, ganciclovir is useful for treatment of CMV-associated UC after immunosuppressive therapy.

  14. Different therapy for different types of ulcerative colitis in China

    Xue-Liang Jiang; Hui-Fei Cui

    2004-01-01

    AIM: To study the different therapy for different types of ulcerative colitis (UC) in China.METHODS: Among 102 UC patients, 42 chronic relapse type UC patients were randomly divided into olsalazine sodium treatment group (n=21) and SASP group (n=-21).Clinical effects and safety were observed in the 2 groups.Forty-two first episode type UC patients were randomly divided into Heartleaf houttuynia herb treatment group (n=21) and SASP group (n=21). Clinical effects were observed in the 2 groups while ultrastructure of colonic mucosa, ICAM-1 and the pressure of distant colon were studied in Heartleaf houttuynia herb group. Eighteen patients (8 males, 10 females) with refractory UC and unresponsive to high-dose prednisolone and sulfasalazine therapy more than one month were treated with Kangshuanling (7 200 U/d). Prednisolone was gradually stopped and sulfasalazine was maintained. Stool frequency,rectal bleeding, colonoscopy, general well-being, histology were observed and CD62p, CD63, CD54, Pgp-170 (flow cytometry), TXA2 (RIA), blood platelet aggregation rate and thrombosis length in vitro were assessed.RESUL TS: In the 42 chronic relapse type UC patients, the overall clinical effects of olsalazine sodium group (complete remission in 16, improvement in 4, inefficiency in L) were better than those of SASP group (complete remission in 10,improvement in 4, inefficiency in 7, P<0.05). Symptomatic remission of olsalazine sodium group (complete remission in 15, partial remission in 5, inefficiency in 1) was better than that of SASP group (complete remission in 10, partial remission in 5, inefficiency in 6, P<0.05). The colonoscopic remission of olsalazine sodium group(complete remission in 11, partial remission in 9, inefficiency in 1) was better than that of SASP group (complete remission in 7, partial remission in 8, inefficiency in 6, P<0.05). The histologic remission of olsalazine sodium group (complete remission in 13, partial remission in 7, inefficiency in in 1

  15. Successful Use of Tocilizumab in a Patient with Coexisting Rheumatoid Arthritis and Ulcerative Colitis

    Matthew Chak Hin Szeto

    2016-01-01

    Full Text Available Tocilizumab is an interleukin-6 receptor inhibitor licensed for moderate to severe rheumatoid arthritis (RA. We report a case of Tocilizumab monotherapy for severe active RA in a patient with coexisting ulcerative colitis (UC. The patient was intolerant to multiple disease-modifying drugs, so Tocilizumab monotherapy was commenced. We found clinical improvement in both RA and UC. There was no major adverse event after 2 years. Manufacturer advised caution in using Tocilizumab in patient with gastrointestinal ulceration due to an increased risk of bowel perforation. However, alternative treatments such as glucocorticoid and nonsteroidal anti-inflammatory drugs may carry a higher bowel perforation risk. The presence of gastrointestinal ulceration therefore should not constitute an absolute contraindication for Tocilizumab therapy. Future studies of registry data will inform clinician of the Tocilizumab-related risk of gastrointestinal toxicity in “real-life” settings. Contrary to previous case report, we found Tocilizumab therapy to have a positive effect on UC. Laboratory studies supported a role for interleukin-6 in the pathophysiology of UC. Further clinical trial to evaluate the therapeutic role of Tocilizumab in UC would be warranted.

  16. Predictive factors of clinical response in steroid-refractory ulcerative colitis treated with granulocyte-monocyte apheresis

    Valeria D'Ovidio; Donatella Meo; Angelo Viscido; Giampaolo Bresci; Piero Vernia; Renzo Caprilli

    2011-01-01

    AIM: To identify factors predicting the clinical response of ulcerative colitis patients to granulocyte-monocyte apheresis (GMA).METHODS: Sixty-nine ulcerative colitis patients (39 F, 30 M) dependent upon/refractory to steroids were treated with GMA.Steroid dependency, clinical activity index (CAI), C reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), values at baseline, use of immunosuppressant, duration of disease, and age and extent of disease were considered for statistical analysis as predictive factors of clinical response.Univariate and multivariate logistic regression models were used.RESULTS: In the univariate analysis, CAI (P = 0.039) and ESR (P = 0.017) levels at baseline were singled out as predictive of clinical remission.In the multivariate analysis steroid dependency [Odds ratio (OR) = 0.390, 95% Confidence interval (CI): 0.176-0.865, Wald 5.361, P = 0.0160] and low CAI levels at baseline (4 < CAI < 7) (OR = 0.770, 95% CI: 0.425-1.394, Wald 3.747, P = 0.028) proved to be effective as factors predicting clinical response.CONCLUSION: GMA may be a valid therapeutic option for steroid-dependent ulcerative colitis patients with mild-moderate disease and its clinical efficacy seems to persist for 12 mo.

  17. {sup 1}H NMR-based spectroscopy detects metabolic alterations in serum of patients with early-stage ulcerative colitis

    Zhang, Ying; Lin, Lianjie [Second Department of Gastroenterology, Shengjing Hospital, China Medical University, Shenyang 110004 (China); Xu, Yanbin [Wanlei Life Sciences (Shenyang) Co., Ltd., Shenyang 110179 (China); Lin, Yan; Jin, Yu [Second Department of Gastroenterology, Shengjing Hospital, China Medical University, Shenyang 110004 (China); Zheng, Changqing, E-mail: changqing_zheng@126.com [Second Department of Gastroenterology, Shengjing Hospital, China Medical University, Shenyang 110004 (China)

    2013-04-19

    Highlights: •Twenty ulcerative colitis patients and nineteen healthy controls were enrolled. •Increased 3-hydroxybutyrate, glucose, phenylalanine, and decreased lipid were found. •We report early stage diagnosis of ulcerative colitis using NMR-based metabolomics. -- Abstract: Ulcerative colitis (UC) has seriously impaired the health of citizens. Accurate diagnosis of UC at an early stage is crucial to improve the efficiency of treatment and prognosis. In this study, proton nuclear magnetic resonance ({sup 1}H NMR)-based metabolomic analysis was performed on serum samples collected from active UC patients (n = 20) and healthy controls (n = 19), respectively. The obtained spectral profiles were subjected to multivariate data analysis. Our results showed that consistent metabolic alterations were present between the two groups. Compared to healthy controls, UC patients displayed increased 3-hydroxybutyrate, β-glucose, α-glucose, and phenylalanine, but decreased lipid in serum. These findings highlight the possibilities of NMR-based metabolomics as a non-invasive diagnostic tool for UC.

  18. Ulcerative colitis and granulocyte-monocyte-apheresis: safety and efficacy of maintenance therapy during pregnancy.

    D'Ovidio, Valeria; Meo, Donatella; Gozer, Maria; Bazuro, Marco E; Vernia, Piero

    2015-02-01

    Inflammatory bowel disease characteristically affects young adults in their reproductive ages. Thus the medication used for the treatment of active disease should not compromise fertility and, also, should not have teratogenic effect on baby. A lot of data are available about effects of steroids, antibiotics, and mesalazine but no data are available about safety and efficacy of granulocyte-monocyte-apheresis (GMA) during pregnancy. In this case report, the 37 year-old pregnant woman with chronically active and steroid dependent ulcerative colitis (UC), at risk of abortion, refused more aggressive pharmacological therapeutic options and gave the informed consent to GMA. To minimize symptoms and the risk of severe clinical relapse, a maintenance GMA treatment was performed throughout pregnancy. The course of pregnancy was uneventful with no side effects; the mother and the baby were all healthy and well at the delivery.

  19. A study of endotoxemia in ulcerative colitis and Crohn's disease. I. Clinical study.

    Aoki,Kunitake

    1978-06-01

    Full Text Available Endotoxin (lipopolysaccharide, LPS and LPS antibody in the blood were studied in 61 cases of ulcerative colitis (U.C. by radioimmunoassay. Lysozyme (LZM concentration was also studied by the turbidimetric method. As a result, it was found that the blood LPS value as well as serum LZM concentration reflects the clinical observations. The case of endotoxemia in the active phase group showed a positive correlation between the LPS value and LZM concentration. LPS antibody which could not be detected in many cases of the active phase, had a high titer in cases of remission with a long history of the disease. These results would suggest that in U.C. with damaged intestinal mucosal barrier, LPS originating from intestinal flora enters into the blood and aggravates the disease and further that this invading LPS releases LZM into the blood. The same studies were performed on 7 cases of Crohn's disease and the same result was obtained.

  20. Surgical management of colonic perforation due to ulcerative colitis during pregnancy: Report of a case

    Douglas; Overbey; Henry; Govekar; Csaba; Gajdos

    2014-01-01

    This report describes a young female in her secondtrimester of pregnancy with known ulcerative colitis onmaintenance medical therapy. She was admitted forabdominal pain, and workup revealed a colonic stric-ture and ulceration with contained perforation. Aftermultidisciplinary discussion she was managed withcolectomy and end ileostomy. She delivered a healthynewborn 18 wk after surgery. Only a few prior reportsdescribed surgical management of inflammatory boweldisease during pregnancy, with recent results indicatinglow risk of adverse outcomes.

  1. Safety and efficacy of Profermin(R) to induce remission in ulcerative colitis

    Aleksander Krag; Hans Israelsen; Bjφrn von Ryberg; Klaus K Andersen; Flemming Bendtsen

    2012-01-01

    AIM:To test the efficacy and safety of Profermin(R) in inducing remission in patients with active ulcerative colitis (UC).METHODS:The study included 39 patients with mild to moderate UC defined as a Simple Clinical Colitis Activity Index (SCCAI) > 4 and < 12 (median:7.5),who were treated open-label with Profermin(R) twice daily for 24 wk.Daily SCCAI was reported observer blinded via the Internet.RESULTS:In an intention to treat (ITT) analysis,the mean reduction in SCCAI score was 56.5%.Of the 39 patients,24 (62%) reached the primary endpoint,which was proportion of patients with ≮ 50% reduction in SCCAI.Our secondary endpoint,the proportion of patients in remission defined as SCCAI ≤ 2.5,was in ITT analysis reached in 18 of the 39 patients (46%).In a repeated-measure regression analysis,the estimated mean reduction in score was 5.0 points (95% CI:4.1-5.9,P < 0.001) and the estimated mean time taken to obtain half the reduction in score was 28 d (95% CI:26-30).There were no serious adverse events (AEs) or withdrawals due to AEs.Profermin(R)was generally well tolerated.CONCLUSION:Profermin(R) is safe and may be effective in inducing remission of active UC.

  2. Effect of aqueous extract of Cucumis sativus Linn. fruit in ulcerative colitis in laboratory animals

    Mithun Vishwanath K Patil; Amit D Kandhare; Sucheta D Bhise

    2012-01-01

    Objective: To elucidate the ameliorative effect of aqueous extract of fruit of Cucumis sativus (C. sativus) (CS) in acetic acid induced colitis in wistar rats. Methods: The animals were administered with 2 mL acetic acid (4%) via intra rectal. The animals were divided into various treatment groups (n=6). Prednisolone was used as standard drug and C. sativus was administered at a dose of 100, 250 and 500 mg/kg p.o. The control group of animals received 1 mL of vehicle (distilled water). Ulcer area, ulcer index, spleen weight, colon weight to length ratio, macroscopic score, hematological parameters, colonic myeloperoxidase (MPO) and histological changes were recorded after the treatment regimen of 11 d. Results: Intrarectal instillation of acetic acid caused enhanced ulcer area, ulcer index, spleen weight, colon weight to length ratio, colonic MPO and hematological parameters. Pretreatment with C. sativus for 7 d exhibited significant effect in lowering of ulcer area, ulcer index as well as neutrophil infiltration at a dose of 250 and 500 mg/kg in acetic acid induced colitis. Conclusion: The present investigation demonstrates C. sativus is of potent therapeutic value in the amelioration of experimental colitis in laboratory animals by inhibiting the inflammatory mediator.

  3. Experimental and Pathalogical study of Pistacia atlantica, butyrate, Lactobacillus casei and their combination on rat ulcerative colitis model.

    Gholami, Mahdi; Ghasemi-Niri, Seyedeh Farnaz; Maqbool, Faheem; Baeeri, Maryam; Memariani, Zahra; Pousti, Iraj; Abdollahi, Mohammad

    2016-06-01

    This study evaluated the effects of Pistacia atlantica (P. atlantica), butyrate, Lactobacillus casei (L. casei) and especially their combination therapy on 2,4,6-trinitrobenzene sulphonic acid (TNBS)-induced rat colitis model. Rats were divided into seven groups. Four groups received oral P. atlantica, butyrate, L. casei and the combination of three agents for 10 consecutive days. The remaining groups were negative and positive controls and a sham group. Macroscopic and histopathological examinations were carried out along with determination of the specific biomarker of colonic oxidative stress, the myeloperoxidase (MPO). Compared with controls, the combination therapy exhibited a significant alleviation of colitis in terms of pathological scores and reduction of MPO activity (55%, p=0.0009). Meanwhile, the macroscopic appearance such as stool consistency, tissue and histopathological scores (edema, necrosis and neutrophil infiltration) were improved. Although single therapy by each P. atlantica, butyrate, and L. casei was partially beneficial in reduction of colon oxidative stress markers, the combination therapy was much more effective. In conclusion, the combination therapy was able to reduce the severity of colitis that is clear from biochemical markers. Future studies have to focus on clinical effects of this combination in management of human ulcerative colitis. Further molecular and signaling pathway studies will help to understand the mechanisms involved in the treatment of colitis and inflammatory diseases.

  4. Oral Vancomycin Therapy in a Child with Primary Sclerosing Cholangitis and Severe Ulcerative Colitis

    Buness, Cynthia; Miloh, Tamir

    2016-01-01

    Primary sclerosing cholangitis (PSC), a rare progressive liver disease characterized by cholestasis and bile duct fibrosis, has no accepted, effective therapy known to delay or arrest its progression. We report a 15 year old female patient diagnosed with PSC and moderate chronic active ulcerative colitis (UC) who achieved normalization of her liver enzymes and bile ducts, and resolution of her UC symptoms with colonic mucosal healing, after treatment with a single drug therapy of the antibiotic oral vancomycin. We postulate that the oral vancomycin may be acting both as an antibiotic by altering the intestinal microbiome and as an immunomodulator. Oral vancomycin may be a promising treatment for PSC that needs to be further studied in randomized trials. PMID:27738604

  5. Novel Techniques in Endoscopy Are Useful in Evaluating Patients with Ulcerative Colitis

    Takafumi Ando

    2011-01-01

    Full Text Available Ulcerative colitis (UC, one of the most common forms of chronic inflammatory bowel disease, is characterized by exacerbations and remissions. Even when conventional colonoscopy suggests remission and a normal mucosal finding, microscopic or histological abnormalities may persist, and relapse may be imminent. Confocal microendoscopy allows histological diagnosis during the endoscopic examination. High-resolution video-magnifying colonoscopy with chromoscopy enables the observation of colorectal mucosal pit patterns and prediction of the probability of subsequent disease relapse in patients in remission. Endoscopic ultrasonography provides an immediate and accurate evaluation of the health status of the colonic wall without the need to wait for histological results and provides an indication of the efficacy of treatment. These novel endoscopic techniques are useful for the evaluation of disease activity and the efficacy of treatment in patients with UC and the prediction of relapse.

  6. Mesalamine in the treatment and maintenance of remission of ulcerative colitis.

    Ham, Maggie; Moss, Alan C

    2012-03-01

    Ulcerative colitis (UC) is a chronic disease of the GI tract that is characterized by mucosal inflammation in the colon. Mesalamine (mesalazine) is a 5-aminosalicylic acid compound that is the first-line treatment for patients with mild-to-moderate UC. There are multiple formulations of mesalamine available, primarily differentiated by their means of delivering active mesalamine to the colon. Mesalamine has been demonstrated in randomized controlled trials to induce both clinical response and remission, and maintain clinical remission, in these patients. It has few serious adverse effects and is generally well tolerated by patients. The main areas of uncertainty with use of mesalamine in patients with UC center on the optimal dose for induction of response, how to maintain patient adherence and the role of mesalamine in cancer chemoprophylaxis. Generic forms of mesalamine have yet to be approved by regulatory bodies in the USA.

  7. Laboratory markers in ulcerative colitis: Current insights and future advances

    Michele; Cioffi; Antonella; De; Rosa; Rosalba; Serao; Ilaria; Picone; Maria; Teresa; Vietri

    2015-01-01

    Ulcerative colitis(UC)and Crohn’s disease(CD)are the major forms of inflammatory bowel diseases(IBD)in man.Despite some common features,these forms can be distinguished by different genetic predisposition,risk factors and clinical,endoscopic and histological characteristics.The aetiology of both CD and UC remains unknown,but several evidences suggest that CD and perhaps UC are due to an excessive immuneresponse directed against normal constituents of the intestinal bacterial flora.Tests sometimes invasive are routine for the diagnosis and care of patients with IBD.Diagnosis of UC is based on clinical symptoms combined with radiological and endoscopic investigations.The employment of non-invasive biomarkers is needed.These biomarkers have the potential to avoid invasive diagnostic tests that may result in discomfort and potential complications.The ability to determine the type,severity,prognosis and response to therapy of UC,using biomarkers has long been a goal of clinical researchers.We describe the biomarkers assessed in UC,with special reference to acute-phase proteins and serologic markers and thereafter,we describe the new biological markers and the biological markers could be developed in the future:(1)serum markers of acute phase response:The laboratory tests most used to measure the acute-phase proteins in clinical practice are the serum concentration of C-reactive protein and the erythrocyte sedimentation rate.Other biomarkers of inflammation in UC include platelet count,leukocyte count,and serum albumin and serum orosomucoid concentrations;(2)serologic markers/antibodies:In the last decades serological and immunologic biomarkers have been studied extensively in immunology and have been used in clinical practice to detect specific pathologies.In UC,the presence of these antibodies can aid as surrogate markers for the aberrant host immune response;and(3)future biomarkers:The development of biomarkers in UC will be very important in the future.The progress

  8. Dietary unsaponifiable fraction from extra virgin olive oil supplementation attenuates acute ulcerative colitis in mice.

    Sánchez-Fidalgo, S; Cárdeno, A; Sánchez-Hidalgo, M; Aparicio-Soto, M; Villegas, I; Rosillo, M A; de la Lastra, C Alarcón

    2013-02-14

    Extra virgin olive oil (EVOO) has demonstrated immunomodulatory and antiinflammatory properties in murine experimental ulcerative colitis (UC). In addition to its high monounsaturated fatty acid content, evidences have accumulated on the favorable properties of minor, although highly bioactive, components present in the unsaponifiable fraction (UF). The present study was designed to evaluate the effects of dietary EVOO's UF supplementation on acute UC. C57BL/6 mice were fed from weaning with sunflower oil (SD), EVOO diet and UF-enriched SD at 5% oil (SD+UF). After 30 days, mice were exposed to 3% dextran sulfate sodium (DSS) for 5 days developing acute colitis. After 4 days of DSS removal, animals were sacrificed and colons were histological and biochemically processed. Disease activity index and microscopic damage score were significantly improved in EVOO and SD+UF dietary groups versus SD group. In addition, both dietary treatments significantly induced decreases in MCP-1 and TNF-α levels, iNOS and COX-2 overexpression and p38 MAPKs activation in colon mucosa. Moreover, an upregulation of IκB expression was also observed after feeding the animals with both diets. However, no statistically differences between data from mice fed with EVOO or UF+SD diets were observed. Dietary enrichment with EVOO's UF reduces the damage in acute colitis model, alleviating the oxidative events and returning proinflammatory proteins expression to basal levels probably through p38 MAPK and NFκB signalling pathways. EVOO's UF diet might provide a basis for developing a new strategy in dietary supplementation for the prevention of UC.

  9. Update on the management of ulcerative colitis: treatment and maintenance approaches focused on MMX® mesalamine

    Nanda K

    2012-07-01

    Full Text Available Kavinderjit Nanda, Alan C MossCenter for Inflammatory Bowel Disease, BIDMC/Harvard Medical School, Boston, MA, USAAbstract: Ulcerative colitis (UC is a chronic inflammatory disease of the colon that typically manifests as diarrhea, abdominal pain, and bloody stool. Complications, such as colorectal cancer and extraintestinal manifestations, may also develop. The goals of management are to induce and maintain clinical remission and to screen for complications of this disease. Mesalamine is a 5-aminosalicylic acid compound that is the first-line therapy to induce and maintain clinical remission in patients with mild-to-moderate UC. For patients who are refractory to mesalamine or have more severe disease, steroids, azathioprine/mercaptopurine, cyclosporine, or infliximab may be used, induce and/or maintain remission. The various formulations of mesalamine available are primarily differentiated by the methods of delivery of the active compound of the drug to the colon. Mesalamine with Multi-Matrix System® (MMX technology (Cosmo SpA, Milan, Italy is an oral (1.2 g, once-daily tablet formulation of mesalamine used for the treatment of UC (Lialda® or Mezavant®, Shire Pharmaceuticals Inc, Wayne, PA. In clinical studies, MMX mesalamine (taken as a once-daily dose of 2.4 or 4.8 g effectively induced and maintained clinical remission in patients with active mild-to-moderate UC. The overall safety profile of MMX mesalamine is similar to other oral mesalamine formulations. The use of such once-daily formulations has led to intense interest in whether simplified pill regimens can improve patient adherence to mesalamine therapy.Keywords: mesalamine, 5-ASA, ulcerative colitis, inflammatory bowel disease

  10. Suicide attempt in ulcerative colitis patient after 4months of infliximab therapy - A case report

    E.J. Eshuis; K.M.M.Y. Magnin; P.C.F. Stokkers; W.A. Bemelman; J. Bartelsman

    2010-01-01

    In the summary of product characteristics of infliximab (IFX), psychiatric side effects are reported to be rare, and in literature only limited data exist. This report presents a case of a patient with ulcerative colitis who developed a depression with psychotic symptoms during IFX therapy and made

  11. HNF4alpha and CDH1 are associated with ulcerative colitis in a Dutch cohort

    Sommeren, S. van; Visschedijk, M.C.; Festen, E.A.; Jong, D.J. de; Ponsioen, C.Y.; Wijmenga, C.; Weersma, R.K.

    2011-01-01

    BACKGROUND: Inflammatory bowel diseases (IBDs), consisting of ulcerative colitis (UC) and Crohn's disease (CD), are complex disorders with multiple genes contributing to disease pathogenesis. A recent genome-wide association scan identified three novel susceptibility loci for UC: HNF4alpha, CDH1, an

  12. HNF4 alpha and CDH1 Are Associated with Ulcerative Colitis in a Dutch Cohort

    van Sommeren, Suzanne; Visschedijk, Marijn C.; Festen, Eleonora A. M.; de Jong, Dirk J.; Ponsioen, Cyriel Y.; Wijmenga, Cisca; Weersma, Rinse K.

    2011-01-01

    Background: Inflammatory bowel diseases (IBDs), consisting of ulcerative colitis (UC) and Crohn's disease (CD), are complex disorders with multiple genes contributing to disease pathogenesis. A recent genome-wide association scan identified three novel susceptibility loci for UC: HNF4 alpha, CDH1, a

  13. Drug prescribing pattern in ulcerative colitis in a tertiary care hospital: an observational study

    Mukunda Narayanareddy

    2016-10-01

    Conclusions: Ulcerative colitis was more common in males. Aminosalicylates were the commonly prescribed drugs and a combination of aminosalicylate and steroid was frequently used regimen in our study. [Int J Basic Clin Pharmacol 2016; 5(5.000: 1862-1865

  14. Mechanisms of acupuncture and moxibustion in regulation of epithelial cell apoptosis in rat ulcerative colitis

    Huan-Gan Wu; Xiao Gong; Li-Qing Yao; Wei Zhang; Yin Shi; Hui-Rong Liu; Ye-Jing Gong; Li-Bin Zhou; Yi Zhu

    2004-01-01

    AIM: To investigate the effect of acupuncture and moxibustion on epithelial cell apoptosis and expression of Bcl-2, Bax, fas and FasL proteins in rat ulcerative colitis.METHODS: A rat model of ulcerative colitis was estabelished by immunological methods and local stimulation. All rats were randomly divided into model control group (MC),electro-acupuncture group (EA), herbs-partition moxibustion group (HPM). Normal rats were used as normal control group (NC). Epithelial cell apoptosis and expression of Bcl-2, Bax, fas and FasL proteins were detected by TUNEL and immunohistochemiscal method respectively.RESULTS: The number of epithelial cell apoptosis in MC was significantly higher than that in NC, and was markedly decreased after the treatment with herbs-partition moxibustion or electro-acupuncture. The expression of Bcl2, Bax, fas and FasL in colonic epithelial cells in MC was higher than that in NC, and was markedly down- regulated by herbspartition moxibustion or electro-acupuncture treatment.CONCLUSION: The pathogenesis of ulcerative colitis in rats involves abnormality of apoptosis. Acupuncture and moxibustion can regulate the expression of Bcl-2, Bax, fas and FasL proteins and inhibit the apoptosis of epithelial cells of ulcerative colitis in rats by Bcl-2/Bax, fas/FasL pathways.

  15. Differential association of two PTPN22 coding variants with Crohn's disease and ulcerative colitis

    Diaz-Gallo, Lina-Marcela; Espino-Paisán, Laura; Fransen, Karin; Gómez-García, María; van Sommeren, Suzanne; Cardeña, Carlos; Rodrigo, Luis; Mendoza, Juan Luis; Taxonera, Carlos; Nieto, Antonio; Alcain, Guillermo; Cueto, Ignacio; López-Nevot, Miguel A; Bottini, Nunzio; Barclay, Murray L; Crusius, J Bart; van Bodegraven, Adriaan A; Wijmenga, Cisca; Ponsioen, Cyriel Y; Gearry, Richard B; Roberts, Rebecca L; Weersma, Rinse K; Urcelay, Elena; Merriman, Tony R; Alizadeh, Behrooz Z; Martin, Javier

    2011-01-01

    BACKGROUND: The PTPN22 gene is an important risk factor for human autoimmunity. The aim of this study was to evaluate for the first time the role of the R263Q PTPN22 polymorphism in ulcerative colitis (UC) and Crohn's disease (CD), and to reevaluate the association of the R620W PTPN22 polymorphism w

  16. Differential Association of Two PTPN22 Coding Variants with Crohn's Disease and Ulcerative Colitis

    Diaz-Gallo, Lina-Marcela; Espino-Paisan, Laura; Fransen, Karin; Gomez-Garcia, Maria; van Sommeren, Suzanne; Cardena, Carlos; Rodrigo, Luis; Mendoza, Juan Luis; Taxonera, Carlos; Nieto, Antonio; Alcain, Guillermo; Cueto, Ignacio; Lopez-Nevot, Miguel A.; Bottini, Nunzio; Barclay, Murray L.; Crusius, J. Bart; van Bodegraven, Adriaan A.; Wijmenga, Cisca; Ponsioen, Cyriel Y.; Gearry, Richard B.; Roberts, Rebecca L.; Weersma, Rinse K.; Urcelay, Elena; Merriman, Tony R.; Alizadeh, Behrooz Z.; Martin, Javier

    2011-01-01

    Background: The PTPN22 gene is an important risk factor for human autoimmunity. The aim of this study was to evaluate for the first time the role of the R263Q PTPN22 polymorphism in ulcerative colitis (UC) and Crohn's disease (CD), and to reevaluate the association of the R620W PTPN22 polymorphism w

  17. The incidence of ulcerative colitis (1995-2011) and Crohn's disease (1995-2012)

    Nørgård, Bente Mertz; Nielsen, Jan; Fonager, Kirsten

    2014-01-01

    BACKGROUND AND AIMS: The incidence of ulcerative colitis (UC) and Crohn's disease (CD) has increased during the 20th century in North America and Western Europe. However, there are conflicting reports whether the incidence has declined, stabilized or even continued to increase. No nationwide Danish...

  18. The incidence of Crohn's disease and ulcerative colitis since 1995 in Danish children and adolescents

    Larsen, Michael Due; Baldal, Mira Eggebrecht; Nielsen, Rasmus Gaardskær

    2016-01-01

    OBJECTIVE: Worldwide the incidence of pediatric Crohn's disease (CD) and ulcerative colitis (UC) is suspected to be increasing. Based on unselected nationwide register data the aim of this study is to examine the change in incidence of CD and UC in children and adolescents in Denmark. MATERIALS...

  19. Increased Risk of Colorectal Cancer in Ulcerative Colitis Patients Diagnosed after 40 Years of Age

    Constantine J Karvellas

    2007-01-01

    Full Text Available BACKGROUND: The association between ulcerative colitis (UC and colorectal cancer (CRC is well established. Retrospective data show a 5.4% CRC incidence rate among patients with pancolitis and suggest that cancer surveillance should be provided to patients following eight to 10 years of extensive UC.

  20. Upregulation of cIAP2 in regenerating colonocytes in ulcerative colitis

    Seidelin, J.B.; Vainer, Ben; Andresen, L.

    2007-01-01

    It has been reported that colonocytes in ulcerative colitis (UC) upregulate anti-apoptotic cytoprotective pathways. An expression-profiling study of apoptosis-related genes suggested that the cellular inhibitor of apoptosis protein-2 (cIAP2) could be upregulated in epithelial cells in UC. The role...

  1. Association of tumor necrosis factor polymorphisms with susceptibility to ulcerative colitis in Chinese Han population

    曹倩

    2006-01-01

    Objective To investigate the association between tumor necrosis factor(TNF) promoter polymorphisms and susceptibility to ulcerative colitis (UC) in the Chinese Han population. Methods Blood samples from 110 unrelated UC patients and 292 healthy controls from Zhejiang Province, Eastern China were studied. Genotyping for 6 common TNF promoter polymorphisms (TNF-

  2. Diffuse enteritis after colectomy for ulcerative colitis : two case reports and review of the literature

    Corporaal, Sietske; Karrenbeld, Arend; van der Linde, Klaas; Voskuil, Jan H; Kleibeuker, Jan H; Dijkstra, Gerard

    2009-01-01

    Ulcerative colitis (UC) is an inflammatory disease of the colon. Involvement of the small bowel is limited to backwash ileitis or pouch-related conditions. Here, we report two men with UC who presented with small bowel inflammation and even perforation, within 1 month after subtotal colectomy. Endos

  3. Oxidative Stress and Carbonyl Lesions in Ulcerative Colitis and Associated Colorectal Cancer

    Zhiqi Wang

    2016-01-01

    Full Text Available Oxidative stress has long been known as a pathogenic factor of ulcerative colitis (UC and colitis-associated colorectal cancer (CAC, but the effects of secondary carbonyl lesions receive less emphasis. In inflammatory conditions, reactive oxygen species (ROS, such as superoxide anion free radical (O2∙-, hydrogen peroxide (H2O2, and hydroxyl radical (HO∙, are produced at high levels and accumulated to cause oxidative stress (OS. In oxidative status, accumulated ROS can cause protein dysfunction and DNA damage, leading to gene mutations and cell death. Accumulated ROS could also act as chemical messengers to activate signaling pathways, such as NF-κB and p38 MAPK, to affect cell proliferation, differentiation, and apoptosis. More importantly, electrophilic carbonyl compounds produced by lipid peroxidation may function as secondary pathogenic factors, causing further protein and membrane lesions. This may in turn exaggerate oxidative stress, forming a vicious cycle. Electrophilic carbonyls could also cause DNA mutations and breaks, driving malignant progression of UC. The secondary lesions caused by carbonyl compounds may be exceptionally important in the case of host carbonyl defensive system deficit, such as aldo-keto reductase 1B10 deficiency. This review article updates the current understanding of oxidative stress and carbonyl lesions in the development and progression of UC and CAC.

  4. Dietary protocatechuic acid ameliorates dextran sulphate sodium-induced ulcerative colitis and hepatotoxicity in rats.

    Farombi, Ebenezer O; Adedara, Isaac A; Awoyemi, Omolola V; Njoku, Chinonye R; Micah, Gabriel O; Esogwa, Cynthia U; Owumi, Solomon E; Olopade, James O

    2016-02-01

    The present study investigated the antioxidant and anti-inflammatory effects of dietary protocatechuic acid (PCA), a simple hydrophilic phenolic compound commonly found in many edible vegetables, on dextran sulphate sodium (DSS)-induced ulcerative colitis and its associated hepatotoxicity in rats. PCA was administered orally at 10 mg kg(-1) to dextran sulphate sodium exposed rats for five days. The result revealed that administration of PCA significantly (p rats. Furthermore, PCA prevented the increase in the plasma levels of pro-inflammatory cytokines, markers of liver toxicity and markedly suppressed the DSS-mediated elevation in colonic nitric oxide concentration and myeloperoxidase activity in the treated rats. Administration of PCA significantly protected against colonic and hepatic oxidative damage by increasing the antioxidant status and concomitantly decreased hydrogen peroxide and lipid peroxidation levels in the DSS-treated rats. Moreover, histological examinations confirmed PCA chemoprotection against colon and liver damage. Immunohistochemical analysis showed that PCA significantly inhibited cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase (iNOS) protein expression in the colon of DSS-treated rats. In conclusion, the effective chemoprotective role of PCA in colitis and the associated hepatotoxicity is related to its intrinsic anti-inflammatory and anti-oxidative properties.

  5. Paradoxical regulation of ChAT and nNOS expression in animal models of Crohn's colitis and ulcerative colitis.

    Winston, John H; Li, Qingjie; Sarna, Sushil K

    2013-08-15

    Morphological and functional changes in the enteric nervous system (ENS) have been reported in inflammatory bowel disease. We examined the effects of inflammation on the expression of choline acetyltransferase (ChAT) and nNOS in the muscularis externae of two models of colonic inflammation, trinitrobenzene sulfonic acid (TNBS)-induced colitis, which models Crohn's disease-like inflammation, and DSS-induced colitis, which models ulcerative Colitis-like inflammation. In TNBS colitis, we observed significant decline in ChAT, nNOS, and protein gene product (PGP) 9.5 protein and mRNA levels. In DSS colitis, ChAT and PGP9.5 were significantly upregulated while nNOS levels did not change. The nNOS dimer-to-monomer ratio decreased significantly in DSS- but not in TNBS-induced colitis. No differences were observed in the percentage of either ChAT (31 vs. 33%)- or nNOS (37 vs. 41%)-immunopositive neurons per ganglia or the mean number of neurons per ganglia (55 ± 5 vs. 59 ± 5, P > 0.05). Incubation of the distal colon muscularis externae in vitro with different types of inflammatory mediators showed that cytokines decreased ChAT and nNOS expression, whereas H₂O₂, a component of oxidative stress, increased their expression. NF-κB inhibitor MG-132 did not prevent the IL-1β-induced decline in either ChAT or nNOS expression. These findings showed that TNBS- and DSS-induced inflammation differentially regulates the expression of two critical proteins expressed in the colonic myenteric neurons. These differences are likely due to the exposure of the myenteric plexus neurons to different combinations of Th1-type inflammatory mediators and H₂O₂ in each model.

  6. [A clinical constelation in disuse: vitiligo, mastocytosis of the bone marrow, circulating heparinoid, chronic leg ulcer, hypoalbuminemia, ulcerative colitis and hepatic fibrosis].

    Goihman Yahr, M; Goldstein, C; González, Y; Aranzazu, N; Convit, J; Acevedo Gallegos, F; Grases, P

    1977-01-01

    We report an unusual case. Our patient had vitiligo, ulcerative colitis, hepatic fibrosis, hypoalbuminemia, bone marrow mastocytosis, a circulating heparinoid and chronic leg ulcers. The relationship between some of the components of this constellation seems logical. This is the case with bone marrow mastocytosis and circulating heparinoid. Also, between hypoalbuminemia and colitis and liver disfunction. On the other hand, the relationship between other features does not seem clear in the light of current knowledge.

  7. Risk for colorectal cancer in ulcerative colitis: Changes, causes and management strategies

    Peter Laszlo Lakatos; Laszlo Lakatos

    2008-01-01

    The risk of colorectal cancer for any patient with ulcerative colitis is known to be elevated, and is estimated to be 2% after 10 years, 8% after 20 years and 18% after 30 years of disease. Risk factors for cancer include extent and duration of ulcerative colitis, primary sclerosing cholangitis, a family history of sporadic colorectal cancer, severity of histologic bowel inflammation, and in some studies, young age at onset of colitis. In this review, the authors discuss recent epidemiological trends and causes for the observed changes. Population-based studies published within the past 5 years suggest that this risk has decreased over time, despite the low frequency of colectomies. The crude annual incidence rate of colorectal cancer in ulcerative colitis ranges from approximately 0.06% to 0.16% with a relative risk of 1.0-2.75. The exact mechanism for this change is unknown; it may partly be explained by the more widespread use of maintenance therapy and surveillance colonoscopy.

  8. Risk for colorectal cancer in ulcerative colitis: changes, causes and management strategies.

    Lakatos, Peter-Laszlo; Lakatos, Laszlo

    2008-07-07

    The risk of colorectal cancer for any patient with ulcerative colitis is known to be elevated, and is estimated to be 2% after 10 years, 8% after 20 years and 18% after 30 years of disease. Risk factors for cancer include extent and duration of ulcerative colitis, primary sclerosing cholangitis, a family history of sporadic colorectal cancer, severity of histologic bowel inflammation, and in some studies, young age at onset of colitis. In this review, the authors discuss recent epidemiological trends and causes for the observed changes. Population-based studies published within the past 5 years suggest that this risk has decreased over time, despite the low frequency of colectomies. The crude annual incidence rate of colorectal cancer in ulcerative colitis ranges from approximately 0.06% to 0.16% with a relative risk of 1.0-2.75. The exact mechanism for this change is unknown; it may partly be explained by the more widespread use of maintenance therapy and surveillance colonoscopy.

  9. Glycyrrhetic Acid Ameliorates Dextran Sulfate Sodium-Induced Ulcerative Colitis in Vivo

    Yong-Deok Jeon

    2016-04-01

    Full Text Available Glycyrrhizae Radix (GR is a Korean traditional herb medicine that is widely used in clinical health care. Glycyrrhetic acid (GA is an aglycone saponin extracted from GR that has anti-inflammatory, anti-cancer, and anti-viral effects. However, the anti-inflammatory effects of GA in colitis have not been reported. This study investigated the role of GA on ulcerative colitis in a dextran sulfate sodium (DSS-induced mouse colitis model. DSS-treated mice displayed weight loss and shortened colon length compared with control mice. Mice administered GA showed less weight loss and longer colon length than the DSS-treated group. Interleukin (IL-6, IL-1β, and tumor necrosis factor-alpha were decreased by GA treatment. GA treatment also reduced DSS-induced microscopic damage to colon tissue. GA regulates the phosphorylation of transcription factors including nuclear factor-kappa B (NF-κB and IκB alpha, and regulates the expression of cycloxygenase-2 and prostaglandin E2. GA thus showed beneficial effects in a mouse model of colitis, implicating GA might be a useful herb-derived medicine in the treatment of ulcerative colitis.

  10. Development of perianal ulcer as a result of acute fulminant amoebic colitis

    Takayuki Torigoe; Yoshifumi Nakayama; Koji Yamaguchi

    2012-01-01

    We report a case of acute fulminant amoebic colitis that resulted in the development of a perianal ulcer in a 29-year-old Japanese homosexual man with acquired immunodeficiency syndrome (AIDS).The patient was admitted to our hospital with a persistent perianal abscess that was refractory to antibiotic therapy administered at another hospital.On admission,we observed a giant ulcer in the perianal region.At first,cytomegalovirus colitis was suspected by blood investigations.Ganciclovir therapy was initiated; however,the patient developed necrosis of the skin around the anus during therapy.We only performed end-sigmoidostomy and necrotomy to avoid excessive surgical invasion.Histopathological examination of the surgical specimen revealed the presence of trophozoite amoebae,indicating a final diagnosis of acute fulminant amoebic colitis.The patient's postoperative course was favorable,and proctectomy of the residual rectum was performed 11 mo later.Amoebic colitis is one of the most severe complications affecting patients with AIDS.Particularly,acute fulminant amoebic colitis may result in a poor prognosis; therefore,staged surgical therapy as a less invasive procedure should be considered as one of the treatment options for these patients.

  11. Accuracy of abdominal ultrasound and MRI for detection of Crohn disease and ulcerative colitis in children

    Ziech, Manon L.W.; Smets, Anne M.J.B.; Lavini, Cristina; Caan, Matthan W.A.; Nederveen, Aart J.; Bipat, Shandra; Stoker, Jaap [Academic Medical Center, Department of Radiology, Amsterdam (Netherlands); Hummel, Thalia Z.; Benninga, Marc A.; Kindermann, Angelika [Emma Children' s Hospital, Academic Medical Center, Department of Pediatric Gastroenterology, Amsterdam (Netherlands); Nievelstein, Rutger A.J. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Roelofs, Joris J.T.H. [Academic Medical Center, Department of Pathology, Amsterdam (Netherlands)

    2014-11-15

    Endoscopy is currently the primary diagnostic technique for inflammatory bowel disease (IBD) in children. To assess the accuracy of US and dynamic contrast-enhanced MRI for diagnosing inflammatory bowel disease and for distinguishing Crohn disease and ulcerative colitis in comparison to a reference standard. Consecutive children with suspected IBD underwent diagnostic workup including ileocolonoscopy and upper gastrointestinal endoscopy as the reference standard, abdominal US, and MR enterography and colonography at 3 T. The protocol included a dynamic contrast-enhanced 3-D sequence. Sensitivity, specificity and kappa values were calculated for one ultrasonographer and two MRI observers. We included 28 children (15 boys) with mean age 14 years (range 10-17 years). The diagnosis was IBD in 23 children (72%), including 12 with Crohn disease, 10 with ulcerative colitis and 1 with indeterminate colitis. For the diagnosis of inflammatory bowel disease the sensitivity was 55% for US and 57% (both observers) for MR entero- and colonography, and the specificity was 100% for US and 100% (observer 1) and 75% (observer 2) for MR entero- and colonography. Combined MRI and US had sensitivity and specificity of 70% and 100% (observer 1) and 74% and 80% (observer 2), respectively. With the addition of a dynamic contrast-enhanced MR sequence, the sensitivity increased to 83% and 87%. US and MRI could only distinguish between Crohn disease and ulcerative colitis when terminal ileum lesions were present. US and MR entero- and colonography have a high accuracy for diagnosing inflammatory bowel disease in children but cannot be used to distinguish Crohn disease and ulcerative colitis. (orig.)

  12. Rectal Hodgkin lymphoma in a patient with ulcerative colitis: a case study.

    Rasmussen, Simon Ladefoged; Thomsen, Christian

    2015-04-16

    A case of Hodgkin lymphoma located in the rectum of a patient with ulcerative colitis is described. The patient was a 44 year old male treated with thiopurines for ulcerative colitis for ten years. He was admitted with malaise, weight loss and abdominal pain. Endoscopy revealed a large ulcerative lesion involving the rectum and distal part of the sigmoid colon. Although it macroscopically resembled a rectal cancer, repeated biopsies did not reveal any malignancy. In order to resolve the symptoms of stenosis and to get the final diagnosis a recto-sigmoid resection was performed. Pathologic examination revealed nodular sclerosis classical Hodgkin lymphoma, positive for Epstein Barr Virus. Subsequent examination revealed disseminated disease involving the pelvic wall, liver, and bone marrow. The patient is currently receiving chemotherapeutic treatment, and follow-up shows disease remission.Hodgkin lymphoma associated with immunosuppressive therapy is rare. However, patients with ulcerative colitis receiving such treatment are at increased risk of lymphoproliferative disordes, potentially due to loss of immunosurveillance and presence of oncogenic viruses (i.e. Epstein-Barr virus). Virtual Slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/6156776351558952.

  13. Leukocytoclastic vasculitis in an adolescent with ulcerative colitis: Report of a case and review of the literature

    G Tyler Butts

    2014-08-01

    Full Text Available An adolescent female with long-standing, difficult-to-control ulcerative colitis developed leukocytoclastic vasculitis, a rare cutaneous extra-intestinal manifestation of the inflammatory bowel disease. The authors provide a literature review on leukocytoclastic vasculitis complicating ulcerative colitis. Furthermore, the clinical features of leukocytoclastic vasculitis are compared and contrasted with the more common cutaneous extra-intestinal manifestations of inflammatory bowel disease, erythema nodosum, and pyoderma gangrenosum.

  14. Protective Effect of Calculus Bovis Sativus on Dextran Sulphate Sodium-Induced Ulcerative Colitis in Mice

    Xiping Li

    2015-01-01

    Full Text Available Calculus Bovis Sativus (CBS is a commonly used traditional Chinese medicine, which has been reported to exhibit antispasmodic, fever-reducing, anti-inflammatory, and gallbladder-repairing effects. The present study aims to investigate the protective effect of CBS on dextran sulphate sodium- (DSS- induced ulcerative colitis (UC in mice. C57BL/6 male mice were exposed to 5% DSS in drinking water. CBS was given orally at 50 and 150 mg/kg once per day for 7 days. Body weight, disease activity index (DAI, colon length, colonic myeloperoxidase (MPO activity, superoxide dismutase (SOD activity, and malondialdehyde (MDA and nitric oxide (NO levels were measured. Administration of CBS significantly reserved these changes, decreased the MPO activity and MDA and NO level, and increased the SOD activity in the colon tissue. Histological observation suggested that CBS alleviated edema, mucosal damage, and inflammatory cells infiltration induced by DSS in the colon. Moreover, CBS significantly downregulated the mRNA expression of tumor necrosis factor-α (TNF-α, interleukin- (IL- 1β and IL-6 in the colon tissue. Our data suggested that CBS exerted protective effect on DSS-induced UC partially through the antioxidant and anti-inflammatory activities.

  15. Quality improvement education to improve performance on ulcerative colitis quality measures and care processes aligned with National Quality Strategy priorities.

    Greene, Laurence; Moreo, Kathleen

    2015-01-01

    Studies on inflammatory bowel disease (IBD) have reported suboptimal approaches to patient care. In the United States, the findings have motivated leading gastroenterology organizations to call for initiatives that support clinicians in aligning their practices with quality measures for IBD and priorities of the National Quality Strategy (NQS). We designed and implemented a quality improvement (QI) education program on ulcerative colitis in which patient charts were audited for 30 gastroenterologists before (n = 300 charts) and after (n = 290 charts) they participated in QI-focused educational activities. Charts were audited for nine measures, selected for their alignment with four NQS priorities: making care safer, ensuring patient engagement, promoting communication, and promoting effective treatment practices. Four of the measures, including guideline-directed vaccinations and assessments of disease type and activity, were part of the CMS Physician Quality Reporting System (PQRS). The other five measures involved counseling patients on various topics in ulcerative colitis management, documentation of side effects, assessment of adherence status, and simplification of dosing. The gastroenterologists also completed baseline and post-education surveys designed to assess qualitative outcomes. One of the educational interventions was a private audit feedback session conducted for each gastroenterologist. The sessions were designed to support participants in identifying measures reflecting suboptimal care quality and developing action plans for improvement. In continuous improvement cycles, follow-up interventions included QI tools and educational monographs. Across the nine chart variables, post-education improvements ranged from 0% to 48%, with a mean improvement of 15.9%. Survey findings revealed improvements in self-reported understanding of quality measures and intentions to apply them to practice, and lower rates of perceived significant barriers to high

  16. Sodium arsenite reduces severity of dextran sulfate sodium-induced ulcerative colitis in rats

    Joshua J. MALAGO; Hortensia NONDOLI

    2008-01-01

    The histopathological features and the associated clinical findings of ulcerative colitis (UC) are due to persistent inflammatory response in the colon mucosa. Interventions that suppress this response benefit UC patients. We tested whether sodium arsenite (SA) benefits rats with dextran sulfate sodium (DSS)-colitis. The DSS-colitis was induced by 5% DSS in drinking water. SA (10 mg/kg; intraperitoneally) was given 8 h before DSS treatment and then every 48 h for 3 cycles of 7,14 or 21 d. At the end of each cycle rats were sacrificed and colon sections processed for histological examination. DSS induced diarrhea, loose stools, hemoccult positive stools, gross bleeding, loss of body weight, loss of epithelium, crypt damage, depletion of goblet cells and infiltration of inflammatory cells. The severity of these changes increased ir the order of Cycles 1,2 and 3. Treatment of rats with SA significantly reduced this severity and improved the weight gain.

  17. What Should Be Kept in Mind in the TCM Differential Treatment for Ulcerative Colitis?

    WU Pei-tian

    2008-01-01

    @@ Ulcerative colitis is a nonspecific inflammatory,disease of colon,clinically characterized by abdominal pain and diarrhea often with blood and mucus.It can be diagnosed based on the clinical manifestations and the endoscopic findings.In addition to mucosal erosion,ulcer and hemorrhage of the diseased section of colon,there can also be seen stiffness of the intestinal canal, decreased or disappeared peristalsis,or multiple inflammatory polypi in the involved region,and in severe cases,intestinal obstruction or obvious anemia.

  18. [Appendiceal orifice inflammation in distal ulcerative colitis. Report of a case and review of the literature].

    Tagle, Martin; Scavino, Yolanda; Luna, Eduardo

    2010-01-01

    We report the case of a 45-year-old female patient with an 18 month diagnosis of distal ulcerative colitis (proctosigmoiditis) of 18 months, who presented initially with allergy to salicylates, for which the disease was managed with corticosteroids and azathioprine and subsequently with Infliximab infusions, entering in remission. When she was about to receive her fifth Infliximab infusion she presented an exacerbation of her underlying disease with frequent stools with mucus, blood and tenesmus. Given that her initial diagnosis was made with a sigmoidoscopy we scheduled a total colonoscopy showing marked inflammation, erythema and friability limited to the recto-sigmoid mucosa, like at the disease onset, and when we reached the cecum an erythematous area circumscribed to the appendiceal orifice was observed, with a mucosal aspect identical to the described for the recto-sigmoid mucosa. The biopsies taken from that area were compatible with ulcerative colitis. We herein describe the details of the case and review the literature.

  19. Genetic update on inflammatory factors in ulcerative colitis: Review of the current literature

    Patricia; Sarlos; Erzsebet; Kovesdi; Lili; Magyari; Zsolt; Banfai; Andras; Szabo; Andras; Javorhazy; Bela; Melegh

    2014-01-01

    Ulcerative colitis(UC) is one of the main types of inflammatory bowel disease, which is caused by dysregulated immune responses in genetically predisposed individuals. Several genetic factors, including interleukin and interleukin receptor gene polymorphisms and other inflammation-related genes play central role in mediating and modulating the inflammation in the human body, thereby these can be the main cause of development of the disease. It is clear these data are very important for understanding the base of the disease, especially in terms of clinical utility and validity, but summarized literature is exiguous for challenge health specialist that can used in the clinical practice nowadays. This review summarizes the current literature on inflammationrelated genetic polymorphisms which are associated with UC. We performed an electronic search of Pubmed Database among publications of the last 10 years, using the following medical subject heading terms: UC, ulcerative colitis, inflammation, genes, polymorphisms, and susceptibility.

  20. Promoter polymorphism of transforming growth factor-β1 gene and ulcerative colitis

    B Tamizifar; KB Lankarani; S Naeimi; M Rismankar Zadeh; A Taghavi; A Ghaderi

    2008-01-01

    AIM: To elucidate the possible difference in two promoter polymorphisms of the transforming growth factor-β1 (TGF-β1) gene (-800G > A, -509C > T)between ulcerative colitis (UC) patients and normal subjects.METHODS: A total of 155 patients with established ulcerative colitis and 139 normal subjects were selected as controls. Two single nucleotide polymorphisms within the promoter region of TGF-β1 gene (-509C > T and -800G > A) were genotyped using PCR-RFLP.RESULTS: There was a statistically significant difference in genotype and allele frequency distributions between UC patients and controls for the -800G > A polymorphism of the TGF-β1 gene (P A of TGF-β1 gene promoter between Iranian patients with UC and normal subjects.

  1. Commonalities and differences between Crohn's disease and ulcerative colitis: the genetic clues to their interpretation.

    Actis, Giovanni C; Pellicano, Rinaldo; Tarallo, Sonia; Rosina, Floriano

    2011-12-01

    Traditional knowledge of clinical, laboratorial, and endoscopic orders regarding ulcerative colitis and Crohn's disease has begun to be implemented by the revolutionary data from genetic studies. Ever since many decades ago it has been clear that inflammatory bowel diseases are complex multifactorial disorders wherein gut-confined and/or environmental factors must synergize with genetic components to effect the full-blown disorder. The sequencing of the human genome and the generation of public resources of single nucleotide polymorphisms permitted the conduction of powerful population based genome-wide association studies. The latter have increased the number of the identified susceptibility loci to 99. In this review we touched on two pathways that make true susceptibility genes for inflammatory bowel diseases; gene loci that confer specific risk for ulcerative colitis and Crohn's disease were discussed in detail.

  2. Mesalamine-Induced Myocarditis and Coronary Vasculitis in a Pediatric Ulcerative Colitis Patient: A Case Report

    Elimarys Perez-Colon

    2011-01-01

    Full Text Available Mesalamine-containing products are often a first-line treatment for ulcerative colitis. Severe adverse reactions to these products, including cardiovascular toxicity, are rarely seen in pediatric patients. We present a case of a 16-year-old boy with ulcerative colitis treated with Asacol, a mesalamine-containing product, who developed sudden onset chest pain after four weeks on therapy. Serial electrocardiograms showed nonspecific ST segment changes, an echocardiogram showed mildly decreased left ventricular systolic function with mild to moderate left ventricular dilation and coronary ectasia, and his troponins were elevated. Following Asacol discontinuation, his chest pain resolved, troponins were trending towards normal, left ventricular systolic function normalized, and coronary ectasia improved within 24 hours suggesting an Asacol-associated severe drug reaction. Mesalamine-induced cardiovascular toxicity, although rare, may represent a life-threatening disorder. Therefore, every patient presenting with acute chest pain should receive a workup to rule out this rare drug-induced disorder.

  3. Maintaining remission in ulcerative colitis – role of once daily extended-release mesalamine

    Lilliana Oliveira

    2011-02-01

    Full Text Available Lilliana Oliveira, Russell D CohenThe Department of Medicine, Section of Gastroenterology, University of Chicago Medical Center, Chicago, IL, USAAbstract: The aminosalicylates (5-ASA; also referred to as mesalamine-based agents are considered as first-line in the maintenance of remission of mild to moderate ulcerative colitis (UC. Traditionally these agents have required a large pill burden and multiple daily dosing regimens which may account for the low adherence rates, especially in patients in remission. Extended-release mesalamine is the first once daily mesalamine product approved by the Food and Drug Administration for the maintenance of UC remission. This review will examine the pharmacokinetics, dosing, efficacy, and safety data of extended-release mesalamine, and discuss the potential role of improving medication compliance and decreasing costs in UC maintenance.Keywords: ulcerative colitis, 5-ASA, mesalamine, adherence, compliance, quality of life, costs

  4. A protein-truncating R179X variant in RNF186 confers protection against ulcerative colitis

    Rivas, Manuel A.; Graham, Daniel; Sulem, Patrick; Stevens, Christine; Desch, A. Nicole; Goyette, Philippe; Gudbjartsson, Daniel; Jonsdottir, Ingileif; Thorsteinsdottir, Unnur; Degenhardt, Frauke; Mucha, Sören; Kurki, Mitja I.; Li, Dalin; D'Amato, Mauro; Annese, Vito; Vermeire, Severine; Weersma, Rinse K.; Halfvarson, Jonas; Paavola-Sakki, Paulina; Lappalainen, Maarit; Lek, Monkol; Cummings, Beryl; Tukiainen, Taru; Haritunians, Talin; Halme, Leena; Koskinen, Lotta L. E.; Ananthakrishnan, Ashwin N.; Luo, Yang; Heap, Graham A.; Visschedijk, Marijn C.; Barrett, J; de Lange, K; Edwards, C; Hart, A; Hawkey, C; Jostins, L; Kennedy, N; Lamb, C; Lee, J; Lees, C; Mansfield, J; Mathew, C; Mowatt, C; Newman, W; Nimmo, E; Parkes, M; Pollard, M; Prescott, N; Randall, J; Rice, D; Satsangi, J; Simmons, A; Tremelling, M; Uhlig, H; Wilson, D; Abraham, C; Achkar, J.P; Bitton, A; Boucher, G; Croitoru, K; Fleshner, P; Glas, J; Kugathasan, S; Limbergen, J.V; Milgrom, R; Proctor, D; Regueiro, M; Schumm, P.L; Sharma, Y; Stempak, J.M; Targan, S.R; Wang, M.H; MacArthur, Daniel G.; Neale, Benjamin M.; Ahmad, Tariq; Anderson, Carl A.; Brant, Steven R.; Duerr, Richard H.; Silverberg, Mark S.; Cho, Judy H; Palotie, Aarno; Saavalainen, Päivi; Kontula, Kimmo; Färkkilä, Martti; McGovern, Dermot P. B.; Franke, Andre; Stefansson, Kari; Rioux, John D.; Xavier, Ramnik J.; Daly, Mark J.; Barrett, J.; de Lane, K.; Edwards, C.; Hart, A.; Hawkey, C.; Jostins, L.; Kennedy, N.; Lamb, C.; Lee, J.; Lees, C.; Mansfield, J.; Mathew, C.; Mowatt, C.; Newman, B.; Nimmo, E.; Parkes, M.; Pollard, M.; Prescott, N.; Randall, J.; Rice, D.; Satsangi, J.; Simmons, A.; Tremelling, M.; Uhlig, H.; Wilson, D.; Abraham, C.; Achkar, J. P.; Bitton, A.; Boucher, G.; Croitoru, K.; Fleshner, P.; Glas, J.; Kugathasan, S.; Limbergen, J. V.; Milgrom, R.; Proctor, D.; Regueiro, M.; Schumm, P. L.; Sharma, Y.; Stempak, J. M.; Targan, S. R.; Wang, M. H.

    2016-01-01

    Protein-truncating variants protective against human disease provide in vivo validation of therapeutic targets. Here we used targeted sequencing to conduct a search for protein-truncating variants conferring protection against inflammatory bowel disease exploiting knowledge of common variants associated with the same disease. Through replication genotyping and imputation we found that a predicted protein-truncating variant (rs36095412, p.R179X, genotyped in 11,148 ulcerative colitis patients and 295,446 controls, MAF=up to 0.78%) in RNF186, a single-exon ring finger E3 ligase with strong colonic expression, protects against ulcerative colitis (overall P=6.89 × 10−7, odds ratio=0.30). We further demonstrate that the truncated protein exhibits reduced expression and altered subcellular localization, suggesting the protective mechanism may reside in the loss of an interaction or function via mislocalization and/or loss of an essential transmembrane domain. PMID:27503255

  5. Personality dimensions and type D personality in female patients with ulcerative colitis

    Marzieh Sadat Sajadinejad; Hossein Molavi; Karim Asgari; Mehrdad Kalantari; Peyman Adibi

    2012-01-01

    Aim : Psychological factors such as personality traits may affect the adjustment capacity and Quality of Life (QOL) in Ulcerative Colitis (UC) patients. Type D personality has some similarities with general personality traits of UC patients. The aims of this study were to compare NEO personality profile and type D personality between healthy normal group and UC patients; and to determine the possible relationship between type D personality and QOL in UC patients. Materials and Methods : The s...

  6. Associations of the decoy receptor and osteoprotegerin gene polymorphisms with ulcerative colitis in Chinese patients

    郑香云

    2014-01-01

    Objective To investigate the correlation between decoy receptor(DcR)1,DcR2 and osteoprotegerin(OPG)gene polymorphisms with the susceptibility to ulcerative colitis(UC)in Chinese population.Methods A total of352 patients with UC as well as 463 sex-and agematched healthy controls were recruited in the study.The genetic polymorphisms of DcR1(rs12549481),DcR2(rs1133782)and OPG(rs3102735)were deter-

  7. Steroid-sparing strategies in the management of ulcerative colitis: Efficacy of leukocytapheresis

    Manabu Shiraki; Takayuki Yamamoto

    2012-01-01

    Active ulcerative colitis (UC) is frequently associated with infiltration of a large number of leukocytes into the bowel mucosa.Leukocytapheresis is a novel nonpharmacologic approach for active UC,in which leukocytes are mechanically removed from the circulatory system.Current data indicate that leukocytapheresis is efficacious in improving response and remission rates with excellent tolerability and safety in patients with UC.Corticosteroid therapy remains a mainstay in the treatment of active UC; however,long-term,high doses of corticosteroids usually produce predictable and potentially serious side effects.If leukocytapheresis can spare patients from exposure to corticosteroids,the risk of steroid-induced adverse events should be minimized.This may be of great benefit to patients because severe side effects of steroids seriously impair healthrelated quality of life.In this article,we reviewed cur rent evidence on whether leukocytapheresis can avoid or reduce the use of corticosteroids in the management of patients with UC.Several studies have shown that leukocytapheresis was effective for steroid-na(i)ve patients with active UC.Furthermore,both short-term and long-term studies have demonstrated the steroidsparing effects of leukocytapheresis therapy in patients with UC.Although the evidence level is not striking,the available data suggest that leukocytapheresis can avoid or reduce the use of corticosteroids in the management of UC.Large,well-designed clinical trials are necessary to more accurately evaluate the steroid-sparing effects of leukocytapheresis in the management of UC.

  8. The Correlation of the Contents of Fecal Calprotectin and the Activity of Colitis in Ulcerative Colitis and its Value as an Indicator of Disease Activity%粪钙卫蛋白含量和结肠炎活动性之间的关系及临床应用价值

    余剑波; 李春生; 林闯; 凌寿坚; 李林; 梁红; 禢少华

    2011-01-01

    Objective To evaluate the correlation of the contents of fecal calprotectin and activity of colitis in ulcerative colitis, and evaluate the accuracy of fecal calprotectin as a non-invasive indicator of disease activity . The references are erythroeyte sedimentation rate (ESR) and C-reactive protein (CRP). Methods 18 healthy persons as control and 45 patients with UC were recruited after colonoscopy. All were asked to collect 5g of stool sample for determining fecal calprotectin by an enzyme--linked immunosorbent assay. The disease activity of UC was evaluated according to colonoscopic and histological criteria. CRP,ESR were also measured. Results The fecal calprotectin concentration among patients with active UC(578.5ug/g)was significantly higher than that of inactive UC group(10.84 ug/g, P<0.01)and healthy controls(4.94 ug/g, P <0.01). The difference between control group and inactive group was not statistically significant ( P>0.05). Significant difference existed between each active grades(Ⅰ, Ⅱ, Ⅲ )and inactive phase of UC( P <0.01). There has a significant correlation between endoscopic grades of disease activity and fecal calprotectin concentration( r=0.965, P<0.01). The correlation coefficient between CRP/ESR and histological grades were 0.952 ( P <0.01) and 0.948 ( P<0.01) respectively. Both were lower than that of calprotectin. Conclusion Fecal calprotectin levels reflect the disease activity in UC and can be used to monitor the response to treatment and detect relapses. It was an objective, simple and noninvasive measurement and was better than ESR and serum CRP.%目的 探讨溃疡性结肠炎(UC)患者粪钙卫蛋白含量(Fecal calprotectin content,FCC)和结肠活动性之间的关系,以明确粪钙卫蛋白作为炎症性肠病诊断标志物的临床价值.方法 肠镜确诊的UC患者45例,肠镜前/后留取5 g粪便用ELISA测定FCC;并检ESR和CRP.炎症活动性根据内镜和病理学标准判断.肠镜正常的18例

  9. Co-administration of α-lipoic acid and cyclosporine aggravates colon ulceration of acetic acid-induced ulcerative colitis via facilitation of NO/COX-2/miR-210 cascade.

    El-Gowelli, Hanan M; Saad, Evan I; Abdel-Galil, Abdel-Galil A; Ibrahim, Einas R

    2015-11-01

    In this work, α-lipoic acid and cyclosporine demonstrated significant protection against acetic acid-induced ulcerative colitis in rats. We proposed that α-lipoic acid and cyclosporine co-administration might modulate their individual effects. Induction of ulcerative colitis in rats was performed by intra-rectal acetic acid (5% v/v) administration for 3 consecutive days. Effects of individual or combined used of α-lipoic acid (35 mg/kg ip) or cyclosporine (5mg/kg sc) for 6 days starting 2 days prior to acetic acid were assessed. Acetic acid caused colon ulceration, bloody diarrhea and weight loss. Histologically, there was mucosal atrophy and inflammatory cells infiltration in submucosa, associated with depletion of colon reduced glutathione, superoxide dismutase and catalase activities and elevated colon malondialdehyde, serum C-reactive protein (C-RP) and tumor necrosis factor-α (TNF-α). Colon gene expression of cyclooxygenase-2 and miR-210 was also elevated. These devastating effects of acetic acid were abolished upon concurrent administration of α-lipoic acid. Alternatively, cyclosporine caused partial protection against acetic acid-induced ulcerative colitis. Cyclosporine did not restore colon reduced glutathione, catalase activity, serum C-RP or TNF-α. Unexpectedly, co-administration of α-lipoic acid and cyclosporine aggravated colon ulceration. Concomitant use of α-lipoic acid and cyclosporine significantly increased nitric oxide production, cyclooxygenase-2 and miR-210 gene expression compared to all other studied groups. The current findings suggest that facilitation of nitric oxide/cyclooxygenase-2/miR-210 cascade constitutes, at least partially, the cellular mechanism by which concurrent use of α-lipoic acid and cyclosporine aggravates colon damage. Collectively, the present work highlights the probable risk of using α-lipoic acid/cyclosporine combination in ulcerative colitis patients.

  10. Development of ulcerative colitis during the course of rheumatoid arthritis: Association with selective IgA deficiency

    Yuki Asada; Yohei Mizuta; Kiyoshi Migita; Masahiro Ito; Shigeru Kohno; Hajime Isomoto; Saburo Shikuwa; Chun Yang Wen; Eiichiro Fukuda; Masaru Miyazato; Kenta Okamoto; Takashi Nakamura; Hitoshi Nishiyama

    2006-01-01

    A 56-year-old woman with a 29-year history of rheumatoid arthritis (RA) was admitted to the hospital, complaining of high fever, abdominal pain and severe bloody diarrhea. Colonoscopy revealed friable and edematous mucosa with spontaneous bleeding, diffuse erosions and ulcers extending from the rectum to the distal transverse colon. Histopathological findings of rectal biopsies were compatible with ulcerative colitis (UC). Being diagnosed as having severe active leftside UC, she was successfully treated with intravenous methylprednisolone followed by prednisolone and leukocytapheresis. Laboratory tests revealed low serum and saliva IgA levels, which might play a role in the development of UC. To our knowledge, this is the first case of UC occurring during the course of PA, accompanied by selective IgA deficiency.

  11. Pouchitis-associated iritis (uveitis) following total proctocolectomy and ileal pouch-to-anal anastomosis in ulcerative colitis.

    Freeman, H J

    2001-02-01

    A 26-year-old woman with ulcerative colitis treated with a proctocolectomy and ileal pouch-to-anal anastomosis developed an erosive and ulcerative pouchitis. Although no ophthalmological manifestations were present before the staged surgical procedures, iritis developed after appearance of the pouchitis. Both conditions subsequently resolved with oral corticosteroids and metronidazole.

  12. Pouchitis-Associated Iritis (Uveitis Following Total Proctocolectomy and Ileal Pouch-to-Anal Anastomosis in Ulcerative Colitis

    Hugh James Freeman

    2001-01-01

    Full Text Available A 26-year-old woman with ulcerative colitis treated with a proctocolectomy and ileal pouch-to-anal anastomosis developed an erosive and ulcerative pouchitis. Although no ophthalmological manifestations were present before the staged surgical procedures, iritis developed after appearance of the pouchitis. Both conditions subsequently resolved with oral corticosteroids and metronidazole.

  13. Clinical Significance and Assessment of Cytokines in Various Stages of Ulcerative Colitis

    ZOU; Kaifang(

    2001-01-01

    [1]Herfarth H H Bocher U Janardhanam R et al.Subtherapeutic corticostevoids potentiate the ability of interleukin 10 to prevent chronic inflammation in rates.Gastroenterology 1998 115:856[2]Strong S A Pizarro T T Klein J S et al.Proinflammatory cytokines differentially modulate their own expression in human intestinal mucosal mesenchymal cells.Gastroenterology 1998 114:1244[3]Nikolaus S Bauditz J Giouchettii P et al.Increased secretion of pro-inflammatory cytkines by circulating Polymorphnuclear neutrophils and regulation by interleukin 10 during intestinal inflammation.Gut 1998 42:470[4]安子元.溃疡性结肠炎的诊断标准.新消化病杂志 1994 2(1)57[5]Mahida Y R Wu K Jewell D P.Enhanced production of interlukin-1β in mononuclear cells isolated from mucosa with active ulcerative colitis and crohn's disease.Gut 1989 30:835[6]Fiorentino D F Zlotnik A Vieira P et al.IL-10 acts on the antigen presenting cell to inhibit cytokine production by Th1 cells.J Immunol 1991 146(10):3444[7]Nielsen O H Koppen T Rudiger N et al.Involvement of interleukin 4 and interleukin 10 in inflammatory bowel disease.Dig Dis Sci 1996 41(9)1786[8]Schreiber S Heinig T Thieve H G et al.Immunoregulatory role of interleukin10 in patients with inflammatory bowel disease.Gastroenterology 1995 108 (5) :1434[9]Steidler L Hans W.Treatment of murine colitis by Iactococcus Iactis secreting interleukin-10.Science 2000 289:352

  14. The potential role of a self-management intervention for ulcerative colitis: a brief report from the ulcerative colitis hypnotherapy trial.

    Keefer, Laurie; Kiebles, Jennifer L; Kwiatek, Monika A; Palsson, Olafur; Taft, Tiffany H; Martinovich, Zoran; Barrett, Terrence A

    2012-01-01

    Inflammatory bowel diseases (IBD) are chronic inflammatory illnesses marked by unpredictable disease flares, which occur spontaneously and/or in response to external triggers, especially personal health behaviors. Behavioral triggers of flare may be responsive to disease self-management programs. We report on interim findings of a randomized controlled trial of gut-directed hypnotherapy (HYP, n = 19) versus active attention control (CON, n = 17) for quiescent ulcerative colitis (UC). To date, 43 participants have enrolled; after 5 discontinuations (1 in HYP) and 2 exclusions due to excessive missing data, 36 were included in this preliminary analysis. Aim 1 was to determine the feasibility and acceptability of HYP in UC. This was achieved, demonstrated by a reasonable recruitment rate at our outpatient tertiary care clinic (20%), high retention rate (88% total), and our representative IBD sample, which is reflected by an equal distribution of gender, an age range between 21 and 69, recruitment of ethnic minorities (∽20%), and disease duration ranging from 1.5 to 35 years. Aim 2 was to estimate effect sizes on key clinical outcomes for use in future trials. Effect sizes (group × time at 20 weeks) were small to medium for IBD self-efficacy (.34), Inflammatory Bowel Disease Questionnaire (IBDQ) total score (.41), IBDQ bowel (.50), and systemic health (.48). Between-group effects were observed for the IBDQ bowel health subscale (HYP > CON; p = .05) at 20 weeks and the Short Form 12 Health Survey Version 2 (SF-12v2) physical component (HYP > CON; p < .05) at posttreatment and 20 weeks. This study supports future clinical trials testing gut-directed HYP as a relapse prevention tool for IBD.

  15. 5-Aminosalicylates reduce the risk of colorectal neoplasia in patients with ulcerative colitis: an updated meta-analysis.

    Li-Na Zhao

    Full Text Available BACKGROUND: Although the chemopreventive effect of 5-aminosalicylates on patients with ulcerative colitis has been extensively studied, the results remain controversial. This updated review included more recent studies and evaluated the effectiveness of 5-aminosalicylates use on colorectal neoplasia prevention in patients with ulcerative colitis. METHODS: Up to July 2013, we searched Medline, Embase, Web of Science, Cochrane CENTRAL, and SinoMed of China for all relevant observational studies (case-control and cohort about the effect of 5-aminosalicylates on the risk of colorectal neoplasia among patients with ulcerative colitis. The Newcastle-Ottawa Scale was used to assess the quality of studies. Adjusted odds ratios (ORs were extracted from each study. A random-effects model was used to generate pooled ORs and 95% confidence intervals (95%CI. Publication bias and heterogeneity were assessed. RESULTS: Seventeen studies containing 1,508 cases of colorectal neoplasia and a total of 20,193 subjects published from 1994 to 2012 were analyzed. 5-aminosalicylates use was associated with a reduced risk of colorectal neoplasia in patients with ulcerative colitis (OR 0.63; 95%CI 0.48-0.84. Pooled OR of a higher average daily dose of 5-aminosalicylates (sulfasalazine ≥ 2.0 g/d, mesalamine ≥ 1.2 g/d was 0.51 [0.35-0.75]. Pooled OR of 5-aminosalicylates use in patients with extensive ulcerative colitis was 1.00 [0.53-1.89]. CONCLUSION: Our pooled results indicated that 5-aminosalicylates use was associated with a reduced risk of colorectal neoplasia in patients with ulcerative colitis, especially in the cases with a higher average daily dose of 5-aminosalicylates use. However, the chemopreventive benefit of 5-aminosalicylates use in patients with extensive ulcerative colitis was limited.

  16. Current approaches to the management of new-onset ulcerative colitis

    Marchioni Beery R

    2014-05-01

    Full Text Available Renée Marchioni Beery,1 Sunanda Kane21Division of Gastroenterology and Hepatology, University of Connecticut Health Center, Farmington, CT, USA; 2Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USAAbstract: Ulcerative colitis (UC is an idiopathic, inflammatory gastrointestinal disease of the colon. As a chronic condition, UC follows a relapsing and remitting course with medical maintenance during periods of quiescent disease and appropriate escalation of therapy during times of flare. Initial treatment strategies must not only take into account current clinical presentation (with specific regard for extent and severity of disease activity but must also take into consideration treatment options for the long-term. The following review offers an approach to new-onset UC with a focus on early treatment strategies. An introduction to the disease entity is provided along with an approach to initial diagnosis. Stratification of patients based on clinical parameters, disease extent, and severity of illness is paramount to determining course of therapy. Frequent assessments are required to determine clinical response, and treatment intensification may be warranted if expected improvement goals are not appropriately reached. Mild-to-moderate UC can be managed with aminosalicylates, mesalamine, and topical corticosteroids with oral corticosteroids reserved for unresponsive cases. Moderate-to-severe UC generally requires oral or intravenous corticosteroids in the short-term with consideration of long-term management options such as biologic agents (as initial therapy or in transition from steroids or thiopurines (as bridging therapy. Patients with severe or fulminant UC who are recalcitrant to medical therapy or who develop disease complications (such as toxic megacolon should be considered for colectomy. Early surgical referral in severe or refractory UC is crucial, and colectomy may be a life-saving procedure. The authors provide

  17. [Oral cavity microflora in patients with non-specific ulcerative colitis and Crohn's disease].

    Kondrakova, O A; Muliar, E A; Voropaeva, E A; Babin, V N; Dubinin, A V; Briko, N I

    2009-01-01

    Results of study of microecological disorders in oral cavity of patients with non-specific ulcerative colitis (NSUC) and Crohn's disease (CD) and control subjects (patients with hypertension). Condition of mucosa was assessed on the basis of morphological data and electrophoretic mobility of cell nuclei, whereas structure of microbiocenosis and metabolic activity of microflora--on the basis of saliva bacterial culture and contents and profile of volatile fat acids in it. Detection rate of negative charge of the cell nuclei (decrease of functional activity of epithelium) was significantly higher in patients with NSUC and CD (66.6%) compared with controls (10%). This fact was directly related with hypercolonization of oral cavity by Gram-negative microflora. Lesions of mucosa which are characteristic of NSUC and CD and determined by pathologic immune mechanisms correlated with quantity of pathogenic microflora (Staphylococcus aureus and Candida). Marked differences of chromatograms' patterns were observed in patients with NSUC and CD indicating the suppression of anaerobic microflora in patients with CD and hypercolonization of oral cavity by anaerobic microflora in majority of patients with NSUC.

  18. Serum Fatty Acids Are Correlated with Inflammatory Cytokines in Ulcerative Colitis.

    Dawn M Wiese

    Full Text Available Ulcerative colitis (UC is associated with increased dietary intake of fat and n-6 polyunsaturated fatty acids (PUFA. Modification of fat metabolism may alter inflammation and disease severity. Our aim was to assess differences in dietary and serum fatty acid levels between control and UC subjects and associations with disease activity and inflammatory cytokines.Dietary histories, serum, and colonic tissue samples were prospectively collected from 137 UC subjects and 38 controls. Both histologic injury and the Mayo Disease Activity Index were assessed. Serum and tissue cytokines were measured by Luminex assay. Serum fatty acids were obtained by gas chromatography.UC subjects had increased total fat and oleic acid (OA intake, but decreased arachidonic acid (AA intake vs controls. In serum, there was less percent saturated fatty acid (SFA and AA, with higher monounsaturated fatty acids (MUFA, linoleic acid, OA, eicosapentaenoic acid (EPA, and docosapentaenoic acid (DPA in UC. Tissue cytokine levels were directly correlated with SFA and inversely correlated with PUFA, EPA, and DPA in UC subjects, but not controls. 5-aminosalicylic acid therapy blunted these associations.In summary, we found differences in serum fatty acids in UC subjects that correlated with pro-inflammatory tissue cytokines. We propose that fatty acids may affect cytokine production and thus be immunomodulatory in UC.

  19. Gram-negative bacteria account for main differences between faecal microbiota from patients with ulcerative colitis and healthy controls

    Vigsnæs, Louise Kristine; Brynskov, J.; Steenholdt, C.

    2012-01-01

    Detailed knowledge about the composition of the intestinal microbiota may be critical to unravel the pathogenesis of ulcerative colitis (UC), a human chronic inflammatory bowel disease, since the intestinal microbes are expected to influence some of the key mechanisms involved in the inflammatory...... that the microbiota in UC patients with active disease differ from that in healthy controls. Our findings indicate that alterations in the composition of the Gram-negative bacterial population, as well as reduced numbers of lactobacilli and A. muciniphila may play a role in UC.......Detailed knowledge about the composition of the intestinal microbiota may be critical to unravel the pathogenesis of ulcerative colitis (UC), a human chronic inflammatory bowel disease, since the intestinal microbes are expected to influence some of the key mechanisms involved in the inflammatory...... process of the gut mucosa. The aim of this study was to investigate the faecal microbiota in patients either with UC in remission (n=6) or with active disease (n=6), and in healthy controls (n=6). The composition of Gram-negative bacteria and Gram-positive bacteria was examined. Antigenic structures...

  20. A pharmacokinetic approach to model-guided design of infliximab schedules in ulcerative colitis patients

    Alejandro Pérez-Pitarch

    2015-03-01

    Full Text Available Background: Infliximab, an anti-tumour necrosis factor approved for treatment of Crohn's disease and ulcerative colitis, is administered at predefined interdose-intervals. On insufficient response or loss of response, treatment can be intensified. The lack or loss of response is likely related to complex pharmacokinetics of infliximab. Aims: To explore optimal dosing strategies of infliximab in treatment-naïve patients with ulcerative colitis through predictive Monte Carlo simulations based on a validated population PK model. Methods: A population of 2,000 treatment-naïve patients was generated by Montecarlo simulation. Six dosing strategies for maintenance therapy were simulated on this population. Strategies 1 and 2 consisted on 5 mg/kg and 6 mg/kg doses, respectively, and 8 weeks inter-dose interval. Strategies 3 and 4 used Individualized doses, adjusted to albumin level, sex and body weight, and a fix inter-dose interval of 8 weeks to achieve a target trough concentration of 5 mg/L or 6 mg/L, respectively. Strategies 5 and 6 used a fix dose of 5 mg/kg and individualized inter-dose intervals, adjusted to the same covariates, to achieve a target concentration, of 5 mg/L or 6 mg/L, respectively. Results: Strategies 2-6 reached trough levels statistically higher than strategy 1 (p < 0.05. Strategy 5 proved to be the best dosing strategy. It was associated with a higher proportion of responder patients than strategy 1 (62 % vs. 40 % without reaching higher peak concentrations. Conclusions: Optimization of maintenance treatment of colitis with infliximab by a pharmacokinetic approach could benefit infliximab-naive patients with ulcerative colitis.

  1. Point Injection for 43 Cases of Chronic Ulcerative Colitis

    ZHU Yue-ping

    2003-01-01

    Pishu ( BL 20), Dachangshu ( BL 25), Zusanli (ST 36), and Shangjuxu (ST 37) were selected to treat chronic ulcerative colonitis in 43 cases by point injection with placental tissue fluid and the curative effect was compared with that of west medicine plus enema in 22 cases (control group). It showed that there was a significant difference in short-term total effective rate between the two groups. It suggested that point therapy was effective.

  2. Use of blood based biomarkers in the evaluation of Crohn’s disease and ulcerative colitis

    Edward; L; Barnes; Choong-Chin; Liew; Samuel; Chao; Robert; Burakoff

    2015-01-01

    Despite significant improvements in our understanding of Crohn’s disease(CD) and ulcerative colitis(UC) in recent years, questions remain regarding the best approaches to assessment and management of these chronic diseases during periods of both relapse and remission. Various serologic biomarkers have been used in the evaluation of patients with both suspected and documented inflammatory bowel disease(IBD), and while each has potential utility in the assessment of patients with IBD, potential limitation remain with each method of assessment. Given these potential shortcomings, there has been increased interest in other means of evaluation of patients with IBD, including an expanding interest in the role of gene expression profiling. Among patients with IBD, gene expression profiles obtained from whole blood have been used to differentiate active from inactive CD, as well as to differentiate between CD, UC, and non-inflammatory diarrheal conditions. There are many opportunities for a non-invasive, blood based test to aid in the assessment of patients with IBD, particularly when considering more invasive means of evaluation including endoscopy with biopsy. Furthermore, as the emphasis on personalized medicine continues to increase, the potential ability of gene expression analysis to predict patient response to individual therapies offers great promise. While whole blood gene expression analysis may not completely replace more traditional means of evaluating patients with suspected or known IBD, it does offer significant potential to expand our knowledge of the underlying genes involved in the development of these diseases.

  3. Clinical and immunological features of chronic non-specific non-ulcerative colitis in infants.

    Marushko RV

    2013-04-01

    Full Text Available Objective: To study the activity of cytokines for determination of their pathogenic role and effective action of the individual factors of the immune system in infants with chronic non&specific non&ulcerative colitis (CNNC. Patients and methods. It is studied 60 children in the age from 1 to 3 years with CNNC, who were under hospitalization. The control group consisted of 30 apparently healthy children of appropriate age. Immunological status of children was evaluated on the base of determination of cytokine concentration in the blood serum by the method of Enzyme-Immuno-Sorbent-Assay. Results. It is found that during the CNNC in infants and the concentration and ratio of the different groups of cytokines in the blood serum undergoes significant changes — increasing the concentration of pro&inflammatory cytokines (IL&1α, IL&6, IL&8, TNF-α and decreases the level of inflammatory cytokines (IL-4 is the IL-10, wherein the content growth factors is changing — by increased hepatocytes growth factor and reduced intestinal trefoil factor. Conclusions. Found changes of cytokines state can be regarded as a violation of the immunoregulatory mechanisms that is the basis of pathogenesis of the formation of a chronic inflammatory process in the infant's intestine.

  4. Promising biological therapies for ulcerative colitis: A review of the literature

    Hirotada; Akiho; Azusa; Yokoyama; Shuichi; Abe; Yuichi; Nakazono; Masatoshi; Murakami; Yoshihiro; Otsuka; Kyoko; Fukawa; Mitsuru; Esaki; Yusuke; Niina; Haruei; Ogino

    2015-01-01

    Ulcerative colitis(UC) is a chronic lifelong condition characterized by alternating flare-ups and remission. There is no single known unifying cause, and the pathogenesis is multifactorial, with genetics, environmental factors, microbiota, and the immune system all playing roles. Current treatment modalities for UC include 5-aminosalicylates, corticosteroids, immunosuppressants(including purine antimetabolites, cyclosporine, and tacrolimus), and surgery. Therapeutic goals for UC are evolving. Medical treatment aims to induce remission and prevent relapse of disease activity. Infliximab, an anti-tumor necrosis factor(TNF)-α monoclonal antibody, is the first biological agent for the treatment of UC. Over the last decade, infliximab and adalimumab(anti-TNF-α agents) have been used for moderate to severe UC, and have been shown to be effective in inducing and maintaining remission. Recent studies have indicated that golimumab(another anti-TNF-α agent), tofacitinib(a Janus kinase inhibitor), and vedolizumab and etrolizumab(integrin antagonists), achieved good clinical remission and response rates in UC. Recently, golimumab and vedolizumab have been approved for UC by the United States Food and Drug Administration. Vedolizumab may be used as a first-line alternative to anti-TNF-α therapy in patients with an inadequate response to corticosteroids and/or immunosuppressants. Here, we provide updated information on various biological agents in the treatment of UC.

  5. Therapeutic effect of ginsenoside Rd in rats with TNBS-induced recurrent ulcerative colitis.

    Yang, Xiao-Lai; Guo, Tian-Kang; Wang, Yan-Hong; Gao, Ming-Tang; Qin, Hong; Wu, Yong-Jie

    2012-07-01

    Ulcerative colitis (UC) is characterized by oxidative and nitrosative stress and neutrophil infiltration. In the present study, we aimed to investigate the therapeutic effect of ginsenoside Rd (GRd) in rats with 2,4,6-trinitrobenzenesulfonic acid (TNBS)-induced recurrent UC. After UC was twice-induced by intracolonic injection of TNBS, rats were intragastrically administered different doses of GRd per day for 7 days. The colonic lesions and inflammation were evaluated both histologically and biochemically. Compared with the TNBS group, GRd treatment facilitated recovery of pathologic changes in the colon after induction of recurrent UC, as evidenced by a significant reduction of colonic weight/length ratio and macroscopic and microscopic damage scores (p inducible nitric oxide synthase activities with malonyldialdehyde and nitric oxide levels in colonic tissues were significantly decreased in the GRd group compared with those in the TNBS group (p TNBS-induced recurrent UC by inhibiting neutrophil infiltration and promoting the antioxidant capacity of the damaged colonic tissue.

  6. Optimizing use of 5-ASA in the treatment of ulcerative colitis: Focus on patient compliance and adherence

    Steven J Bernick

    2010-06-01

    Full Text Available Steven J Bernick1, Sunanda Kane21Department of Gastroenterology, Naval Medical Center, San Diego California; 2Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USAAbstract: Ulcerative colitis is a chronic condition that requires long-term treatment. The first-line therapy remains 5-ASA, which is available in a variety of different formulations and dosing schedules. Multiple studies have demonstrated that adherence rates to prescribed 5-ASA products is below what would have been expected with significant consequences for important outcomes. Worse disease outcomes, higher medical costs, and even potentially higher rates of colorectal cancer have been associated with nonadherence. Nonadherence is multifactorial, fluid in nature over time, and dependent on disease activity level. Interventions to improve adherence rates have to be individualized. With the advent of simpler dosing regimens it was assumed that adherence rates would improve, but this has not necessarily been the case. Despite our current knowledge about nonadherence, it remains difficult to manage in the long term.Keywords: ulcerative colitis, adherence, mesalamine, persistence, compliance

  7. Pyoderma gangrenosum associated with ulcerative colitis: response to infliximab Pioderma gangrenoso asociado a colitis ulcerosa: respuesta a infliximab

    A. López San Román

    2004-06-01

    Full Text Available Pyoderma gangrenosum is an extraintestinal manifestation of inflammatory bowel disease that can be therapeutically troublesome. We comment on the case of a patient with clinically inactive ulcerat-ive colitis who progressively developed necrotic lesions on both tibial aspects of his legs, which corresponded both clinically and histologically to pyoderma gangrenosum. Treatment with steroids and azathioprine could not control this complication. A single dose of infliximab 5 mg/kg was given, achieving an impressive response of the skin lesions followed by complete healing 3 months later. Infliximab can be useful in the management of refractory extraintestinal manifestations of inflammatory bowel disease.Dentro de las manifestaciones extraintestinales de la enfermedad inflamatoria intestinal, el pioderma gangrenoso plantea con frecuencia dificultades terapéuticas. Presentamos el caso de un enfermo diagnosticado de colitis ulcerosa, inactiva en ese momento, que presentó un pioderma gangrenoso en miembros inferiores y no respondió a esteroides y azatioprina. Se administró una dosis de 5 mg/kg de infliximab obteniendo una rápida mejoría de las lesiones y la completa curación a los 3 meses. Infliximab puede ser útil en manifestaciones extraintestinales de la enfermedad inflamatoria intestinal, como el pioderma gangrenoso, si no responden a los tratamientos habituales.

  8. Expression of T-cell KV1.3 potassium channel correlates with pro-inflammatory cytokines and disease activity in ulcerative colitis

    Koch Hansen, Lars; Møller, Linda Maria Sevelsted; Rabjerg, Maj;

    2014-01-01

    by excessive T-cell infiltration and cytokine production. It is unknown if KV1.3 and KCa3.1 in the inflamed mucosa are markers of active UC. We hypothesized that KV1.3 and KCa3.1 correlate with disease activity and cytokine production in patients with UC. METHODS: Mucosal biopsies were collected from patients...

  9. Norisoboldine ameliorates DSS-induced ulcerative colitis in mice through induction of regulatory T cells in colons.

    Lv, Qi; Qiao, Si-miao; Xia, Ying; Shi, Can; Xia, Yu-feng; Chou, Gui-xin; Wang, Zheng-tao; Dai, Yue; Wei, Zhi-feng

    2015-12-01

    Norisoboldine (NOR), the main active constituent of Radix Linderae, was previously demonstrated to ameliorate collagen-induced arthritis in rats through regulating the imbalance of T cells in intestines, which implied its therapeutic potential in inflammatory bowel disease. Here, we investigated the effect of NOR on ulcerative colitis (UC) induced by dextran sulfate sodium (DSS) in mice. Results showed that NOR (20, 40mg/kg) markedly reduced the symptoms of colitis, the levels of IL-1β and TNF-α, and the activation of ERK, p38 MAPK and NF-κB-p65. NOR only slightly decreased the levels of IFN-γ and IL-17A in mouse colons, but it dramatically increased the level of IL-10 at both protein and mRNA grades. Consistently, NOR increased the number of CD4(+)CD25(+)Foxp3(+) Treg cells more obviously than it decreased that of CD4(+)IL-17(+) Th17 cells in mesenteric lymph nodes (MLNs) and colonic lamina proprias (LPs) of colitis mice, and promoted the expression of Foxp3 mRNA in colon tissues. It could facilitate the in vitro differentiation of Treg cells from naive T cells and promote the phosphorylations of Smad2/3 in colon tissues of colitis mice. On the other hand, NOR did not affect the expressions of homing receptors CCR9 and α4β7 in SPs, and homing ligands CCL25 and Madcam-1 in MLNs and colonic LPs, suggesting that the increase of Treg cells in colons by NOR was not due to gut homing. In conclusion, NOR can ameliorate DSS-induced UC in mice, and the mechanisms involve reduction of pro-inflammatory cytokines and selective induction of Treg cells in colons.

  10. Pre-operative use of anti-TNF-α agents and the risk of post-operative complications in patients with ulcerative colitis - a nationwide cohort study

    Nørgård, B M; Nielsen, J; Qvist, N;

    2012-01-01

    It is still controversial whether pre-operative anti-tumour necrosis factor-alpha (anti-TNF-α) agents increase post-operative complications in patients with ulcerative colitis (UC).......It is still controversial whether pre-operative anti-tumour necrosis factor-alpha (anti-TNF-α) agents increase post-operative complications in patients with ulcerative colitis (UC)....

  11. A Maximum Likelihood Estimator of a Markov Model for Disease Activity in Crohn's Disease and Ulcerative Colitis for Annually Aggregated Partial Observations

    Borg, Søren; Persson, U.; Jess, T.;

    2010-01-01

    Hospital, Copenhagen, Denmark, during 1991 to 1993. The data were aggregated over calendar years; for each year, the number of relapses and the number of surgical operations were recorded. Our aim was to estimate Markov models for disease activity in CD and UC, in terms of relapse and remission...

  12. A Maximum Likelihood Estimator of a Markov Model for Disease Activity in Crohn's Disease and Ulcerative Colitis for Annually Aggregated Partial Observations

    Borg, Søren; Persson, U.; Jess, T.;

    2010-01-01

    Hospital, Copenhagen, Denmark, during 1991 to 1993. The data were aggregated over calendar years; for each year, the number of relapses and the number of surgical operations were recorded. Our aim was to estimate Markov models for disease activity in CD and UC, in terms of relapse and remission...... data and has good face validity. The disease activity model is less suitable for UC due to its transient nature through the presence of curative surgery......, with a cycle length of 1 month. The purpose of these models was to enable evaluation of interventions that would shorten relapses or postpone future relapses. An exact maximum likelihood estimator was developed that disaggregates the yearly observations into monthly transition probabilities between remission...

  13. Abnormal function of platelets and role of angelica sinensis in patients with ulcerative colitis

    Wei-Guo Dong; Shao-Ping Liu; Hai-Hang Zhu; He-Sheng Luo; Jie-Ping Yu

    2004-01-01

    AIM: To explore the abnormal function of platelets and the role of angelica sinensis injection (ASI) in patients with ulcerative colitis (UC).METHODS: In 39 patients with active UC, 25 patients with remissive UC and 30 healthy people, α-granule membrane protein (GMP-140) and thromboxane B2 (TXB2) were detected by means of ELISA, 6-keto-PGF1awas detected by radioimmunoassay, platelet count (PC) and 1 min platelet aggregation rate (1 min PAR) were detected by blood automatic tester and platelet aggregation tester respectively,and yon Willebrand factor related antigen (vWF:Ag) was detected by the means of monoclonal -ELISA. The 64 patients with UC were divided into two therapy groups. After routine treatment and angelica sinensis injection (ASI) + routine treatment respectively for 3 weeks, all these parameters were also detected.RESULTS: The PC, 1 min PAR and levels of GMP-140,TXB2, and vWF:Ag in active UC were significanrly higher than those in remissive UC and normal controls (P<0.05-0.01).Meanwhile, 1 min PAR and levels of GMP-140, TXB2,and vWF:Ag in remissive UC were still significantly higher than those in normal controls (P<0.05). Furthermore, 6-keto-PGF1a level in active and remissive UC was remarkably lower than that in normal control (P<0.05-0.01). These parameters except 6-keto-PGF1a were significantly improved after the treatment in ASI therapy group (P<0.05-0.01),whereas they all were little changed in routine therapy group (P>0.05).CONCLUSION: Platelets can be significantly activated in UC, which might be related with vascular endothelium injury and imbalance between TXB2 and 6-keto-PGF1a in blood.ASI can significantly inhibit platelet activation, relieve vascular endothelial cell injury, and improve microcirculation in UC.

  14. Mesalamine induced symptom exacerbation of ulcerative colitis: Case report and brief discussion

    Maneesh; Kumar; Gupta; Scott; Pollack; John; J; Hutchings

    2010-01-01

    This paper describes a rare case in which the oral ad-ministration of mesalamine resulted in the exacerbation of ulcerative colitis (UC) in a patient who was previously responsive to mesalamine and whose colitis had been in remission for eight years. Mesalamine and other 5-ami-nosalicylic acid compounds are the mainstay of treatment for UC; however up to 8% of patients are unable to take the medications due to intolerance or hypersensitivity reactions. Common drug reactions are fever, nausea, di-arrhea and abdominal pain; however, exacerbation of UC has rarely been reported. This study highlights the impor-tance of ruling out mesalamine as the causative agent in cases of UC exacerbations.

  15. Predictive factors for a severe clinical course in ulcerative colitis: Results from population-based studies

    Magnus Hofrenning Wander?s; Bj?rn A Moum; Marte Lie H?ivik; ?istein Hovde

    2016-01-01

    Ulcerative colitis(UC)is characterized by chronic inflammation of the large bowel in genetically suscep-tible individuals exposed to environmental risk factors.The disease course can be difficult to predict,with symptoms ranging from mild to severe.There is no generally accepted definition of severe UC,and no single outcome is sufficient to classify a disease course as severe.There are several outcomes indicating a severe disease course,including progression of the disease’s extension,a high relapse rate,the development of acute severe colitis,colectomy,the occurrence of colorectal cancer and UC-related mortality.When evaluating a patient’s prognosis,it is helpful to do so in relation to these outcomes.Using these outcomes also makes it easier to isolate factors predictive of severe disease.The aims of this article are to evaluate different disease outcomes and to present predictive factors for these outcomes.

  16. Combined portal, splenic and mesenteric venous thrombosis in inactive ulcerative colitis with heterozygous mutation in MTHFR gene: A rare case of thrombophilia

    Gül Gürsoy

    2011-01-01

    Full Text Available Thrombophilia is a rare but potentially catastrophic phenomenon occurring in patients having tendency of thrombosis. It may lead to serious complications. The etiology of thrombophilia is thought to be multifactorial and related to both acquired and inherited factors. Inflammatory bowel disease is an acquired cause of thrombophilia. Thromboembolic events are seen during inflammatory bowel disease, especially during the active period of the disease. In inflammatory bowel disease, thrombus formation in portal, splenic and mesenteric veins are not common. Besides, the association of genetic disorders related to metabolism of homocysteine with inflammatory bowel disease has been evidenced, especially in Crohn disease and rarely in ulcerative colitis. We present a rare case of ulcerative colitis in association with combined portal, splenic and mesenteric vein thrombosis. The patient was recently diagnosed with the disease which was in the inactive period. Interestingly, our patient was also heterozygous for the mutation in methylenetetrahydrofolate reductase (MTHFR gene.

  17. Development of ulcerative colitis in a patient with multiple sclerosis following treatment with interferonβ 1a

    Eckart Schott; Friedemann Paul; Jens T Wuerfel; Frauke Zipp; Birgit Rudolph; Bertram Wiedenmann; Daniel C Baumgart

    2007-01-01

    To alert clinicians to a potential novel adverse drug effect of interferonβ 1a, we herein report a patient with relapsing-remitting multiple sclerosis who developed ulcerative colitis following treatment with interferonβ 1a. Ulcerative colitis persisted despite discontinuation of interferonβ 1a treatment and switching the patient to glatiramer acetate. Tacrolimus (FK506),6-mercaptopurine, and prednisolone were required to induce remission. Both ulcerative colitis and multiple sclerosis were eventually well controlled using this regimen. Our report underscores that caution should be exercised when prescribing immunostimulatory agents in patients with inflammatory bowel disease (IBD) and challenges current efforts to stimulate innate immunity as a novel therapeutic concept for IBD.

  18. Value of Fecal Calprotectin in Activity Evaluation of Ulcerative Colitis%粪钙卫蛋白在溃疡性结肠炎活动性分级评价中的临床意义

    郐国虎; 李春雨

    2013-01-01

    Objective To explore the value of fecal calprotectin (FCP) in the activity evaluation for ulcerative colitis (UC).Methods Sixty three patients with UC (UC group) and 30 patients with gastrointestinal symptoms but without abnormal results of colonoscopy (control group),who were treated in The Forth Affiliated Hospital of China Medical University between Sep.2007 to Dec.2009 were enrolled to examine the FCP,C-creative protein (CRP),and erythrocyte sedimentation rate (ESR).Then comparison between UC group and control group was performed.Results Levels of FCP and CRP in active grade Ⅰ,Ⅱ,and Ⅲ group were all significantly higher than those of control group and inactive UC group (P< 0.05),with the increase of active grade of UC,the level of FCP gradually increased (P< 0.05).The levels of CRP in active grade Ⅱ and Ⅲ group were all significantly higher than those of grade Ⅰ group (P < 0.05),but didn't differed between active grade Ⅱ and Ⅲ group (P>0.05).There were no significant difference among 5 groups on ESR (P>0.05).Levels ofFCP (rs=0.807,P<0.01),CRP (rs=0.651,P<0.01),and ESR (rs=0.371,P<0.05) in active grade group were significantly related to histological grade under colonoscopy.Conclusion FCP examination is simple,inexpensive,repeatable,and noninvasive,and FCP can be used as an marker of activity evaluation in UC.%目的 探讨粪钙卫蛋白在溃疡性结肠炎(UC)活动性评价中的临床意义.方法 收集2007年9月至2009年12月期间中国医科大学附属第四医院肛肠外科确诊为UC的患者63例及结肠镜检查结果正常但存在相应消化道症状的患者30例,检测并比较其粪钙卫蛋白、红细胞沉降率及C反应蛋白水平.结果 活动期Ⅰ、Ⅱ及Ⅲ级组的粪钙卫蛋白和C反应蛋白水平均高于对照组和缓解组(P<0.05),且随活动期级别增高,粪钙卫蛋白的水平逐渐增高(P<0.05);活动期Ⅱ级及Ⅲ级组的C反应蛋白水平均高于Ⅰ级组(P<0

  19. Onset of Ulcerative Colitis after Helicobacter pylori Eradication Therapy: A Case Report.

    Chiba, Mitsuro; Tsuji, Tsuyotoshi; Takahashi, Kenichi; Komatsu, Masafumi; Sugawara, Takeshi; Ono, Iwao

    2016-01-01

    In Japan, Helicobacter pylori eradication has been approved since 2013 for treatment of H pylori-induced chronic gastritis, in an attempt to reduce the prevalence of gastric cancer, a leading cancer in Japan. H pylori infection affects more than 50% of the world's population. H pylori eradication therapy is generally safe. To our knowledge, no case of newly diagnosed ulcerative colitis occurring immediately after H pylori eradication therapy has previously been reported.A 63-year-old man received a diagnosis of chronic gastritis and H pylori infection. In early March 2014, primary H pylori eradication therapy was initiated; lansoprazole, amoxicillin, and clarithromycin were administered for 1 week. Beginning on the fourth day, he had watery diarrhea twice a day. From the 11th day, bloody stools and watery diarrhea increased to 6 times a day. Colonoscopy, performed on the 40th day after termination of drug therapy, revealed diffuse inflammation in the distal aspect of the colon, with histologic findings consistent with ulcerative colitis. He was admitted to the hospital and was provided with a semivegetarian diet and metronidazole. He noticed a gradual decrease in the amount of blood in his feces then a disappearance of the blood. A fecal occult blood test on the 11th hospital day recorded 337 ng/mL. Fecal occult blood test is not indicated during macroscopic bloody stool but is indicated after disappearance of bloody stool. Therefore, he achieved clinical remission by the 11th hospital day. He was in remission on discharge.New onset of ulcerative colitis should be added to a list of adverse events of H pylori eradication therapy.

  20. Review article: insurance risks for patients with ulcerative colitis or Crohn's disease.

    Travis, S P

    1997-02-01

    Prospective population-based studies have allowed a re-evaluation of the risks of insuring patients with ulcerative colitis or Crohn's disease. Life expectancy, the risk of cancer and working capacity are very much better than previously recognised and are normal for many patients. Three population-based studies in ulcerative colitis have shown a mortality similar to or slightly less than the general population except in the first year after diagnosis, whilst two have shown a slightly higher mortality (standardized mortality ratio, SMR = 1.4), except for those with proctitis. In Crohn's disease, two population-based studies have also shown an increased mortality (SMR = 1.4), which is similar to that of unskilled manual labourers (SMR = 1.43) from all causes of death. Three other studies have shown no increase in overall mortality, except in the first 5 years after diagnosis, in those with proximal small intestinal disease and in some patients needing multiple operations. Insurance risks should be evaluated on an individual basis, after details of the extent and pattern of disease have been obtained. Although the 'standard life' in insurance terms differs from that of the general population, because people who seek life assurance are self-selected from a more affluent section of society, many patients can be identified who have a particularly good prognosis. These include patients with ulcerative proctitis, those with left-sided colitis in extended remission (> 12 months), and patients more than 30 years old with localized ileal or ileocaecal Crohn's disease that has responded to treatment. From the published data, it is difficult to justify increasing the insurance premium in such patients.

  1. Colectomy rates in patients with ulcerative colitis following treatment with infliximab or ciclosporin: a systematic literature review.

    Thorne, Kymberley; Alrubaiy, Laith; Akbari, Ashley; Samuel, David G; Morrison-Rees, Sian; Roberts, Stephen E

    2016-04-01

    This review aimed to compile all available published data on colectomy rates following treatment using infliximab or ciclosporin in adult ulcerative colitis patients and to analyse colectomy rates, timing to colectomy and postcolectomy mortality for each treatment. We systematically reviewed the literature after 1990 reporting colectomy rates in ulcerative colitis patients treated with infliximab or ciclosporin, excluding articles on paediatric patients, patients with indeterminate colitis or Crohn's disease and bowel surgery not related to ulcerative colitis. We presented weighted mean colectomy rates and mortality rates. Cox's regression was used to assess time to colectomy adjusting for colitis severity, patient age and sex. We tabulated 78 studies reporting on ciclosporin and/or infliximab and colectomy rates or postcolectomy mortality rates. Not all studies reported data in a standardized manner. Infliximab had a significantly lower colectomy rate than ciclosporin at 36 months when analysing all studies, studies directly comparing infliximab and ciclosporin and studies using severe colitis patients, but not at 3, 12 or 24 months. Severity and age were key indicators in the likelihood of undergoing colectomy after treatment. Postcolectomy mortality rates were less than 1.5% for both drugs. This review indicates that long-term colectomy rates following infliximab are significantly lower than ciclosporin in the longer term, and that postcolectomy mortality following infliximab and ciclosporin is very low. However, many key data items were missing from research articles, reducing our ability to establish with more confidence the actual impact of these two drugs on colectomy rates and postcolectomy mortality rates.

  2. Computer-Aided Prediction of Long-Term Prognosis of Patients with Ulcerative Colitis after Cytoapheresis Therapy.

    Tetsuro Takayama

    Full Text Available Cytoapheresis (CAP therapy is widely used in ulcerative colitis (UC patients with moderate to severe activity in Japan. The aim of this study is to predict the need of operation after CAP therapy of UC patients on an individual level using an artificial neural network system (ANN. Ninety UC patients with moderate to severe activity were treated with CAP. Data on the patients' demographics, medication, clinical activity index (CAI and efficacy of CAP were collected. Clinical data were divided into training data group and validation data group and analyzed using ANN to predict individual outcomes. The sensitivity and specificity of predictive expression by ANN were 0.96 and 0.97, respectively. Events of admission, operation, and use of immunomodulator, and efficacy of CAP were significantly correlated to the outcome. Requirement of operation after CAP therapy was successfully predicted by using ANN. This newly established ANN strategy would be used as powerful support of physicians in the clinical practice.

  3. Abdominal and scrotal wall emphysema in a patient with severe ulcerative colitis.

    Sharma, Manik; Thandassery, Ragesh Babu; Hilli, Shatha Al; Kaabi, Saad Al

    2014-07-01

    Severe ulcerative colitis can be associated with bowel perforation. Bowel perforation rarely leads on to abdominal wall and scrotal wall emphysema. Bowel perforation in such cases can be spontaneous or iatrogenic (colonoscopy-related). We report a rare scenario where a patient presented with abdominal wall and scrotal emphysema after topical corticosteroid enema-induced traumatic rectal perforation. Topical corticosteroids were stopped immediately after identification of rectal perforation. The patient was managed conservatively with intravenous antibiotics. With this report we intend to sensitise clinicians and topical enema manufacturers regarding this rare complication.

  4. Case of ulcerative colitis%溃疡性结肠炎案

    吴佳; 李胜吾; 张钰敏; 胡幼平

    2011-01-01

    Patient,female,30 years old,a stewardess.Date of visit:11 Nov.2009.Main complaints:repeated occurrence of abdominal distention,defecation with pus and blood for more than 2 years.She had abdominal distension,defecation with pus and blood,repeatedly 2 years ago.She was diagnosed as ulcerative colitis by Huaxi Hospital,Sichuan University,and was given Mesalazine Suppositories to relieve the symptoms.However,her symptoms couldn't be controlled satisfactorily.

  5. Relationship between Various Chinese Medicine Types and T-cell Subsets in Patients with Ulcerative Colitis

    常廷民; 李秀敏; 赵习德

    2009-01-01

    Objective:To investigate the relationship between various Chinese medicine(CM) types and T-cell subsets(CD4~+ and CD8~+) in the colonic mucous membranes of patients with ulcerative colitis(UC).Methods: Fifty UC patients were enrolled,after differentiation into four types by CM syndromes,i.e.,the internal heat-damp accumulation type(IHDA),the qi-stagnancy with blood stasis type(QSBS),the Pi(脾)-Shen(肾) yang-deficiency type(PSYD) and the yin-blood deficiency type(YBD).From every patient,3-5 pieces of intest...

  6. Maintaining remission in ulcerative colitis--role of once daily extended-release mesalamine.

    Oliveira, Lilliana; Cohen, Russell D

    2011-02-27

    The aminosalicylates (5-ASA; also referred to as mesalamine-based agents) are considered as first-line in the maintenance of remission of mild to moderate ulcerative colitis (UC). Traditionally these agents have required a large pill burden and multiple daily dosing regimens which may account for the low adherence rates, especially in patients in remission. Extended-release mesalamine is the first once daily mesalamine product approved by the Food and Drug Administration for the maintenance of UC remission. This review will examine the pharmacokinetics, dosing, efficacy, and safety data of extended-release mesalamine, and discuss the potential role of improving medication compliance and decreasing costs in UC maintenance.

  7. Managing Ulcerative Colitis in the Adolescent: Highlighting the Developmental and Self-management Needs.

    Ahmed, Azza H; Sonnenburg, Katie; Foli, Karen J; Walters, Becky

    2016-01-01

    Ulcerative colitis (UC) is a lifelong disease that peaks in diagnosis between the ages of 15 to 25 years, making UC a significant chronic disease among adolescents that could affect the adolescents throughout their life. This article provides an overview of the role of nurse practitioners as health care providers in managing adolescent patients with UC with a holistic approach that encompasses the physical aspects of the disease, as well as developmental and psychosocial needs. By describing the influence that developmental stage and psychological stress have on patients with UC, the nurse practitioners can facilitate evidence-based and holistic care for adolescents and promote self-management.

  8. Intra-aortic mural thrombosis and splenic infarction in association with ulcerative colitis.

    Kok, H K

    2010-03-04

    BACKGROUND: Arterial thrombosis is a very rare, but recognised complication of inflammatory bowel disease that can result in significant morbidity and mortality. CASE PRESENTATION: We present the case of a 48-year-old female with previously well-controlled ulcerative colitis who presented with severe left upper quadrant abdominal pain. Imaging investigations subsequently revealed a large intra-aortic mural thrombus extending into the coeliac axis complicated by splenic infarction. This occurred in the absence of other prothrombotic states such as thrombophilias or vasculitis. CONCLUSION: This case highlights the frequently overlooked association between inflammatory bowel disease and arterial thrombosis.

  9. Risk of ulcerative colitis and Crohn's disease among offspring of patients with chronic inflammatory bowel disease

    Orholm, Marianne; Fonager, Kirsten; Sørensen, Henrik Toft

    1999-01-01

    ) and Crohn's disease (CD) among first-degree relatives of patients with these diseases. To give more precise risk estimates we conducted a nationwide study using population-based data from the Danish National Registry of Patients (NRP). METHODS: All patients from the entire Danish population (5.2 million......OBJECTIVE: The incidence of inflammatory bowel disease (IBD) varies among and within countries, but several studies have indicated that genetic factors may play an important role in the etiology of IBD. A Danish regional study has observed an almost 10-fold increased risk for ulcerative colitis (UC...

  10. Pulmonary toxocariasis mimicking invasive aspergillosis in a patient with ulcerative colitis.

    Park, Eun Jin; Song, Joon Young; Choi, Min Ju; Jeon, Ji Ho; Choi, Jah-Yeon; Yang, Tae Un; Hong, Kyung Wook; Noh, Ji Yun; Cheong, Hee Jin; Kim, Woo Joo

    2014-08-01

    A 45-year-old-male who had underlying ulcerative colitis and presented with fever and dry cough. Initially, the patient was considered to have invasive aspergillosis due to a positive galactomannan assay. He was treated with amphotericin B followed by voriconazole. Nevertheless, the patient deteriorated clinically and radiographically. The lung biopsy revealed eosinophilic pneumonia, and ELISA for Toxocara antigen was positive, leading to a diagnosis of pulmonary toxocariasis. After a 10-day treatment course with albendazole and adjunctive steroids, the patient recovered completely without any sequelae. Pulmonary toxocariasis may be considered in patients with subacute or chronic pneumonia unresponsive to antibiotic agents, particularly in cases with eosinophilia.

  11. Telomere shortening correlates to dysplasia but not to DNA aneuploidy in longstanding ulcerative colitis

    Friis-Ottessen, Mariann; Bendix, Laila; Kølvraa, Steen;

    2014-01-01

    Ulcerative colitis (UC) is a chronic, inflammatory bowel disease which may lead to dysplasia and adenocarcinoma in patients when long-lasting. Short telomeres have been reported in mucosal cells of UC patients. Telomeres are repetitive base sequences capping the ends of linear chromosomes......, and protect them from erosion and subsequent wrongful recombination and end-to-end joining during cell division. Short telomeres are associated with the development of chromosomal instability and aneuploidy, the latter being risk factors for development of dysplasia and cancer. Specifically, the abrupt...... shortening of one or more telomeres to a critical length, rather than bulk shortening of telomeres, seems to be associated with chromosomal instability....

  12. IL-33 promotes GATA-3 polarization of gut-derived T cells in experimental and ulcerative colitis

    Seidelin, Jakob Benedict; Coskun, Mehmet; Kvist, Peter Helding;

    2015-01-01

    of the immune response in experimental colitis (piroxicam-accelerated colitis (PAC) in IL-10 -/- mice, dextran sodium sulfate (DSS) model) and UC.METHODS: Colonic IL-33 expression was determined in UC (8 active UC, 8 quiescent UC, and 7 controls) and experimental colitis. Mesenteric lymph node (MesLN) T cells...

  13. Effects of probiotic on intestinal mucosa of patients with ulcerative colitis

    Hai-Hong Cui; Xue-Qing Chen; Cun-Long Chen; Ji-De Wang; Yu-Jie Yang; Yong Cun; Jin-Bao Wu; Yu-Hu Liu; Han-Lei Dan; Yan-Ting Jian

    2004-01-01

    AIM: To investigate the effects of probiotic on intestinal mucosae of patients with ulcerative colitis (UC), and to evaluate the role of probiotic in preventing the relapse of UC.METHODS: Thirty patients received treatment with sulphasalazine (SASP) and glucocorticoid and then were randomly administered bifid triple viable capsule (BIFICO) (1.26 g/d), or an identical placebo (starch) for 8 wk. Fecal samples were collected for stool culture 2 wk before and after the randomized treatments. The patients were evaluated clinically, endoscopically and histologically after 2 mo of treatment or in case of relapse of UC. p65 and IκB expressions were determined by Western blot analysis.DNA-binding activity of NF-κB in colonic nuclear extracts was detected by electrophoretic mobility shift assay (EMSA). mRNA expressions of cytokines were identified by semi-quantitative assay, reverse transcriptasepolymerase chain reaction (RT-PCR).RESULTS: Three patients (20%) in the BIFICO group had relapses during 2-mo follow-up period, compared with 14 (93.3%) in placebo group (P<0.01). The concentration of fecal lactobacilli, bifidobacteria was significantly increased in BIFICO-treated group only (P<0.01).The expressions of NF-κB p65 and DNA binding activity of NF-κB were significantly attenuated in the treatment group than that in control (P<0.05). The mRNA expression of anti-inflammatory cytokines was elevated in comparison with the control group.CONCLUSION: The probiotic could impede the activation of NF-κB, decrease the expressions of TNF-α and IL-1β and elevate the expression of IL-10.These results suggest that oral administration of this new probiotic preparation is effective in preventing flare-ups of chronic UC. It may become a prophylactic drug to decrease the relapse of UC.

  14. Neutrophil-to-Lymphocyte Ratio for Predicting Loss of Response to Infliximab in Ulcerative Colitis

    Nishida, Yu; Yamagami, Hirokazu; Yukawa, Tomomi; Otani, Koji; Nagami, Yasuaki; Tanaka, Fumio; Taira, Koichi; Kamata, Noriko; Tanigawa, Tetsuya; Shiba, Masatsugu; Watanabe, Kenji; Watanabe, Toshio; Tominaga, Kazunari; Fujiwara, Yasuhiro

    2017-01-01

    Objectives Neutrophil-to-lymphocyte ratio (NLR) has been used to determine the outcome in malignancies and coronary heart disease. Some reports considered the value of NLR as a predictor of response to infliximab in patients with Crohn’s disease or rheumatoid arthritis; however, no similar studies have been reported for ulcerative colitis (UC). This study aimed to evaluate the clinical significance of the baseline NLR in patients with UC treated by infliximab. Materials and Methods Patients with moderate-to-severe active UC who received the first infliximab infusion in our hospital between 2010 and 2015, who showed clinical response during the induction period, were retrospectively evaluated for long-term outcomes and risk factors for loss of response (LOR) during infliximab maintenance therapy. Baseline inflammatory markers including NLR were measured within one week before the initiation of infliximab. Results Fifty-nine patients with moderate-to-severe active UC started treatment with infliximab and 37 patients (62.7%) experienced clinical response after induction therapy. Fourteen of 37 patients on maintenance therapy lost the response during follow-up. Baseline NLR of patients with LOR was significantly higher than in patients with sustained response. The NLR cut-off value of 4.488 was predictive of LOR, using receiver operating characteristic analysis (sensitivity: 78.6%, specificity: 78.3%). A univariate analysis revealed a significant relationship between relapse-free survival and the NLR (P = 0.018). Multivariate analysis indicated the NLR as an independent prognostic factor for LOR (hazard ratio = 3.86, 95% confidence interval: 1.20–12.4, P = 0.023). Conclusions Baseline NLR is a useful prognostic marker in patients with moderate-to-severe active UC treated with infliximab, and may contribute to appropriate use of infliximab. PMID:28076386

  15. Level of Fecal Calprotectin Correlates With Endoscopic and Histologic Inflammation and Identifies Patients With Mucosal Healing in Ulcerative Colitis

    Theede, Klaus; Holck, Susanne; Ibsen, Per

    2015-01-01

    BACKGROUND & AIMS: In patients with ulcerative colitis (UC), mucosal healing is an important goal of treatment. However, mucosal healing is difficult to determine on the basis of clinical evaluation alone, and endoscopy is uncomfortable and can cause complications. Fecal calprotectin (FC) is a ma......BACKGROUND & AIMS: In patients with ulcerative colitis (UC), mucosal healing is an important goal of treatment. However, mucosal healing is difficult to determine on the basis of clinical evaluation alone, and endoscopy is uncomfortable and can cause complications. Fecal calprotectin (FC...

  16. [Mitral valve repair for mitral regurgitation induced by infective endocarditis complicated with ulcerative colitis; report of a case].

    Shiraishi, Shoichiro; Koike, Masato; Aoshima, Minoru; Asai, Tohru

    2014-05-01

    Infective endocarditis is a rare complication of ulcerative colitis. We report on a 22-year-old man, who had been treated of ulcerative colitis for 5 years. He presented with dyspnea on effort. In spite of medical treatment, he developed congestive heart failure. Transthoracic echocardiography showed a large perforation on the anterior leaflet of the mitral valve, and prolapses of the posterior leaflet of the mitral valve with rupture of the chordae. The patient underwent mitral valve repair with an autologous pericardial patch on the anterior leaflet combined with butterfly resection and suture of the posterior leaflet. The postoperative course was uneventful.

  17. Overlap syndrome consisting of PSC-AIH with concomitant presence of a membranous glomerulonephritis and ulcerative colitis.

    Warling, Odile; Bovy, Christophe; Coïmbra, Carla; Noterdaeme, Timothée; Delwaide, Jean; Louis, Edouard

    2014-04-28

    The association of primary sclerosing cholangitis (PSC) and autoimmune hepatitis (AIH) is known as an overlap syndrome (OS). OS can also be described in the setting of concomitant presence of AIH and PSC. These diseases can in some cases be associated with ulcerative colitis. In this case report we describe, to our knowledge, the first case in the literature of a young Caucasian male suffering from ulcerative colitis and an overlap syndrome consisting of an association between PSC-AIH, with the concomitant presence of a membranous glomerulonephritis.

  18. Genome-wide association study of ulcerative colitis identifies three new susceptibility loci, including the HNF4A region

    Barrett, Jeffrey C.; Lee, James C.; Lees, Charles W.; Prescott, Natalie J.; Anderson, Carl A.; Phillips, Anne; Wesley, Emma; Parnell, Kirstie; Zhang, Hu; DRUMMOND, HAZEL; Elaine R Nimmo; Massey, Dunecan; Blaszczyk, Kasia; Elliott, Timothy; Cotterill, Lynn

    2009-01-01

    Ulcerative colitis is a common form of inflammatory bowel disease with a complex etiology. As part of the Wellcome Trust Case Control Consortium 2, we performed a genome-wide association scan for ulcerative colitis in 2,361 cases and 5,417 controls. Loci showing evidence of association at P < 1 x 10(-5) were followed up by genotyping in an independent set of 2,321 cases and 4,818 controls. We find genome-wide significant evidence of association at three new loci, each containing at least o...

  19. The role of coloscopy in the differential diagnosis between idiopathic ulcerative colitis and Crohn's disease of the colon.

    Banche, M; Rossini, F P; Ferrari, A; Roatta, L; Gilli, E; Cirillo, R

    1976-06-01

    The authors point out the striking significance of coloscopy in establishing a correct diagnosis of inflammatory diseases of the colon. In particular, the most valuable endoscopic features are indicated which may permit distinguishing between idiopathic ulcerative colitis and Crohn's disease of the colon. Differentiation between these two diseases cannot always be achieved by means of available diagnostic procedures other than coloscopy. Moreover, the endoscopic findings enable an assessment to be made of the extent, stage, severity and course of either disease. The authors' experience encompass 2,478 coloscopy examinations: the observed cases of idiopathic ulcerative colitis are 182, those of Crohn's disease of the colon are 104.

  20. Integrative Transcriptomic and Metabonomic Molecular Profiling of Colonic Mucosal Biopsies Indicates a Unique Molecular Phenotype for Ulcerative Colitis

    Rantalainen, Mattias; Bjerrum, Jacob Tveiten; Olsen, Jørgen

    2015-01-01

    Ulcerative colitis is the most prevailing entity of several disorders under the umbrella term inflammatory bowel disease, with potentially serious symptoms and devastating consequences for affected patients. The exact molecular etiology of ulcerative colitis is not yet revealed. In this study, we...... controls and other disease-related phenotypes such as steroid dependency and age at diagnosis, to determine if there is evidence of enrichment of differential expression in candidate genes from genome-wide association studies and if there are particular pathways influenced by disease-associated genes. Both...

  1. Catgut Point-Embedding Therapy in Treatment of 76 Cases of Ulcerative Colitis

    肖冠峰; 周桂荣

    2001-01-01

    @@In recent years, our department has adopted a catgut point-embedding therapy in the treatment of 76 cases of chronic ulcerative colitis, with quite good therapeutic effects. The following is a report of it. Clinical Data Of 76 cases we treated, 32 were male, and 44 female, with the ages ranging from 23 to 65 years and the duration of illness from 6 months to 20 years. All the cases complained of chronic diarrhea, most of them had mucous and blood stool, and some had tenesmus. Sigmoscopic findings showed that all the cases had varying degrees of colic mucosal congestion and edema, fragile mucosa easy to bleed upon touching, or rough mucosa with multiple ulcers varying in size, shape, and depth.

  2. Crohn disease and ulcerative colitis in children: an update for 2014.

    Lemberg, Daniel A; Day, Andrew S

    2015-03-01

    Crohn disease (CD) and ulcerative colitis (UC), the two main types of inflammatory bowel disease (IBD), have become increasingly common in Australasian children and adolescents in recent years. Furthermore, CD and UC are seen more often in younger children. These conditions are typically more extensive in children and tend to follow more severe disease courses than in adults. Although many children may present with typical symptoms (such as abdominal pain or bloody diarrhoea), others have atypical features (including oral ulceration, short stature or skin manifestations). In addition, many children with IBD will have altered growth or nutrition, which may compromise normal linear growth and pubertal development. Early identification and full assessment of children presenting with possible IBD are essential to avoid consequences of diagnostic delay and to optimise short- and long-term outcomes. Management of IBD encompasses various options and should be undertaken within a team-based, child and family-focused, multidisciplinary setting.

  3. B1a lymphocytes in the rectal mucosa of ulcerative colitis patients

    Lino Polese; Stefano Merigliano; Riccardo Boetto; Giuseppe De Franchis; Imerio Angriman; Andrea Porzionato; Lorenzo Norberto; Giacomo Carlo Sturniolo; Veronica Macchi; Raffaele De Caro

    2012-01-01

    AIM: To assess B1a cell expression in the rectal mucosa of ulcerative colitis (UC) patients in comparison with healthy controls. METHODS: Rectal mucosa biopsies were collected from 15 UC patients and 17 healthy controls. CD5+ B cells were analysed by three colour flow cytometry from rectal mucosal samples after mechanical disaggregation by Medimachine?. Immunohistochemical analysis of B and T lymphocytes was also performed. Correlations between, on the one hand, rectal B1a cell concentrations and, on the other, erythrocyte sedimentation rate and C-reactive protein levels and clinical, endoscopic and histological disease activity indices were evaluated.RESULTS: Rectal B-lymphocyte (CD19+/CD45+) rate and concentration were higher in UC patients compared with those in healthy controls (47.85% ± 3.12% vs 26.10% ± 3.40%, P = 0.001 and 501 ± 91 cells/ mm2 vs 117 ± 18 cells/mm2, P < 0.001); Rectal B1a cell density (CD5+CD19+) was higher in UC patients than in healthy controls (85 ± 15 cells/mm2 vs 31 ± 6.7 cells/mm2, P = 0.009). Rectal B1a cell (CD5/CD19+) rate correlated inversely with endoscopic classification (Rs = -0.637, P < 0.05). CONCLUSION: B1a lymphocytes seem to be involved in the pathogenesis of UC, however, the role they play in its early phases and in disease activity, have yet to be defined.

  4. 多层螺旋CT肠道造影在溃疡性结肠炎活动期的影像分析%The analysis for images of multi-slice spiral CTE performance levels in active ulcerative ;colitis

    赵宾; 王继红

    2016-01-01

    Objective: To investigate the imaging characteristics of the intestinal multi-slice spiral CT enterography (CTE) in active ulcerative colitis(UC), analyze and summarize its application value. Methods: A total 43 cases diagnosed with active UC from April 2014 to April 2015 in our hospital were selected and divided into mild, moderate and severe three levels with each level as a group, treated by multi-slice spiral CTE examination system based on the improved Mayo system, comparing different performances of CTE levels. Results:43 cases of UC patients participating in the study, eight patients were mild, 16 cases were moderate and 19 cases were severe. There was statistically different in the intestinal mucosa in the presence of air bubbles between the mild and moderate group (x2=21.62; P0.05). Conclusion:UC patients CTE examination, which can effectively conduct a comprehensive assessment against bowel, intestinal and parenteral, provide favorable conditions for the activity of UC clinical diagnosis and classification.%目的:观察多层螺旋CT肠道造影(CTE)在溃疡性结肠炎活动期(UC)中的成像特点,分析探讨其应用价值。方法:选取43例确诊的活动期UC患者,对其行多层螺旋CTE检查,依据改良后的Mayo系统将患者分为轻、中、重三个等级,每个等级为一组,对比不同等级患者CTE的表现。结果:43例UC患者中,8例为轻度,16例为中度,19例为重度,将三组患者多层螺旋CTE检查结果进行对比,其中轻度组与中度组对比,于肠黏膜下气泡一项上差异存在统计学意义(x2=21.62,P<0.05);中度组与重度组进行对比,于结肠袋消失情况、淋巴结肿大情况以及肠壁分层情况3个项目上差异有统计学意义(x2=25.95,x2=17.46,x2=19.46;P<0.05);而于肠黏膜强化程度增加、肠壁增厚、直肠周围脂肪沉积以及肠腔狭窄等项目上,差异均无统计学意义(F=0.36,F=1.58,F=0.31,P>0.05)

  5. Alpha-1 antitrypsin and granulocyte colony-stimulating factor as serum biomarkers of disease severity in ulcerative colitis

    Soendergaard, Christoffer; Nielsen, Ole Haagen; Seidelin, Jakob Benedict

    2015-01-01

    biomarkers are currently needed for identification of patients with mild or moderate disease activity. Using a commercially available platform, we aimed at identifying serum biomarkers that are able to grade the disease severity. METHODS: Serum samples from 65 patients with UC with varying disease activity......-stimulating factor produced a predictive model with an AUC of 0.72 when differentiating mild and moderate UC, and an AUC of 0.96 when differentiating moderate and severe UC, the latter being as reliable as CRP. CONCLUSIONS: Alpha-1 antitrypsin is identified as a potential serum biomarker of mild-to-moderate disease......BACKGROUND: Initial assessment of patients with ulcerative colitis (UC) is challenging and relies on apparent clinical symptoms and measurements of surrogate markers (e.g., C-reactive protein [CRP] or similar acute phase proteins). As CRP only reliably identifies patients with severe disease, novel...

  6. Transhepatic fibrinolysis of mesenteric and portal vein thrombosis in a patient with ulcerative colitis: A case report

    Alfredo Guglielmi; Francesca Fior; Orsolya Halmos; Gian Franco Veraldi; Lorenzo Rossaro; Andrea Ruzzenente; Claudio Cordiano

    2005-01-01

    AIM: To present a case of acute mesenteric and portal vein thrombosis treated with thrombolytic therapy in a patient with ulcerative colitis in acute phase and to review the literature on thrombolytic therapy of mesenteric-portal system. Treatment of acute portal vein thrombosis has ranged from conservative treatment with thrombolysis and anticoagulation therapy to surgical treatment with thrombectomy and/or intestinal resection.METHODS: We treated our patient with intraportal infusion of plasminogen activator and then heparin through a percutaneous transhepatic catheter.RESULTS: Thrombus resolved despite premature interruption of the thrombolytic treatment for neurological complications, which subsequently resolved.CONCLUSION: Conservative management with plasminogen activator, could be considered as a good treatment for patients with acute porto-mesenteric thrombosis.

  7. Ferulic acid ameliorates TNBS-induced ulcerative colitis through modulation of cytokines, oxidative stress, iNOs, COX-2, and apoptosis in laboratory rats.

    Sadar, Smeeta S; Vyawahare, Niraj S; Bodhankar, Subhash L

    2016-01-01

    Ulcerative colitis (UC) is a chronic immune-inflammatory disorder characterized by oxido-nitrosative stress, the release of pro-inflammatory cytokines and apoptosis. Ferulic acid (FA), a phenolic compound is considered to possess potent antioxidant, anti-apoptotic and anti-inflammatory activities. The aim is to evaluate possible mechanism of action of FA against trinitrobenzensulfonic acid (TNBS) induced ulcerative colitis (UC) in rats. UC was induced in Sprague-Dawley rats (150-200 g) by intrarectal administration of TNBS (100 mg/kg). FA was administered (10, 20 and 40 mg/kg, p.o.) for 14 days after colitis was induced. Various biochemical, molecular and histological changes were assessed in the colon. Intrarectal administration of TNBS caused significant induction of ulcer in the colon with an elevation of oxido-nitrosative stress, myeloperoxidase and hydroxyproline activity in the colon. Administration of FA (20 and 40 mg/kg) significantly decrease oxido-nitrosative stress, myeloperoxidase, and hydroxyproline activities. Up-regulated mRNA expression of TNF-α, IL-1β, IL-6, COX-2, and iNOs, as well as down-regulated IL-10 mRNA expressions after TNBS administration, were significantly inhibited by FA (20 and 40 mg/kg) treatment. Flow cytometric analysis revealed that intrarectal administration of TNBS-induced significantly enhanced the colonic apoptosis whereas administration of FA (20 and 40 mg/kg) significantly restored the elevated apoptosis. FA administration also significantly restored the histopathological aberration induced by TNBS. The findings of the present study demonstrated that FA ameliorates TNBS-induced colitis via inhibition of oxido-nitrosative stress, apoptosis, proinflammatory cytokines production, and down- regulation of COX-2 synthesis.Graphical Abstract: TNBS caused activation of T cells which interact with CD40 on antigen presenting cells i.e. dendritic cells (DC) that induce the key Interleukin 12 (IL-12)-mediated Th1 T cell immune

  8. Screening and analysis of nutrition risk in active ulcerative colitis%活动期溃疡性结肠炎的营养风险筛查及分析

    郭晓鹤; 张彩凤; 朱艳丽; 秦咏梅; 韩宇

    2013-01-01

    目的 筛查溃疡性结肠炎(UC)患者营养风险的发生情况.方法 采用营养风险筛查2002(NRS2002)对在我院就诊的130例UC患者进行营养风险筛查.体质量指数(BMI)采用中国标准,以<18.5 kg/m2结合临床判定为营养不良,直接记录为3分.采用True-Love标准将溃疡性结肠炎(UC)分为轻型、中型和重型.结果 130例UC患者中,营养风险发生率为44.6%.营养风险发生率与疾病严重程度相关.重型UC患者营养不良(不足)发生率显著低于营养风险发生率(P=0.004).结论 活动期UC患者营养风险发生率较高,NRS2002有助于发现UC患者的营养风险.%Objective To assess the nutritional risk of patients with ulcerative colitis ( UC ) . Methods The nutritional status of 130 UC patients from our hospital were evaluated by Nutritional Risk Screening 2002 ( NRS 2002) . Using Chinese standard, a body mass index(BMI) was lowered 18.5 kg/m according to clinical material was regarded malnutrition, and the score was recorded as 3. The severity of ulcerative colitis ( UC ) was evaluated by True-Love criteria as mild, moderate , and severe. Results All 130 patients were evaluated by NRS 2002. 54 patients (44. 6% ) were judged as at the risk of malnutrition. It was also significantly correlated with the severity of disease. In patients with severe UC, the rate of real-nutrition evaluated by BMI according to clinical material was significantly lower than the rate of nutritional risk ( P=0. 004 ) . Conclusion The risk of malnutrition is high in UC patients. NRS 2002 can be used for nutritional risk screening.

  9. A Cytosolic Multiprotein Complex Containing p85α Is Required for β-Catenin Activation in Colitis and Colitis-associated Cancer.

    Goretsky, Tatiana; Bradford, Emily M; Ryu, Hyunji; Tahir, Maryam; Moyer, Mary Pat; Gao, Tianyan; Li, Linheng; Barrett, Terrence A

    2016-02-19

    Wnt/β-catenin signaling is required for crypt structure maintenance. We previously observed nuclear accumulation of Ser-552 phosphorylated β-catenin (pβ-Cat(Ser-552)) in intestinal epithelial cells (IEC) during colitis and colitis-associated cancer. Data here delineate a novel multiprotein cytosolic complex (MCC) involved in β-catenin signaling in the intestine. The MCC contains p85α, the class IA subunit of PI3K, along with β-catenin, 14-3-3ζ, Akt, and p110α. MCC levels in IEC increase in colitis and colitis-associated cancer patients. IEC-specific p85α-deficient (p85(ΔIEC)) mice develop more severe dextran sodium sulfate colitis due to delayed ulcer healing and reduced epithelial β-catenin activation. In colonic IEC, p85α deficiency did not alter PI3K signaling. In vitro shRNA depletion of individual complex members disrupts the MCC and reduces β-catenin signaling. Despite worse colitis, p85(ΔIEC) mice have reduced tumor burden after azoxymethane/dextran sodium sulfate treatment. Together the data indicate that the β-catenin MCC is needed for mucosal repair and carcinogenesis. This novel MCC may be an attractive therapeutic target in preventing cancer in colitis patients.

  10. Long-term alteration of intestinal microbiota in patients with ulcerative colitis by antibiotic combination therapy.

    Koido, Shigeo; Ohkusa, Toshifumi; Kajiura, Takayuki; Shinozaki, Junko; Suzuki, Manabu; Saito, Keisuke; Takakura, Kazuki; Tsukinaga, Shintaro; Odahara, Shunichi; Yukawa, Toyokazu; Mitobe, Jimi; Kajihara, Mikio; Uchiyama, Kan; Arakawa, Hiroshi; Tajiri, Hisao

    2014-01-01

    Previous work has demonstrated that intestinal bacteria, such as Fusobacterium varium (F. varium), contribute to the clinical activity in ulcerative colitis (UC); thus, an antibiotic combination therapy (amoxicillin, tetracycline, and metronidazole (ATM)) against F. varium can induce and maintain UC remission. Therefore, we investigated whether ATM therapy induces a long-term alteration of intestinal microbiota in patients with UC. Patients with UC were enrolled in a multicenter, randomized, double-blind, placebo-controlled study. Biopsy samples at the beginning of the trial and again at 3 months after treatment completion were randomly obtained from 20 patients. The terminal restriction fragment length polymorphism (T-RFLP) in mucosa-associated bacterial components was examined to assess the alteration of the intestinal microbiota. Profile changes of T-RFLP in mucosa-associated bacterial components were found in 10 of 12 patients in the treatment group and in none of 8 in the placebo group. Dice similarity coefficients using the unweighted pair group method with arithmetic averages (Dice-UPGMA) confirmed that the similarity of mucosal microbiota from the descending colon was significantly decreased after the ATM therapy, and this change was maintained for at least 3 months. Moreover, at 3 months after treatment completion, the F. varium/β-actin ratio, examined by real-time PCR using nested PCR products from biopsy samples, was reduced less than 40% in 8 of 12 treated patients, which was higher, but not significantly, than in 4 of 8 patients in the placebo group. Together, these results suggest that ATM therapy induces long-term alterations in the intestinal microbiota of patients with UC, which may be associated, at least in part, with clinical effects of the therapy.

  11. Aquaporin 8 expression is reduced and regulated by microRNAs in patients with ulcerative colitis

    MIN Min; PENG Li-hua; SUN Gang; GUO Ming-zhou; QIU Ze-wu; YANG Yun-sheng

    2013-01-01

    Background Ulcerative colitis (UC) is associated with differential expression of genes involved in inflammation and tissue remodeling.MicroRNA (miRNA) plays an important role in the pathogenesis of UC by regulating the gene expression at the post-transcriptional level and control crucial physiological processes.This study aimed to identify aquaporin 8 (AQP8) expression and its relationship with miRNA in UC patients.Methods Human colon samples,in this study,were obtained from 20 patients with UC and 16 healthy subjects undergoing diagnostic colonoscopy at the Chinese People's Liberation Army General Hospital between December 2009and June 2010.We screened different genes from UC tissues and healthy subjects using genome-wide microarray,quantitative reverse transcription-polymerase chain reaction (qRT-PCR) and Western blotting.Regulation of gene expression by miRNAs was assessed by luciferase reporter construct assays and transfection of specific miRNA mimics and inhibitor.Results We identified that 1596 genes were increased and 1301 genes were decreased in UC patients compared to healthy subjects.Among them,we focused on the analysis of AQP8 which was decreased three folds in UC tissues (P <0.01).The expression of AQP8 mRNA and protein were decreased in UC tissue and tumor necrosis factor (TNF)-αtreated HT29 cells compared with controls (P <0.05).We searched candidate target miRNAs of AQP8 through bioformatics and the luciferase report assay analysis indicated that miR-424,miR-195,miR-330,miR-612,and miR-16 which has complementary site in the 3-untranslated region (3'UTR) of AQP8 could decrease the relative luciferase activities by 10%-45%.Conclusion AQP8 and its relationship with miRNAs may be involved in the pathogenesis of UC.

  12. Predictors of response to anti-tumor necrosis factor therapy in ulcerative colitis

    Evanthia; Zampeli; Michalis; Gizis; Spyros; I; Siakavellas; Giorgos; Bamias

    2014-01-01

    Ulcerative colitis(UC) is an immune-mediated, chronic inflammatory disease of the large intestine. Its course is characterized by flares of acute inflammation and periods of low-grade chronic inflammatory activity or remission. Monoclonal antibodies against tumor necrosis factor(anti-TNF) are part of the therapeutic armamentarium and are used in cases of moderate to severe UC that is refractory to conventional treatment with corticosteroids and/or immunosuppressants. Therapeutic response to these agents is not uniform and a large percentage of patients either fail to improve(primary non-response) or lose response after a period of improvement(secondary non-response/loss of response). In addition, the use of anti-TNF agents has been related to uncommon but potentially serious adverse effects that preclude their administration or lead to their discontinuation. Finally, use of these medications is associated with a considerable cost for the health system. The identification of parameters thatmay predict response to anti-TNF drugs in UC would help to better select for patients with a high probability to respond and minimize risk and costs for those who will not respond. Analysis of the major clinical trials and the accumulated experience with the use of anti-TNF drugs in UC has resulted to the report of such prognostic factors. Included are clinical and epidemiological characteristics, laboratory markers, endoscopic indicators and molecular(immunological/genetic) signatures. Such predictive parameters of long-term outcomes may either be present at the commencement of treatment or determined during the early period of therapy. Validation of these prognostic markers in large cohorts of patients with variable characteristics will facilitate their introduction into clinical practice and the best selection of UC patients who will benefit from anti-TNF therapy.

  13. Rhinosinusitis derived Staphylococcal enterotoxin B possibly associates with pathogenesis of ulcerative colitis

    An Zi-Yuan

    2005-09-01

    Full Text Available Abstract Background During clinical practice, we noticed that some patients with both ulcerative colitis (UC and chronic rhinosinusitis (CRS showed amelioration of UC after treatment of CRS. This study was designed to identify a possible association between CRS and UC. Methods Thirty-two patients with both CRS and UC received treatment with functional endoscopic sinus surgery (FESS for CRS. Clinical symptom scores for CRS and UC, as well as serum levels of anti-Staphylococcal enterotoxin B (SEB were evaluated at week 0 and week 12. Sinus wash fluid SEB content was measured with enzyme-linked immunosorbent assay (ELISA. The surgically removed tissues were cultured to identify growth of Staphylococcus. aureus (S. aureus. Immunohistochemistry was employed to identify anti-SEB positive cells in the colonic mucosa. Colonic biopsies were obtained and incubated with SEB. Mast cell activation in the colonic mucosa in response to incubation with SEB was observed with electron microscopy and immunoassay. Results The clinical symptom scores of CRS and UC severe scores (UCSS were significantly reduced in the UC-CRS patients after FESS. The number of cultured S. aureus colonies from the surgically removed sinus mucosa significantly correlated with the decrease in UCSS. High levels of SEB were detected in the sinus wash fluids of the patients with UC-CRS. Histamine and tryptase release was significantly higher in the culture supernate in the patients with UC-CRS than the patients with UC-only and normal controls. Anti-SEB positive cells were located in the colonic mucosa. Conclusion The pathogenesis of UC in some patients may be associated with their pre-existing CRS by a mechanism of swallowing sinusitis-derived SEB. We speculate that SEB initiates inappropriate immune reactions and inflammation in the colonic mucosa that further progresses to UC.

  14. Pneumocystis jiroveci pneumonia and pneumomediastinum in an anti-TNFα naive patient with ulcerative colitis

    James C Lee; Deborah C Bell; Richard M Guinness; Tariq Ahmad

    2009-01-01

    We report the case of a 21-year-old man who was noted to have pneumomediast inum dur ing an admission for an acute flare of ulcerative colitis. At that time, he was on maintenance treatment with azathioprine at a dose of 1.25 mg/kg per day, and had not received supplementary steroids for 9 mo. He had never received anti-tumor necrosis factor (TNF)α therapy. Shortly after apparently effective treatment with intravenous steroids and an increased dose of azathioprine, he developed worsening colitic and new respiratory symptoms, and was diagnosed with Pneumocystis jiroveci ( carinii) pneumonia (PCP). Pneumomediastinum is rare in immunocompetent hosts, but is a recognized complication of PCP in human immunodeficiency virus (HIV) patients, although our patient 's HIV test was negative. Treatment of PCP with co-trimoxazole resulted in resolution of both respiratory and gastrointestinal symptoms, without the need to increase the steroid dose. There is increasing vigilance for opportunistic infections in patients with inflammatory bowel disease following the advent of anti-TNFα therapy. This case emphasizes the importance of considering the possibility of such infections in all patients with inflammatory bowel disease, irrespective of the immunosuppressants they receive, and highlights the potential of steroid-responsive opportunistic infections to mimic worsening colitic symptoms in patients with ulcerative colitis.

  15. Patient considerations in the management of ulcerative colitis: role of once-daily MMX mesalamine

    Daniel B Zandman

    2009-03-01

    Full Text Available Daniel B Zandman, Mark A PeppercornHarvard Medical School, Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USAAbstract: Mesalamine and its derivatives are effective and well-tolerated therapies for ulcerative colitis. However, patient adherence to traditional mesalamine-based therapy is poor, and is often limited by heavy pill burdens and frequent dosing intervals. This can lead to ineffective disease control, impaired quality of life, and preventable morbidity and mortality. Previous studies have suggested that a once-daily mesalamine regimen would be strongly adhered to in the outpatient setting, but at that time no such formulation of mesalamine existed. In 2007, clinical trial data showed a novel, once-daily, multi-matrix (MMX formulation of mesalamine to be effective in both remission induction and remission maintenance. This breakthrough in drug delivery allowed the unification of an effective therapeutic with a formulation that enables outpatients to be increasingly adherent to their medication. In theory, this might result in improved outpatient disease control and a decreased number of flares. As the use of MMX mesalamine increases, studies examining the outpatient community adherence rate need to be performed.Keywords: mesalamine, MMX, Lialda™, ulcerative colitis, inflammatory bowel disease, adherence

  16. Quantitative Analysis of Intestinal Flora of Uygur and Han Ethnic Chinese Patients with Ulcerative Colitis.

    Yao, Ping; Cui, Min; Wang, Haikun; Gao, Hongliang; Wang, Lei; Yang, Tao; Cheng, Yongbo

    2016-01-01

    Aim. To study the correlation between intestinal flora and ulcerative colitis by analyzing the abundance of Bacteroides, Fusobacterium, Clostridium, Bifidobacterium spp., and Faecalibacterium prausnitzii in the intestinal of ulcerative colitis (UC) patients and healthy controls with Uygur and Han ethnic. Methods. Bacterial genomic DNA was extracted from fecal samples and analyzed with real-time fluorescence quantitative polymerase chain reaction (PCR) to identify the abundance of Bacteroides, Fusobacterium, Clostridium, Bifidobacterium spp., and Faecalibacterium prausnitzii. Results. The samples from UC patients, Uygur and Han ethnic combined, had higher abundance of Bacteroides (P = 0.026) but lower Clostridium (P = 0.004), Bifidobacterium spp. (P = 0.009), and Faecalibacterium prausnitzii (P = 0.008) than those from healthy controls. Among UC patients, Bacteroides population was raised in acute UC patients (P ≤ 0.05), while the abundance of Clostridium, Bifidobacterium spp., Fusobacterium, and Faecalibacterium prausnitzii decreased (P ≤ 0.05) compared with the remission. In both UC patients group and control group, no difference was observed in the abundance of these 5 bacteria between the Han and the Uygur group. Conclusions. Variations in the abundance of these five bacterial strains in intestines may be associated with the occurrence of UC in Uygur and Han populations; however, these variations were not associated with ethnic difference.

  17. Benefit–risk assessment of golimumab in the treatment of refractory ulcerative colitis

    Pugliese D

    2016-02-01

    Full Text Available Daniela Pugliese, Carla Felice, Rosario Landi, Alfredo Papa, Luisa Guidi, Alessandro Armuzzi Inflammatory Bowel Disease Unit, Complesso Integrato Columbus, Catholic University, Rome, Italy Abstract: Significant advances in the management of patients with ulcerative colitis (UC have been made since the introduction of anti-tumor necrosis factor (TNF-alpha agents, especially for those who fail or do not tolerate conventional therapies. Two drugs, infliximab first, then adalimumab afterward, showed effectiveness in inducing and maintaining long-term remission both in pivotal trials as well as in clinical practice. However, approximately 25% of patients with UC, who fail or do not tolerate all available therapies, require a colectomy for refractory disease. The therapeutic scenario of UC has been recently upgraded by the introduction of golimumab, the latest anti TNF-alpha agent to be approved. Golimumab is a totally humanized monoclonal antibody, administered by a subcutaneous injection every 4 weeks. Treatment with golimumab has shown to be effective to induce sustained clinical benefit in tough-to-treat patients with UC, including steroid and/or immunosuppressive refractory and steroid-dependent patients. In this review, we summarize all available efficacy and safety data of golimumab in UC, analyzing the potential therapeutic position for the treatment of refractory patients with UC. Keywords: ulcerative colitis, refractoriness, anti-TNF-alpha, golimumab 

  18. Quantitative Analysis of Intestinal Flora of Uygur and Han Ethnic Chinese Patients with Ulcerative Colitis

    Ping Yao

    2016-01-01

    Full Text Available Aim. To study the correlation between intestinal flora and ulcerative colitis by analyzing the abundance of Bacteroides, Fusobacterium, Clostridium, Bifidobacterium spp., and Faecalibacterium prausnitzii in the intestinal of ulcerative colitis (UC patients and healthy controls with Uygur and Han ethnic. Methods. Bacterial genomic DNA was extracted from fecal samples and analyzed with real-time fluorescence quantitative polymerase chain reaction (PCR to identify the abundance of Bacteroides, Fusobacterium, Clostridium, Bifidobacterium spp., and Faecalibacterium prausnitzii. Results. The samples from UC patients, Uygur and Han ethnic combined, had higher abundance of Bacteroides (P=0.026 but lower Clostridium (P=0.004, Bifidobacterium spp. (P=0.009, and Faecalibacterium prausnitzii (P=0.008 than those from healthy controls. Among UC patients, Bacteroides population was raised in acute UC patients (P≤0.05, while the abundance of Clostridium, Bifidobacterium spp., Fusobacterium, and Faecalibacterium prausnitzii decreased (P≤0.05 compared with the remission. In both UC patients group and control group, no difference was observed in the abundance of these 5 bacteria between the Han and the Uygur group. Conclusions. Variations in the abundance of these five bacterial strains in intestines may be associated with the occurrence of UC in Uygur and Han populations; however, these variations were not associated with ethnic difference.

  19. Colitis

    ... this page: //medlineplus.gov/ency/article/001125.htm Colitis To use the sharing features on this page, please enable JavaScript. Colitis is swelling (inflammation) of the large intestine (colon). ...

  20. Protective Effect of Jiechangning (结肠宁)Decoction in Treating Experimental Ulcerative Colitis in Guinea Pigs

    XIONG Wu-jun; QIU Qi-yu; QIU De-kai

    2005-01-01

    Objective:To study the therapeutic effects and mechanism of Jiechangning (结肠宁, JCN)decoction on carrageenan induced experimental ulcerative colitis (UC). Methods: After sensitizing guinea pigs with carrageenan, we established UC animal models by free drinking water containing 2 % acid degraded carrageenan (ADC). JCN decoction was orally administered once a day for 2 weeks after carrageenan treatment. Salicylazosulfapyridine (SASP) and normal saline were given to the other two groups as control. The levels of colon lipid peroxide (LPO), acid phosphatase (ACP)activity and tumor necrosis factor-α (TNF-α)were measured; colitis activity score (CAS) was carried out for assessment of the degree of tissue inflammation and injury; the colonic pathological changes were examined simultaneously with hematoxylin and eosin (HE) and toluidine blue staining used to evaluate the therapeutic effects of JCN decoction and SASP. Results:Experimental colitis models resembling human UC were successfully induced. The levels of tissue LPO, ACP activity and the content of tissue TNF-α were markedly increased in the model group as compared with the normal control group (P<0.01) and were positively correlated with CAS. JCN decoction could reverse these changes like SASP. HE staining showed that JCN decoction and SASP could reduce CAS and the degree of tissue injury, toluidine blue staining revealed that mucosa and submucosa red metachromasia pellets in JCN group and SASP group were markedly fewer than those in the model group. Conclusion: JCN decoction is effective in treating experimental UC, which provides theoretical basis for its clinical application.

  1. Comparative analysis of inflamed and non-inflamed colon biopsies reveals strong proteomic inflammation profile in patients with ulcerative colitis

    Poulsen, Nina Aagaard; Andersen, Vibeke; Moller, Jens Christian;

    2012-01-01

    Background: Accurate diagnostic and monitoring tools for ulcerative colitis (UC) are missing. Our aim was to describe the proteomic profile of UC and search for markers associated with disease exacerbation. Therefore, we aimed to characterize specific proteins associated with inflamed colon mucosa...... from patients with acute UC using mass spectrometry-based proteomic analysis. Methods: Biopsies were sampled from rectum, sigmoid colon and left colonic flexure from twenty patients with active proctosigmoiditis and from four healthy controls for proteomics and histology. Proteomic profiles of whole...... annotated by image analysis and 222 of these had a statistically different protein level between inflamed and non-inflamed tissue in the patient group. Principal component analysis clearly grouped non-inflamed samples separately from the inflamed samples indicating that the proteomic signature of colon...

  2. CMV - gastroenteritis/colitis

    Colitis - cytomegalovirus; Gastroenteritis - cytomegalovirus; Gastrointestinal CMV disease ... or after bone marrow or organ transplant Ulcerative colitis or Crohn disease Rarely, serious CMV infection involving ...

  3. Lactobacillus bulgaricus OLL1181 activates the aryl hydrocarbon receptor pathway and inhibits colitis.

    Takamura, Takeyuki; Harama, Daisuke; Fukumoto, Suguru; Nakamura, Yuki; Shimokawa, Naomi; Ishimaru, Kayoko; Ikegami, Shuji; Makino, Seiya; Kitamura, Masanori; Nakao, Atsuhito

    2011-10-01

    Increasing evidence suggests that the aryl hydrocarbon receptor (AhR) pathway has an important role in the regulation of inflammatory responses. Most recently, we have shown that the activation of the AhR pathway by a potent AhR agonist inhibits the development of dextran sodium sulfate (DSS)-induced colitis, a model of human ulcerative colitis, by the induction of prostaglandin E2 (PGE2) in the large intestine. Because several strains of probiotic lactic acid bacteria have been reported to inhibit DSS-induced colitis by unidentified mechanisms, we hypothesized that particular strains of lactic acid bacterium might have the potential to activate the AhR pathway, thereby inhibiting DSS-induced colitis. This study investigated whether there are specific lactic acid bacterial strains that can activate the AhR pathway, and if so, whether this AhR-activating potential is associated with suppression of DSS-induced colitis. By using AhR signaling reporter cells, we found that Lactobacillus bulgaricus OLL1181 had the potential to activate the AhR pathway. OLL1181 also induced the mRNA expression of cytochrome P450 family 1A1 (CYP1A1), a target gene of the AhR pathway, in human colon cells, which was inhibited by the addition of an AhR antagonist, α-naphthoflavon (αNF). In addition, mice treated orally with OLL1181 showed an increase in CYP1A1 mRNA expression in the large intestine and amelioration of DSS-induced colitis. Thus, OLL1181 can induce activation of the intestinal AhR pathway and inhibit DSS-induced colitis in mice. This strain of lactic acid bacterium has therefore the potential to activate the AhR pathway, which may be able to suppress colitis.

  4. [Ulcerative colitis and Crohn's disease. Part 1. Definition, terminology, prevalence, etiology and patogenesis, clinical features, complications, classification].

    Tsimmerman, Ia S; Tsimmerman, I Ia; Tret'iakova, Iu I

    2013-01-01

    Definitions of ulcerative colitis (UC) and Crohn's disease (CD) are given, related terminological problems are discussed, the prevalence of UC and CD in the population is considered along with their etiology pathogenesis, clinical symptoms, complications and extraintestinal (systemic) lesions. Classification and diagnostics of UC and CD are discussed with special reference to current international recommendations on their diagnostics and differential treatment.

  5. Iatrogenic colorectal Kaposi sarcoma complicating a refractory ulcerative colitis in a human immunodeficiency negative-virus patient.

    Hamzaoui, Lamine; Kilani, Houda; Bouassida, Mahdi; Mahmoudi, Moufida; Chalbi, Emna; Siai, Karima; Ezzine, Heykel; Touinsi, Hassen; Azzouz, Mohamed M'saddak; Sassi, Sadok

    2013-01-01

    Kaposi sarcoma is a mesenchymal tumor associated to a human herpes virus-8. It often occurs in human immunodeficiency virus-positive subjects. Colorectal localization is rare. We report the case of a colorectal Kaposi sarcoma complicating a refractory ulcerative colitis treated with surgery after the failure of immunomodulator therapy in a human immunodeficiency virus-negative heterosexual man.

  6. Epidemiologic study of 80 patients with ulcerative colitis referred to Imam Hospital in Ardabil city during 2004-2011

    Vahid Sadeghifard

    2014-08-01

    Results: Mean age of patients was 36.4 (SD=18.4. Duration of symptoms onset until diagnosis was 8 months. Male to female ratio was 0.8/1. 38(47.5% of patients were male and 42 (52.5% were female. 3 (3.75% of patients have history of positive UC and 4 (5% history of appendectomy. According to colonoscopy finding, 1 (1.25% have rectum involvement, 27 (33.75% recto sigmoid, 23 (28.75% left side colon and 4 (5% have pan colitis. Conclusion: Results showed that in compare with other places, clinical signs of ulcerative colitis in Ardabil province are different and so doing other d epidemiologic studies based on population to determine incidence and prevalence ulcerative colitis in Ardabil province is necessary. [Int J Res Med Sci 2014; 2(4.000: 1417-1422

  7. Faecal Bacterial Communities in Healthy Controls and Ulcerative Colitis Patients

    Vigsnæs, Louise Kristine; Wilcks, Andrea; Brynskov, Jørn

    patients with either clinically inactive or active disease. To analyse the composition of the faecal microbiota, we performed quantitative PCR (qPCR) using species and group-specific primers targeting Bifidobacterium spp., Lactobacillus spp., Firmicutes, Bacteroidetes and Faecalibacterium prausnitzii...

  8. Crohn's Disease and Ulcerative Colitis: A Guide for Parents

    ... a clinical trial of experimental treatments. Interactive Disease Tracker Use GI Buddy to keep a daily log ... therapies should not receive live virus vaccines. Daily activities Now that your child has a disease that ...

  9. Utilidad de la ecografía en la valoración de la extensión de la colitis ulcerosa Usefulness of digestive ultrasonography in assessment of ulcerative colitis extent

    D. Martínez Ares

    2007-07-01

    should be avoided upon finding severe endoscopic lesions in patients with ulcerative colitis. However, knowledge of the precise extent of disease is quite important for disease prognosis and the making of therapeutic decisions. Therefore, any validation of a non-invasive technique to assess the extent of ulcerative colitis gains a lot of interest and importance. Material and method: the study included patients that were previously diagnosed of having ulcerative colitis or were beginning to suffer from the disease. A prospective and blind evaluation was carried out to determine the precision of digestive ultrasonography in assessment of ulcerative colitis extent. All ultrasonography was carried out by the same person and was always performed prior to carrying out a full endoscopic study, which is used as the gold standard. The hydrocolonic ultrasonograpy technique was not used in any of the cases. Results: a total of 20 patients -13 males (65% and 7 females (35%, with an average age of 51.7 years (aged between 24-82 years- were included in the study. Endoscopic studies revealed severe disease in 5 cases (25%, moderate disease in 12 patients (60%, and mild lesions in the 3 remaining cases (15%. A colonic ultrasonogram was considered satisfactory in 18 cases (90%, and the extent of disease as established by ultrasonography was in all cases consistent with that established through colonoscopy: 3 patients (16.6% had ulcerative proctitis, 9 patients (50% had left-sided ulcerative colitis, and 6 (33.3% had extensive colitis. Conclusions: digestive ultrasonography allows to study the colon in most patients, especially when inflammatory activity is present, and provides a greater accuracy in assessing ulcerative colitis extent, which is independent of its activity level.

  10. Biologics in the management of ulcerative colitis – comparative safety and efficacy of TNF-α antagonists

    Fausel R

    2015-01-01

    Full Text Available Rebecca Fausel,1 Anita Afzali1,2 1Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA, USA; 2Inflammatory Bowel Disease Program, UW Medicine – Harborview Medical Center, Seattle, WA, USA Abstract: Ulcerative colitis can cause debilitating symptoms and complications such as colonic strictures, colonic dysplasia, colorectal cancer, and toxic megacolon or perforation. Goals of treatment in ulcerative colitis include resolution of gastrointestinal symptoms, healing of colonic mucosa, and prevention of disease complications. Our treatment armamentarium has expanded dramatically over the past 10 years, and we now have multiple biologic agents approved for the treatment of moderate-severe disease, in addition to conventional therapies such as 5-aminosalicylates, thiopurines, and corticosteroids. In this review, we will provide a detailed discussion of the three tumor necrosis factor-alpha (TNF-α inhibitors currently approved for treatment of ulcerative colitis: infliximab, adalimumab, and golimumab. All three agents are effective for inducing and maintaining clinical response and remission in patients with ulcerative colitis, and they have comparable safety profiles. There are no head-to-head trials comparing their efficacy, and the choice of agent is most often based on insurance coverage, route of administration, and patient preference. Combination therapy with an immunomodulator is proven to be more effective than anti-TNF monotherapy, and patients who lose response to an anti-TNF agent should undergo dose intensification in order to regain clinical response. Despite therapeutic optimization, a significant percentage of patients will not achieve clinical remission with anti-TNF agents, and so newer therapies are on the horizon. Keywords: ulcerative colitis, inflammatory bowel disease, infliximab, adalimumab, golimumab

  11. Role of surgery in severe ulcerative colitis in the era of medical rescue therapy

    Bosmat Dayan; Dan Turner

    2012-01-01

    Despite the growing use of medical salvage therapy,colectomy has remained a cornerstone in managing acute severe ulcerative colitis (ASC) both in children and in adults.Colectomy should be regarded as a life saving procedure in ASC,and must be seriously considered in any steroid-refractory patient.However,colectomy is not a cure for the disease but rather the substitution of a large problem with smaller problems,including fecal incontinence,pouchitis,irritable pouch syndrome,cuffitis,anastomotic ulcer and stenosis,missed or de-novo Crohn's disease and,in young females,reduced fecundity.This notion has led to the widespread practice of offering medical salvage therapy before colectomy in most patients without surgical abdomen or toxic megacolon.Medical salvage therapies which have proved effective in the clinical trial setting include cyclosporine,tacrolimus and infliximab,which seem equally effective in the short term.Validated predictive rules can identify a subset of patients who will eventually fail corticosteroid therapy after only 3-5 d of steroid therapy with an accuracy of 85%-95%.This accuracy is sufficiently high for initiating medical therapy,but usually not colectomy,early in the admission without delaying colectomy if required.This approach has reduced the colectomy rate in ASC from 30%-70% in the past to 10%-20% nowadays,and the mortality rate from over 70% in the 1930s to about 1%.In general,restorative proctocolectomy (ileoanal pouch or ileal pouch-anal anastomosis),especially the J-pouch,is preferred over straight pullthrough (ileo-anal) or ileo-rectal anastomosis,which may still be considered in young females concerned about infertility.Colectomy in the acute severe colitis setting,is usually performed in three steps due to the severity of the inflammation,concurrent steroid treatment and the generally reduced clinical condition.The first surgical step involves colectomy and constructing an ileal stoma,the second-constructing the

  12. Safety and clinical efficacy of granulocyte and monocyte adsorptive apheresis therapy for ulcerative colitis

    Takayuki Yamamoto; Satoru Umegae; Koichi Matsumoto

    2006-01-01

    Active ulcerative colitis (UC) is frequently associated with infiltration of a large number of leukocytes into the bowel mucosa. Therefore, removal of activated circulating leukocytes by apheresis has the potential for improving UC. In Japan, since April 2000, leukocytapheresis using Adacolumn has been approved as the treatment for active UC by the Ministry of Health and Welfare. The Adacolumn is an extracorporeal leukocyte apheresis device filled with cellulose acetate beads, and selectively adsorbs granulocytes and monocytes/macrophages. To assess the safety and clinical efficacy of granulocyte and monocyte adsorptive apheresis (GMCAP) for UC, we reviewed 10 open trials of the use of GMCAP to treat UC. One apheresis session (session time, 60 min) per week for five consecutive weeks (a total of five apheresis sessions) has been a standard protocol. Several studies used modified protocols with two sessions per week, with 90-min session, or with a total of 10 apheresis sessions.Typical adverse reactions were dizziness, nausea,headache, flushing, and fever. No serious adverse effects were reported during and after GMCAP therapy, and almost all the patients could complete the treatment course. GMCAP is safe and well-tolerated. In the majority of patients, GMCAP therapy achieved clinical remission or improvement. GMCAP is a useful alternative therapy for patients with steroid-refractory or -dependent UC.GMCAP should have the potential to allow tapering the dose of steroids, and is useful for shortening the time to remission and avoiding re-administration of steroids at the time of relapse. Furthermore, GMCAP may have efficacy as the first-line therapy for steroid-naive patients or patients who have the first attack of UC. However,most of the previous studies were uncontrolled trials. To assess a definite efficacy of GMCAP, randomized, doubleblind, sham-controlled trials are necessary. A seriousproblem with GMCAP is cost; a single session costs (¥)145 000 ($1 300

  13. Infliximab induces clinical, endoscopic and histological responses in refractory ulcerative colitis Infliximab induce respuesta clínica, endoscópica e histológica en la colitis ulcerosa refractaria

    F. Bermejo

    2004-02-01

    Full Text Available Background: infliximab is a monoclonal antiTNF-α antibody that has repeatedly shown to be effective in the management of Crohn's disease. However, data are scarce about its efficacy in ulcerative colitis. Aim: to describe the joint experience of three Spanish hospitals in the use of infliximab in patients with active refractory ulcerative colitis. Patients and methods: we present seven cases of ulcerative colitis (6 with chronic active disease despite immunosuppressive therapy, and one with acute steroid-refractory ulcerative colitis treated with infliximab 5 mg/kg of body weight. Clinical response was evaluated by means of the Clinical Activity Index at 2, 4 and 8 weeks after initial infusion. Biochemical (erythrocyte sedimentation rate and C-reactive protein, endoscopic, and histological changes were also assessed. Results: mean age of patients was 45.8 ± 17 years (range 23-77; 4 were female. No adverse effects were recorded. Inflammatory activity diminished significantly in 6 of 7 patients (85.7%; CI 95%: 42-99% both from a clinical (p = 0.01 and biochemical (p Introducción: infliximab, un anticuerpo monoclonal quimérico antiTNF-α ha demostrado su eficacia en pacientes con enfermedad de Crohn. Sin embargo, son escasos los datos sobre su efectividad en el tratamiento de la colitis ulcerosa. Objetivo: describir la experiencia conjunta de 3 hospitales españoles en el uso de infliximab en enfermos con CU activa resistente a otros tratamientos. Pacientes y métodos: se presentan 7 casos de colitis ulcerosa (6 con enfermedad crónicamente activa a pesar de tratamiento con inmunosupresor y 1 con colitis aguda grave refractaria a esteroides tratados con infliximab a dosis de 5 mg/kg de peso. Se evaluó la respuesta clínica mediante un Índice de Actividad Clínica trascurridas 2, 4 y 8 semanas de la infusión inicial. Así mismo, se estudiaron los cambios analíticos (velocidad de sedimentación y proteína C reactiva, endoscópicos e histol

  14. 活动期溃疡性结肠炎患者血清瘦素与ghrelin水平的临床分析%Serum leptin and ghrelin levels in patients with active ulcerative colitis

    张爽; 梅俏; 许建明; 张旭; 杨清峰; 张丽萍; 江泳

    2012-01-01

    Objective To investigate the change of serum leptin and ghrelin levels in patients with active ulcerative colitis (UC) and their clinical significance.Methods Fifty-four patients with active UC and 25 normal controls were enrolled in this study,and serum levels of leptin and ghrelin were determined by enzyme-linked immunosorbent absorption.The correlations between serum leptin/ghrelin and the main clinicopathological features of patients with active UC were analyzed.The nutritional status of these patients were assessed by using the Nutritional Risk Screening 2002 ( NRS 2002).Results The serum levels of leptin and ghrelin in patients with active UC were significantly higher than those in normal controls [leptin:(245.51 ± 129.72) vs.( 183.80 ±59.67) pg/ml,P =0.029; ghrelin:(1477.96 ±501.86) vs.(1188.00±474.51) pg/ml,P=0.041]; and both of them were correlated with the disease severity ( leptin:r =0.715,P =0.019 ; ghrelin:r =0.667,P =0.027),but were not correlated with the clinical type,the extent of lesion,and the endoscopic grading (all P > 0.05).In the UC patients with nutritional risk,the serum levels of leptin and ghrelin were also significantly higher than those in subjects without nutritional risk [ leptin:(332.82 ± 172.92) vs.( 194.15 ± 49.71 ) pg/ml,P =0.026 ; ghrelin: ( 1848.60 ±326.48) vs.(1259.93±459.24) pg/ml,P=0.021].Conclusion Patients with active UC have remarkably higher serum leptin and ghrelin levels,which is associated with the disease severity and the nutritional risk.%目的 研究活动期溃疡性结肠炎(UC)患者血清瘦素及ghrelin水平变化情况及其临床意义.方法 纳入54例活动期UC患者和25例正常对照,采用ELISA法检测所有入选者的血清瘦素及ghrelin水平,并与UC患者的主要临床病理特征进行相关性分析.采用营养风险筛查2002( NRS 2002)筛查活动期UC患者的营养风险.结果 活动期UC患者的血清瘦素[(245.51±129.72)比(183.80±59.67)pg/ml,P=0.029]

  15. Ulcerative Colitis

    ... such as infections caused by bacteria, viruses and parasites. Colonoscopy. This exam allows your doctor to view ... affected. Rarely, these medications have been associated with kidney and pancreas problems. Corticosteroids. These drugs, which include ...

  16. Positions of selective leukocytapheresis in the medical therapy of ulcerative colitis

    Hiroyuki Hanai

    2006-01-01

    Ulcerative colitis (UC) and Crohn's disease (CD) are the major forms of idiopathic inflammatory bowel disease (IBD). Both UC and CD are debilitating chronic disorders that afflict millions of individuals throughout the world with symptoms which impair function and quality of life. The etiology of IBD is inadequately understood and therefore, drug therapy has been empirical instead of being based on sound understanding of IBD pathogenesis. This is a major factor for poor drug efficacy and drug related side effects that often add to the disease complexity. The development of biologicals notably infliximab to intercept tumor necrosis factor (TNF)-α reflects some progress, albeit major concern about their side effects and lack of long-term safety and efficacy profiles. However, IBD seems to be perpetuated by inflammatory cytokines like TNF-α, interleukin (IL)-1β,IL-6 and IL-8 for which activated peripheral granulocytes and monocytes/macrophages (GM) are major sources.Further, in IBD, peripheral GMs are elevated with activation behavior, increased survival time and are found in vast numbers within the inflamed intestinal mucosa; they are suspected to be major factors in the immunopathogenesis of IBD. Hence, peripheral blood GMs should be appropriate targets of therapy. The Adacolumn is a medical device developed for selective depletion of GM by receptor-mediated adsorption (GMA). Clinical data show GMA, in patients with steroid dependent or steroid refractory UC, is associated with up to 85% efficacy and tapering or discontinuation of steroids, while in steroid na(i)ve patients (the best responders), GMA spares patients from exposure to steroids. Likewise, GMA at appropriate intervals in patients at a high risk of clinical relapse suppresses relapse thus sparing the patients from the morbidity associated with IBD relapse. Further, GMA appears to reduce the number of patients being submitted to colectomy or exposure to unsafe immunosupressants.First UC episode

  17. Natural history of cytomegalovirus infection in a series of patients diagnosed with moderate-severe ulcerative colitis

    Valeria Criscuoli; Maria Rosa Rizzuto; Luigi Montalbano; Elena Gallo; Mario Cottone

    2011-01-01

    AIM: To evaluate the natural history of human cytomegalovirus (HCMV) infection in a series of 28 ulcerative colitis patients in whom the search for HCMV was positive.METHODS: A series of 85 patients with moderate-severe ulcerative colitis flare-up were evaluated for a HCMV search by performing a haematoxylin and eosin stain,immunohistochemical assay and nested polymerase chain reaction on rectal biopsies. Among 85 screened patients (19 of whom were steroid resistant/dependant),28 were positive for HCMV; after remission the patients were followed up clinically and histologically.RESULTS: Among the 22 patients with complete followup,in 8 (36%) patients HCMV-DNA persisted in the intestinal specimens. Among the HCMV positive patients,4 (50%) experienced at least one moderate-severe flare-up of colitis without evidence of peripheral HCMV.Among the 14 HCMV negative patients, 3 with pouches developed pouchitis and 5 out of 11 (45%) experienced a colitis flare-up.CONCLUSION: Our preliminary results suggest that HCMV may remain in the colon after an acute colitis flareup despite remission; it seems that the virus is not responsible for the disease relapse.

  18. Fecal Microbiota-based Therapeutics for Recurrent Clostridium difficile Infection, Ulcerative Colitis and Obesity

    Christian Carlucci

    2016-11-01

    Full Text Available The human gut microbiome is a complex ecosystem of fundamental importance to human health. Our increased understanding of gut microbial composition and functional interactions in health and disease states has spurred research efforts examining the gut microbiome as a valuable target for therapeutic intervention. This review provides updated insight into the state of the gut microbiome in recurrent Clostridium difficile infection (CDI, ulcerative colitis (UC, and obesity while addressing the rationale for the modulation of the gut microbiome using fecal microbiota transplant (FMT-based therapies. Current microbiome-based therapeutics in pre-clinical or clinical development are discussed. We end by putting this within the context of the current regulatory framework surrounding FMT and related therapies.

  19. Flare-up of ulcerative colitis after systemic corticosteroids:A strong case for Strongyloides

    2008-01-01

    Super-imposed infection with intestinal organisms can mimic a flare-up of underlying disease in patients with inflammatory bowel disease (IBD). We report a case of patient with long standing ulcerative colitis (UC), who presented with abdominal pain, diarrhea and low- grade fever after receiving systemic corticosteroids for an unrelated disorder. Despite a negative stool examination, a peripheral eosinophilia reappeared upon tapering down of a corticosteroid dose. Subsequently, duodenal biopsies showed evidence for Strongyloides, presumably acquired 20 years ago when the patient was residing in Brazil. The patient fully recovered following anti-helmintic therapy. This case underscores the importance of considering Strongyloides in the work-up of flaring-up IBD patients, even if a history of residing or traveling to endemic areas is in the distant past.

  20. Linear IgA Bullous Dermatosis Secondary to Infliximab Therapy in a Patient with Ulcerative Colitis.

    Hoffmann, Jochen; Hadaschik, Eva; Enk, Alexander; Stremmel, Wolfgang; Gauss, Annika

    2015-01-01

    Linear IgA bullous disease (LABD) is a rare vesiculobullous autoimmune skin disorder whose etiology and pathogenesis are not completely understood. Its occurrence has been related to malignancies, inflammatory diseases and several drugs. This report describes a 49-year-old Caucasian male with a 14-year history of ulcerative colitis who received infliximab to treat the refractory course of his bowel disease. During induction therapy with infliximab, he developed LABD. Treatment with infliximab was discontinued, and the skin lesions were successfully treated with oral steroids and dapsone. Considering the close chronological relation between administration of the tumor necrosis factor-α inhibitor and onset of the skin disease, we hypothesize that this is the first reported case of infliximab-induced LABD. Similar to psoriasis, it may represent a 'paradoxical' autoimmune reaction triggered by anti-tumor necrosis factor-α therapy.

  1. Ulcerative Colitis, Autoimmune Hemolytic Anemia and Primary Sclerosing Cholangitis in a Child

    Susan M Gilmour

    1996-01-01

    Full Text Available A 15-month-old female who initially presented with autoimmune hemolytic anemia (AIHA is described. She developed bloody stools and was diagnosed with ulcerative colitis (UC. Investigations of persistent hepatomegaly revealed primary sclerosing cholangitis (PSC. The association of AIHA, UC and PSC has never been reported. All these conditions entail impaired immunoregulation. Patients with a clustering of autoimmune diseases may help to delineate the pathogenesis of UC. Autoimmune phenomena may be prominent in inflammatory bowel disease. UC, in particular, exhibits a high incidence of associated autoimmune diseases including hypothyroidism, PSC, vitiligo and alopecia areata. AIHA is well described in 0.5% to 1.0% of adult UC patients but has not been reported in children with UC.

  2. Mesalizine-Induced Acute Pancreatitis and Interstitial Pneumonitis in a Patient with Ulcerative Colitis.

    Chung, Min Jae; Lee, Jae Hee; Moon, Kyung Rye

    2015-12-01

    Ulcerative colitis (UC) is a chronic idiopathic inflammatory bowel disease. Mesalizine for the first-line therapy of UC has adverse effects include pancreatitis, pneumonia and pericarditis. UC complicated by two coexisting conditions, however, is very rare. Moreover, drug-related pulmonary toxicity is particularly rare. An 11-year-old male patient was hospitalized for recurring upper abdominal pain after meals with vomiting, hematochezia and exertional dyspnea developing at 2 weeks of mesalizine therapy for UC. The serum level of lipase was elevated. Chest X-ray and thorax computed tomography showed interstitial pneumonitis. Mesalizine was discontinued and steroid therapy was initiated. Five days after admission, symptoms were resolved and mesalizine was resumed after a drop in amylase and lipase level. Symptoms returned the following day, however, accompanied by increased the serum levels of amylase and lipase. Mesalizine was discontinued again and recurring symptoms rapidly improved.

  3. Influences of the colonic microbiome on the mucous gel layer in ulcerative colitis.

    Lennon, Gráinne

    2014-04-01

    The colonic mucus gel layer (MGL) is a critical component of the innate immune system acting as a physical barrier to microbes, luminal insults, and toxins. Mucins are the major component of the MGL. Selected microbes have the potential to interact with, bind to, and metabolize mucins. The tolerance of the host to the presence of these microbes is critical to maintaining MGL homeostasis. In disease states such as ulcerative colitis (UC), both the mucosa associated microbes and the constituent MGL mucins have been shown to be altered. Evidence is accumulating that implicates the potential for mucin degrading bacteria to negatively impact the MGL and its stasis. These effects appear more pronounced in UC.   This review is focused on the host-microbiome interactions within the setting of the MGL. Special focus is given to the mucolytic potential of microbes and their interactions in the setting of the colitic colon.

  4. Ulcerative Colitis and Crohn's Disease Are Associated with Decreased Serum Selenium Concentrations and Increased Cardiovascular Risk.

    Castro Aguilar-Tablada, Teresa; Navarro-Alarcón, Miguel; Quesada Granados, Javier; Samaniego Sánchez, Cristina; Rufián-Henares, José Ángel; Nogueras-Lopez, Flor

    2016-12-01

    The incidence of inflammatory bowel disease (IBD) and associated oxidative stress is increasing. The antioxidant mineral selenium (Se) was measured in serum samples from 106 IBD patients (53 with ulcerative colitis (UC) and 53 with Crohn's disease (CD)) and from 30 healthy controls. Serum Se concentrations were significantly lower in UC and CD patients than in healthy controls (p disease and the length of time since onset (p serum Se and cardiovascular status was observed in CD than in UC patients. An adequate nutritional Se status is important in IBD patients to minimize the cardiovascular risk associated with increased inflammation biomarkers, especially in undernourished CD patients, and is also related to an improved nutritional and body iron status.

  5. Co-occurrence of rheumatoid arthritis with ulcerative colitis: A rare case

    Haridas V

    2015-03-01

    Full Text Available Ulcerative colitis (UC, an autoimmune disorder with unknown etiology, is a systemic disease with various extraintestinal manifestations such as arthritis, kidney and liver disease, and eye disorders. The present case study focuses on the co-occurrence of UC and rheumatoid arthritis (RA in a 60-year old female patient. Although the co-existence of RA with autoimmune disease is common, its association with inflammatory bowel disease is rare. The present study highlights the significance of further research to identify the factors and interactions that influence and contribute to the co-existence, which may assist in early diagnosis. Moreover, it focuses on the need to consider the chance of co-occurrence during the differential diagnosis, though the association is rare.

  6. Yellow fever vaccination during treatment with infliximab in a patient with ulcerative colitis: A case report.

    Rüddel, J; Schleenvoigt, B T; Schüler, E; Schmidt, C; Pletz, M W; Stallmach, A

    2016-09-01

    We report the case of a 59-year-old patient who accidentally underwent live vaccination against yellow fever during continuous treatment with the TNF-α-antibody (AB) infliximab for ulcerative colitis. The clinical course showed fever of short duration and elevation of liver enzymes without further clinical complications. Yellow fever viremia was not detectable and protective antibodies were developed. A primary vaccination against yellow fever under infliximab has not been reported in the literature before, although vaccination is an important topic in IBD. Live vaccinations, like Stamaril(®) against yellow fever, are contraindicated during TNF-α-AB treatment. Treatment regimens containing TNF-α-AB are of growing importance, not only in gastroenterology, but also in rheumatology and dermatology. We discuss this topic by presenting our case and reviewing the current literature.

  7. Catheter-Related Acremonium kiliense Fungemia in a Patient with Ulcerative Colitis under Treatment with Infliximab

    Fernando A. Díaz-Couselo

    2011-01-01

    Full Text Available Acremonium spp. are filamentous, cosmopolitan fungi commonly isolated from plant debris and soil. They are infrequent pathogens in humans. Acremonium fungemia has been reported in neutropenic patients associated with central venous catheters and in nonneutropenic patients receiving long-term total parenteral nutrition. TNF-α blockade is associated with fungal infections, but no Acremonium spp. infection had been reported up to the present. In this paper, we present a patient with ulcerative colitis who developed Acremonium kiliense fungemia associated with infliximab therapy while receiving total parenteral nutrition. The patient was successfully treated with voriconazole. Acremonium sp. infection must be suspected as another cause of fungal infection in patients under treatment with infliximab.

  8. Mesalazine preparations for the treatment of ulcerative colitis: Are all created equal?

    Bei; Ye; Daniel; R; van; Langenberg

    2015-01-01

    Oral mesalazine(also known as mesalamine) is a 5-aminosalicylic acid compound used in the treatment of mild to moderate ulcerative colitis, with high rates of efficacy in induction and maintenance of remission.The therapeutic effect of mesalazine occurs topically at the site of diseased colonic mucosa. A myriad of oral mesalazine preparations have been formulated with various drug delivery methods to minimize systemic absorption and maximise drug availability at the inflamed colonic epithelium. It remains unclear whether different oral mesalazine formulations are bioequivalent. This review aims to evaluate the differences between mesalazine formulations based on the currently available literature and explore factors which may influence the selection of one agent above another.

  9. Secondary pouchitis in a post-operative patient with ulcerative colitis, successfully treated by salvage surgery

    Yuji Toiyama; Toshimitsu Araki; Shigeyuki Yoshiyama; Chikao Miki; Masato Kusunoki

    2005-01-01

    We report a case of secondary pouchitis, defined as a mucosal inflammatory lesion in the ileal reservoir provoked by pouch-related complication following total colectomy and pouch anal anastomosis, which was successfully treated by salvage surgery. A 20-year-old woman with ulcerative colitis developed acute severe bloody diarrhea following proctocolectomy, ileal pouchanal anastomosis and diverting ileostomy. She was diagnosed as having a secondary pouchitis mainly caused by a peripouch abscess and partly concerned with the abnormal pouch formation. The remnantrectum and ileal pouch were excised and ileal pouch-anal anastomosis and diverting ileostomy were constructed.The postoperative course was uneventful with no sign of pouchitis. Salvage surgery may be indicated to treat secondary pouchitis when caused by surgery-related complications.

  10. Long term results of use of azathioprine in patients with ulcerative colitis in India

    Ajit Sood; Vandana Midha; Neena Sood; Manu Bansal

    2006-01-01

    AIM: To evaluate the role of azathioprine (AZA) in Indian patients with ulcerative colitis over longer duration of time.METHODS: One hundred fifty six patients with ulcerative colitis who were treated with AZA from .January 1995 to December 2003 were reviewed. The indications for its use were as follows: (1) steroid dependent and steroid refractory disease; (2) Azathioprine monotherapy for na(i)ve patients with severe disease; and (3) combination therapy (AZA + sulfasalazine or 5-aminosalicylates) for na(i)ve patients with severe disease. The data included patient and disease demographics, efficacy and toxicity profile of AZA. Patients with a minimum duration of 6 mo use of AZA were included in this report.RESULTS: Of a total of 156 patients treated with AZA,45 were excluded from analysis for the following reasons(follow up less than 6 mo,n = 9; poor follow up,n = 18;adverse affects,n = 18). In steroid refractory/dependent group the mean number of relapses prior to and post initiation of AZA therapy were 3.28 (± 0.81) and 0.94 (±0.29) respectively. Discontinuation of steroids could be accomplished in 12 of the 15 steroid dependent patients.The proportion of patients with sustained remission of 1,2, 3, 4 and 5 years duration were calculated. Eighteen patients experienced adverse effects necessitating withdrawal of AZA (pancreatitis,n = 7; hepatitis,n = 3; gastrointestinal intolerance,n = 2; alopecia,n = 2; and hematological, n = 4) while 13 patients needed dose reduction or temporary withdrawal of the drug.CONCLUSION: Azathioprine is well tolerated and has therapeutic benefits lasting as long as 4 years. Adverse effects such as pancreatitis, hepatitis, cytopenias and gastrointestinal symptoms do occur but are controlled by drug withdrawal only.

  11. Update on medical and surgical options for patients with acute severe ulcerative colitis: What is new?

    Andrew, Rachel E; Messaris, Evangelos

    2016-01-01

    Acute severe ulcerative colitis (UC) is a highly morbid condition that requires both medical and surgical management through the collaboration of gastroenterologists and colorectal surgeons. First line treatment for patients presenting with acute severe UC consists of intravenous steroids, but those who do not respond require escalation of therapy or emergent colectomy. The mortality of emergent colectomy has declined significantly in recent decades, but due to the morbidity of this procedure, second line agents such as cyclosporine and infliximab have been used as salvage therapy in an attempt to avoid emergent surgery. Unfortunately, protracted medical therapy has led to patients presenting for surgery in a poorer state of health leading to poorer post-operative outcomes. In this era of multiple medical modalities available in the treatment of acute severe UC, physicians must consider the advantages and disadvantages of prolonged medical therapy in an attempt to avoid surgery. Colectomy remains a mainstay in the treatment of severe ulcerative colitis not responsive to corticosteroids and rescue therapy, and timely referral for surgery allows for improved post-operative outcomes with lower risk of sepsis and improved patient survival. Options for reconstructive surgery include three-stage ileal pouch-anal anastomosis or a modified two-stage procedure that can be performed either open or laparoscopically. The numerous avenues of medical and surgical therapy have allowed for great advances in the treatment of patients with UC. In this era of options, it is important to maintain a global view, utilize biologic therapy when indicated, and then maintain an appropriate threshold for surgery. The purpose of this review is to summarize the growing number of medical and surgical options available in the treatment of acute, severe UC.

  12. Genetic susceptibility to ulcerative colitis in the Chinese Han ethnic population: association with TNF polymorphisms

    CAO Qian; ZHU Qin; WU Min-liang; HU Wei-ling; GAO Min; SI Jian-min

    2006-01-01

    Background Tumor necrosis factor α (TNFα) is an important proinflammatory cytokine that has been implicated in the pathogenesis of inflammatory bowel disease (IBD). Recent studies have evaluated the role of TNF promoter polymorphisms in IBD, whereas the data are inconsistent. Trans-racial mapping in an ethnically distinct but homogenous population may help clarify these associations. We investigate the association between TNF promoter polymorphisms and susceptibility to ulcerative colitis (UC) in the Chinese Han ethnic population.Methods We studied 110 unrelated UC patients and 292 healthy controls from Zhejiang Province, China.Genotyping for 6 common TNF promoter polymorphisms (TNF -1031T/C, -863C/A, -857C/T, -380G/A,-308G/A, -238G/A) was carried out by polymerase chain reaction sequence-specific primers (PCR-SSP).Results TNF-308A was associated with disease (allele frequency patients 14.6% vs controls 8.9%, P=0.02).TNF -857T was increased in patients but without statistical significance (allele frequency 17.3% vs 12.2%,P=0.06). Haplotype analysis revealed 6 haplotypes including two (H5 and H3), which contained TNF -308A. H5was associated with disease (haplotype frequency patients -12.3% vs controls 7.5%, P=0.03). Of note the rare haplotype H3 has not previously been identified in Caucasian populations. Homozygosity for the haplotype H4comprising the common alleles at each TNF promoter single-nucleotide polymorphism (SNP) was negatively associated with disease (patients vs controls 24.5% vs 34.9%, P<0.05).Conclusions We report the association with TNF -308A polymorphisms in Chinese patients with ulcerative colitis. The functional study in Chinese Han ethnic population is now required.

  13. Autofluorescence imaging endoscopy for identification and assessment of inflammatory ulcerative colitis

    Taro Osada; Atsushi Arakawa; Naoto Sakamoto; Hiroya Ueyama; Tomoyoshi Shibuya; Tatsuo Ogihara; Takashi Yao; Sumio Watanabe

    2011-01-01

    AIM: To validate the clinical relevance of autofluorescence imaging (AFI) endoscopy for the assessment of inflammatory ulcerative colitis (UC). METHODS: A total of 572 endoscopic images were selected from 42 UC patients: 286 taken with white light imaging (WLI) and 286 with AFI from the same sites. WLI images were assessed for overall mucosal inflammation according to Mayo endoscopic subscore (MES), and for seven characteristic endoscopic features. Likewise, AFI photographs were scored according to relative abundance of red, green and blue color components within each image based on an RGB additive color model. WLI and AFI endoscopic scores from the same sites were compared. Histological evaluation of biopsies was according to the Riley Index. RESULTS: Relative to red (r = 0.52, P < 0.01) or blue (r = 0.56, P < 0.01) color component, the green color component of AFI (r = -0.62, P < 0.01) corresponded more closely with mucosal inflammation sites. There were significant differences in green color components between MES-0 (0.396 ± 0.043) and MES-1 (0.340 ± 0.035) (P < 0.01), and between MES-1 and ≥ MES-2 (0.318 ± 0.037) (P < 0.01). The WLI scores for "vascular patterns" (r = -0.65, P < 0.01), "edema" (r = -0.62, P < 0.01), histology scores for "polymorphonuclear cells in the lamina propria" (r = -0.51, P < 0.01) and "crypt architectural irregularities" (r = -0.51, P < 0.01) showed correlation with the green color component of AFI. There were significant differences in green color components between limited (0.399 ± 0.042) and extensive (0.375 ± 0.044) (P = 0.014) polymorphonuclear cell infiltration within MES-0. As the severity of the mucosal inflammation increased, the green color component of AFI decreased. The AFI green color component was well correlated with the characteristic endoscopic and histological inflammatory features of UC. CONCLUSION: AFI has application in detecting inflammatory lesions, including microscopic activity in the colonic mucosa of UC

  14. A randomised double-blind placebo-controlled trial with Lactobacillus acidophilus La-5 and Bifidobacterium animalis subsp. lactis BB-12 for maintenance of remission in ulcerative colitis

    Nordgaard, Inge; Rumessen, Jüri Johs.; Wildt, Signe

    2011-01-01

    To investigate the clinical effect of treatment with Lactobacillus acidophilus La-5 and Bifidobacterium animalis subsp. lactis BB-12 (Probio-Tec AB-25) to maintain remission in patients with ulcerative colitis.......To investigate the clinical effect of treatment with Lactobacillus acidophilus La-5 and Bifidobacterium animalis subsp. lactis BB-12 (Probio-Tec AB-25) to maintain remission in patients with ulcerative colitis....

  15. Amaranthus roxburghianus root extract in combination with piperine as a potential treatment of ulcerative colitis in mice

    Sunil A.Nirmal; Jayashri M.Ingale; Shashikant R.Pattan; Sanjay B.Bhawar

    2013-01-01

    OBJECITVE:The present work was undertaken to determine the effects of Amaranthus roxburghianus Nevski.(Amaranthaceae) root alone and in combination with piperine in treating ulcerative colitis (UC) in mice.METHODS:Swiss albino mice were divided into seven groups (n =6).Standard group received prednisolone (5 mg/kg,intraperitoneally).Treatment groups received hydroalcoholic extract of roots of A.roxburghianus (50 and 100 mg/kg,per oral) and a combination of hydroalcoholic extract of roots of A.roxburghianus (50 and 100 mg/kg,per oral) and piperine (5 mg/kg,per oral).Ulcer index,colitis severity,myeloperoxidase (MPO),malondialdehyde and glutathione were estimated from blood and tissue.Column chromatography of the extract was done and purified fractions were analyzed by gas chromatography-mass spectroscopy (GC-MS).RESULTS:Treatment with the combination of hydroalcoholic extract of A.roxburghianus and piperine showed minimal ulceration,hemorrhage,necrosis and leucocyte infiltration by histopathological observation.Acetic acid increased MPO levels in blood and colon tissue to 355 U/mL and 385 U/mg,respectively.The combination of hydroalcoholic extract of A.roxburghianus (100 mg/kg) and piperine (5 mg/kg) significantly decreased MPO in blood and tissue to 182 U/mL and 193 U/mg,respectively (P < 0.05).Similarly,this combination significantly reduced malondialdehyde levels and increased glutathione levels in blood and tissue.Various phytoconstituents were detected by GC-MS.CONCLUSION:The combination of hydroalcoholic extract of A.roxburghianus and piperine is effective in the treatment of UC and the effects are comparable with the standard drug prednisolone.4H-pyran-4-one,2,3-dihydro-3,5-dihydroxy-6-methyl,eugenol and benzene,and 1-(1,5-dimethyl-4-hexenyl)-4-methyl are reported having analgesic,anti-inflammatory,and antioxidant properties; they may play a role in the biological activity of A.roxburghianus root.

  16. Influencia de una combinación de lactobacilos + bifidobacterias sobre la actividad de la enfermedad, el hábito defecatorio y el estado nutricional de pacientes con colitis ulcerosa Influence of a combination of lactobacilli and bifidobacteria upon disease activity, stool pattern and nutritional status of ulcerative colitis patients

    S. Santana Porbén

    2010-12-01

    én resultó en una disminución de la actividad de la enfermedad y la ESR Eritrosedimentación, respectivamente [Cambio en el Índice de Actividad Clínica: Grupo Control: -1,1 ± 3,2 vs Grupo Tratamiento: -4,1 ± 3,3; p A quasi-experimental clinical assay was carried out to assess the tolerance, safety and usefulness of a 4 lactobacili + 1 bifidobacterium combination as adjuvant to the pharmacological treatment of UC Ulcerative colitis patients differing in mucosal change. The effectiveness of the probiotic treatment was assessed from changes in patient´s stool pattern, body composition, and selected biochemical indicators of disease activity and nutritional status. Fifty patients entered consecutively in the trial between December 2005-June 2009 (Control Group: 29; Treatment Group: 21. Twenty of them completed treatment with probiotics. Effectiveness of regular pharmacological treatment was recorded with 24 control patients. Thirty-six days of probiotic treatment per patient were accumulated. Probiotic treatment obedience rate was 99.3%. Five days of treatment were lost due to non-availability of the product. No adverse reactions were reported after probiotic treatment. Two deaths were recorded after completion of the study, one on each group. Improvement in the quality of the stools [RR Relative risk: 1.69; 95% IC: 0.87-3.27]; frequency [RR: 1.35; 95% IC: 0.15-11.90]; and volume [RR: 1.11; 95% IC: 0.16-7.63] was observed in treated patients, although biological variability prevented these trends to become statistically significant. Probiotic treatment also resulted in reduction of occurrence of nocturnal depositions [RR: 1.75; 95% IC: 0.53-5.73]. Probiotic treatment prevented the onset of undesirable changes in stool pattern of treated patients who presented free of symptoms, but observed effect was no superior to that of medication administered. Probiotic treatment did not influence upon presence of blood in stools. Probiotic treatment also resulted in reduction of

  17. Astragalus polysaccharides protect against dextran sulfate sodium-induced colitis by inhibiting NF-κВ activation.

    Lv, Jun; Zhang, Yahong; Tian, Zhiqiang; Liu, Fang; Shi, Ying; Liu, Yao; Xia, Peiyuan

    2017-05-01

    Astragalus polysaccharide (APS) is a bioactive extract of Astragalus membranaceus (AM), which possess a wide range of medicinal benefits, including anti-inflammatory, anti-oxidative, anti-tumor and anti-diabetic effects. The present work evaluated the therapeutic effect of APS and its potential mechanisms in a mouse model of dextran sulfate sodium (DSS)-induced colitis. The APS treatment led to significant improvements in colitis disease activity index (DAI) and histological scores, as well as significantly increased weight and colon length in mice as compared to the control group. Mechanically, reduced NF-κВ DNA phosphorylation activity and downregulated TNF-α, IL-1β, IL-6, IL-17 expressions and myeloperoxidase (MPO) activity were associated with improvement in colitis observed in APS-treated mice. These findings suggest that APS may represent a natural therapeutic approach for treating inflammatory bowel disease, such as ulcerative colitis.

  18. Use of infliximab in the prevention and delay of colectomy in severe steroid dependant and refractory ulcerative colitis

    Robert P Willert; Ian Craig Lawrance

    2008-01-01

    AIM: To determine if infliximab can prevent or delay surgery in refractory ulcerative colitis (UC).METHODS: UC patients who failed to have their disease controlled with conventional therapies and were to undergo colectomy if infliximab failed to induce a clinical improvement were reviewed.Patients were primarily treated with a single 5 mg/kg infliximab dose.The Colitis Activity Index (CAI) was used to determine response and remission.Data of 8 wk response and colectomy rates at 6 mo and 12 mo were collected.RESULTS: Fifteen patients were included, 7 with UC unresponsive or intolerant to IV hydrocortisone, and 8 with active disease despite oral steroids (all but one with therapeutic dosage and duration of immunomodulation).All the Ⅳ hydrocortisone-resistant/intolerant patients had been on azathioprine/6-MP < 8 wk.At 8 wk, infliximab induced a response in 86.7% (13/15) with 40% in remission (6/15).Within 6 mo of treatment 26.7% (4/15)had undergone colectomy and surgery was avoided in 46.6% (7/15) at 12 mo.The colectomy rate at 12 mo in those on immunomodulatory therapy < 8 wk at time of infliximab was 12.5% (1/8) compared with 100%(7/7) in patients who were on long-term maintenance immunomodulators (P < 0.02).CONCLUSION: Infliximab prevented colectomy due to active disease in immunomodulatory-naive, refractory UC patients comparable to the use of Cyclosporine.In patients, however, on effective dosage and duration of immunomodulation at time of infliximab therapy colectomy was not avoided.

  19. Expression of matrix metalloproteinase-1 and tissue inhibitor of metalloproteinase-1 in ulcerative colitis

    Ying-De Wang; Pei-Yun Yan

    2006-01-01

    AIM: To examine the expression of metalloproteinase-1(MMP-1) and tissue inhibitor of metalloproteinase-1(TIMP-1) in the colonic mucosa of patients with ulcerative colitis (UC).METHODS: Reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry were used to study the expression of MMP-1 and TTMP-1 at both mRNA and protein levels in patients with UC and controls. The relationship between MMP-1 mRNA, TIMP-1mRNA, MMP-1 mRNA/TIMP-1 mRNA ratio and the severity of clinical symptoms of the patients with UC were also analyzed.RESULTS: The expression of MMP-1 mRNA and TIMP-1mRNA in the ulcerated and inflamed colonic mucosa was significantly higher than that in the non-inflamed colonic mucosa (P < 0.001), but there was no statistically significant difference in the non-inflamed colcnic mucosa of UC patients and normal controls (P > 0.05). The mRNA expression of MMP-1 and TIMP-1 in ulcerated colonic mucosa of UC patients was increased by 80-fold and 2.2-fold,respectively when compared with the normal controls. In the inflamed colonic mucosa, the increase was 30-fold and 1.6-fold, respectively. Tmmunohistochemical analysis showed that among the ulcerated, inflamed, and non-inflamed colonic mucosae of UC patients and the normal controls, the positive rate of MMP-1 expression was 87%, 87%, 40% and 35% respectively, and the positive rate of TIMP-1 expression was 89%, 89%, 80%and 75%, respectively. Furthermore, the expression of MMP-1 mRNA, TIMP-1 mRNA and the MMP-1 mRNA/TIMP-1 mRNA ratio were correlated with the severity of clinical symptoms (P <0.05).CONCLUSION: Excessive expression of MMP-1 in the diseased colonic mucosa causes excessive hydrolysis of the extracellular matrix (ECM) and ulceration in UC patients. MMP-1 mRNA, TIMP-1 mRNA and MMP-1 mRNA/TIMP-1 mRNA ratio can be used as biomarkers to judge the severity of clinical symptoms in patients with UC.Exogenous TIMP-1 or MMP-1 inhibitor therapy is a novel treatment for patients with UC.

  20. Therapeutic effect and mechanism of proanthocyanidins from grape seeds in rats with TNBS-induced ulcerative colitis.

    Li, Xiao-Li; Cai, Yong-Qing; Qin, Hong; Wu, Yong-Jie

    2008-12-01

    The aim of the study was to investigate the therapeutic effect and mechanism of proanthocyanidins from grape seeds (GSPE) in the treatment of ulcerative colitis (UC). Rats were intragastrically administered different doses of GSPE (100, 200, and 400 mg/kg) per day for 7 days after UC was twice-induced by intracolonic injection of 2,4,6-trinitrobenzene sulfonic acid (TNBS)dissolved in 50% ethanol. Sulfasalazine (SASP) at 200 mg/kg was used as a positive control drug. Macroscopic and microscopic damage scores and changes in weight/length ratio (mg/mm) of colon segments were analyzed. The levels of malonyldialdehyde (MDA), interleukin (IL)-1beta, IL-2, IL-4, and myeloperoxidase (MPO) activity in the colon tissues and MPO activity in the serum were all measured by biochemical methods or double antibody sandwich ELISA methods. Compared with the TNBS control group, GSPE treatment facilitated recovery of pathologic changes in the colon after insult with TNBS, as demonstrated by increased body weight (p rats treated with GSPE was significantly lower than that in the TNBS control group. The MDA and IL-1beta levels of colon tissues were also decreased in GSPE groups. The intestinal antiinflammatory effect of GSPE was accompanied by a significant improvement of IL-2 and IL-4 levels in the colon tissues of rats in the high-dose GSPE group (p 0.05). GSPE exerts a beneficial antiinflammatory effect in the acute phase of TNBS-induced colitis in rats by downregulating some of the mediators involved in the intestinal inflammatory response, inhibiting inflammatory cell infiltration and antioxidation damage, promoting damaged tissue repair to improve colonic oxidative stress, decreasing production of proinflammatory cytokines IL-1beta, and increasing production of antiinflammatory cytokines IL-2 and IL-4.

  1. Proanthocyanidins from grape seeds modulates the nuclear factor-kappa B signal transduction pathways in rats with TNBS-induced recurrent ulcerative colitis.

    Wang, Yan-Hong; Ge, Bin; Yang, Xiao-Lai; Zhai, Jing; Yang, Li-Ning; Wang, Xiao-Xia; Liu, Xia; Shi, Jin-Cheng; Wu, Yong-Jie

    2011-10-01

    The aim of this study was to elucidate the molecular mechanisms involved in the therapeutic effects of proanthocyanidins from grape seeds (GSPE) on recurrent ulcerative colitis (UC) in rats. GSPE in doses of 100, 200, and 400mg/kg were intragastrically administered per day for 7 days after recurrent colitis was twice-induced by TNBS. The levels of GSH, as well as the activity of GSH-Px and SOD in colon tissues were measured by biochemical methods. The expression levels of tumor necrosis factor-α (TNF-α) and the nuclear translocation levels of nuclear factor-kappa B (NF-κB) in the colon tissues were measured by enzyme-linked immunosorbent assay methods. Western blotting analysis was used to determine the protein expression levels of inhibitory kappa B-alpha (IκBα), inhibitor kappa B kinase (IKKα/β), phosphorylated IκBα and phosphorylated IKKα/β. GSPE treatment was associated with a remarkable increased the activity of GSH-Px and SOD with GSH levels in TNBS-induced recurrent colitis rats as compared to the model group. GSPE also significantly reduced the expression levels of TNF-α, p-IKKα/β, p-IκBα and the translocation of NF-κB in the colon mucosa. GSPE exerted a protective effect on recurrent colitis in rats by modifying the inflammatory response and promoting damaged tissue repair to improve colonic oxidative stress. Moreover, GSPE inhibited the TNBS-induced inflammatory of recurrent colitis though blocking NF-κB signaling pathways.

  2. Fecal Bacteriotherapy: A Case Report in an Immunosuppressed Patient with Ulcerative Colitis and Recurrent  Clostridium difficile Infection

    Hadeel Zainah

    2012-01-01

    Full Text Available We report a case of ulcerative colitis (UC and recurrent Clostridium difficile infection (CDI where the patient was on immunomodulatory therapy and had successful CDI eradication after fecal transplantation. This is the first case report in the literature documenting successful C. difficile eradication in an immunosuppressed patient. We feel that fecal transplantation should be studied as a treatment option in these patients.

  3. Susceptibility to Ulcerative Colitis and Genetic Polymorphisms of A251G SOD1 and C-262T CAT

    El-Kheshen Gadier; Moeini Maryam; Saadat Mostafa

    2016-01-01

    Background: Reactive oxygen species can attack and damage almost every molecule found in living cells, including proteins, carbohydrates, lipids, and DNA. For this reason, their production is normally tightly controlled. Among the most important defenses against these radicals are the super oxide dismutase (SOD) enzymes and catalase (CAT). In creasing attention has been given to the role of reactive oxygen metabolites in the pathogenesis of ulcerative colitis (UC), which is defined as an idio...

  4. Infliximab versus Cyclosporine Treatment for Severe Corticosteroid-Refractory Ulcerative Colitis: A Korean, Retrospective, Single Center Study

    Kim, Eun Hye; Kim, Duk Hwan; Park, Soo Jung; Hong, Sung Pil; Kim, Tae Il; Kim, Won Ho; Cheon, Jae Hee

    2014-01-01

    Background/Aims In patients with corticosteroid-refractory ulcerative colitis (UC), cyclosporine or infliximab may be added to the treatment regimen to induce remission. Here, we aimed to compare the efficacy of cyclosporine and infliximab. Methods Between January 1995 and May 2012, the medical records of 43 patients with corticosteroid-refractory UC who received either infliximab or cyclosporine as a rescue therapy at a tertiary care hospital in Korea were reviewed. Results Among the 43 pati...

  5. Ulcerative Colitis and Crohn’s Disease Are Associated with Decreased Serum Selenium Concentrations and Increased Cardiovascular Risk

    2016-01-01

    The incidence of inflammatory bowel disease (IBD) and associated oxidative stress is increasing. The antioxidant mineral selenium (Se) was measured in serum samples from 106 IBD patients (53 with ulcerative colitis (UC) and 53 with Crohn’s disease (CD)) and from 30 healthy controls. Serum Se concentrations were significantly lower in UC and CD patients than in healthy controls (p < 0.001) and significantly lower in CD patients than in UC patients (p = 0.006). Se concentrations in patients ...

  6. Secretion of alpha-hemolysin by Escherichia coil disrupts tight junctions in ulcerative colitis patients

    Mirsepasi-Lauridsen, Hengameh Chloé; Du, Zhengyu; Struve, Carsten;

    2016-01-01

    OBJECTIVES: The potential of Escherichia coli (E. coli) isolated from inflammatory bowel disease (IBD) patients to damage the integrity of the intestinal epithelium was investigated. METHODS: E. coli strains isolated from patients with ulcerative colitis (UC) and healthy controls were tested...... in a mutant unable to express α-hemolysin. These results suggest that high Hly expression may be a mechanism by which specific strains of E. coli pathobionts can contribute to epithelial barrier dysfunction and pathophysiology of disease in IBD....

  7. The Impact of Clostridum Difficile on Surgical Rate Among Ulcerative Colitis Patients: A Systemic Review and Meta-analysis

    Jiang-Chen Peng; Jun Shen; Qi Zhu; Zhi-Hua Ran

    2015-01-01

    There is growing recognition of the impact of Clostridum difficile infection (CDI) on patients with inflammatory bowel disease. Clostridium difficile infection causes greater morbidity and mortality. This study aimed to evaluate the impact of C. difficile on surgical risk among ulcerative colitis (UC) patients. We searched the following databases: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, ACP Journal Club, DARE, CMR, and HTA. Studies were included if fulfilled the f...

  8. The Mutyh base excision repair gene influences the inflammatory response in a mouse model of ulcerative colitis.

    Ida Casorelli

    Full Text Available BACKGROUND: The Mutyh DNA glycosylase is involved in the repair of oxidized DNA bases. Mutations in the human MUTYH gene are responsible for colorectal cancer in familial adenomatous polyposis. Since defective DNA repair genes might contribute to the increased cancer risk associated with inflammatory bowel diseases, we compared the inflammatory response of wild-type and Mutyh(-/- mice to oxidative stress. METHODOLOGY/PRINCIPAL FINDINGS: The severity of colitis, changes in expression of genes involved in DNA repair and inflammation, DNA 8-oxoguanine levels and microsatellite instability were analysed in colon of mice treated with dextran sulfate sodium (DSS. The Mutyh(-/- phenotype was associated with a significant accumulation of 8-oxoguanine in colon DNA of treated mice. A single DSS cycle induced severe acute ulcerative colitis in wild-type mice, whereas lesions were modest in Mutyh(-/- mice, and this was associated with moderate variations in the expression of several cytokines. Eight DSS cycles caused chronic colitis in both wild-type and Mutyh(-/- mice. Lymphoid hyperplasia and a significant reduction in Foxp3(+ regulatory T cells were observed only in Mutyh(-/- mice. CONCLUSIONS: The findings indicate that, in this model of ulcerative colitis, Mutyh plays a major role in maintaining intestinal integrity by affecting the inflammatory response.

  9. Anti-inflammatory effect of Prunus armeniaca L. (Apricot) extracts ameliorates TNBS-induced ulcerative colitis in rats.

    Minaiyan, M; Ghannadi, A; Asadi, M; Etemad, M; Mahzouni, P

    2014-01-01

    Prunus armeniaca L. (Apricot) is a tree cultivated in different parts of the world. Apricot kernel as a good dietary supplement has shown antioxidant, anti-inflammatory and other pharmacologic properties which suggest that it may be functional as an anticolitis agent. In this study we evaluated the effects of apricot kernel extract and oil on ulcerative colitis in rats. Rats were fasted for 36 h before the experiment. Colitis was induced by intra-rectal instillation of 50 mg/kg trinitrobenzene sulfonic acid in male Wistar rats. Treatments were started 6 h after colitis induction and continued every 24 h for 5 days. Apricot kernel extract (100, 200, 400 mg/kg p.o. and 100, 400 mg/kg i.p.) and apricot kernel extract/oil (100, 200, 400 mg/kg p.o.) were used as experimental treatments and prednisolone (4 mg/kg p.o. or i.p.) was used as reference drug. On the day 6, colon tissue was removed and macroscopic and pathologic parameters were evaluated. Ulcer index and total colitis index as representative of macroscopic and histologic parameters respectively showed ameliorating effects in experimental groups especially those treated by intraperitoneal administration route. Results also demonstrated that oil fraction was not able to potentiate the effects of extract. These data suggest that apricot kernel extracts (with or without oil) can be introduced for further mechanistic and clinical studies as a complementary medicine for inflammatory bowel disorders.

  10. Study on the physicochemical properties and anti-inflammatory effects of paeonol in rats with TNBS-induced ulcerative colitis.

    Zong, Shi-Yu; Pu, Yi-Qiong; Xu, Ben-Liang; Zhang, Tong; Wang, Bing

    2017-01-01

    Paeonol, an active component from Paeonia suffruticosa Andr., has a variety of biological activities, such as vascular endothelial cell protection, anti-oxidation, and anti-inflammation. The aim of this study was to investigate the basic physicochemical properties of paeonol, including solubility, oil-water partition coefficient, and permeability. Then evaluated the anti-inflammatory effects of paeonol were evaluated on 2,4,6-trinitrobenzenesulfonic acid-induced ulcerative colitis in rats. The rats were divided randomly into 6 groups, namely, normal, model, paeonol-treated (100, 200, and 400mg/kg), and positive. Each group had 10 rats. Inhibition effects were evaluated by the disease activity index (DAI), colon weight/length ratio, as well as macroscopical and histological evaluations. Serum interleukin (IL)-17, IL-6 and transforming growth factor beta 1 (TGF-β1) levels were determined by enzyme-linked immunosorbent assay. The solubility and oil-water partition coefficient of paeonol in different phosphate buffer solutions were 284.06-598.23 and 461.97-981.17μg/mL, respectively. The effective passive permeability value Pe was 23.49×10(-6)cm/s. In terms of anti-inflammatory results, compared with the model group, treatment with 200 and 400mg/kg doses of paeonol had significantly decreased DAI, colon weight/length ratio, and macroscopic and histopathological scores. Furthermore, the serum levels of IL-17 and IL-6 were significantly reduced, whereas the TGF-β1 level was increased in the two paeonol-treated groups (medium- and high-dose group). Therefore, paeonol had poor water solubility, but oral absorption was good. In addition, paeonol had therapeutic effects on ulcerative colitis, and the therapeutic efficacy was dose dependent. The results presented in this study provide evidence for the development of a novel therapeutic agent in the treatment of UC. However, whether this agent could have therapeutic benefit or adverse effects in human IBD remains to be

  11. BTZO-15, an ARE-activator, ameliorates DSS- and TNBS-induced colitis in rats.

    Yukitake, Hiroshi; Kimura, Haruhide; Suzuki, Hirobumi; Tajima, Yasukazu; Sato, Yoshimi; Imaeda, Toshihiro; Kajino, Masahiro; Takizawa, Masayuki

    2011-01-01

    Inflammatory bowel disease (IBD) is a group of chronic inflammatory disorders that are primarily represented by ulcerative colitis and Crohn's disease. The etiology of IBD is not well understood; however, oxidative stress is considered a potential etiological and/or triggering factor for IBD. We have recently reported the identification of BTZO-1, an activator of antioxidant response element (ARE)-mediated gene expression, which protects cardiomyocytes from oxidative stress-induced insults. Here we describe the potential of BTZO-15, an active BTZO-1 derivative for ARE-activation with a favorable ADME-Tox profile, for the treatment of IBD. BTZO-15 induced expression of heme oxygenase-1 (HO-1), an ARE-regulated cytoprotective protein, and inhibited NO-induced cell death in IEC-18 cells. Large intestine shortening, rectum weight gain, diarrhea, intestinal bleeding, and an increase in rectal myeloperoxidase (MPO) activity were observed in a dextran sulfate sodium (DSS)-induced colitis rat model. Oral administration of BTZO-15 induced HO-1 expression in the rectum and attenuated DSS-induced changes. Furthermore BTZO-15 reduced the ulcerated area and rectal MPO activity in 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced colitis rats without affecting rectal TNF-α levels. These results suggest that BTZO-15 is a promising compound for a novel IBD therapeutic drug with ARE activation properties.

  12. BTZO-15, an ARE-activator, ameliorates DSS- and TNBS-induced colitis in rats.

    Hiroshi Yukitake

    Full Text Available Inflammatory bowel disease (IBD is a group of chronic inflammatory disorders that are primarily represented by ulcerative colitis and Crohn's disease. The etiology of IBD is not well understood; however, oxidative stress is considered a potential etiological and/or triggering factor for IBD. We have recently reported the identification of BTZO-1, an activator of antioxidant response element (ARE-mediated gene expression, which protects cardiomyocytes from oxidative stress-induced insults. Here we describe the potential of BTZO-15, an active BTZO-1 derivative for ARE-activation with a favorable ADME-Tox profile, for the treatment of IBD. BTZO-15 induced expression of heme oxygenase-1 (HO-1, an ARE-regulated cytoprotective protein, and inhibited NO-induced cell death in IEC-18 cells. Large intestine shortening, rectum weight gain, diarrhea, intestinal bleeding, and an increase in rectal myeloperoxidase (MPO activity were observed in a dextran sulfate sodium (DSS-induced colitis rat model. Oral administration of BTZO-15 induced HO-1 expression in the rectum and attenuated DSS-induced changes. Furthermore BTZO-15 reduced the ulcerated area and rectal MPO activity in 2,4,6-trinitrobenzene sulfonic acid (TNBS-induced colitis rats without affecting rectal TNF-α levels. These results suggest that BTZO-15 is a promising compound for a novel IBD therapeutic drug with ARE activation properties.

  13. Preparation and evaluation of mesalamine collagen in situ rectal gel: a novel therapeutic approach for treating ulcerative colitis.

    Ramadass, Satiesh Kumar; Perumal, Sathiamurthi; Jabaris, Sugin Lal; Madhan, Balaraman

    2013-01-23

    Ulcerative colitis (UC) is a chronic inflammatory disease that primarily affects the colonic mucosa. Mesalamine had been established as a first line drug for treating mild to moderate UC. A continued availability of the drug for treatment of damaged tissues remains a great challenge today. In the present study, a novel mesalamine collagen in situ gel has been prepared using type I collagen, which is pH/temperature sensitive. This hydrogel undergoes sol-gel transition under physiological pH and temperature which was confirmed by rheological studies. The in vitro release profile demonstrated sustained release of mesalamine over a period of 12h. The in vivo efficacy of the in situ gel was performed using dextran sodium sulphate induced ulcerative colitis model in BALB/c mice. The clinical parameters such as, body weight changes, rectal bleeding and stool consistency were evaluated. In addition, the histopathological investigation was conducted to assess severity of mucosal damage and inflammation infiltrate. There was a significant reduction in rectal bleeding and mucosal damage score for collagen-mesalamine in situ gel group compared to the reference group. Apart from releasing mesalamine in controlled manner, the strategy of administering mesalamine through collagen in situ gel facilitates regeneration of damaged mucosa resulting in a synergistic effect for the treatment of ulcerative colitis.

  14. CD34 is required for infiltration of eosinophils into the colon and pathology associated with DSS-induced ulcerative colitis.

    Maltby, Steven; Wohlfarth, Carolin; Gold, Matthew; Zbytnuik, Lori; Hughes, Michael R; McNagny, Kelly M

    2010-09-01

    Eosinophil migration into the gut and the release of granular mediators plays a critical role in the pathogenesis of inflammatory bowel diseases, including ulcerative colitis. We recently demonstrated that eosinophil migration into the lung requires cell surface expression of the sialomucin CD34 on mast cells and eosinophils in an asthma model. Based on these findings, we investigated a similar role for CD34 in the migration of eosinophils and other inflammatory cells into the colon as well as explored the effects of CD34 ablation on disease development in a dextran sulfate sodium-induced model of ulcerative colitis. Our findings demonstrate decreased disease severity in dextran sulfate sodium-treated Cd34(-/-) mice, as assessed by weight loss, diarrhea, bleeding, colon shortening and tissue pathology, compared with wild-type controls. CD34 was predominantly expressed on eosinophils within inflamed colon tissues, and Cd34(-/-) animals exhibited drastically reduced colon eosinophil infiltration. Using chimeric animals, we demonstrated that decreased disease pathology resulted from loss of CD34 from bone marrow-derived cells and that eosinophilia in Cd34(-/-)IL5(Tg) animals was sufficient to overcome protection from disease. In addition, we demonstrated a decrease in peripheral blood eosinophil numbers following dextran sulfate sodium treatment. These findings demonstrate that CD34 was expressed on colon-infiltrating eosinophils and played a role in eosinophil migration. Further, our findings suggest CD34 is required for efficient eosinophil migration, but not proliferation or expansion, in the development of ulcerative colitis.

  15. Comparison of maintenance effect of probiotics and aminosalicylates on ulcerative colitis:A meta-analysis of randomized controlled trials

    Yong Jiang; Zhi-Guang Zhang; Feng-Xiang Qi; Ying Zhang; Tao Han

    2016-01-01

    Objective: To evaluate the maintenance effect of probiotics versus that of aminosalicylates on ulcerative colitis. Methods: MEDLINE, EMBASE, the Cochrane Controlled Trials Register, and the Chinese Biomedical Database were searched in English or Chinese. Data extracted were selected with strict criteria. Results: In six randomized controlled trials (RCTs), a total of 721 participants were enrolled and the maintenance effect of probiotics (n ¼ 364) versus that of aminosalicylates (n ¼ 357) on ulcerative colitis was investigated. No significant difference was observed between probiotics and aminosalicylate groups (relative risk (RR) ¼ 1.08; 95% confidence interval (CI): 0.91e1.28;P ¼ 0.40). Three RCTs compared the incidence of adverse events with probiotics versus those with aminosalicylates. No significant difference was observed in the incidence of adverse events between the two groups (RR ¼ 1.20;95%CI:0.92e1.56;P ¼ 0.17). Conclusions: Probiotics and aminosalicylates both showed a maintenance effect on ulcerative colitis. However, more well-designed RCTs are required.

  16. Effects of Moxibustion Stimulation on the Intensity of Infrared Radiation of Tianshu (ST25 Acupoints in Rats with Ulcerative Colitis

    Xiaomei Wang

    2012-01-01

    Full Text Available ST25 is a key acupoint used in the treatment of ulcerative colitis by moxibustion stimulation, but the biophysical mechanism underlying its effects is still unknown. The aim of the present study was to explore the biophysical properties of ST25 acupoint stimulated by moxibustion in a rat model of ulcerative colitis. The infrared radiation intensity of fourteen wavelengths of ST25 showed significant differences between the normal and model control groups. The intensity of infrared radiation of forty wavelengths showed significant differences compared with the corresponding control points in normal rats. The intensity of infrared radiation of twenty-eight wavelengths showed significant differences compared with the corresponding control points in model rats. The intensity of infrared radiation of nine wavelengths in the herb-partition moxibustion group, eighteen wavelengths in the ginger-partition moxibustion group, seventeen wavelengths in the garlic-partition moxibustion group, and fourteen wavelengths in the warming moxibustion group of the left ST25 showed significant differences compared with that of the model control group. For the right-hand-side ST25, these values were 33, 33, 2, and 8 wavelengths, respectively. This indicated that one possible biophysical mechanism of moxibustion on ST25 in ulcerative colitis model rats might involve changes in the intensity of infrared radiation of ST25 at different wavelengths.

  17. The Healing Effect of Hydroalcoholic Extract of Hypericum Perforatum on Acetic Acid-Induced Ulcerative Colitis in Male Rats

    Nader Tanideh

    2017-02-01

    Full Text Available Background & Objective: Anti-inflammatory effect of Hypericum have long been considered. Ulcerative Colitis (UC is a form of Inflammatory Bowel Disease (IBD. In this study, the effects of Hypericum perforatum on histopathological changes and tissue malondialdehyde (MDA level of colonic tissue in rats with induced UC were evaluated. Materials & Methods: 70 rats were divided into seven equal groups. Colitis was induced by acetic acid.. Groups I and II received 1 mL of 600 and 300 mg/kg H. perforatum extract orally per day respectively; groups III and IV received 1 mL of 20% and 10% intra-colonic gel form of H. perforatum extract daily respectively; group V, as positive control, received 1 mL of intra-colonic Asacol; group VI received 1 mL of normal saline as negative control; group VII received just intra-colonic gel base. All the animals were evaluated for histological changes and tissue MDA level of colon seven days after the treatment. Results: H. perforatum extract in the two forms of trans-rectal and oral administration could result in a more healing effect on acetic acid-induced damaged colonic tissue with a reduction in the MDA activity. In trans-rectal administration, the 20% gel had a better healing response than the 10% gel. In oral administration, the 600 mg/kg dosage had a better healing response than the 300 mg/kg. Conclusions: Therefor, H. perforatum can be considered as a treatment of choice for UC especially in trans-rectal gel form.

  18. Downregulation of electroacupuncture at ST36 on TNF-α in rats with ulcerative colitis

    Li Tian; Yu-Xin Huang; Min Tian; Wei Gao; Qing Chang

    2003-01-01

    AIM: To investigate the regulatory effect of electroacupuncture (EA) at Zusanli (ST36) on tumor necrosis factor-alpha (TNFα) in rats with ulcerative colitis (UC), and further elucidate the therapeutic mechanism of EA on UC.METHODS: Thirty-two male Sprague-Dawley (SD) rats were randomly divided into four groups (n=-8): normal control group, UC control group, UC+ST36 group and UC+nonacupoint group. A solution containing ethanol and 2,4,6-trinitrobenzenesulfonic acid (TNBS) was instilled into the distal colon in the rat (at a dose of 100 mg/kg) to set up UC rat model. Rats in wakefulness state of UC+ST36 group were stimulated at ST36 by EA once a day, while those of UC+nonacupoint group were done at 0.5 cm beside ST36. After 10d treatment, all rats were sacrificed simultaneously. Colon musocal inflammation and damage were assessed by measuring colon mass, morphologic damage score, colonic myeloperoxidase enzyme (MPO) activity, serum TNF-α and colonic TNF-α mRNA level. Morphologic damage score was examined under stereomicroscope. Colonic MPO activity was measured by spectrophotometer method. Serum TNF-αconcentration was determined by radioimmunoassay (RIA).Colonic TNF-α mRNA expression level was analyzed by semiquantitative reverse transcription polymerase chain reaction (RT-PCR).RESULTS: Ratio of colonic mass/body mass (mC/mB) and activity of colonic MPO (μkat/g tissue) markedly increased (8.5±2.6 vs 2.5±0.4; 145±25 vs 24±8, P<0.01 vs normal control group). Compared with normal control rats, serum TNF-α and colonic TNF-α mRNA level in UC control group were increased 2.5 fold (2 278±170 vs 894±248, P<0.01)and 4.3 fold (0.98±0.11 vs 0.23±0.11, P<0.01)respectively. After EA at ST36, mc/mB and MPO activity were reduced significantly (5.3±2.0 vs 8.5±2.6; 104±36 vs145±25, P<0.01, 0.05) compared with those of UC control group. Serum TNF-α and colonic TNF-α mRNA level were inhibited by EA stimulation at ST36 (P<0.01). The inhibitory rate was 16

  19. Ulcerative colitis in a multiracial Asian country: Racial differences and clinical presentation among Malaysian patients

    Yan-Mei Tan; Khean-Lee Goh

    2005-01-01

    AIM: To determine the prevalence of ulcerative colitis (UC) in Malaysian patients and to establish the spectrum of the disease seen in Malaysian patients.METHODS: Data were obtained retrospectively from a review of the medical records of in- and out-patients with a diagnosis of UC at the University Hospital, Kuala Lumpur between 1985 and 1998.RESULTS: There were 45 confirmed cases of UC, of which 3 were foreigners, who were excluded from analysis.Thirty new cases of UC were diagnosed during the study period. Their mean age at presentation was 33.0±10.0 years.The highest prevalence of UC was 17.9/100 000 hospital admissions in the Indians, followed by 11.2/100 000 hospital admissions in the Chinese. The lowest prevalence was 3.7/100 000 hospital admissions in the Malays. The prevalence of UC was significantly higher in the Indians and the Chinese when compared with the Malays with an OR of 4.89 (CI = 2.02-12.24; χ2 = 15.45, P<0.001) and 3.06 (CI = 1.24-7.78; χ2 = 6.30; P= 0.012) respectively. The extent of colonic disease was similar in the Malay and Indian patients. In contrast, distal or left-sided colitis predominated in the Chinese with an OR of 8.17 (95%CI = 1.31-64.87;χ2 = 5.53, P = 0.02). Extraintestinal manifestations were uncommon (11.9%).CONCLUSION: UC is an uncommon disease in Malaysia,but racial differences exist. The Indians had the highest prevalence of UC with the Chinese demonstrating the least extensive disease.

  20. Versatile methods for synthesizing organic acid salts of quaternary berberine-type alkaloids as anti-ulcerative colitis agents.

    Zhang, Zhi-Hui; Li, Jing; Zhang, Hai-Jing; Deng, An-Jun; Wu, Lian-Qiu; Li, Zhi-Hong; Song, Hong-Rui; Wang, Wen-Jie; Qin, Hai-Lin

    2016-06-01

    Two versatile methods to synthesize kinds of organic acid salts of quaternary berberine-type alkaloids were investigated in order to determine which is more efficient to improve the liposolubility of the target compounds and to explore the efficacy of the target compounds as anti-ulcerative colitis (UC) agents. Overall evaluation according to the reaction results and yields of the final products indicated that the synthetic method using tertiary (±)-8-acylmethyldihydroberberine-type alkaloids as key intermediates is superior to that of using tertiary dihydroberberine-type alkaloids as intermediates. Ten target compounds were synthesized using quaternary berberine chloride and quaternary coptisine chloride as starting materials, respectively, and the anti-UC activity of some target compounds was evaluated in an in vitro x-box-binding protein 1 (XBP1) transcriptional activity assay using dual luciferase reporter detection. At 10 μM, the tested compounds were found to activate the transcription of XBP1 target at almost the same level as that of quaternary coptisine chloride. The synthesized target compounds were also found to share higher liposolubility than the inorganic acid salts of quaternary berberine-type alkaloid.

  1. A review on treating ulcerative colitis in TCM%溃疡性结肠炎的中医药治疗进展

    王微; 柳越冬

    2015-01-01

    综述中医治疗溃疡性结肠炎(Ulcerative Colitis,UC)的独特优势及研究进展;查阅近些年以来的大量有关文献,从溃疡性结肠炎的病因病机、辨证论治及治疗方面总结中医治疗溃疡性结肠炎的研究概况,提出中医治疗的优势和不足,为广大中医工作者探讨治疗溃疡性结肠炎的中医中药新方法提供参考和启迪。%To review treating ulcerative colitis(Ulcerative Colitis, UC) in TCM. First of all, in recent years, a number of related documents were consulted. Second, by analyzing the pathogenesis of ulcerative colitis, syndrome differentiation and treatment. TCM research survey of treating ulcerative colitis was summarized. And then, advantages and disadvantages of TCM were brought up for TCM workers to discuss how to use a new method of TCM treating ulcerative colitis.

  2. Anti-inflammatory and anti-oxidant activities of olmesartan medoxomil ameliorate experimental colitis in rats

    Nagib, Marwa M. [Department of Pharmacology and Toxicology, Faculty of Pharmacy, Misr International University, Cairo (Egypt); Tadros, Mariane G., E-mail: mirogeogo@yahoo.com [Department of Pharmacology and Toxicology, Faculty of Pharmacy, Ain Shams University, Cairo (Egypt); ELSayed, Moushira I. [Department of Pharmacology and Toxicology, Faculty of Pharmacy, Misr International University, Cairo (Egypt); Khalifa, Amani E. [Department of Pharmacology and Toxicology, Faculty of Pharmacy, Ain Shams University, Cairo (Egypt)

    2013-08-15

    Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) driven through altered immune responses with production of proinflammatory cytokines. Many therapies are used, but side effects and loss of response limit long-term effectiveness. New therapeutic strategies are thus needed for patients who don't respond to current treatments. Recently, there is suggested involvement of the proinflammatory hormone angiotensin II in inflammatory bowel disease. The aim of this study was to investigate the possible role of olmesartan medoxomil (OLM-M), an angiotensin II receptor blocker in ameliorating ulcerative colitis. Colitis was induced in male Wistar rats by administration of 5% dextran sodium sulphate (DSS) in drinking water for 5 days. OLM-M (1, 3 and 10 mg/kg) was administered orally during 21 days prior to the induction of colitis, and for 5 days after. Sulfasalazine (500 mg/kg) was used as reference drug. All animals were tested for changes in colon length, disease activity index (DAI) and microscopic damage. Colon tissue concentration/activity of tumor necrosis alpha (TNF-α), myeloperoxidase (MPO), prostaglandin E2 (PGE2), reduced glutathione (GSH) and malondialdehyde (MDA) were assessed. Results showed that the OLM-M dose-dependently ameliorated the colonic histopathological and biochemical injuries, an effect that is comparable or even better than that of the standard sulfasalazine. These results suggest that olmesartan medoxomil may be effective in the treatment of UC through its anti-inflammatory and antioxidant effects. - Highlights: • Olmesartan medoximil reduced dextran sodium sulphate- induced colitis. • Mechanism involved anti-inflammatory and antioxidant effects dose- dependently. • It suppressed malondialdehyde and restored reduced glutathione levels. • It reduced inflammatory markers levels and histological changes.

  3. Ileal lesions in patients with ulcerative colitis after ileo-rectal anastomosis: Relationship with colonic metaplasia

    Livia Biancone; Francesco Pallone; Emma Calabrese; Giampiero Palmieri; Carmelina Petruzziello; Sara Onali; Giuseppe Sigismondo Sica; Marta Cossignani; Giovanna Condino; Kiron Moy Das

    2008-01-01

    AIM:To assess whether in ulcerative colitis (UC) patients with ileo-rectal anastomosis (IRA),ileal lesions may develop in the neo-terminal-ileum and their possible relation with phenotypic changes towards colonic epithelium.METHODS:A total of 19 patients with IRA under regular follow up were enrolled,including 11.UC and 8 controls (6 Crohn's disease,CD;1 familial adenomatous polyposis,FAP;1 colon cancer,colon K).Ileal lesions were identified by ileoscopy with biopsies taken from the ileum (involved and uninvolved) and from the rectal stump.Staining included HE and immunohistochemistry using monoclonal antibodies against colonic epithelial protein CEP (Das-1) and human tropomyosin isoform 5,hTMS (CG3).Possible relation between development of colonic metaplasia and ileal lesions was investigated.RESULTS:Stenosing adenocarcinoma of the rectal stump was detected in 1 UC patient.The neo-terminal ileum was therefore investigated in 10/11 UC patients.Ileal ulcers were detected in 7/10 UC,associated with colonic metaplasia in 4/7 (57.1%) and Das-1 and CG3 reactivity in 3/4 UC.In controls,recurrence occurred in 4/6 CD,associated with colonic metaplasia in 3/4 and reactivity with Das-1 and CG3 in 2/3.CONCLUSION:Present findings suggest that in UC,ileal lesions associated with changes towards colonic epithelium may develop also after IRA.Changes of the ileal content after colectomy may contribute to the development of colonic metaplasia,leading to ileal lesions both in the pouch and in the neo-terminal ileum after IRA.

  4. Intestinal CCL25 expression is increased in colitis and correlates with inflammatory activity

    Trivedi, Palak J.; Bruns, Tony; Ward, Stephen; Mai, Martina; Schmidt, Carsten; Hirschfield, Gideon M.; Weston, Chris J.; Adams, David H.

    2016-01-01

    CCL25-mediated activation of CCR9 is critical for mucosal lymphocyte recruitment to the intestine. In immune-mediated liver injury complicating inflammatory bowel disease, intrahepatic activation of this pathway allows mucosal lymphocytes to be recruited to the liver, driving hepatobiliary destruction in primary sclerosing cholangitis (PSC). However, in mice and healthy humans CCL25 expression is restricted to the small bowel, whereas few data exist on activation of this pathway in the inflamed colon despite the vast majority of PSC patients having ulcerative colitis. Herein, we show that colonic CCL25 expression is not only upregulated in patients with active colitis, but strongly correlates with endoscopic Mayo score and mucosal TNFα expression. Moreover, approximately 90% (CD4+) and 30% (CD8+) of tissue-infiltrating T-cells in colitis were identified as CCR9+ effector lymphocytes, compared to <10% of T-cells being CCR9+ in normal colon. Sorted CCR9+ lymphocytes also demonstrated enhanced cellular adhesion to stimulated hepatic sinusoidal endothelium compared with their CCR9– counterparts when under flow. Collectively, these results suggest that CCR9/CCL25 interactions are not only involved in colitis pathogenesis but also correlate with colonic inflammatory burden; further supporting the existence of overlapping mucosal lymphocyte recruitment pathways between the inflamed colon and liver. PMID:26873648

  5. Intestinal CCL25 expression is increased in colitis and correlates with inflammatory activity.

    Trivedi, Palak J; Bruns, Tony; Ward, Stephen; Mai, Martina; Schmidt, Carsten; Hirschfield, Gideon M; Weston, Chris J; Adams, David H

    2016-04-01

    CCL25-mediated activation of CCR9 is critical for mucosal lymphocyte recruitment to the intestine. In immune-mediated liver injury complicating inflammatory bowel disease, intrahepatic activation of this pathway allows mucosal lymphocytes to be recruited to the liver, driving hepatobiliary destruction in primary sclerosing cholangitis (PSC). However, in mice and healthy humans CCL25 expression is restricted to the small bowel, whereas few data exist on activation of this pathway in the inflamed colon despite the vast majority of PSC patients having ulcerative colitis. Herein, we show that colonic CCL25 expression is not only upregulated in patients with active colitis, but strongly correlates with endoscopic Mayo score and mucosal TNFα expression. Moreover, approximately 90% (CD4(+)) and 30% (CD8(+)) of tissue-infiltrating T-cells in colitis were identified as CCR9(+) effector lymphocytes, compared to colitis pathogenesis but also correlate with colonic inflammatory burden; further supporting the existence of overlapping mucosal lymphocyte recruitment pathways between the inflamed colon and liver.

  6. A study of the effects of Cydonia oblonga Miller (Quince) on TNBS-induced ulcerative colitis in rats.

    Minaiyan, M; Ghannadi, A; Etemad, M; Mahzouni, P

    2012-04-01

    Cydonia oblonga Miller (Quince) from Rosaceae family is a fruit tree cultivated in many countries mainly in Iran. This study was carried out to investigate the effect of quince juice (QJ) and quince hydroalcoholic extract (QHE) on ulcerative colitis (UC) induced by TNBS (trinitrobenzene sulfonic acid) in rats. Rats were grouped (n=6) and fasted for 36 h before colitis induction. TNBS was instilled into the colon with a hydroalcoholic carrier and then treatments were made for 5 days starting 6 h after colitis induction with different doses of QJ (200, 400, 800 mg/kg), QHE (200, 500 & 800 mg/kg) orally, QJ (400 mg/kg) and QHE (200 and 500 mg/kg) intraperitoneally. The colon tissue was removed and tissue damages were scored after macroscopic and histopathologic assessments. Albeit the examined doses of QJ and QHE were apparently effective to reduce the extent of UC lesions, only the greatest doses (500 and 800 mg/kg) resulted in significant alleviation. Weight/Length ratio as an illustrative of tissue inflammation and extravasation was also diminished with quince treatments while the results correlated with macroscopic and histopathologic evaluations. These data suggest that QJ and QHE were effective to diminish inflammation and ulcer indices in this murine model of acute colitis. Although QHE with different doses was effective in induced colitis, the dose and/or route of administration dependency was not confirmed. So quince fractions could be considered as a suitable anticolitic alternative, however further studies are needed to support this hypothesis for clinical setting.

  7. Matrix metalloproteinases in the restorative proctocolectomy pouch of pediatric ulcerative colitis

    Laura M(a)kitalo; Maija Piekkala; Merja Ashorn; Mikko Pakarinen; Antti Koivusalo; Riitta Karikoski; Johanna Natunen

    2012-01-01

    AIM:To investigate matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) in pouch mucosa of pediatric onset ulcerative colitis (UC).METHODS:In this cross-sectional study,28 patients with pediatric onset UC underwent ileal pouch biopsy 13 years (median) after proctocolectomy.Expression of MMPs-3,-7,-8,-9,-12 and-26 and TIMPs-1,-2 and-3 in samples was examined using immunohistochemichal methods,and another biopsy was used to evaluate the grade of histological inflammation.Two investigators independently graded the immunohistochemical specimens in a semiquantitative fashion,using a scale marking staining intensity as follows:0 =less than 20 positive cells; 1 =20-50 positive cells; 2 =50-200 positive cells; 3 =over 20 positive cells.Fecal calprotectin and blood inflammatory markers [serum C-reactive protein (CRP) and erythrocyte sedimentation rate] were determined during a follow-up visit to examine correlations between these markers and the expression of MMPs and TIMPs.RESULTS:Of the 28 patients with pediatric onset UC,nine had not experienced pouchitis,whereas thirteen reported a single episode,and six had recurrent pouchitis (≥ 4 episodes).At the time of the study,six patients required metronidazole.In all of the others,the most recent episode of pouchitis had occurred over one month earlier,and none were on antibiotics.Only four samples depicted no sign of inflammation,and these were all from patients who had not had pouchitis.Two samples were too small to determine the grade of inflammation,but both had suffered pouchitis,the other recurrent.No sample depicted signs of colonic metaplasia.Most pouch samples showed expression of epithelial (e) and stromal (s) MMP-3 (e,n =22; s,n =20),MMP-7 (e,n =28; s,n =27),MMP-12 (e,n =20; s,n =24),TIMP-2 (e,n =23; s,n =23) and MMP-3 (e,n =23; s,n =28) but MMP-8 (e,n =0; s,n =1),MMP-9 (e,n =0; s,n =9) and MMP-26 (e,n =0; s,n =3) and TIMP-1 (n =0,both) were lacking.In samples with low grade of inflammatory activity

  8. The incidence of postoperative venous thrombosis among patients with ulcerative colitis.

    O'Connor, O J

    2012-02-03

    BACKGROUND: Patients with Ulcerative Colitis (UC) have inherent prothrombotic tendencies. It is unknown whether this necessitates the use of additional perioperative anti-thrombotic prophylaxis when such patients require major surgery. METHODS: The postoperative courses of 79 patients with UC undergoing 180 major abdominal and pelvic operations were examined for clinical and radiological evidence of venous thrombosis. Eighteen patients with Familial Adenomatous Polyposis (FAP) having surgery (35 operations) of similar magnitude were also studied. Standard anti-thrombosis prophylaxis was utilised in all patients. RESULTS: Nine patients with UC were clinically suspected of developing postoperative venous thrombosis, but only three (3.8%) had their diagnosis confirmed radiologically (all had a pulmonary embolus). Therefore, the overall postoperative thrombosis rate, on an intention to treat basis, was 1.7% (3\\/180). No patient with FAP developed significant venous thrombosis. CONCLUSION: Standard perioperative antithrombotic modalities are sufficient to maintain any potential increase in postoperative thrombotic risk at an acceptable level in patients with UC undergoing operative intervention.

  9. Asymptomatic and persistent elevation of pancreatic enzymes in an ulcerative colitis patient.

    Liverani, Elisa; Leonardi, Filippo; Castellani, Lucia; Cardamone, Carla; Belluzzi, Andrea

    2013-01-01

    Azathioprine has been extensively used in the management of inflammatory bowel diseases. It might cause pancreatic damage in the form of either asymptomatic elevation in serum amylase/lipase or overt acute pancreatitis. Here we report the case of a 61-year-old patient with ulcerative colitis who had been treated with azathioprine for three years, achieving clinical remission. During treatment he presented an asymptomatic elevation of serum pancreatic enzymes, without any signs of pancreatitis at imaging. This evidence brought us to reassess the drug dosage, without achieving a normalization of biochemical analysis. Autoimmune pancreatitis was excluded. One year after the suspension of azathioprine, we still face persistent high levels of amylase/lipase. Normalization of enzymatic values in patients who develop intolerance to azathioprine, in the form of either asymptomatic elevation in serum amylase/lipase or overt acute pancreatitis, is usually achieved in about two months after stopping drug intake. Asymptomatic elevation in serum pancreatic enzymes in the absence of pancreatic disease is reported in the literature and defined as "Gullo's syndrome," but nobody of the subjects studied had been treated in the past with pancreatotoxic drugs. Might this case be defined as "benign pancreatic hyperenzymemia"?

  10. Asymptomatic and Persistent Elevation of Pancreatic Enzymes in an Ulcerative Colitis Patient

    Elisa Liverani

    2013-01-01

    Full Text Available Azathioprine has been extensively used in the management of inflammatory bowel diseases. It might cause pancreatic damage in the form of either asymptomatic elevation in serum amylase/lipase or overt acute pancreatitis. Here we report the case of a 61-year-old patient with ulcerative colitis who had been treated with azathioprine for three years, achieving clinical remission. During treatment he presented an asymptomatic elevation of serum pancreatic enzymes, without any signs of pancreatitis at imaging. This evidence brought us to reassess the drug dosage, without achieving a normalization of biochemical analysis. Autoimmune pancreatitis was excluded. One year after the suspension of azathioprine, we still face persistent high levels of amylase/lipase. Normalization of enzymatic values in patients who develop intolerance to azathioprine, in the form of either asymptomatic elevation in serum amylase/lipase or overt acute pancreatitis, is usually achieved in about two months after stopping drug intake. Asymptomatic elevation in serum pancreatic enzymes in the absence of pancreatic disease is reported in the literature and defined as “Gullo’s syndrome,” but nobody of the subjects studied had been treated in the past with pancreatotoxic drugs. Might this case be defined as “benign pancreatic hyperenzymemia”?

  11. Fatal ulcerative colitis in a western lowland gorilla (Gorilla gorilla gorilla).

    Lankester, F; Mätz-Rensing, K; Kiyang, J; Jensen, S A; Weiss, S; Leendertz, F H

    2008-12-01

    A captive western lowland gorilla (Gorilla gorilla gorilla) presented with watery diarrhoea that progressed to become profuse and haemorrhagic. Faecal analyses revealed Balantidium (B.) coli trophozoites and salmonella-like bacteria. Despite treatment the gorilla died on the 5th day after onset of symptoms. Post-mortem examination revealed a severe erosive-ulcerative superficial and deep colitis. Histological examination of post-mortem samples of the colon showed plentiful B. coli invading into the mucosa and submucosa, whilst PCR screening of bacterial DNA could not confirm any bacteria species which could be connected to the clinical picture. As B. coli is usually a non-pathogenic gut commensal, and as this animal previously showed evidence of non-symptomatic infection of B. coli, it is possible that the switch in pathogenicity was triggered by an acute bacterial infection. Despite successful treatment of the bacterial infection the secondary deep invasion of B. coli was not reversed, possibly because of the failure of the treatment regimen, and led to the death of the gorilla.

  12. Hsp10, Hsp70, and Hsp90 immunohistochemical levels change in ulcerative colitis after therapy

    G. Tomasello

    2011-10-01

    Full Text Available Ulcerative colitis (UC is a form of inflammatory bowel disease (IBD characterized by damage of large bowel mucosa and frequent extra-intestinal autoimmune comorbidities. The role played in IBD pathogenesis by molecular chaperones known to interact with components of the immune system involved in inflammation is unclear. We previously demonstrated that mucosal Hsp60 decreases in UC patients treated with conventional therapies (mesalazine, probiotics, suggesting that this chaperonin could be a reliable biomarker useful for monitoring response to treatment, and that it might play a role in pathogenesis. In the present work we investigated three other heat shock protein/molecular chaperones: Hsp10, Hsp70, and Hsp90. We found that the levels of these proteins are increased in UC patients at the time of diagnosis and decrease after therapy, supporting the notion that these proteins deserve attention in the study of the mechanisms that promote the development and maintenance of IBD, and as biomarkers of this disease (e.g., to monitor response to treatment at the histological level.

  13. Analysis ulcerative colitis for presence Epstein-Barr virus DNA sequences by polymerase chain reaction technique

    Sahar Mehrabani khasraghi

    2016-02-01

    Full Text Available Introduction: Ulcerative colitis (UC is one type of inflammatory bowel disease (IBD. The purpose of this study is to explore the prevalence of Epstein–Barr virus (EBV in UC patients in comparison with healthy subjects using the polymerase chain reaction (PCR method. Methods: In this case-control study, five biopsies of patients with UC and 30 healthy people as controls were selected. Sampling was performed by endoscopic biopsy operation. After DNA extraction, PCR was used to determine EBV genome by specific primers. Statistical analysis was performed using the chi-square test. Results: The results of PCR indicated that EBV genome was detected in 60.0% of samples in the case group, and 36.7% of samples in the control group were positive for EBV. Thus, no significant association was observed between the prevalence of EBV and incidence of UC in comparison with the control group (P = 0.36. Conclusion: The findings presented herein demonstrate no direct molecular evidence to support an association of EBV with UC. These results, do not exclude the possibility oncogenic role of EBV to infect the different colon cell.

  14. Rectal hepatoid carcinoma with liver metastases in a patient affected by ulcerative colitis

    Giacomo Borgonovo; Francesco Razzetta; Michela Assalino; Emanuela Varaldo; Maria Puglisi; Paola Ceppa

    2008-01-01

    BACKGROUND: Hepatoid tumors (HTs) are rare extra-hepatic neoplasms with the histological features, biochemical proifle and, sometimes, even clinical course of hepatocellular carcinoma. We present a case of rectal hepatoid adenocarcinoma with metachronous liver metastases. METHODS: Four months after total procto-colectomy for a rectal adenocarcinoma (Astler-Coller C2), a 42-year-old man with ulcerative colitis showed hypoechoic masses in the hepatic parenchyma by abdominal ultrasonography. Carcinoembryonic antigen was normal, but alpha-fetoprotein was 32 000 μg/L. Fine-needle biopsy revealed that liver masses were positive for hepatocellular carcinoma. The patient underwent left hepatectomy and alcoholisation of a small deep nodule in segment 8. RESULTS:  Immunohistochemistry and albumin mRNA in situ hybridization suggested that the nodules were metastases of a HT. The patient was well during the ifrst 6 months and refused any adjuvant chemotherapy. He died from liver failure 19 months after initial diagnosis. CONCLUSIONS: HT is a rare colon cancer. The preoperative diagnosis of this tumor requires a high degree of suspicion, the availability of a panel of immunohistochemical markers, and a certain amount of luck. The prognosis is poor despite an aggressive and multimodal therapeutic strategy. So far, none of the hypotheses proposed about the origin and the biology of these tumors is convincing.

  15. Pouchitis and pre-pouch ileitis developed after restorative proctocolectomy for ulcerative colitis: A case report

    Takashi Iwata; Takayuki Yamamoto; Satoru Umegae; Koichi Matsumoto

    2007-01-01

    We report a case of pouchitis and pre-pouch ileitis, and inflammation in the neo-terminal ileum proximal to the pouch, developed after restorative proctocolectomy for ulcerative colitis. A 35-year old female presented with fever and abdominal pain five weeks after ileostomy closure following proctocolectomy. Computed tomography showed collection of feces in the pouch and proximal ileum. A drainage tube was placed in the pouch perianally,and purulent feces were discharged. With antibiotic treatment, her symptoms disappeared, but two weeks later, she repeatedly developed fever and abdominal pain along with anal bleeding. Pouchscopy showed mucosal inflammation in both the pouch and the pre-pouch ileum. The mucosal cytokine production was elevated in the pouch and pre-pouch ileum. With antibiotic and corticosteroid therapy, her symptoms were improved along with improvement of endoscopic inflammation and decrease of mucosal cytokine production. The fecal stasis with bacterial overgrowth is the major pathogenesis of pouchitis and pre-pouch ileitis in our case.

  16. Clinical Study on the Prevention and Treatment of Intestinal Fibrosis in Ulcerative Colitis by Moxibustion

    WU Huan-gan; AN Guang-qing; LIU Hui-rong; SHI Zheng; CHEN Han-ping; LIU Shi-min; SHI Yin; XIAO Yuan-chun

    2003-01-01

    Objective To observe the therapeutic effects and action mechanism of moxibustion in the treatment of intestinal fibrosis in ulcerative colitis. Methods Tianshu (ST 25) and Qihai ( CV 6) were the main acupoint; other points were used according to syndrome differentiation. Sixty-five patients were randomized into two groups: Group A in which 32 cases were treated by herbpartitioned moxibustion and group B in which 33 cases were treated by bran-partitioned moxibustion. The therapeutic effects and TGF-β1, Ⅰ and Ⅲ collagen expressions were measured before and after treatment. Results In group A, 17 cases were cured, 12 cases improved and 3 failed; in group B, 1 1 cases were cured, 16 cases improved and 6 cases failed. Ⅰ , Ⅲ collagen expressions were obviously inhibited in the two groups, in group A in particular. Conclusion In the prevention and treatment of intestinal fibrosis, moxibustion may reduce the expression of TGF-β1, and hence to block or inhibit the synthesis of Ⅰ、Ⅲ collagens, and improve the structure and function.

  17. Review of Clinical Studies of the Treatment of Ulcerative Colitis Using Acupuncture and Moxibustion

    Jun Ji

    2016-01-01

    Full Text Available Background. Clinical studies suggest that acupuncture and moxibustion therapy in ulcerative colitis (UC can regulate bowel inflammation, and these treatments have the advantages of low rates of adverse reactions and recurrence as well as good long-term efficacy. We reviewed the current status of clinical studies of the treatment. Methods. Randomized controlled trials (RCTs using the therapy as the major intervention for treating UC were included from 1995 to 2015. The extracted data mainly included diagnostic standards, treatment methods, selection of acupoints, treatment times and courses, and efficacy determination criteria. Results. The use of diagnostic standards and efficacy criteria lacked unification and standardization. There were two main groups: acupuncture and moxibustion therapy combined with drug treatment and the use of all types of acupuncture and moxibustion therapy alone or in combination. The acupoint compositions included distal-proximal point combinations, back-shu point and front-mu point combinations, and acupuncture through meridians. The treatment courses in all the clinical trials had large variations. Conclusion. The treatment of UC in the examined articles was mainly based on the classical theory. However, many links of the clinical regimen design were still lacking, which affected the repeatability of the clinical studies and the accuracy of the clinical conclusions.

  18. Comparative trial of sodium cromoglycate enemas with prednisolone enemas in the treatment of ulcerative colitis.

    Grace, R H; Gent, A E; Hellier, M D

    1987-01-01

    A double blind multicentre study comparing sodium cromoglycate (600 mg/100 ml) by enema with prednisolone (20 mg/100 ml) by enema is reported. The study was conducted over a nine week period in the treatment of 70 patients with ulcerative colitis. Analysis of symptoms showed significant decreases in scores for patients in both groups, both at four and eight weeks; the only difference between the two groups was a significantly greater improvement in the reduction of rectal bleeding after four weeks in the prednisolone group. On sigmoidoscopy, both treatment groups showed a highly significant improvement after four and eight weeks with no significant differences being seen between the groups. Histology of the rectal biopsies showed a significant improvement in the inflammation of the mucosa for both treatment groups after four and eight weeks with no differences being observed between the groups. There were no significant changes in eosinophils from baseline and no difference between the groups at four and eight weeks. PMID:3102323

  19. Benefit-risk assessment of golimumab in the treatment of refractory ulcerative colitis.

    Pugliese, Daniela; Felice, Carla; Landi, Rosario; Papa, Alfredo; Guidi, Luisa; Armuzzi, Alessandro

    2016-01-01

    Significant advances in the management of patients with ulcerative colitis (UC) have been made since the introduction of anti-tumor necrosis factor (TNF)-alpha agents, especially for those who fail or do not tolerate conventional therapies. Two drugs, infliximab first, then adalimumab afterward, showed effectiveness in inducing and maintaining long-term remission both in pivotal trials as well as in clinical practice. However, approximately 25% of patients with UC, who fail or do not tolerate all available therapies, require a colectomy for refractory disease. The therapeutic scenario of UC has been recently upgraded by the introduction of golimumab, the latest anti TNF-alpha agent to be approved. Golimumab is a totally humanized monoclonal antibody, administered by a subcutaneous injection every 4 weeks. Treatment with golimumab has shown to be effective to induce sustained clinical benefit in tough-to-treat patients with UC, including steroid and/or immunosuppressive refractory and steroid-dependent patients. In this review, we summarize all available efficacy and safety data of golimumab in UC, analyzing the potential therapeutic position for the treatment of refractory patients with UC.

  20. Morphologic features of chronic hepatitis associated with primary sclerosing cholangitis and chronic ulcerative colitis

    Ludwig, J.; Barham, S.S.; LaRusso, N.F.; Elveback, L.R.; Wiesner, R.H.; McCall, J.T.

    Histologic, ultrastructural, chemical, and statistical methods were used to study liver biopsy and autopsy specimens from 43 patients who had primary sclerosing cholangitis (PSC), with or without chronic ulcerative colitis (CUC), and from 19 patients who had CUC without PSC. In all study groups, essentially the same abnormalities were found in the hepatic parenchyma outside the major bile ducts, although nondiagnostic tissue samples were observed also. Specimens from patients with extrahepatic PSC were indistinguishable from those patients with combined extra- and intrahepatic PSC. Common findings included periductal fibrosis and inflammation, portal edema and fibrosis, focal proliferation of bile ducts and ductules, focal bile duct obliteration and loss of bile ducts, copper deposition, and cholestasis. Proliferation of bile ducts in some portal tracts and obliteration or absence of bile duct in others were the most characteristic changes. In most specimens, inflammatory changes appeared mild, yet biliary cirrhosis had developed in 34% of the patients. Specimens from patients with PSC, with or without CUC, more often contained bile and strikingly increased stainable copper (Grades 2 and 3) than did specimens from patients with CUC without PSC. Hepatic copper contents, measured by atomic absorption spectrophotometry, also were higher in specimens from patients with PSC. Study of PCS specimens by transmission electron microscopy and by energy-dispersive X-ray microanalysis revealed that most copper was sequestered in lipolysosomes. The recognition of strikingly similar morphologic features in many liver specimens from patients with either PSC or CUC or both suggests that the causes of these conditions are closely related.