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Sample records for experimental ulcerative colitis

  1. Types of Ulcerative Colitis

    Science.gov (United States)

    ... 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. Characterization of Growth Hormone Resistance in Experimental and Ulcerative Colitis

    DEFF Research Database (Denmark)

    Soendergaard, Christoffer; Kvist, Peter Helding; Thygesen, Peter

    2017-01-01

    Growth hormone (GH) resistance may develop as a consequence of inflammation during conditions such as inflammatory bowel disease, encompassing ulcerative colitis (UC). However, the specific role of the GH-insulin growth factor (IGF)-1-axis and/or the functional consequences of GH resistance in th...

  3. Ulcerative Colitis - Multiple Languages

    Science.gov (United States)

    ... Expand Section Ulcerative Colitis: MedlinePlus Health Topic - English Colitis ulcerativa: Tema de salud de MedlinePlus - español (Spanish) National Library of Medicine Ulcerative Colitis - español (Spanish) Bilingual PDF Health Information Translations Ukrainian ( ...

  4. Effect of appendicectomy on colonic inflammation and neoplasia in experimental ulcerative colitis.

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    Harnoy, Y; Bouhnik, Y; Gault, N; Maggiori, L; Sulpice, L; Cazals-Hatem, D; Boudjema, K; Panis, Y; Ogier-Denis, E; Treton, X

    2016-10-01

    Ulcerative colitis (UC) promotes cancer, and can be ameliorated by early appendicectomy for appendicitis. The aim of the study was to explore the effect of appendicectomy on colitis and colonic neoplasia in an animal model of colitis and a cohort of patients with UC. Five-week old IL10/Nox1(DKO) mice with nascent colitis and 8-week-old IL10/Nox1(DKO) mice with established colitis underwent appendicectomy (for experimental appendicitis or no appendicitis) or sham laparotomy. The severity and extent of colitis was assessed by histopathological examination, and a clinical disease activity score was given. From a cohort of consecutive patients with UC who underwent colectomy, the prevalence of appendicectomy and pathological findings were collected from two institutional databases. Appendicectomy for appendicitis ameliorated experimental colitis in the mice; the effect was more pronounced in the 5-week-old animals. Appendicectomy in the no-appendicitis group was associated with an increased rate of colonic high-grade dysplasia (HGD) or cancer compared with rates in sham and appendicitis groups (13 of 20 versus 0 of 20 and 0 of 20 respectively; P neoplasia (odds ratio 16·88, 95 per cent c.i. 3·32 to 112·69). Appendicectomy for experimental appendicitis ameliorated colitis. The risk of colorectal neoplasia appeared to increase following appendicectomy without induced appendicitis in a mouse model of colitis, and in patients with UC who had undergone appendicectomy. Surgical relevance Appendicectomy for appendicitis protects against UC. In this murine model of colitis, appendicectomy for experimental appendicitis protected against colitis, but appendicectomy without appendicitis promoted colorectal carcinogenesis. In patients with ulcerative colitis who underwent colectomy, absence of the appendix (proof of previous appendicectomy) in the resection specimen was independently associated with colorectal neoplasia. Although patients with UC and a history of

  5. Ulcerative colitis

    Science.gov (United States)

    ... are lactose intolerant. Dairy products are a good source of protein and calcium. STRESS You may feel worried, embarrassed, or even sad ... Groups Social support can often help ... the best treatment and coping with the condition. The Crohn's and Colitis Foundation ...

  6. Effect of secondary lymphoid tissue chemokine suppression on experimental ulcerative colitis in mice.

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    Zhang, H; Zhang, X; Ding, X; Cao, W; Qu, L; Zhou, G

    2014-04-29

    The secondary lymphoid tissue chemokine (CCL21) is closely associated with lymphoid homing and anti-tumor immune responses. CCL21 also has a chemotactic effect on intestinal lymphocytes. This study mainly focused on CCL21 expression in experimental ulcerative colitis and on the effects of CCL21 suppression on this disease in mice. The mouse colitis model was induced by dextran sulfate sodium (DSS) in 40 female BALB/c mice that were equally distributed into five groups: control, DSS, propylene glycol, triptolide (TL), and dexamethasone treatment groups. The disease activity index, general morphology score of the colon, and histological pathology score of colon tissues were evaluated. CCL21 expression was examined in colons of mice by immunohistochemistry, reverse transcription-polymerase chain reaction, and Western blotting analysis. CCL21 was upregulated in the mouse model of ulcerative colitis (control group vs DSS group/propylene glycol group, Pdexamethasone treatments improved colitis symptoms and decreased CCL21 expression (TL group/dexamethasone group vs DSS group/propylene glycol group, PSuppression of CCL21 expression decreased damage induced from ulcerative colitis, indicating that CCL21 targeted therapy might be an effective treatment for this disease.

  7. Dysplasia in Ulcerative Colitis

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    RH Riddell

    1990-01-01

    Patients at highest risk for developing cancer in ulcerative colitis are those with ‘extensive’ or total involvement of the large bowel who have had the disease for at least seven years. Dysplasia is used as a marker bur has many problems including those of sampling, reproducibility and management. The risk in patients with colitis is unclear particularly in those with left-sided or distal ulcerative colitis. In countries at high risk from colorectal cancer about 4 to 6% of the population can...

  8. Nutrition and ulcerative colitis.

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    Burke, A; Lichtenstein, G R; Rombeau, J L

    1997-03-01

    The role of diet in the aetiology and pathogenesis of ulcerative colitis (UC) remains uncertain. Impaired utilization by colonocytes of butyrate, a product of bacterial fermentation of dietary carbohydrates escaping digestion, may be important. Sulphur-fermenting bacteria may be involved in this impaired utilization. Oxidative stress probably mediates tissue injury but is probably not of causative importance. Patients with UC are prone to malnutrition and its detrimental effects. However, there is no role for total parenteral nutrition and bowel rest as primary therapy for UC. The maintenance of adequate nutrition is very important, particularly in the peri-operative patient. In the absence of massive bleeding, perforation, toxic megacolon or obstruction, enteral rather than parenteral nutrition should be the mode of choice. Nutrients may be beneficial as adjuvant therapy. Butyrate enemas have improved patients with otherwise recalcitrant distal colitis in small studies. Non-cellulose fibre supplements are of benefit in rats with experimental colitis. Eicosapentaenoic acid in fish oil has a steroid-sparing effect which, although modest, is important, particularly in terms of reducing the risk of osteoporosis, but it seems to have no role in the patient with inactive disease. gamma-Linolenic acid and anti-oxidants also are showing promise. Nutrients may also modify the increased risk of colorectal carcinoma. Oxidative stress can damage tissue DNA but there are no data published at present on possible protection from oral anti-oxidants. Butyrate protects against experimental carcinogenesis in rats with experimental colitis. Folate supplementation is weakly associated with decreased incidence of cancer in UC patients when assessed retrospectively. Vigilance should be maintained for increased micronutrient requirements and supplements given as appropriate. Calcium and low-dose vitamin D should be given to patients on long-term steroids and folate to those on

  9. Pseudomembranous colitis complicating ulcerative colitis.

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    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. © 2010 The Authors. Digestive Endoscopy © 2010 Japan Gastroenterological Endoscopy Society.

  10. Effects of Malva sylvestris and Its Isolated Polysaccharide on Experimental Ulcerative Colitis in Rats.

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    Hamedi, Azadeh; Rezaei, Hossein; Azarpira, Negar; Jafarpour, Mehrnaz; Ahmadi, Fatemeh

    2016-01-01

    Malva sylvestris is an edible plant that is consumed as a herbal supplement for its antiulcer and colon cleansing properties in traditional Persian medicine. This study was designed to evaluate its effects on ulcerative colitis, which is a chronic gastrointestinal inflammation. Colitis was induced by rectal instillation of acetic acid solution. Rats in different groups received aqueous, n-hexane, or ethanolic fractions of the plant before induction of colitis. Isolated polysaccharide of plant was also tested in 2 groups before and after induction of colitis. Macroscopic and microscopic evaluation of colitis showed that the aqueous fraction was very effective in preventing the inflammation and efficacy was lower for ethanolic and n-hexane fractions. Polysaccharide was effective in reducing signs of inflammation, especially as pretreatment. These beneficial effects provide evidences that this plant can be suggested for patients with this disease to improve their health condition or to reduce adverse effects of their medication. © The Author(s) 2015.

  11. Management of pediatric ulcerative colitis

    DEFF Research Database (Denmark)

    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. Association of Serotonin Transporter Promoter Polymorphism (5-HTTLPR) with Microscopic Colitis and Ulcerative Colitis.

    Science.gov (United States)

    Sikander, Arbab; Sinha, Saroj Kant; Prasad, Kaushal Kishor; Rana, Satya Vati

    2015-04-01

    Serotonin (5-HT) release and serotonin reuptake transporter (5-HTT) expression have been reported to be decreased in experimental colitis, in interleukin-10 knockout-associated colitis, and in patients with ulcerative colitis. Serotonin is known to play an important role in the pathogenesis of colitis, but individual genetic variants of 5-HTT gene in microscopic colitis and ulcerative colitis are not known. This study aimed to evaluate the association between the serotonin transporter gene promoter polymorphism (5-HTTLPR) and 5-HT concentration in microscopic colitis (MC) and ulcerative colitis (UC) patients. This prospective case-control study included 41 patients with microscopic colitis (age 19-82 years, mean 35 ± 13.6), 75 patients with ulcerative colitis (age 16-65 years, mean 38.5 ± 11.6), and 100 controls (age 20-64 years, mean 38 ± 11). 5-HTTLPR gene polymorphism was studied by polymerase chain reaction-based assay. 5-HT levels were measured by ELISA. The frequency of the 5-HTTLPR (SS) genotype was significantly lower in MC (12 %) patients compared to controls (30 %) (p microscopic colitis, suggesting that 5-HTTLPR is a potential candidate gene involved in the pathogenesis of microscopic colitis. Serotonin levels were significantly higher in microscopic colitis and ulcerative colitis patients compared to healthy controls.

  13. Mucosal healing in ulcerative colitis

    DEFF Research Database (Denmark)

    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...

  14. [Ulcerative colitis and cytomegalovirus infection].

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    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.

  15. Impact of probiotics on toll-like receptor 4 expression in an experimental model of ulcerative colitis.

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    Yang, Xia; Fu, Yu; Liu, Jun; Ren, Hong-yu

    2013-10-01

    Toll-like receptors (TLRs) are key components of the innate immune system which trigger antimicrobial host defense responses. This study aimed to investigate the impact of probiotics (Lactobacillus, Bifidobacterium) on the expression of TLR4 and tumor necrosis factor-alpha (TNF-α) in the colon mucosa of rat experimental ulcerative colitis model induced by trinitrobenzene sulfonic acid (TNBS)/ethanol and immune complexes. The gross and histological changes of the colonic mucosa were observed and assessed by the means-standard deviation and independent samples t-test. The protein expression levels of TLR4 and TNF-α were detected by using immunohistochemistry and Western blotting, respectively. It was revealed that there was visible infiltration of inflammatory cells, formation of crypt abscess, and the reduction of goblet cells in the colon tissue of experimental models. As compared with the control group, the levels of TLR4 and TNF-α protein were significantly increased in the model group (Pprobiotics treatment group and the model group (P>0.05), whereas significant reductions were shown in rats which were treated with probiotics for four weeks as compared with the model group (Pprobiotics-treated groups. Our results implied that probiotics were likely to play a key role in protecting ulcerative colitis by reducing the inflammatory factor TNF-α expression through inhibiting the TLR4 expression in the colon tissue of experimental models.

  16. Confocal laser endomicroscopy in ulcerative colitis

    DEFF Research Database (Denmark)

    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.)....

  17. Dietary Agents and Phytochemicals in the Prevention and Treatment of Experimental Ulcerative Colitis

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    Arpit Saxena

    2014-10-01

    Full Text Available Inflammatory bowel diseases (IBDs, consisting mainly of ulcerative colitis (UC and Crohn's disease (CD, are important immune-mediated diseases of the gastrointestinal tract. The etiology of the disease includes environmental and genetic factors. Its management presents a constant challenge for gastroenterologists and conventional surgeon. 5-Amninosalicylates, antibiotics, steroids, and immune modulators have been used to reduce the symptoms and for maintenance of remission. Unfortunately, long-term usage of these agents has been found to lead to severe toxicities, which are deterrent to the users. Pre-clinical studies carried out in the recent past have shown that certain dietary agents, spices, oils, and dietary phytochemicals that are consumed regularly possess beneficial effects in preventing/ameliorating UC. For the first time, this review addresses the use of these dietary agents and spices in the treatment and prevention of IBD and also emphasizes on the mechanisms responsible for their effects.

  18. Effects of Guchang Capsule on Dextran Sulphate Sodium-Induced Experimental Ulcerative Colitis in Mice

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    Baoshan Liu

    2016-01-01

    Full Text Available Guchang capsule (GC is a Chinese materia medica standardized product extracted from 15 Chinese traditional medical herbs and it has been clinically used in the treatment of intestinal disease. In this study, in order to extend the research of GC in intestinal disease, we were aiming to evaluate potential effects of GC on dextran sulphate sodium- (DSS- induced murine experimental colitis and to elucidate the underlying mechanisms. GC treatment attenuated DSS-induced body weight loss and reduced the mortality. Moreover, GC treatment prevented DSS-induced colonic pathological damage; meanwhile it inhibited proinflammatory cytokines production in colon tissues. In vitro, GC significantly reduced LPS-induced proinflammatory cytokines production via inhibiting the activation of NF-κB in macrophage cells, and the expressions of several long noncoding RNAs (lncRNAs which were reported in regulating NF-κB signaling pathway were obviously affected by adding GC into culture medium. In conclusion, our data suggested that administration of GC exhibits therapeutic effects on DSS-induced colitis partially through regulating the expression of NF-κB related lncRNAs in infiltrating immune cells.

  19. Oral Grapeseed Oil and Sesame Oil in Experimental Acetic Acid-Induced Ulcerative Colitis in Rat

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    Hosseinzadeh

    2016-06-01

    Full Text Available Background Ulcerative colitis (UC is a multi-factorial disease with unknown etiology and has many clinical manifestations. Objectives The current study aimed to evaluate the effects of sesame oil (SO and grapeseed oil (GSO on acetic acid-induced UC in rats. Materials and Methods Eighty male rats were divided into eight groups as health control (HC1, received normal saline; HC2, received SO; HC3, received GSO; negative control (NC, UC and normal saline; positive control (PC, UC and mesalamine; SO, UC and SO; GSO, UC and GSO, and SO + GSO. The daily weight changes, serum levels of oxidative stress markers and lipid profile plus colon macroscopic and microscopic histological changes were measured at the end of the seventh day. Results Significant differences were detected between HC1 and PC on the 3rd (P = 0.002, 4th (0.013 and 6th days (0.014 and between HC1 and NC on the 4th day (0.027 in weight of rats. Use of GSO alone or in combination with SO decreased the extent of the changes both in macroscopic and microscopic indices and also at the inflammation level. The most significant decrease in the MDA level and the most obvious increase in the TAC belonged to the GSO group in comparison to the NC group. The lowest cholesterol (51.43 ± 5.62 mg/dL and HDL levels (29.29 ± 6.24 mg/dL were detected in response to SO consumption in comparison to NC group (P = 0.030 and P = 0.257, respectively. Conclusions GSO in combination with SO may be considered as the treatment of choice for UC based on antioxidant and histopathological evaluations.

  20. Mucosal healing in ulcerative colitis

    DEFF Research Database (Denmark)

    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...... epithelial cells and other cells of the mucosa are discussed. The biochemistry of wound healing in UC provides the basis for the subsequent description of how these pathways are affected by the current medications, and what can be learnt on how to design future treatment regimens for UC based on targeting...

  1. Intestinal microbiota and ulcerative colitis.

    Science.gov (United States)

    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. Copyright © 2015 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  2. Atypical disease phenotypes in pediatric ulcerative colitis

    DEFF Research Database (Denmark)

    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 of at...... of atypical inflammatory bowel disease (IBD) patients. Our aim was to identify the prevalence of atypical disease patterns in new-onset pediatric UC using the Paris classification.......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...

  3. Left Ventricular Thrombosis in Ulcerative Colitis

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    Tarek Saleh

    2010-07-01

    Full Text Available Left ventricular thrombi usually occur in the setting of an acute myocardial infarction, left ventricular aneurysm, or dilated cardiomyopathy. In the absence of ventricular wall motion abnormalities, they are rare. This report describes a patient with ulcerative colitis in whom two-dimensional echocardiography revealed a left intraventricular mass. Thrombosis in ulcerative colitis is a serious condition and can occur in a very young population. This case also shows that left ventricular thrombi can occur in the active setting of ulcerative colitis.

  4. Surgical management of ulcerative colitis.

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    Bennis, Malika; Tiret, Emmanuel

    2012-01-01

    Surgery is the only curative option in the treatment of ulcerative colitis. Despite advances in the medical management surgery is required in about a third of patients. In the acute setting surgery is indicated when medical treatment fails to improve an episode of acute severe colitis. The intervention of choice is a staged colectomy with end ileostomy and preservation of the rectal stump in the first instance. Indications for elective surgery are failure of medical therapy and malignant transformation. The surgical options include conventional proctectomy with ileostomy or a Kock's continent ileostomy and colectomy with an ileorectal anastomosis. The current gold standard is restorative proctocolectomy with ileal pouch-anal anastomosis. Most frequently the technique includes a J pouch with a stapled anastomosis and temporary faecal diversion with a loop ileostomy. Laparoscopic pouch surgery is a feasible and safe option with an excellent cosmetic result. Although the morbidity remains significant after surgery, the quality of life is good with a satisfactory long-term functional outcome.

  5. Scientists Spot Genes Behind Crohn's, Ulcerative Colitis

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    ... medlineplus.gov/news/fullstory_166957.html Scientists Spot Genes Behind Crohn's, Ulcerative Colitis Large study finds key ... Researchers say they've come closer to pinpointing genes linked with inflammatory bowel diseases such as Crohn's ...

  6. The economics of adalimumab for ulcerative colitis.

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    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.

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

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    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. Copyright © 2016 Elsevier GmbH. All rights reserved.

  8. Dietary supplementation of krill oil attenuates inflammation and oxidative stress in experimental ulcerative colitis in rats.

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    Grimstad, Tore; Bjørndal, Bodil; Cacabelos, Daniel; Aasprong, Ole Gunnar; Janssen, Emiel A M; Omdal, Roald; Svardal, Asbjørn; Hausken, Trygve; Bohov, Pavol; Portero-Otin, Manuel; Pamplona, Reinald; Berge, Rolf K

    2012-01-01

    To evaluate the effects of krill oil (KO) on inflammation and redox status in dextran sulfate sodium (DSS)-induced colitis in rats. Thirty male Wistar rats were divided into three groups: Control, DSS, and DSS + KO 5% in a 4-week diet study. Colitis was induced by 5% DSS in the drinking water the last week of the experiment. Weight and disease activity index (DAI), colon length, histological combined score (HCS), colon levels of selected cytokines and prostaglandins, markers of protein oxidative damage, fatty acid profile, and expression of selected genes were measured. Rats in the DSS group increased their DAI and HCS compared with healthy controls. The colon length was significantly preserved after KO diet. Tumor necrosis factor (TNF)-α and interleukin (IL)-1β were elevated in the DSS group compared with controls. Cytokines and HCS were nonsignificantly lower in the KO versus the DSS group. Prostaglandin (PG)E(3) increased significantly in the KO versus the other groups. Peroxisome proliferator-activated receptor (PPAR)-γ expression was nonsignificantly increased while PPAR-γ coactivator 1α (Pparg1α) expression increased significantly after KO. The levels of protein oxidation markers decreased significantly. KO showed protective potential against DSS colitis based on the preservation of colon length, reduction of oxidative markers and the consistent beneficial changes of HCS, cytokine, and (PG)E(3) levels, as well as PPAR-γ and Pparg1α expression compared with DSS alone. These findings indicate an anti-inflammatory and a protein antioxidant effect of KO.

  9. Golimumab in unresponsive ulcerative colitis

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    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

  10. Mindfulness May Be Helpful for People with Ulcerative Colitis

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    ... Mindfulness May Be Helpful for People With Ulcerative Colitis Share: © Jupiter Images Mindfulness-based stress reduction (MBSR), ... and decrease perceived stress in people with ulcerative colitis. These findings come from a small pilot study ...

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

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    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...

  12. Vedolizumab as induction and maintenance therapy for ulcerative colitis

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    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....

  13. Immunosuppressive and biologic therapy for ulcerative colitis.

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    Ardizzone, Sandro; Cassinotti, Andrea; de Franchis, Roberto

    2012-12-01

    Recent insight into the pathogenesis of ulcerative colitis have led to the development of new treatment options. A better understanding of IBD pathophysiology has progressively led to a more frequent use of immunosuppressants and biologics. The use of the conventional immunomodulators, such as azathioprine, 6-mercaptopurine, methotrexate, cyclosporine and tacrolimus, and anti-TNF-α agents, such as infliximab and adalimumab, in the treatment of ulcerative colitis are reviewed. Moreover, the ongoing studies evaluating the efficacy of emerging immunosuppressants in treating patients with ulcerative colitis are discussed. An effort is made to explore some critical areas in which early and more diffuse use of these agents may be advocated. Ulcerative colitis is a chronic condition mainly affecting young people in their more productive age, and determining high indirect costs to the patient and to society. Thus, there is a need for optimizing and renewing our traditional therapeutic approach to UC, and new therapies beyond conventional treatment options possibly aiming to change the poor clinical course of many patients with ulcerative colitis. Keeping in mind this potentially new therapeutic scenario, there are some critical areas in which early and more diffuse use of conventional and emerging new immunomodulators is advocated.

  14. Primary sclerosing cholangitis and Biliary cirrhosis associated with Ulcerative colitis

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    Aleem Ahmed Khan

    2011-07-01

    Full Text Available Primary sclerosing cholangitis and Ulcerative colitis are caused by progressive inflammation of the bile duct and large intestine respectively. The existence of any plausible association between Primary sclerosing cholangitis and Ulcerative colitis remains highly elusive. Little is known about the incidence and prevalence of primary sclerosing cholangitis with concomitant Ulcerative colitis in the Indian subcontinent. We report a case of Primary sclerosing cholangitis with long standing Ulcerative colitis which later also developed Primary biliary cirrhosis.

  15. Cerebral Arterial Thrombosis in Ulcerative Colitis

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    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.

  16. Cerebral arterial thrombosis in ulcerative colitis.

    Science.gov (United States)

    Casella, Giovanni; Cortelezzi, Claudio Camillo; Marialuisa, Delodovici; Cariddi Lucia, Princiotta; Elena Pinuccia, Verrengia; Baldini, Vittorio; Segato, Sergio

    2013-01-01

    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.

  17. Microarray Assisted Gene Discovery in Ulcerative Colitis

    DEFF Research Database (Denmark)

    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...

  18. Golimumab for moderate to severe ulcerative colitis

    NARCIS (Netherlands)

    Strik, Anne S.; Berends, Sophie E.; Mathôt, Ron A.; D'Haens, Geert R.; Löwenberg, Mark

    2017-01-01

    Golimumab (GLM) is a subcutaneously administered human anti-tumor necrosis factor (TNF) agent that has been approved by the regulatory authorities for the treatment of moderate to severe ulcerative colitis (UC) in 2013. Areas covered: Maintained clinical remission rates up to 50% have been shown in

  19. Golimumab for the treatment of ulcerative colitis

    NARCIS (Netherlands)

    Löwenberg, Mark; de Boer, Nanne K. H.; Hoentjen, Frank

    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.

  20. Intestinal anti-inflammatory activity of the seeds of Raphanus sativus L. in experimental ulcerative colitis models.

    Science.gov (United States)

    Choi, Ki-Choon; Cho, Seong-Wan; Kook, Sung-Ho; Chun, Sa-Ra; Bhattarai, Govinda; Poudel, Sher Bahadur; Kim, Min-Kook; Lee, Kyung-Yeol; Lee, Jeong-Chae

    2016-02-17

    Water extract of Raphanus sativus L. (RSL) seeds was traditionally used to treat digestive inflammatory complaints in Korean culture. RSL seeds exerted antioxidant, anti-inflammatory, and anti-septic functions, suggesting their pharmacological potential for the treatment of inflammatory pathologies associated with oxidative stress such as inflammatory bowel disease. We evaluated the intestinal anti-inflammatory effects of RSL seed water extract (RWE) in experimental rat models of trinitrobenzenesulphonic acid (TNBS)- or dextran sodium sulfate (DSS)-induced colitis. RWE was characterized by determining the content of sinapic acid as a reference material and then assayed in the DSS and TNBS models of rat colitis. Male Sprague-Dawley rats were divided into 10 groups (n=7/group): non-colitic control, DSS or TNBS control, DSS colitis groups treated with RWE (100mg/kg) or mesalazine (25mg/kg), and TNBS colitis groups treated with various doses (10, 40, 70, and 100mg/kg) of RWE or mesalazine (25mg/kg). RWE or mesalazine treatment started the same day of colitis induction and rats were sacrificed 24h after the last treatment followed by histological and biochemical analyses. Oral administration with RWE suppressed intestinal inflammatory damages in both DSS- and TNBS-induced colitic rats. The treatment with 100mg/kg RWE recovered intestinal damages caused by TNBS or DSS to levels similar to that of mesalazine, decreasing the activity of myeloperoxidase activity and the secretion of tumor necrosis factor (TNF)-α and interleukin (IL)-1β. RWE treatment inhibited malondialdehyde production and glutathione reduction in colon of colitis rats. The administration of RWE at dose of 100mg/kg also suppressed the TNBS- or DSS-stimulated expression of TNF-α, IL-1β, monocyte chemotactic protein-1, inducible nitric oxide, and intercellular adhesion molecule-1. Furthermore, RWE inhibited p38 kinase and DNA-nuclear factor-κB binding activities, both of which were stimulated in the

  1. The application of molecular topology for ulcerative colitis drug discovery.

    Science.gov (United States)

    Bellera, Carolina L; Di Ianni, Mauricio E; Talevi, Alan

    2018-01-01

    Although the therapeutic arsenal against ulcerative colitis has greatly expanded (including the revolutionary advent of biologics), there remain patients who are refractory to current medications while the safety of the available therapeutics could also be improved. Molecular topology provides a theoretic framework for the discovery of new therapeutic agents in a very efficient manner, and its applications in the field of ulcerative colitis have slowly begun to flourish. Areas covered: After discussing the basics of molecular topology, the authors review QSAR models focusing on validated targets for the treatment of ulcerative colitis, entirely or partially based on topological descriptors. Expert opinion: The application of molecular topology to ulcerative colitis drug discovery is still very limited, and many of the existing reports seem to be strictly theoretic, with no experimental validation or practical applications. Interestingly, mechanism-independent models based on phenotypic responses have recently been reported. Such models are in agreement with the recent interest raised by network pharmacology as a potential solution for complex disorders. These and other similar studies applying molecular topology suggest that some therapeutic categories may present a 'topological pattern' that goes beyond a specific mechanism of action.

  2. Electroacupuntura en el tratamiento de la colitis ulcerosa experimental en ratas Sprague Dawley - Electro acupuncture in the treatment of experimental ulcerous colitis in Sprague Dawley rats

    OpenAIRE

    Molina Martínez, José L.; Cuesta Mazorra, Mario; Silveira Prado, Enrique A; Castro Gutiérrez, Maribel; González Madariaga, Yisell; Sánchez Álvarez, Carmen; Blanco Machado, Freisman; Verdecia Machado, Belkis; Rodriguez Santos, Caridad

    2010-01-01

    ResumenSe realizó un estudio sobre la efectividad terapéutica de la electroacupuntura (EA) en la colitis ulcerosa (CU) provocada experimentalmente en ratas Sprague Dawley por administración intracolónica de una disolución de ácido acético al 4%. El experimento se realizó en 57 ratas distribuidas en tres grupos: Grupo I (control placebo), al que se administró solución salina fisiológica mediante instilación intracolónica, Grupo II (control no tratado) y Grupo III (estudio), integrado ambos por...

  3. Novel treatment options for ulcerative colitis

    OpenAIRE

    Vaughn, Byron P.; Moss, Alan C.

    2013-01-01

    The approved treatment options for patients with ulcerative colitis (UC) are currently limited to mesalamine or immunosuppressants. Patients who do not respond to mesalamine-based therapy can be treated with immunomodulators or anti-TNF antibody therapy. Failure or adverse reactions to these medications leaves the patient with little choice other than colectomy. However, novel insights into the pathogenic drivers of UC have led to new developments in drugs that promise clinical efficacy via m...

  4. Bronchiolitis obliterans organising pneumonia in a patient with ulcerative colitis.

    Science.gov (United States)

    Swinburn, C R; Jackson, G J; Cobden, I; Ashcroft, T; Morritt, G N; Corris, P A

    1988-01-01

    A young woman with ulcerative colitis developed pneumonia, which responded to corticosteroids. Histological examination showed this to be bronchiolitis obliterans organising pneumonia. Images PMID:3194883

  5. [Ulcerative colitis and eosinophilic corpus gastritis].

    Science.gov (United States)

    Nagy, Ferenc; Molnár, Tamás; F Kiss, Zsuzsanna; Tiszlavicz, László; Lonovics, János

    2004-10-31

    Ulcerative colitis seldom associated with nutritive and/or salicylate allergy. Authors present a case of both allergic events at the course of the disease. In 1996 a 19-year-old girl was referred with a history of blood in stool as well as diarrhoea, suggesting ulcerative proctitis. Biopsy revealed ulcerative colitis of the rectum mucosa with eosinophilic infiltration and 20% peripheral eosinophilia was found. Allergic origin and worm infection were ruled out, and after tinidazol treatment, four year elapsed without any signs or symptoms. In December 2000 blood in stools and upper abdominal complaints developed without peripheral eosinophilia. Gastroscopy and biopsy showed a mild chronic gastritis. Olsalazine, budesonide enema and famotidin treatment were started, but then later changed to mesalazine and pantoprazol, because of the constant stomach complaints. The next five months passed without any symptoms. The patient had to break off her seashore journey in July 2000 because of stomach complaints, vomiting and exsiccosis. Peripheral eosinophilia (27.3%) was evident. Gastroscopy revealed erosive ulcers and the biopsy showed eosinophilic gastritis. Biopsies from the jejunum, duodenum and antrum as well as enteroscopy and biopsies from the rectum showed mild eosinophilic infiltration. An allergy test proved the presence of IgE against salicylate, egg protein, seafood protein and the lymphocyte transformation test was also positive against salicylate. Oral food challenges proved to be negative and the amino-salicylate treatment was stopped. After a temporary symptom free period, bloody stools reappeared in May 2003; the peripheral eosinophilia still existed, but had decreased (22.2%). Esomeprazol, and methyl-prednisolone containing enema (40 mg/day/2 weeks) followed by budesonide enema twice a week resulted in a symptom free period and peripheral eosinophilia became almost normalised (6.2%). The authors report a case having ulcerative proctitis first, than

  6. Colonic biogeography in health and ulcerative colitis.

    Science.gov (United States)

    Lavelle, Aonghus; Lennon, Grainne; Winter, Desmond C; O'Connell, P Ronan

    2016-09-02

    The relevance of biogeography to the distal gut microbiota has been investigated in both health and inflammatory bowel disease (IBD), however multiple factors, including sample type and methodology, microbiota characterization and interpersonal variability make the construction of a core model of colonic biogeography challenging. In addition, how phylogenetic classification relates to immunogenicity and whether consistent alterations in the microbiota are associated with ulcerative colitis (UC) remain open questions. This addendum seeks to review the human colonic microbiota in health and UC as currently understood, in the broader context of the human microbiome.

  7. Golimumab for the treatment of ulcerative colitis

    Directory of Open Access Journals (Sweden)

    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. Management and treatment of distal ulcerative colitis

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    DEFF Research Database (Denmark)

    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......, 50 and 75 ml/min coefficient of variation 21%; n = 6). In patients with ulcerative colitis, colonic output of NO was 10-fold higher (P collagenous colitis, colonic output of NO was 50-fold...... for quantification of colonic mucosal NO production. Increased colonic production of NO in collagenous colitis, which exceeds the output observed even in extensive ulcerative colitis, militates against the theory that NO per se is a cause of mucosal injury....

  11. Probiotics in the Management of Ulcerative Colitis.

    Science.gov (United States)

    Chibbar, Richa; Dieleman, Levinus A

    2015-01-01

    Rapid progress has been made to understand the pathophysiology of inflammatory bowel diseases and to identify new treatments. Interaction of the gut microbiota on the host inflammatory response has suggested that alternative therapies, such as probiotics, might have a complementary role in treating and preventing disease flares. Multiple probiotics and their formulations have been studied for both the induction and maintenance of remission of ulcerative colitis (UC); however, mainly Escherichia coli Nissle 1917 and VSL#3 have been shown to provide significant benefits for the prevention and treatment of mild to moderate UC. Although these data are promising, there is still a paucity of robust, randomized-controlled trials to suggest that probiotics be utilized as part of a standard treatment regimen. With continued research and a movement toward carefully selected, individualized management based on an individual's specific microbiota composition and function, probiotics may become an integral part of tailored therapy for UC.

  12. Neutrophil extracellular traps in ulcerative colitis

    DEFF Research Database (Denmark)

    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...... from noninflamed tissue of 10 patients with UC and 10 controls. The biopsies were either snap-frozen for protein analysis or prepared for histology. The protein content of the biopsies was characterized by high-throughput gel-free quantitative proteomics, and biopsy histology was analyzed by light...... microscopy and confocal microscopy. RESULTS: We identified and quantified 5711 different proteins with proteomics. The abundance of the proteins calprotectin and lactotransferrin in the tissue correlated with the degree of tissue inflammation as determined by histology. However, fecal calprotectin did...

  13. Ulcerative colitis may not necessarily be rare as previously thought ...

    African Journals Online (AJOL)

    Ulcerative colitis may not necessarily be rare as previously thought in tropical and subtropical Africa. With increasing westernized life style, greater utilization and accessibility to modern medical practice,availability of tertiary level health care di.

  14. Clostridium difficile Infection Worsens the Prognosis of Ulcerative Colitis

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    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.

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

    DEFF Research Database (Denmark)

    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...

  17. Pathogenesis and biomarkers of carcinogenesis in ulcerative colitis

    DEFF Research Database (Denmark)

    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......-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...

  18. Treatment of right dorsal ulcerative colitis in a horse.

    Science.gov (United States)

    Simmons, T R; Gaughan, E M; Ducharme, N G; Dill, S G; King, J M; Anderson, W I

    1990-02-01

    Excessive administration of phenylbutazone was associated with development of right dorsal ulcerative colitis. The clinical signs of right dorsal colitis include chronic colic and weight loss. The laboratory abnormalities include panhypoproteinemia and a high WBC count in the abdominal fluid. Medical management of the chronic colic and protein-losing enteropathy associated with the ulcerative lesions in the right dorsal colon and surgical bypass of the right dorsal colon did not result in long-term resolution of clinical signs. Resection of the ulcerated right dorsal colon through a right lateral approach at the 16th rib resulted in resolution of intestinal protein loss and colic. The results of this case suggest that surgical resection of the ulcerated right dorsal colon may be the recommended treatment for right dorsal ulcerative colitis.

  19. Desulfovibrio bacterial species are increased in ulcerative colitis.

    LENUS (Irish Health Repository)

    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.

  20. Strongyloides colitis is a lethal mimic of ulcerative colitis: the key morphologic differential diagnosis.

    Science.gov (United States)

    Qu, Zhenhong; Kundu, Uma R; Abadeer, Rania A; Wanger, Audrey

    2009-04-01

    Strongyloides stercoralis colitis is a severe, but easily curable, form of strongyloidiasis that carries a high mortality rate if untreated. Autoinfection characteristic of Strongyloides stercoralis frequently makes the infection a life-long disease unless it is effectively treated. Our experience with 4 cases of Strongyloides colitis prompted us to assess the clinical outcome of the disease by literature review. In this case series, the misdiagnosis and resultant mortality rates of Strongyloides colitis are 52% and 39.1%, respectively. A low index of suspicion and morphologic resemblance to ulcerative colitis were the main sources of diagnostic error. Ulcerative colitis alone accounted for 38.5% of the erroneous diagnoses. Features of Strongyloides colitis that contrast with those of ulcerative colitis include (1) skip pattern of the inflammation, (2) distal attenuation of the disease, (3) eosinophil-rich infiltrates, (4) relative intact crypt architecture, and (5) frequent involvement of submucosa. We also found that history of steroid therapy, chronic colitis refractory to conventional immune-modifying management, and endoscopic finding of distal attenuation of the colitis are helpful clues. It is also our experience that if Strongyloides colitis is included in the differential diagnosis, the correct diagnosis can usually be made. Current therapy with ivermectin or albendazole is very effective at a cure rate greater than 98%. We believe that the misdiagnosis and mortality rates of this curable, but often, unnecessarily deadly, infectious disease are alarming and warrant efforts to increase the awareness of the disease.

  1. Optimal management of steroid-dependent ulcerative colitis

    Directory of Open Access Journals (Sweden)

    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

  2. Omega 3 fatty acids supplementation has an ameliorative effect in experimental ulcerative colitis despite increased colonic neutrophil infiltration Los suplementos de ácidos grasos omega 3 tienen efectos beneficiosos en colitis ulcerosa a pesar del aumento de la infiltracción por neutrófilos del colon

    Directory of Open Access Journals (Sweden)

    Ioannis Varnalidis

    2011-10-01

    Full Text Available Purpose: omega 3 polyunsaturated fatty acids have anti-inflammatory properties and can be beneficial in the treatment of inflammatory diseases, such as ulcerative colitis. Dextran sodium sulphate (DSS colitis in rats appears to mimic nearly all of the morphological characteristics and lesion distributions of ulcerative colitis. The purpose of the current study was to investigate the efficacy of omega 3 fatty acids in the treatment of experimental ulcerative colitis. Methods: thirty-six Wistar rats were randomly assigned to group A or group B receiving 5% dextran sulfate sodium (DSS in their drinking water for eight days. For the next eight days post-DSS, group A animals received tap-water, and group B animals were fed a nutritional solution containing high levels of omega 3 polyunsaturated fatty acids (ProSure®, Abbott Laboratories, Zwolle, Netherlands once per day, administrated with a orogastric feeding tube. Results: animals fed an omega 3 rich diet exhibited a statistically significant increase in hematocrit and hemoglobin levels, compared to animals drinking tap water, and a trend towards histopathological and clinical improvement, with the administration of omega 3 fatty acids ameliorating epithelial erosion by day 8 post-DSS, but no statistically significant difference was observed between group A and group B animals at 4 or 8 days post-DSS. Also, a statistically significant increase in neutrophil infiltration was observed, as depicted by myelohyperoxidase activity. Conclusion: our findings support a positive role of omega 3 polyunsaturated fatty acids supplementation in an experimental model of ulcerative colitis despite the increased colonic neutrophil infiltration. Further studies are needed in order to investigate the role of increased neutrophils in colonic mucosa.

  3. Antineutrophil cytoplasmic autoantibodies in ulcerative colitis

    Directory of Open Access Journals (Sweden)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  6. Mesalamine with MMX technology for the treatment of ulcerative colitis.

    Science.gov (United States)

    Schreiber, Stefan; Kamm, Michael A; Lichtenstein, Gary R

    2008-06-01

    Mesalamine with MMX Multi Matrix System technology (hereafter referred to as MMX mesalamine) is an oral, high-strength (1.2 g/tablet), once-daily formulation of 5-aminosalicylic acid used for the treatment of ulcerative colitis. This new formulation has been designed to provide delayed and prolonged 5-aminosalicylic acid release throughout the colon. In recent clinical studies, MMX mesalamine (taken as a once-daily dose of 2.4 or 4.8 g) effectively induced clinical remission and mucosal healing versus placebo in patients with active, mild-to-moderate ulcerative colitis. Once remission was achieved, MMX mesalamine effectively maintained disease remission in the majority of patients for at least 12 months. In this paper, we comprehensively review the results of studies exploring the clinical pharmacology, efficacy and safety of MMX mesalamine in patients with ulcerative colitis, and examine the implications of these findings on clinical practice.

  7. Managing osteoporosis in ulcerative colitis: Something new?

    Science.gov (United States)

    Piodi, Luca Petruccio; Poloni, Alessandro; Ulivieri, Fabio Massimo

    2014-01-01

    The authors revise the latest evidence in the literature regarding managing of osteoporosis in ulcerative colitis (UC), paying particular attention to the latest tendency of the research concerning the management of bone damage in the patient affected by UC. It is wise to assess vitamin D status in ulcerative colitis patients to recognize who is predisposed to low levels of vitamin D, whose deficiency has to be treated with oral or parenteral vitamin D supplementation. An adequate dietary calcium intake or supplementation and physical activity, if possible, should be guaranteed. Osteoporotic risk factors, such as smoking and excessive alcohol intake, must be avoided. Steroid has to be prescribed at the lowest possible dosage and for the shortest possible time. Moreover, conditions favoring falling have to been minimized, like carpets, low illumination, sedatives assumption, vitamin D deficiency. It is advisable to assess the fracture risk in all UC patient by the fracture assessment risk tool (FRAX® tool), that calculates the ten years risk of fracture for the population aged from 40 to 90 years in many countries of the world. A high risk value could indicate the necessity of treatment, whereas a low risk value suggests a follow-up only. An intermediate risk supports the decision to prescribe bone mineral density (BMD) assessment and a subsequent patient revaluation for treatment. Dual energy X-ray absorptiometry bone densitometry can be used not only for BMD measurement, but also to collect data about bone quality by the means of trabecular bone score and hip structural analysis assessment. These two indices could represent a method of interesting perspectives in evaluating bone status in patients affected by diseases like UC, which may present an impairment of bone quality as well as of bone quantity. In literature there is no strong evidence for instituting pharmacological therapy of bone impairment in UC patients for clinical indications other than those that

  8. Therapeutic effect of imiquimod on dextran sulfate sodium-induced ulcerative colitis in mice.

    Directory of Open Access Journals (Sweden)

    Lu Chen

    Full Text Available Imiquimod is a Toll-like receptor-7 agonist that regulates immunity and can be used as an immune adjuvant. Ulcerative colitis has a close correlation with immune disorder.To investigate the therapeutic effect of imiquimod on dextran sulfate sodium (DSS-induced colitis and explore the underlying mechanisms.C57BL/6J C57 mice received 3% DSS for 7 days to induce ulcerative colitis. Groups of mice were intraperitoneally injected with dexamethasone (DXM, 1.5 mg/kg or imiquimod (IMQ, 30 mg/kg at the same time daily. During the experimental period, clinical signs, body weight, stool consistency and visible fecal blood were monitored and recorded daily; colitis was evaluated by disease activity index (DAI score and by histological score. At the conclusion of the experiment, the level of colonic myeloperoxidase (MPO activity and the serum levels of the cytokines tumor necrosis factor-α (TNF-α, interleukin 6 (IL-6 and interleukin 10 (IL-10 were measured.Administration of 3% DSS for 7 days successfully induced acute colitis associated with diarrhea, bloody mucopurulent stool, body weight decreases, and other changes. Colitis severity was significantly ameliorated in the IMQ treatment groups, as determined by hematoxylin-eosin (HE staining and histopathological scores. Moreover, IMQ significantly reduced the activity of MPO in colonic tissue and the serum levels of inflammatory cytokines, increased colon length and spleen weight, and effectively inhibited microscopic damage to the colon tissue.IMQ had beneficial effects on DSS-induced ulcerative colitis, supporting its further development and clinical application in ulcerative colitis.

  9. SOME ASPECTS OF TREATMENT FOR LEFT-SIDED ULCERATIVE COLITIS

    Directory of Open Access Journals (Sweden)

    P. A. Makarchuk

    2015-01-01

    Full Text Available Background: There is no published data on changes in the endoscopic activity index within first weeks of treatment with various pharmaceutical forms of mesalazine.Aim: Comparative assessment of clinical efficacy and safety of various pharmaceutical forms of mesalazine (tablets, enemas and foam in the treatment of left-sided ulcerative colitis.Materials and methods: Thirty patients with chronic relapsing left-sided moderate ulcerative colitis participated in the study. They were administered mesalazine either orally (group 1, n = 10 or rectally in micro-enemas (group 2, n = 10 and as foam (group 3, n = 10. Activity of ulcerative colitis was accessed before and after the treatment, along with collecting of patient responses regarding the ease of their use.Results: The mean index of ulcerative colitis activity among all patients before treatment was 7.2 ± 0.8 points. After 1 week of treatment with oral mesalazine, the index of ulcerative colitis activity decreased to 5.2 points and in those patients who were using microenemas and foam, to 4.6 and 3.4 points, respectively, with the difference before/after treatment being significant only in the group 3 (p < 0.05. At 2 weeks of treatment, the activity index decreased more than 2-fold in all groups (p < 0.05. According to the questionnaire, 83.3% of patients accepted the oral intake of the agent as the most convenient one. The highest proportion of compliant patients was in the group using the foam. Conclusion: Mesalazine is highly effective, as shown by a 2-fold decrease in the ulcerative colitis activity index after 2 weeks of treatment. The endoscopic activity index shows more rapid decrease after the use of mesalazine foam (already at 1 week of treatment.

  10. Faecal Bacterial Communities in Healthy Controls and Ulcerative Colitis Patients

    DEFF Research Database (Denmark)

    Vigsnæs, Louise Kristine; Wilcks, Andrea; Brynskov, Jørn

    Ulcerative colitis (UC) is an idiopathic inflammatory bowel disease (IBD) that is characterized by chronic inflammation of the colonic mucosa. The aetiology of IBD is not well understood, however the commensal intestinal microbiota is thought to play an important pathogenetic role. Hence, a detai......Ulcerative colitis (UC) is an idiopathic inflammatory bowel disease (IBD) that is characterized by chronic inflammation of the colonic mucosa. The aetiology of IBD is not well understood, however the commensal intestinal microbiota is thought to play an important pathogenetic role. Hence...

  11. BODY COMPOSITION IN PATIENTS WITH CROHN'S DISEASE AND ULCERATIVE COLITIS.

    Science.gov (United States)

    Back, Ivi Ribeiro; Marcon, Sonia Silva; Gaino, Natalia Moreno; Vulcano, Daniela Salate Biagioni; Dorna, Mariana de Souza; Sassaki, Ligia Yukie

    2017-01-01

    The nutritional status of individuals with inflammatory bowel diseases is directly related to the severity of the disease and is associated with poor prognosis and the deterioration of immune competence. To assess the nutritional status and the body composition of outpatients with inflammatory bowel diseases. A cross-sectional study was conducted with clinical and nutritional assessment of patients with Crohn's disease and ulcerative colitis. Patients were classified according to the clinical activity through Crohn's Disease Activity Index and Mayo Score. Nutritional assessment consisted of anthropometric measurements of current weight, height, mid-arm circumference, triceps skinfold thickness and thickness of adductor policis muscle, with subsequent calculation of BMI, arm muscle circumference and the mid-arm muscle area (MAMA). The phase angle (PhA) and lean and fat mass were obtained with the use of electrical bioimpedance. Descriptive statistics, chi-square test or Fisher exact test, ANOVA and t-test. We evaluated 141 patients of which 54 (38.29%) had Crohn's disease and 87 (61.70%) ulcerative colitis. The mean age was 43.98 (±15.68) years in Crohn's disease and 44.28 (±16.29) years for ulcerative colitis. Most of the patients were in clinical remission of the disease (Crohn's disease: 88.89%; ulcerative colitis: 87.36%). Regarding the nutritional classification using BMI, it was found that 48.15% of Crohn's disease patients were eutrophic and 40.74% were overweight or obese; among patients with ulcerative colitis, 52.87% were classified as overweight or obese. When considering the triceps skinfold, it was observed in both groups a high percentage of overweight and obesity (Crohn's disease: 75.93%; ulcerative colitis: 72.42%). Crohn's disease patients showed the most affected nutritional status according to the nutritional variables when compared to patients with ulcerative colitis (BMI: 24.88 kg/m² x BMI: 26.56 kg/m², P=0.054; MAMA: 35.11 mm x MAMA: 40

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

    Directory of Open Access Journals (Sweden)

    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.

  13. Peritonsillar Involvement in Pyoderma Gangrenosum associated with Ulcerative Colitis

    OpenAIRE

    Byeon, Yu Mi; Lee, Jun; Lee, Sang Jun; Park, Chol Jin; Yun, Na Ra; Kim, Young Dae; Park, Chan Guk; Kim, Man Woo

    2014-01-01

    Peritonsillar abscess is a common deep throat infection. Early diagnosis and prompt, appropriate management of a peritonsillar abscess prevents mortality. A 45-year-old woman on steroids for an ulcerative colitis (UC) exacerbation presented with sore throat and multiple skin ulcers on her left forearm and right foot. Computed tomography of the neck revealed a peritonsillar abscess. Gram staining and culture of the abscess were negative, and a skin biopsy suggested pyoderma gangrenosum (PG). T...

  14. CCR9 Antagonists in the Treatment of Ulcerative Colitis

    Science.gov (United States)

    Bekker, Pirow; Ebsworth, Karen; Walters, Matthew J.; Berahovich, Robert D.; Ertl, Linda S.; Charvat, Trevor T.; Punna, Sreenivas; Powers, Jay P.; Campbell, James J.; Sullivan, Timothy J.; Jaen, Juan C.; Schall, Thomas J.

    2015-01-01

    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. PMID:26457007

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

    DEFF Research Database (Denmark)

    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...

  16. Ulcerative colitis in a Nigerian child: case report | Ekanem | Nigerian ...

    African Journals Online (AJOL)

    Ulcerative colitis (UC) is a chronic re-occuring inflammatory disease affecting mainly the colon. It is more prevalent in the United Kingdom, North America Scandinavia and less common in southern Europe, Asia and Africa. Commonly, UC is suspected in patients presenting with bloody diarrhoea, tenesmus, abdominal pain, ...

  17. Ulcerative Colitis Prone to Delayed Diagnosis in a Nigerian ...

    African Journals Online (AJOL)

    Inflammatory bowel disease is an emerging disease burden in the developing world. In Nigeria there is a persisting perception among physicians that it is a very rare disease, and publications on it are sparse. Early manifestations of ulcerative colitis (UC) are therefore likely to be missed at many health institutions.

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

    DEFF Research Database (Denmark)

    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...

  19. Ulcerative Colitis Prone to Delayed Diagnosis in a Nigerian Population

    African Journals Online (AJOL)

    have been contributory. The disease burden may be plateauing in Western nations, but this is not the case in previously low incidence regions like Eastern Europe, Asia and other developing nations.[2] In Nigeria and indeed Africa, there is still the perception among physicians that ulcerative colitis (UC) is a rare disease.

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

    DEFF Research Database (Denmark)

    Seidelin, Jakob Benedict; Bjerrum, Jacob Tveiten; 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...

  1. Treatment of Ulcerative Colitis; Update | Gadour | Sudan Journal of ...

    African Journals Online (AJOL)

    Ulcerative Colitis [UC] is a chronic debilitating inflammatory process that is usually confined to the mucosa and on occasions submucosa of the large bowel. It affects all age groups but is more common at 15-30 years and spares no sex. Typically the disease has relapsing-remitting course. Bloody diarrhea forms the cardinal ...

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

    DEFF Research Database (Denmark)

    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...

  3. Phylogenetic Analysis of Dysbiosis in Ulcerative Colitis During Remission

    NARCIS (Netherlands)

    Rajilic-Stojanovic, M.; Shanahan, F.; Guarner, F.; Vos, de W.M.

    2013-01-01

    BACKGROUND:: Presence of intestinal microbes is a prerequisite for the development of ulcerative colitis (UC), although deviation of the normal intestinal microbiota composition, dysbiosis, is presumably implicated in the etiology of UC. METHODS:: The fecal microbiota of 30 UC samples obtained from

  4. An update on anti-TNF agents in ulcerative colitis

    NARCIS (Netherlands)

    Samaan, Mark A.; Bagi, Preet; Vande Casteele, Niels; D'Haens, Geert R.; Levesque, Barrett G.

    2014-01-01

    Anti-tumor necrosis factor-α agents are key therapeutic options for the treatment of ulcerative colitis. Their efficacy and safety have been shown in large randomized controlled trials. The key evidence gained from these trials of infliximab, adalimumab, and golimumab is reviewed along with their

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

    DEFF Research Database (Denmark)

    Rumessen, Jüri Johs.; 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 de...

  6. Low prevalence of Blastocystis sp. in active ulcerative colitis patients

    NARCIS (Netherlands)

    Rossen, N. G.; Bart, A.; Verhaar, N.; van Nood, E.; Kootte, R.; de Groot, P. F.; D'Haens, G. R.; Ponsioen, C. Y.; van Gool, T.

    2015-01-01

    Ulcerative colitis (UC) is thought to originate from a disbalance in the interplay between the gut microbiota and the innate and adaptive immune system. Apart from the bacterial microbiota, there might be other organisms, such as parasites or viruses, that could play a role in the aetiology of UC.

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

    LENUS (Irish Health Repository)

    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

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

    DEFF Research Database (Denmark)

    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...

  9. Overall and cause-specific mortality in ulcerative colitis

    DEFF Research Database (Denmark)

    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...... 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...

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

    Directory of Open Access Journals (Sweden)

    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.

  11. Synchronous cytomegalovirus infection in a newly diagnosed ulcerative colitis patient

    Directory of Open Access Journals (Sweden)

    Jin Yu Chieng

    2017-12-01

    Full Text Available A 61-year-old Punjabi female patient presented with six months history of mild abdominal discomfort with bloody diarrhea. She did not have underlying chronic medical illness; she neither took steroid nor immunosuppressant. She was found anemic, thrombocytosis, and elevated C-reactive protein. Colonoscopy showed moderate left sided colitis, with histopathology evidence of ulcerative colitis (UC with cytomegalovirus (CMV infection. Her serum anti-CMV IgM antibody was detected. She was treated with intravenous ganciclovir, together with 5-ASA and tapering dose of steroid. Anemia was corrected. Subsequent clinic reviews and follow up endoscopies showed dramatically improvement. CMV colitis should be considered for the patients presenting with moderate to severe UC. Early prescription of antiviral would be beneficial in the treatment of flare of UC.

  12. INTEGRATED APPLICATION OF OPTICAL DIAGNOSTIC METHODS IN ULCERATIVE COLITIS

    Directory of Open Access Journals (Sweden)

    E. V. Velikanov

    2013-01-01

    Full Text Available Abstract. Our results suggest that the combined use of optical coherent tomography (OCT and fluorescence diagnosis helps to refine the nature and boundaries of the pathological process in the tissue of the colon in ulcerative colitis. Studies have shown that an integrated optical diagnostics allows us to differentiate lesions respectively to histology and to decide on the need for biopsy and venue. This method is most appropriate in cases difficult for diagnosis. 

  13. Managing Ulcerative Colitis – The Guidelines and Beyond

    Directory of Open Access Journals (Sweden)

    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.

  14. Immunomodulators and Immunosuppressants for Japanese Patients with Ulcerative Colitis

    OpenAIRE

    Shigeki Bamba; Tomoyuki Tsujikawa; Masaya Sasaki; Yoshihide Fujiyama; Akira Andoh

    2011-01-01

    Ulcerative colitis (UC) is characterized by a long-standing chronic course with remissions and exacerbations. Previously, patients do not respond to 5-aminosalicylic acid compounds and corticosteroids are considered for colectomies, however, in recent years, alternative treatments emerged for steroid-refractory or steroid-dependent UC. In this review article, we focus on immunomodulators (such as azathioprine [AZA] and 6-mercaptopurine [6-MP]) and immunosuppressants (such as cyclosporine A [C...

  15. Epsilon-aminocaproic acid therapy in ulcerative colitis

    Science.gov (United States)

    Salter, R. H.; Read, A. E.

    1970-01-01

    On the supposition that excessive fibrinolysis at the rectal mucosal level may contribute to the pathogenesis of ulcerative colitis, 11 patients with this condition, in whom rectal bleeding was the predominant feature, were given a course of epsilon-aminocaproic acid therapy. Six patients responded dramatically to this treatment, there was a partial response in two, no effect in two others, and one patient found it necessary to discontinue the treatment after 48 hours because of the severity of side effects. PMID:5311202

  16. The Association Between CMV Viremia or Endoscopic Features and Histopathological Characteristics of CMV Colitis in Patients with Underlying Ulcerative Colitis.

    Science.gov (United States)

    Yang, Hong; Zhou, Weixun; Lv, Hong; Wu, Dongsheng; Feng, Yunlu; Shu, Huijun; Jin, Meng; Hu, Lingling; Wang, Qiang; Wu, Dong; Chen, Jie; Qian, Jiaming

    2017-05-01

    Cytomegalovirus (CMV) infection has been shown to be related to severe or steroid-refractory ulcerative colitis (UC) flare-ups. The aim of this study was to evaluate the endoscopic and pathological characteristics of CMV colitis in patients with UC and to assess the predictive value of the endoscopic and pathological features of CMV colitis. A total of 50 consecutive UC patients with CMV infection who were admitted to Peking Union Medical College Hospital from 2010 to 2015 were enrolled in this study. Twenty-five UC patients with CMV infection (50.0%) had concurrent CMV colitis. When the cutoff value was set at 1150 copies, the sensitivity and specificity of blood CMV DNAq polymerase chain reaction for predicting CMV colitis were 44.4% and 78.9%, respectively. A higher proportion of endoscopic punched-out ulcers, irregular ulcers, and cobblestone-like appearance were observed among the patients in the CMV colitis group than those in the non-CMV colitis group (52.0% versus 20.0%, 60.0% versus 16.0%, and 20.0% versus 0%, respectively, P colitis group than in the control group (68.0% versus 44.0%). Characteristic endoscopic features with punch-out ulcers and high CMV viremia load may be useful for predicting the presence of CMV colitis in histology. Punch-out ulcers were found to be associated with a higher number of inclusion bodies on histology, suggesting a role of targeted biopsy for endoscopist.

  17. Patients with ulcerative colitis from diverse populations: The Leicester experience.

    Science.gov (United States)

    Farrukh, Affifa; Mayberry, John

    2016-03-01

    Ulcerative colitis is common in migrant communities. There is evidence that access to care in general is impaired among such communities. The purpose of this study was to investigate whether South Asians experienced the same quality of care as English patients with ulcerative colitis. The study assessed clinical care in the decade subsequent to diagnosis through a retrospective review of case notes. Newly diagnosed patients who lived in Leicester were identified and the frequency and type of consultation, in-patient admissions, surveillance colonoscopies, discharge rates, surgery and death were recorded. Of 372 candidate cases identified, 70 met the criteria to be included in the study. Forty-two were of English origin and 28 South Asian. South Asian patients were significantly less likely to see a consultant and more likely to be discharged. South Asian patients were admitted to hospital more often but had significantly fewer tests than European patients. This trend was also seen in surveillance colonoscopy, although it did not reach significance. Despite these differences in the provision of care, surgical and death rates were comparable. Patients with ulcerative colitis who are of South Asian origin receive poorer quality clinical care than their European counterparts. © The Author(s) 2015.

  18. Delayed recurrence of ulcerative colitis manifested by tracheobronchitis, bronchiolitis, and bronchiolectasis

    Directory of Open Access Journals (Sweden)

    Iclal Ocak MD,

    2017-12-01

    Full Text Available Ulcerative colitis can cause inflammation of small and large airways, characterized by mucosal inflammation, tracheobronchial stenosis, bronchiestasis, and bronchiolitis. We present a case of tracheobronchitis and bronchiolitis associated with ulcerative colitis in a 58-year-old nonsmoking man, 17 years after the total colectomy and complete resolution of intestinal findings. Computed tomography demonstrated wall thickening of trachea and left main stem bronchus, and multiple bronchi around the both hilum with mild to moderate stenosis. Fiberoptic bronchial biopsy showed inflammation of the airways, similar to histologic findings of ulcerative colitis within colon. Keywords: Ulcerative colitis, Trachea, Lung

  19. Cerbral Venous Thrombosis in Ulcerative Colitis and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Hugh Chaun

    1991-01-01

    Full Text Available A 30-year-old man with an eight year history of ulcerative colitis developed left occipital headache, mental confusion, dysphasia and right-sided weakness when his bowel disease was asymptomatic. Investigations revealed thrombosis of the cerebral sagittal sinus and left transverse sinus. The literature relating to cerebrovascular complications associated with ulcerative colitis is reviewed, and the possible pathogenetic mechanisms of venous thrombosis in ulcerative colitis are discussed. The importance of recognizing that venous thrombosis may occur in association with ulcerative colitis in remission is emphasized.

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

    DEFF Research Database (Denmark)

    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...

  1. Protective effect of sanguinarine against acetic acid-induced ulcerative colitis in mice.

    Science.gov (United States)

    Niu, Xiaofeng; Fan, Ting; Li, Weifeng; Huang, Huimin; Zhang, Yanmin; Xing, Wei

    2013-03-15

    The quaternary ammonium salt, sanguinarine (SANG), is of great practical and research interest because of its pronounced, widespread physiological effects, which promote anti-microbial and anti-inflammatory responses in experimental animals. Although SANG is originally shown to possess anti-inflammatory properties and it has been used to treat various inflammatory diseases, its effects on ulcerative colitis have not been previously explored. The aim of the present study is to evaluate the effect of SANG on acetic acid-induced ulcerative colitis in mice. Experimental animals received SANG (1, 5 and 10 mg/kg, p.o.) and sulfasalazine (500 mg/kg, p.o.) for seven consecutive days after induction of colitis by intra-rectal acetic acid (5% v/v) administration. The colonic mucosal injury was assessed by clinical, macroscopic, biochemical and histopathological examinations. SANG treatment significantly decreased mortality rate, body weight loss, disease activity index (DAI), wet colon weight, macroscopic and histological score when compared to acetic acid-induced controls. In addition, administration of SANG effectively inhibited p65 NF-κB protein expression and MPO activity accumulation. The levels of TNF-α and IL-6 in the serum and colon tissue of mice with experimental colitis were decreased by SANG in a concentration-dependent manner in response to p65 NF-κB. The possible mechanism of protection on experimental colitis was that SANG could be through attenuating early steps of inflammation as well as decreasing the expression of NF-κB and subsequent pro-inflammatory cytokines production. Copyright © 2013 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

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

    LENUS (Irish Health Repository)

    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.

  5. Successful treatment of ulcerative colitis with leukocytapheresis using non-woven polyester filter.

    Science.gov (United States)

    Sakata, Hiromi; Kawamura, Naoyuki; Horie, Takashi; Ohizumi, Hiroko; Tamaki, Tohru; Kukita, Kazutaka; Meguro, Jun-ichi; Yonekawa, Motoki; Saitoh, Masao; Kawamura, Akio

    2003-12-01

    Ulcerative colitis is a chronic inflammatory disease of the rectum and colon. Although the pathogenesis of ulcerative colitis is not fully elucidated, cell-mediated immunity plays an important role in disease pathogenesis. Leukocytapheresis is a newly emerging therapy to eliminate activated leukocyte from systemic circulation. We have studied the effects of leukocytapheresis on patients with ulcerative colitis who had failed to respond to conventional therapy. A total of 51 patients with ulcerative colitis were treated with apheresis using a non-woven polyester fiber filter (Finecell, Asahi Medical Co.,Tokyo, Japan) originally developed as a microcoagulation elimination filter for massive transfusion. Of the 51 patients, 33 (64.7%) achieved clinical remission manifested by clinical activity and colonoscopic findings without any adverse effects. This result suggested that leukocytapheresis using Finecell might serve as an alternative therapy for ulcerative colitis as other leukocytapheresis using centrifugation or column.

  6. Pathogenesis and biomarkers of carcinogenesis in ulcerative colitis

    DEFF Research Database (Denmark)

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

    2011-01-01

    -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...

  7. Tofacitinib as Induction and Maintenance Therapy for Ulcerative Colitis.

    Science.gov (United States)

    Sandborn, William J; Su, Chinyu; Sands, Bruce E; D'Haens, Geert R; Vermeire, Séverine; Schreiber, Stefan; Danese, Silvio; Feagan, Brian G; Reinisch, Walter; Niezychowski, Wojciech; Friedman, Gary; Lawendy, Nervin; Yu, Dahong; Woodworth, Deborah; Mukherjee, Arnab; Zhang, Haiying; Healey, Paul; Panés, Julian

    2017-05-04

    Tofacitinib, an oral, small-molecule Janus kinase inhibitor, was shown to have potential efficacy as induction therapy for ulcerative colitis in a phase 2 trial. We further evaluated the efficacy of tofacitinib as induction and maintenance therapy. We conducted three phase 3, randomized, double-blind, placebo-controlled trials of tofacitinib therapy in adults with ulcerative colitis. In the OCTAVE Induction 1 and 2 trials, 598 and 541 patients, respectively, who had moderately to severely active ulcerative colitis despite previous conventional therapy or therapy with a tumor necrosis factor antagonist were randomly assigned to receive induction therapy with tofacitinib (10 mg twice daily) or placebo for 8 weeks. The primary end point was remission at 8 weeks. In the OCTAVE Sustain trial, 593 patients who had a clinical response to induction therapy were randomly assigned to receive maintenance therapy with tofacitinib (either 5 mg or 10 mg twice daily) or placebo for 52 weeks. The primary end point was remission at 52 weeks. In the OCTAVE Induction 1 trial, remission at 8 weeks occurred in 18.5% of the patients in the tofacitinib group versus 8.2% in the placebo group (P=0.007); in the OCTAVE Induction 2 trial, remission occurred in 16.6% versus 3.6% (PInduction 1 and 2 trials, the rates of overall infection and serious infection were higher with tofacitinib than with placebo. In the OCTAVE Sustain trial, the rate of serious infection was similar across the three treatment groups, and the rates of overall infection and herpes zoster infection were higher with tofacitinib than with placebo. Across all three trials, adjudicated nonmelanoma skin cancer occurred in five patients who received tofacitinib and in one who received placebo, and adjudicated cardiovascular events occurred in five who received tofacitinib and in none who received placebo; as compared with placebo, tofacitinib was associated with increased lipid levels. In patients with moderately to severely

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

    DEFF Research Database (Denmark)

    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......-DR antigens on rectal epithelial cells of patients with UC could not be predicted from the clinical, rectoscopic, or histologic findings. HLA-DR expression is normally restricted to immunocompetent cells. The presence of HLA-DR antigens on epithelial cells may be a consequence of immunological reactions...

  9. Quality of life in patients with ulcerative colitis.

    Science.gov (United States)

    Nedelciuc, Otilia; Pintilie, Iulia; Dranga, Mihaela; Mihai, Cătălina; Prelipcean, Cristina Cijevschi

    2012-01-01

    Patients with inflammatory bowel disease (IBD) have to live with the perspective of a potential disability, which may lead in time to impaired quality of life (QoL). In order to fully understand the impact of IBD on patients and their careers we need to quantify the QoL. To evaluate HRQol in ulcerative colitis patients as opposed to the general population and to identify the significant changes of HRQoL in accordance with the specific progression of UC. The prospective study (January 2010 - December 2012), included 105 patients with ulcerative colitis (UC). Disease activity was quantified by means of the Truelove and Witts score (mild, moderate and severe). All patients were administered a self-completed IBD questionnaire (IBDQ). Lower scores were related to a worse QoL. Statistical analysis was performed and di fferences were considered significant when p 0.05). The patients with severe form had a lower score (50-140) than patients in remission (130-180) (p<0.01). Patients with UC have significantly influenced the QoL as compared to the general population. We found no significant differences regarding the extension of the lesions. The severity of the flare had a significant impact on the QoL.

  10. Pediatric ulcerative colitis: current treatment approaches including role of infliximab

    Directory of Open Access Journals (Sweden)

    Bradley GM

    2012-06-01

    Full Text Available Gia M Bradley, Maria Oliva-HemkerDivision of Pediatric Gastroenterology and Nutrition, Johns Hopkins University School of Medicine, Baltimore, MD, USAAbstract: Ulcerative colitis is a chronic inflammatory bowel disease that can lead to derangements in the growth, nutritional status, and psychosocial development of affected children. There are several medical options for the induction and maintenance of disease remission, but the benefits of these medications need to be carefully weighed against the risks, especially in the pediatric population. As the etiology of the disease has become increasingly understood, newer therapeutic alternatives have arisen in the form of biologic therapies, which are monoclonal antibodies targeted to a specific protein or receptor. This review will discuss the classical treatments for children with ulcerative colitis, including 5-aminosalicylates, corticosteroids, thiopurine immunomodulators, and calcineurin inhibitors, with a particular focus on the newer class of anti-tumor necrosis factor-α agents.Keywords: 5-aminosalicylates, anti-tumor necrosis factor-α agents, corticosteroids, cyclosporine, inflammatory bowel disease, thiopurine immunomodulators

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

    Science.gov (United States)

    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

  12. Clinical features and natural history of ulcerative colitis in Korea.

    Science.gov (United States)

    Park, Sang Hyoung; Kim, Young Min; Yang, Suk-Kyun; Kim, Sai-Hui; Byeon, Jeong-Sik; Myung, Seung-Jae; Cho, Yun Kyung; Yu, Chang-Sik; Choi, Kwi-Sook; Chung, Jun-Won; Kim, Benjamin; Choi, Kee Don; Kim, Jin-Ho

    2007-03-01

    The clinical characteristics of ulcerative colitis (UC) in Asian populations have not been well characterized. We therefore investigated the clinical features and natural history of UC in Korea. We retrospectively analyzed 304 Korean patients with UC first diagnosed at the Asan Medical Center between June 1989 and August 2005. The male-to-female ratio of the patients was 0.94:1, and their median age at diagnosis was 40.0 years (range, 12-72 years). At diagnosis, proctitis was noted in 134 patients (44.1%), left-sided colitis in 69 patients (22.7%), and extensive colitis in 101 patients (33.2%). Disease activity at diagnosis was mild in 149 patients (49.0%), moderate in 125 patients (41.1%), and severe in 26 patients (8.6%). In addition, 4 asymptomatic patients (1.3%) were detected as a result of a screening colonoscopy. Clinical remission after the first attack was documented in 97.4% of patients. The cumulative relapse rate after 1, 5, and 10 years was 30.2%, 72.0%, and 88.4%, respectively. The cumulative risk of proximal extension in patients with proctitis or left-sided colitis was 33.0% after 5 years and 44.5% after 10 years. The cumulative probability of colectomy was 2.0% after 1 year, 2.8% after 3 years, and 3.3% after 5 to 15 years. The cumulative survival rate after 1, 5, and 10 years was 100%, 99.4%, and 97.4%, respectively. The clinical features of Korean UC patients at diagnosis are similar to those of Westerners. However, UC in Koreans may have a milder course than in Westerners, as indicated by the lower rate of colectomy among Koreans.

  13. The effect of theophylline on acetic acid induced ulcerative colitis in rats.

    Science.gov (United States)

    Ghasemi-Pirbaluti, Masoumeh; Motaghi, Ehsan; Najafi, Ali; Hosseini, Mohammad Javad

    2017-06-01

    Ulcerative colitis is a relapsing inflammatory disorder of the colon. There is a need to explore the new treatments for this disorder. Theophylline, a competitive inhibitor of phosphodiesterase, is shown to have anti-inflammatory properties. However, the effect of theophylline on ulcerative colitis has not yet been investigated. The present study evaluated the effect of theophylline on acetic acid induced ulcerative colitis in rats. Colitis was induced by instillation of 2ml of acetic acid solution (3%). Colon samples were evaluated grossly and microscopically and assayed for myeloperoxidase (MPO) activity and proinflammatory cytokine concentrations. Treatment with theophylline at the doses of 20 and 50mg/kg attenuated acetic acid induced ulcerative colitis as shown by improvement in body weight loss, macroscopic score, ulcer area, hematocrit and histopathological score. Theophylline treatment also reduced MPO activity and tumor necrosis factor-α (TNF-α), interleukin 1β (IL-1 β) and interleukin 6 (IL-6) concentrations in inflamed colon. Theophylline has a protective effect in acetic acid-induced ulcerative colitis which might be due to its anti-inflammatory activities. Therefore, theophylline has the potential to be used for successful treatment of ulcerative colitis. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  14. Can temperature explain the latitudinal gradient of ulcerative colitis? Cohort of Norway

    Science.gov (United States)

    2013-01-01

    Background Incidence and prevalence of ulcerative colitis follow a north–south (latitudinal) gradient and increases northwards at the northern hemisphere or southwards at the southern hemisphere. The disease has increased during the last decades. The temporal trend has been explained by the hygiene hypothesis, but few parallel explanations exist for the spatial variability. Many factors are linked to latitude such as climate. Our purpose was to investigate the association between variables governing the climate and prospectively identified patients. Methods In this study, we used a subset of the population-based Cohort of Norway (n = 80412) where 370 prevalent cases of ulcerative colitis were identified through self-reported medication. The meteorological and climatic variables temperature, precipitation, and altitude were recorded from weather stations of the Norwegian Meteorological Institute. Summer temperature was used to capture environmental temperature. Results Summer temperature was significantly related to the prevalence of ulcerative colitis. For each one-degree increase in temperature the odds for ulcerative colitis decreased with about 9% (95% CI: 3%-15%). None of the other climatic factors were significantly associated to the risk of ulcerative colitis. Contextual variables did not change the association to the prevalence of ulcerative colitis. Conclusions The present results show that the prevalence of ulcerative colitis is associated to summer temperature. Our speculation is that summer temperature works as an instrumental variable for the effect of microbial species richness on the development of ulcerative colitis. Environmental temperature is one of the main forces governing microbial species richness and the microbial composition of the commensal gut flora is known to be an important part in the process leading to ulcerative colitis. PMID:23724802

  15. Can temperature explain the latitudinal gradient of ulcerative colitis? Cohort of Norway.

    Science.gov (United States)

    Aamodt, Geir; Bengtson, May-Bente; Vatn, Morten H

    2013-05-31

    Incidence and prevalence of ulcerative colitis follow a north-south (latitudinal) gradient and increases northwards at the northern hemisphere or southwards at the southern hemisphere. The disease has increased during the last decades. The temporal trend has been explained by the hygiene hypothesis, but few parallel explanations exist for the spatial variability. Many factors are linked to latitude such as climate. Our purpose was to investigate the association between variables governing the climate and prospectively identified patients. In this study, we used a subset of the population-based Cohort of Norway (n = 80412) where 370 prevalent cases of ulcerative colitis were identified through self-reported medication. The meteorological and climatic variables temperature, precipitation, and altitude were recorded from weather stations of the Norwegian Meteorological Institute. Summer temperature was used to capture environmental temperature. Summer temperature was significantly related to the prevalence of ulcerative colitis. For each one-degree increase in temperature the odds for ulcerative colitis decreased with about 9% (95% CI: 3%-15%). None of the other climatic factors were significantly associated to the risk of ulcerative colitis. Contextual variables did not change the association to the prevalence of ulcerative colitis. The present results show that the prevalence of ulcerative colitis is associated to summer temperature. Our speculation is that summer temperature works as an instrumental variable for the effect of microbial species richness on the development of ulcerative colitis. Environmental temperature is one of the main forces governing microbial species richness and the microbial composition of the commensal gut flora is known to be an important part in the process leading to ulcerative colitis.

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

    Directory of Open Access Journals (Sweden)

    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.

  17. Efficacy and safety of granulocyte, monocyte/macrophage adsorptive in pediatric ulcerative colitis

    DEFF Research Database (Denmark)

    Ruuska, Tarja; Küster, Peter; Grahnquist, Lena

    2016-01-01

    AIM: To investigate efficacy and safety for granulocyte, monocyte apheresis in a population of pediatric patients with ulcerative colitis. METHODS: The ADAPT study was a prospective, open-label, multicenter study in pediatric patients with moderate, active ulcerative colitis with pediatric...... mg daily on average from Baseline to week 12. CONCLUSION: Adacolumn(®) GMA apheresis treatment was effective in pediatric patients with moderate active Ulcerative Colitis. No new safety signals were reported. The present data contribute to considering GMA apheresis as a therapeutic option...... in pediatric patients having failed first line therapy....

  18. Strontium Chloride: Can It Be a New Treatment Option for Ulcerative Colitis?

    Science.gov (United States)

    Topal, Firdevs; Yonem, Ozlem; Tuzcu, Mehmet; Ataseven, Hilmi; Akyol, Melih

    2014-01-01

    Background/Aims. Patients with ulcerative colitis still need effective therapy without major side effects. It has been found that strontium can suppress NFκB activation induced by TNF-α. This opens a gate to a new anti-TNF agent which is cheap and can be given orally. We for the first time aimed to investigate the effect of strontium chloride (SrCl2) on inflammation in experimental colitis. Methods. Thirty female Wistar albino rats were divided into 5 groups each containing 6 rats. The rats in groups 1 and 2 served as the healthy control and colitis group, respectively. The rats in groups 3, 4, and 5 had colitis and received 40 mg/kg SrCl2, 160 mg/kg SrCl2, and 1 mg/kg prednisolone by oral gavage, respectively. The rats were sacrificed for histological evaluation and determination of serum neopterin, TNF-α, and IFN-γ levels. Results. The neopterin, TNF-α and IFNγ levels of group 2 was significantly higher than the other groups. The neopterin, TNF-α, and IFN-γ levels of controls and other treatment groups were comparable. There were a significant difference in macroscopic and microscopic healing between group 2 and other groups histologically. But there was not a significant difference within treatment receiving groups. Conclusion. SrCl2 had comparable therapeutic efficiency with prednisolone. PMID:25032214

  19. Strontium Chloride: Can It Be a New Treatment Option for Ulcerative Colitis?

    Directory of Open Access Journals (Sweden)

    Firdevs Topal

    2014-01-01

    Full Text Available Background/Aims. Patients with ulcerative colitis still need effective therapy without major side effects. It has been found that strontium can suppress NFκB activation induced by TNF-α. This opens a gate to a new anti-TNF agent which is cheap and can be given orally. We for the first time aimed to investigate the effect of strontium chloride (SrCl2 on inflammation in experimental colitis. Methods. Thirty female Wistar albino rats were divided into 5 groups each containing 6 rats. The rats in groups 1 and 2 served as the healthy control and colitis group, respectively. The rats in groups 3, 4, and 5 had colitis and received 40 mg/kg SrCl2, 160 mg/kg SrCl2, and 1 mg/kg prednisolone by oral gavage, respectively. The rats were sacrificed for histological evaluation and determination of serum neopterin, TNF-α, and IFN-γ levels. Results. The neopterin, TNF-α and IFNγ levels of group 2 was significantly higher than the other groups. The neopterin, TNF-α, and IFN-γ levels of controls and other treatment groups were comparable. There were a significant difference in macroscopic and microscopic healing between group 2 and other groups histologically. But there was not a significant difference within treatment receiving groups. Conclusion. SrCl2 had comparable therapeutic efficiency with prednisolone.

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

    Directory of Open Access Journals (Sweden)

    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

  1. Lecithin as a therapeutic agent in ulcerative colitis.

    Science.gov (United States)

    Stremmel, Wolfgang; Gauss, Annika

    2013-01-01

    Lecithin [phosphatidylcholine (PC)] was shown to account for more than 70% of total phospholipids within the intestinal mucus layer. It is arranged in lamellar membranes (surfactant-like particles) and establishes a hydrophobic barrier preventing invasion of the colonic commensal microbiota. In ulcerative colitis (UC), the mucus PC content was demonstrated to be reduced by about 70%, irrespective of the presence of inflammation. This may be of primary pathogenetic significance allowing bacteria to enter the mucus and induce mucosal inflammation. Therefore, a new therapeutic strategy is being developed to substitute the missing mucus PC content in UC. Indeed, a delayed-release PC formulation was able to compensate the lack of PC and improve the inflammatory activity. In randomized controlled studies, delayed-release PC was proven to be clinically and endoscopically effective, which now awaits a phase III authority approval trial.

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

    Directory of Open Access Journals (Sweden)

    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.

  3. Homoeopathic treatment of ulcerative Colitis: A case report

    Directory of Open Access Journals (Sweden)

    Partha Pratim Pal

    2017-01-01

    Full Text Available Ulcerative colitis (UC is one of the most common inflammatory bowel diseases. As in most of the cases, the exact cause is unknown Homoeopathy, however, provides a better response in such conditions, one such case report is presented below. Patient attended out patient department (OPD chiefly for complaints of frequent passage of bloody stool and abdominal pain. He was suffering from idiopathic UC for the past 10 years. After unsatisfactory outcome with modern medicine, patient turned to homoeopathic treatment. After detailed case-taking and repertorization, Hydrastis was given in low potency, and gradually, the potency was raised as per the response of the medicine upon patient. Within 3–4 months of homoeopathic treatment, the patient started improving and continues to be free from his complains at the time of last follow-up visit in OPD.

  4. Epithelial apoptosis: cause or consequence of ulcerative colitis?

    DEFF Research Database (Denmark)

    Seidelin, Jakob Benedict; Nielsen, Ole Haagen

    2009-01-01

    OBJECTIVE: Epithelial apoptosis rates are increased in ulcerative colitis (UC). The increased apoptosis rate could expose mucosal cells to luminal pathogens and thereby be regarded as a primary pathogenic factor in UC. On the other hand, the local inflammatory reaction could cause epithelial...... apoptosis secondary to the release of cytotoxic mediators. If apoptosis is a primary defect, apoptosis rates could influence the degree of spreading of inflammation and the clinical course of UC. If apoptosis is a side effect of local inflammation, apoptosis rates would be expected only to correlate...... with the degree of local inflammation. The aim of the study was to investigate the relationship between epithelial apoptosis and clinical characteristics of UC. MATERIAL AND METHODS: Twenty patients with UC (12 with active disease) and 20 control subjects were included. Freshly isolated colonic epithelial cells...

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

    DEFF Research Database (Denmark)

    Cleynen, Isabelle; Boucher, Gabrielle; Jostins, Luke

    2016-01-01

    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......-phenotype associations across 156,154 genetic variants. We generated genetic risk scores by combining information from all known inflammatory bowel disease associations to summarise the total load of genetic risk for a particular phenotype. We used these risk scores to test the hypothesis that colonic Crohn's disease...... of a patient's disease, in part genetically determined, and the major driver to changes in disease behaviour over time. FUNDING: International Inflammatory Bowel Disease Genetics Consortium members funding sources (see Acknowledgments for full list)....

  6. 5-Aminosalicylate intolerance causing exacerbation in pediatric ulcerative colitis.

    Science.gov (United States)

    Shimizu, Hirotaka; Arai, Katsuhiro; Tang, Julian; Hosoi, Kenji; Funayama, Rie

    2017-05-01

    5-Aminosalicylate (5-ASA) is widely used as the first-line drug for ulcerative colitis (UC). 5-ASA is mostly a safe and effective drug, but it can bring about exacerbation due to 5-ASA intolerance. 5-ASA intolerance can be confusing and it can mislead physicians into considering unnecessary treatment escalation, including corticosteroid (CS), biologics, or even surgery. In spite of the clinical importance of 5-ASA intolerance, there have been few studies on its incidence, clinical features, and diagnosis. In order to evaluate the incidence, characteristic symptoms, disease course, and laboratory data of children with 5-ASA intolerance, we retrospectively reviewed the medical records of 80 children with UC. Eleven of 80 children (13.8%) with UC were diagnosed with 5-ASA intolerance. The median time between the initiation of 5-ASA and the onset of 5-ASA intolerance was 10 days (range, 4-20 days) in patients not receiving CS. Drug-induced lymphocyte stimulation test (DLST) was performed in 10 patients, and was positive in eight. C-reactive protein (CRP) increased significantly when exacerbation of colitis symptoms occurred. The incidence of 5-ASA intolerance was relatively high. Besides the challenge test, elevation of CRP and positive DLST appeared to support the diagnosis of 5-ASA intolerance. © 2017 Japan Pediatric Society.

  7. Second Korean guidelines for the management of ulcerative colitis

    Science.gov (United States)

    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

  8. Appendiceal Mucocele Detected under Treatment of Ulcerative Colitis

    Directory of Open Access Journals (Sweden)

    Rohta Noaki

    2009-11-01

    Full Text Available A 33-year-old female patient with ulcerative colitis was referred to our outpatient clinic in January 2008 with right lower abdominal pain without bloody diarrhea. Colonoscopy found mild proctosigmoiditis and a submucoal tumor with a maximal diameter of 5 cm in the cecum. Computed tomography revealed a large, hypodense, cystic cylindrical structure extending to the pelvic space. For severe pain, she underwent partial resection of the cecum including the tumor in March 2008. Intraoperatively, the vermiform appendix was swollen like a sausage and compressing the cecum, which accounted for what appeared to be a submucosal tumor like a volcano by endoscopy. Lymphadenectomy was not performed because malignancy was not suspected. In the surgical specimen, the vermiform appendix was spindle-shaped and contained a large quantity of viscous liquid. Postoperative pathological diagnosis was mucinous cystadenoma, and no cancer cells were present in the viscous liquid within the vermiform appendix. The patient left the hospital 7 days postoperatively, and her colitis remains in remission without any complications.

  9. Ulcerative colitis in northern Portugal and Galicia in Spain.

    Science.gov (United States)

    Barreiro-de Acosta, Manuel; Magro, Fernando; Carpio, Daniel; Lago, Paula; Echarri, Ana; Cotter, José; Pereira, Santos; Gonçalves, Raquel; Lorenzo, Aurelio; Carvalho, Laura; Castro, Javier; Barros, Luisa; Dias, Jorge Amil; Rodrigues, Susana; Portela, Francisco; Dias, Camila; da Costa-Pereira, Altamiro

    2010-07-01

    Clinical and therapeutic patterns of ulcerative colitis (UC) are variable in different world regions. The purpose of this study was to examine two close independent southern European UC populations from 2 bordering countries and observe how demographic and clinical characteristics of patients can influence the severity of UC. A cross-sectional study was conducted during a 15-month period (September 2005 to December 2006) based on data of 2 Web registries of UC patients. Patients were stratified according to the Montreal Classification and disease severity was defined by the type of treatment taken. A total of 1549 UC patients were included, 1008 (65%) from northern Portugal and 541 (35%) from Galicia (northwest Spain). A female predominance (57%) was observed in Portuguese patients (P Galicia (odds ratio [OR] 2.737, 95% confidence interval [CI]: 1.846-4.058; OR 5.799, 95% CI: 3.433-9.795, respectively) and biologic treatment in Galicia (OR 6.329, 95% CI: 2.641-15.166). Younger patients presented a severe course at onset with more frequent use of immunosuppressors in both countries. In a large population of UC patients from two independent southern European countries, most patients did not require aggressive therapy, but extensive colitis was a clear risk factor for more severe disease.

  10. Placebo response and remission rates in randomised trials of induction andmaintenance therapy for ulcerative colitis

    NARCIS (Netherlands)

    Jairath, Vipul; Zou, G. Y.; Parker, Claire E.; Macdonald, John K.; AlAmeel, Turki; Al Beshir, Mohammad; Almadi, Majid A.; Al-Taweel, Talal; Atkinson, Nathan S. S.; Biswas, Sujata; Chapman, Thomas; Dulai, Parambir S.; Glaire, Mark A.; Hoekman, Daniel R.; Koutsoumpas, Andreas; Minas, Elizabeth; Mosli, Mahmoud H.; Samaan, Mark; Khanna, Reena; Travis, Simon; D'Haens, Geert; Sandborn, William J.; Feagan, Brian G.

    2017-01-01

    Background It is important to minimize placebo rates in randomised controlled trials (RCTs) to efficiently detect treatment differences between interventions. Historically, high placebo rates have been observed in clinical trials of ulcerative colitis (UC). A better understanding of factors

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

    DEFF Research Database (Denmark)

    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...

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

    Directory of Open Access Journals (Sweden)

    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.

  13. Inherited determinants of Crohn's disease and ulcerative colitis phenotypes : a genetic association study

    NARCIS (Netherlands)

    Cleynen, Isabelle; Boucher, Gabrielle; Jostins, Luke; Schumm, L. Philip; Zeissig, Sebastian; Ahmad, Tariq; Andersen, Vibeke; Andrews, Jane M.; Annese, Vito; Brand, Stephan; Brant, Steven R.; Cho, Judy H.; Daly, Mark J.; Dubinsky, Marla; Duerr, Richard H.; Ferguson, Lynnette R.; Franke, Andre; Gearry, Richard B.; Goyette, Philippe; Hakonarson, Hakon; Halfvarson, Jonas; Hov, Johannes R.; Huang, Hailang; Kennedy, Nicholas A.; Kupcinskas, Limas; Lawrance, Ian C.; Lee, James C.; Satsangi, Jack; Schreiber, Stephan; Theatre, Emilie; van der Meulen-de Jong, Andrea E.; Weersma, Rinse K.; Wilson, David C.; Parkes, Miles; Vermeire, Severine; Rioux, John D.; Mansfield, John; Silverberg, Mark S.; Radford-Smith, Graham; McGovern, Dermot P. B.; Barrett, Jeffrey C.; Lees, Charlie W.

    2015-01-01

    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

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

    NARCIS (Netherlands)

    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

  15. Six ulcerative colitis patients with refractory symptoms co-infective with Blastocystis hominis in China.

    Science.gov (United States)

    Tai, Wei-Ping; Hu, Pin-Jin; Wu, Jing; Lin, Xiang-Chun

    2011-05-01

    Blastocystis hominis is an enteric parasite which has long been considered as an innocuous commensal living in the intestinal tract. Our research was to explore the role of B. hominis in refractory ulcerative colitis. Our department admitted 122 cases of ulcerative colitis patients. In these patients, there were 73 cases of patients who were responsive to sulfasalazinec, mesalazine in a standard dosage, according to the symptoms change. There was one patient who was detected to have B. hominis infection through stool detection. There were 49 patients with relapse symptoms. In this group, there were six patients who were detected with B. hominis infection through stool detection. The six patients of refractory ulcerative colitis were treated with metronidazole for 10-14 days. They almost completely recovered 3 weeks later. Patients diagnosed with ulcerative colitis should always consider this parasite infection when the symptoms are refractory and cannot be released.

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

    LENUS (Irish Health Repository)

    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.

  17. Infliximab or cyclosporine as rescue therapy in hospitalized patients with steroid-refractory ulcerative colitis

    DEFF Research Database (Denmark)

    Sjöberg, Mats; Walch, Andrea; Meshkat, Mina

    2012-01-01

    Cyclosporine (CsA) or infliximab (IFX) are used as rescue therapies in steroid-refractory, severe attacks of ulcerative colitis (UC). There are no data comparing the efficacy of these two alternatives.......Cyclosporine (CsA) or infliximab (IFX) are used as rescue therapies in steroid-refractory, severe attacks of ulcerative colitis (UC). There are no data comparing the efficacy of these two alternatives....

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

    DEFF Research Database (Denmark)

    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...

  19. Medium-term follow-up of ulcerative colitis in Cape Town | O'Keefe ...

    African Journals Online (AJOL)

    The 114 patients with ulcerative colitis diagnosed in Greater Cape Town between 1970 and 1979 were followed up 11 years later. Ninety per cent of those contacted were in remission or had mild symptoms only. Eleven patients had died; 3 deaths (in total colitis patients) were disease-related but the overall mortality rate in ...

  20. Medium-term follow-up of ulcerative colitis in Cape Town

    African Journals Online (AJOL)

    1989-08-19

    Aug 19, 1989 ... The 114 patients with ulcerative colitis diagnosed in Greater. Cape Town between 1970 and 1979 were followed up 11 years later. Ninety per cent of those contacted were in remission or had mild symptoms only. Eleven patients had died; 3 deaths (in total colitis patients) were disease-related.

  1. Peculiarities of the course of ulcerative colitis in children at the present stage

    Directory of Open Access Journals (Sweden)

    M.F. Denisova

    2017-03-01

    Full Text Available Background. As to severity of the course, the incidence of complications and mortality rate, ulcerative colitis hold a position within the top of the gastrointestinal system diseases in children. Goal of research — to study peculiarities of the course of ulcerative colitis at the present stage. Materials and methods. The retrospective analysis was conducted of 184 clinical records of the children, who were on examination and treatment at the Department of the diseases of gastrointestinal system of the State Institution “Institute of Pediatrics, Obstetrics and Gynecology of the National Academy of Medical Sciences of Ukraine” between 2004 and 2014. Results and discussion. Ulcerative colitis is common in the children of all ages, among which the preschool children and teenagers are at greater risk than others. The risk factors include both the antenatal and the postnatal ones: gestational toxicosis and miscarriage threat, weight deficit at birth, artificial feeding, intestinal infections. Ulcerative colitis is characterized by chronic relapse, slow progression of the disease, and the typical clinical symptoms are: diarrhea, hemorrhagic colitis, abdominal pain syndrome, toxic syndrome, late physical development. In terms of localization, the inflammation process most often affects the entire large bowel (59.6 %, left-sided colitis (28.5 %, and proctosigmoiditis (accounts for 11.9 % are less common. The informative criteria of ulcerative colitis activity are the Pediatric Ulcerative Colitis Activity Index (PUCAI, fecal calprotectin level, a number of complete blood count values (hemoglobin, leucocytes, platelets, erythrocyte sedimentation rate and biochemical studies (C-reactive protein, alpha-2 globulins. The modern combined baseline therapy is efficient in 22 % of patients suffering from total colitis, in 42–58 % — from left-sided colitis according to the follow-up study results. Monotherapy with 5-aminosalicylic acid medications was

  2. Ulcerative colitis and Crohn's disease: is Mycobacterium avium subspecies paratuberculosis the common villain?

    Science.gov (United States)

    2010-01-01

    Mycobacterium avium, subspecies paratuberculosis (MAP) causes a chronic disease of the intestines in dairy cows and a wide range of other animals, including nonhuman primates, called Johne's ("Yo-knee's") disease. MAP has been consistently identified by a variety of techniques in humans with Crohn's disease. The research investigating the presence of MAP in patients with Crohn's disease has often identified MAP in the "negative" ulcerative colitis controls as well, suggesting that ulcerative colitis is also caused by MAP. Like other infectious diseases, dose, route of infection, age, sex and genes influence whether an individual infected with MAP develops ulcerative colitis or Crohn's disease. The apparently opposite role of smoking, increasing the risk of Crohn's disease while decreasing the risk of ulcerative colitis, is explained by a more careful review of the literature that reveals smoking causes an increase in both diseases but switches the phenotype from ulcerative colitis to Crohn's disease. MAP as the sole etiologic agent of both ulcerative colitis and Crohn's disease explains their common epidemiology, geographic distribution and familial and sporadic clusters, providing a unified hypothesis for the prevention and cure of the no longer "idiopathic" inflammatory bowel diseases. PMID:21167058

  3. Confocal laser endomicroscopy for the differential diagnosis of ulcerative colitis and Crohn's disease: a pilot study.

    Science.gov (United States)

    Tontini, Gian Eugenio; Mudter, Jonas; Vieth, Michael; Atreya, Raja; Günther, Claudia; Zopf, Yurdagül; Wildner, Dane; Kiesslich, Ralf; Vecchi, Maurizio; Neurath, Markus F; Neumann, Helmut

    2015-05-01

    The differential diagnosis of ulcerative colitis from Crohn's disease is of pivotal importance for the management of inflammatory bowel diseases, as both entities involve specific therapeutic management strategies. Confocal laser endomicroscopy (CLE) allows on-demand, in vivo characterization of architectural and cellular details during endoscopy. The aim of this study was to assess the efficacy of CLE to differentiate between ulcerative colitis and Crohn's disease. This was a prospective study involving consecutive patients with a well-established diagnosis of ulcerative colitis or Crohn's disease who underwent colonoscopy with fluorescein-aided confocal imaging. Overall, 79 patients were included (40 Crohn's disease, 39 ulcerative colitis). CLE findings in patients with Crohn's disease, showed significantly more discontinuous inflammation (87.5 % vs. 5.1 %), focal cryptitis (75.0 % vs. 12.8 %), and discontinuous crypt architectural abnormality (87.5 % vs. 10.3 %) than in ulcerative colitis (P Crohn's disease), decreased crypt density (79.5 % vs. 22.5 %), and frankly irregular surface (89.7 % vs. 17.5 %; P Crohn's disease. However, because of the limited penetration depth of CLE, submucosal details or granulomas were not visible. The new scoring system may allow in vivo diagnosis of ulcerative colitis or Crohn's disease. Trial registered at ClinicalTrials.gov: NCT 02238665. © Georg Thieme Verlag KG Stuttgart · New York.

  4. Dietary Salt Exacerbates Experimental Colitis.

    Science.gov (United States)

    Tubbs, Alan L; Liu, Bo; Rogers, Troy D; Sartor, R Balfour; Miao, Edward A

    2017-08-01

    The Western diet is characterized by high protein, sugar, fat, and low fiber intake, and is widely believed to contribute to the incidence and pathogenesis of inflammatory bowel disease (IBD). However, high sodium chloride salt content, a defining feature of processed foods, has not been considered as a possible environmental factor that might drive IBD. We set out to bridge this gap. We examined murine models of colitis on either a high salt diet (HSD) or a low salt diet. We demonstrate that an HSD exacerbates inflammatory pathology in the IL-10-deficient murine model of colitis relative to mice fed a low salt diet. This was correlated with enhanced expression of numerous proinflammatory cytokines. Surprisingly, sodium accumulated in the colons of mice on an HSD, suggesting a direct effect of salt within the colon. Similar to the IL-10-deficient model, an HSD also enhanced cytokine expression during infection by Salmonella typhimurium This occurred in the first 3 d of infection, suggesting that an HSD potentiates an innate immune response. Indeed, in cultured dendritic cells we found that high salt media potentiates cytokine expression downstream of TLR4 activation via p38 MAPK and SGK1. A third common colitis model, administration of dextran sodium sulfate, was hopelessly confounded by the high sodium content of the dextran sodium sulfate. Our results raise the possibility that high dietary salt is an environmental factor that drives increased inflammation in IBD. Copyright © 2017 by The American Association of Immunologists, Inc.

  5. [The effects of kuijiekang capsule on ulcerative colitis induced by TNBS in rats].

    Science.gov (United States)

    Xing, Jianfeng; Hou, Jiayu; Zou, Jieming; Xue, Chunxia; Wang, Xiankung; Zheng, Xiaohe; Meng, Jie

    2005-04-01

    To evaluate the effects of Kuijiekang Capsule (KJK) on rats colitis induced by TNBS. Rats with TNBS/ethanol-induced colitis were used and treated with KJK. The experimental animals were divided into 6 groups: control group, model group, SASP group (0.50 g/kg), KJK group (0.64, 0.32, 0.16 g/kg). The animals were administrated 0. 5% carboxymethyl cellulose, SASP and KJK respectively (from the 6th d after the establishment of ulcerative colitis model to the end of the experiment, 18 d totally). At the end of the experiment, the colon mucosal damage index (CMDI), the activity of myelperoxidase (MPO) and the occult blood test (OB) in feces were observed, the mucosa pathohistology was measured and thymus and spleen of rats were weighed respectively. Meanwhile, the content of malondiadehyde (MDA) , superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) of colonic tissue were detected. The remarkable effects of KJK at dosage of 0.64, 0.32 g/kg on TNBS-induced colitis were observed, the extent of CMDI and OB were decreased, MPO activeity of colonic tissue was reduced. The extent of atrophy of thymus gland and intumesce of spleen of rat were ameliorated. Meanwhile, the content of MDA was reduced, and the activities of SOD and GSH-Px were increased. Pathological histology results showed that KJK could alleviate the pathohistological lesion of the colon of rat. Treatment with KJK shows beneficial effects on the mucosal damage of rats colitis induced by TNBS/ethanol. The mechanism of the actions of KJK may relate to anti-inflammatory effect, immunoloregulation and anti-oxidation.

  6. The prevalence and efficacy of ganciclovir on steroid-refractory ulcerative colitis with cytomegalovirus infection: a prospective multicenter study.

    Science.gov (United States)

    Kim, You Sun; Kim, Young-Ho; Kim, Joo Sung; Cheon, Jae Hee; Ye, Byong Duk; Jung, Sung-Ae; Park, Young Sook; Choi, Chang Hwan; Jang, Byung Ik; Han, Dong Soo; Yang, Suk-Kyun; Kim, Won Ho

    2012-01-01

    It remains controversial whether or not cytomegalovirus infection in patients with active ulcerative colitis reflects a nonpathogenic colonization or a pathogenic disease warranting antiviral therapy. The aim of this study was to determine the prevalence of cytomegalovirus infection in patients with active ulcerative colitis and the therapeutic efficacy of ganciclovir against cytomegalovirus infection in patients with steroid-refractory ulcerative colitis. A prospective, multicenter study was conducted in 72 patients with moderate-to-severe ulcerative colitis who were treated with intravenous steroids. The presence of cytomegalovirus was evaluated serologically and histopathologic examination, including immunohistochemical staining. In patients with steroid-refractory ulcerative colitis, cytomegalovirus infections were treated with intravenous ganciclovir. In patients with steroid-responsive ulcerative colitis, steroid therapy was continued irrespective of cytomegalovirus infection. The evidence of cytomegalovirus infection was found in 31 patients (43%) with moderate-to-severe active ulcerative colitis. In patients with steroid-refractory ulcerative colitis, the cytomegalovirus infection rate increased to 67% (14 of 21). No significant clinical and endoscopic differences existed between patients with and without a cytomegalovirus infection; however, the amount of steroids used during the flare-up period was significantly higher in patients with a cytomegalovirus infection (P = 0.013). Eleven of 14 patients (79%) with steroid-refractory ulcerative colitis and a cytomegalovirus infection improved with ganciclovir treatment. Cytomegalovirus infections in the steroid-responsive group (17 of 31) did not require ganciclovir therapy. Cytomegalovirus infections are frequently observed in patients with moderate-to-severe ulcerative colitis, especially steroid-refractory ulcerative colitis. Ganciclovir was effective in patients with steroid-refractory ulcerative colitis who

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

    Science.gov (United States)

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

    2016-09-30

    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. 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). 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. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  9. Ulcerative Colitis: Are We Neglecting Its Progressive Character

    Directory of Open Access Journals (Sweden)

    Paulo Massinha

    2017-10-01

    Full Text Available Introduction: Ulcerative colitis (UC is a chronic disease but its progressive character, with structural damage, is insufficiently studied. Objectives: To analyze a group of patients without referral bias, regarding its clinical course, the morphological damage, and functional status. Methods: We evaluated UC patients diagnosed between January 1, 2000 and December 31, 2004, living in the direct referral area of the hospital and determined the medication use, colectomy rate, structural damage (“lead pipe,” stenosis, pseudopolyps, fibrous bridges, and anorectal function (prospective evaluation with the Cleveland Clinic Incontinence Score [CCIS] and the Fecal Incontinence Quality of Life Scale. Results: We identified 104 patients, 47% female, with a mean age at diagnosis of 38 ± 17 years, 24% with proctitis, 57% with left colitis, and 19% with pancolitis. In 3 patients, it was not possible to obtain follow-up data. Of the studied patients, 56% needed corticosteroid therapy, 38% immunosuppressants, and 16% anti-tumor necrosis factors (anti-TNFs. After a mean follow-up of 13 ± 2 years, we found structural damage in 25 patients (24%: 5% with proctocolectomy, 15% with “lead pipe,” 16% with pseudopolyps, and 3% with stenosis and fibrous bridges. Reference to functional anorectal disorders was identified in 49%, mostly previous and self-limited episodes of incontinence, but including persistent incontinence in 10% (CCIS 8 ± 4.8. There was an increased incidence of structural damage and anorectal dysfunction in patients who needed corticosteroid therapy (p = 0.001, immunosuppressants (p p = 0.002 and an association of structural damage with anorectal dysfunction (p Conclusions: UC is a disease with structural and functional consequences in a significant subset of patients. This should be incorporated when defining the therapeutic strategy.

  10. Appendiceal-sigmoid fistula presenting in a man with ulcerative colitis: a case report

    Directory of Open Access Journals (Sweden)

    Minutolo Vincenzo

    2010-07-01

    Full Text Available Abstract Introduction Ulcerative colitis is a chronic disease characterized by diffuse mucosal inflammation limited to the colon. It mostly affects young adults, yet a large number of middle-aged and older patients with ulcerative colitis have also been reported. Case presentation A 58-year-old Caucasian man presented to our hospital in August 2006 with continuous and diffuse abdominal pain, meteorism, fever and bloody diarrhea. He had a two-year history of ulcerative colitis. Our patient was treated with intravenous medical therapy. As his condition worsened, he underwent surgery. An explorative laparotomy revealed that the entire colon was distended and pus was found around an appendiceal-sigmoid fistula. Conclusions Therapy for ulcerative colitis is a rapidly evolving field, with many new biological agents under investigation that are likely to change therapeutic strategies radically in the next decade. Indications for surgery are intractability (49%, stricture, dysplasia, toxic colitis, hemorrhage and perforation. To the best of our knowledge, this is the first case of an appendiceal-sigmoid fistula in a patient affected by ulcerative colitis reported in the literature. Fistulae between the appendix and the sigmoid tract are rarely reported in cases of diverticular disease and appendicitis.

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

    Energy Technology Data Exchange (ETDEWEB)

    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

  12. Surgical management of ulcerative colitis in the era of biologicals.

    Science.gov (United States)

    Devaraj, Bikash; Kaiser, Andreas M

    2015-01-01

    Proctocolectomy has been a curative option for patients with severe ulcerative colitis. In recent years, there has been a growing use of medical salvage therapy in the management of patients with moderate to severe ulcerative colitis. We aimed at reviewing the role of surgical management in a time of intensified medical management on the basis of published trial data. The aim was to determine the efficacy of aggressive medical versus surgical management in achieving multifaceted treatment goals. A comprehensive search of Pubmed, Medline, the Cochrane database was performed. Abstracts were evaluated for relevance. Selected articles were then reviewed in detail, including references. Recommendations were then drafted based on evidence and conclusions in the selected articles. The majority of patients with UC will not need surgery. However, steroid-refractoriness and steroid-dependence signal a subset of patients with more challenging disease. Biological therapy has been shown to achieve short-term improvement and temporarily reduce the need for a colectomy. However, there is a substantial financial and medical price to pay because a high fraction of these salvaged patients will still need a curative colectomy but may be exposed to the negative impact of prolonged immunosuppression, chronic illness, and a higher probability to require 3 rather than 2 operations. Proctocolectomy with ileo-anal pouch anastomosis-performed in 1, 2, or 3 steps depending on the patient's condition-remains the surgical procedure of choice. Even though it has its share of possible complications, it has been associated with excellent long-term outcomes and high levels of satisfaction, such that in the majority of patients they become indistinguishable from unaffected normal individuals. The current data demonstrate that use of medical salvage therapy in the treatment of UC will likely continue to grow and evolve. Consensus is being developed to better define and predict failure of medical

  13. Indications and Contraindications to Reconstructive Surgery in Ulcerative Colitis

    Directory of Open Access Journals (Sweden)

    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

  14. Vedolizumab: toward a personalized therapy paradigm for people with ulcerative colitis

    Directory of Open Access Journals (Sweden)

    Dart RJ

    2017-03-01

    Full Text Available Robin J Dart,1–3,* Mark A Samaan,1,* Nick Powell,1,4 Peter M Irving1 1Department of Gastroenterology, IBD Centre, St. Thomas’ Hospital, 2Immunosurveillance Laboratory, The Francis Crick Institute, London, 3Division of Immunology, Infection, and Inflammatory Disease (DIIID, King’s College London, 4Department of Experimental Immunobiology, Division of Transplantation and Mucosal Biology, King’s College London, London, UK *These authors contributed equally to this work Abstract: Ulcerative colitis (UC is a chronic relapsing and remitting inflammatory bowel disease, with a characteristic leukocytic infiltration of the mucosa. Immunosuppression including anti-TNF-α therapy is a mainstay of treatment for many; however, systemic immunosuppression is not universally effective and is associated with potential side effects. The gut-tropic integrin α4β7, which is expressed on leukocytes, mediates migration from the circulation to the intestinal mucosa. Vedolizumab is a monoclonal antibody which blocks the egress of leukocytes via α4β7, preventing accumulation in the mucosa, and attenuating inflammation without systemic immunosuppression. Vedolizumab has been evaluated in UC in a phase III trial, demonstrating efficacy as both an induction and a maintenance agent. In this article, we review the clinical trial data and also explore the growing body of “real-world” effectiveness data, investigating response and remission rates of vedolizumab in clinical practice. In addition, we review the increasing volume of data supporting the reassuring safety profile associated with vedolizumab. Keywords: vedolizumab, ulcerative colitis, personalized therapy

  15. Food intolerance prevalence in active ulcerative colitis in southwest China.

    Science.gov (United States)

    Ma, Xinling; Chen, Yuke; Huang, Fangyan; Luo, Qianying; Lv, Hui; Long, Hua

    2016-01-01

    Food intolerance is believed to be a source of frequent medical problems in ulcerative colitis (UC), which closely correlate with patients' dietary pattern. Living in an underdeveloped area of China, residents in southwestern region have diverse dietary habits. The objective of this study is to determine the prevalence of food intolerance in the UC patients in this area and to discuss some of the possible risk factors leading to the condition. Food antibodies in serum of 80 patients with active UC were determined by standard enzyme-linked immuno sorbent assay (ELISA). This study examined the risk factors contributing to high titers of food antibodies and the dietary patterns correlating with food intolerance in these demographics. 83.8% of patients (67/80) were found to be seropositive for food intolerance. Patients of female, aged between 20 to 40 and the one who tended to have a high fat diet were tested to be highly seropositive (pintolerance (p>0.05). Active UC patients in southwestern region of China have showed to be high seropositive in food intolerance, particularly in female and young patients. Dietary patterns with high in fat intake seem to have caused high prevalence of seropositivity in food intolerance. Although rice has been taken as staple food and the spicy food has been popular among citizen in this region, these foods have indicated to no effect on food intolerance in this study.

  16. Magnetic resonance colonography in severe attacks of ulcerative colitis

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  17. Cytomegalovirus and ulcerative colitis: Place of antiviral therapy.

    Science.gov (United States)

    Pillet, Sylvie; Pozzetto, Bruno; Roblin, Xavier

    2016-02-14

    The link between cytomegalovirus (CMV) infection and inflammatory bowel diseases remains an important subject of debate. CMV infection is frequent in ulcerative colitis (UC) and has been shown to be potentially harmful. CMV reactivation needs to be diagnosed using methods that include in situ detection of viral markers by immunohistochemistry or by nucleic acid amplification techniques. Determination of the density of infection using quantitative tools (numbers of infected cells or copies of the genome) is particularly important. Although CMV reactivation can be considered as an innocent bystander in active flare-ups of refractory UC, an increasing number of studies suggest a deleterious role of CMV in this situation. The presence of colonic CMV infection is possibly linked to a decreased response to steroids and other immunosuppressive agents. Some treatments, notably steroids and cyclosporine A, have been shown to favor CMV reactivation, which seems not to be the case for therapies using anti-tumor necrosis factor drugs. According to these findings, in flare-ups of refractory UC, it is now recommended to look for the presence of CMV reactivation by using quantitative tools in colonic biopsies and to treat them with ganciclovir in cases of high viral load or severe disease.

  18. 5-ASA in ulcerative colitis: Improving treatment compliance

    Science.gov (United States)

    Prantera, Cosimo; Rizzi, Marina

    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®), 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. PMID:19764084

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

    Directory of Open Access Journals (Sweden)

    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.

  20. Ulcerative colitis and Crohn's disease tissue cytotoxins

    Energy Technology Data Exchange (ETDEWEB)

    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.

  1. Butyrate increases colonocyte protein synthesis in ulcerative colitis.

    Science.gov (United States)

    Frankel, W; Lew, J; Su, B; Bain, A; Klurfeld, D; Einhorn, E; MacDermott, R P; Rombeau, J

    1994-07-01

    Butyrate promotes epithelial cell healing and improves symptoms when administered rectally in patients with distal ulcerative colitis (UC). It was hypothesized that butyrate may enhance healing in patients with UC by stimulating colonocyte proliferation and/or protein production. Mucosa from the descending colon was obtained from patients with UC (n = 5), Crohn's disease (n = 8), diverticulitis (n = 6), and cancer (normal tissue 10 cm from tumor; n = 10). Epithelial cells were isolated using dispase/collagenase and differential sedimentation and incubated for 4 hr at 37 degrees C with either Na butyrate (10 mM) or NaCl (10 mM). Protein synthesis was assessed by [14C]leucine incorporation and proliferation was determined with [3H]thymidine. Mean viability and purity were >88%. Spontaneous proliferation was significantly increased in UC when compared to diverticulitis and normal controls. Butyrate significantly increased protein synthesis in UC epithelial cells when compared to saline control. The therapeutic effects of butyrate in patients with UC may be due to its use by epithelial cells as a metabolic fuel to increase protein production and promote healing.

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

    Science.gov (United States)

    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. 2014 BMJ Publishing Group Ltd.

  3. Herbal medicine in the treatment of ulcerative colitis.

    Science.gov (United States)

    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.

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

    LENUS (Irish Health Repository)

    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.

  5. ADALIMUMAB FOR ULCERATIVE COLITIS: RESULTS OF A BRAZILIAN MULTICENTER OBSERVATIONAL STUDY

    Directory of Open Access Journals (Sweden)

    Patrícia ZACHARIAS

    2017-10-01

    Full Text Available ABSTRACT BACKGROUND: Adalimumab is a monoclonal antibody, tumor necrosis factor-alpha (TNFα inhibitor that has efficacy for inducing and maintaining remission in moderate-to-severe ulcerative colitis. Real world studies with adalimumab in Latin American ulcerative colitis patients are scarce. OBJECTIVE: To assess the clinical remission rates in induction and maintenance with adalimumab therapy in ulcerative colitis. METHODS: Observational, multicenter and retrospective study on a case series of patients with moderate-to-severe ulcerative colitis under adalimumab therapy. The variables analyzed were: demographic data, previous infliximab status, concomitant drugs, the Montreal Classification, disease activity (Mayo score at weeks 0, 8, 26 and 52, or until the last follow-up. Clinical remission was defined as a partial Mayo score ≤2 and Last observation carried forward (LOCF and Non responder imputation (NRI analysis were used. RESULTS: Thirty-six patients were included in the study. With LOCF analysis, remission rates at weeks 8, 26 e 52 were of 41.7%, 47.2% and 47.2%, respectively. With NRI analysis, remission rates at weeks 8, 26 and 52 were of 41.7%, 41.7% and 27.8%, respectively. CONCLUSION: Adalimumab was effective in the treatment of moderate-to-severe ulcerative colitis. Clinical remission was observed in approximately 40% of the patients at weeks 8 and 26, and in almost a quarter of the patients after 1 year of follow up.

  6. Challenges in the diagnosis of ulcerative colitis with concomitant bacterial infections and chronic infectious colitis.

    Directory of Open Access Journals (Sweden)

    Wei-Chen Lin

    Full Text Available Ulcerative colitis (UC is a chronic inflammation of the large bowel characterized by diarrhea and a negative stool culture. However, several enteropathogens have been implicated as causative agents in UC. The differentiation between chronic infectious colitis (IC and UC with concurrent infection is difficult owing to their similar clinical presentations. The study aimed to explore the presentations and diagnostic clues that enable differentiation between UC with concomitant infections and chronic IC. The study included 17 UC patients with a bacterial infection and 46 with chronic IC. The UC patients (47 ± 19 years were younger than the chronic IC patients (58 ± 20 years (P = 0.022. Bloody diarrhea was more common in UC than in chronic IC (58.8% vs 10.9%, P < 0.001. Previous antibiotic usage was a risk factor for chronic IC (5.9% vs 32.6%, P = 0.031. Malignancy was a common comorbidity of chronic IC (5.9% vs 34.8%, P = 0.022. UC patients had lower antibiotic response rates than chronic IC patients (60.0% vs 87.2%, P = 0.026. Aeromonas species and Clostridium difficile were common in both groups. Histological features of cryptitis and crypt abscess were useful in the diagnosis of UC (P = 0.052 and P = 0.016, respectively. Bloody diarrhea in a young adult, decreased response to antibiotic treatment, and results of endoscopy with biopsy are important features in the diagnosis of UC with bacterial infection.

  7. The Role of Centralized Reading of Endoscopy in a Randomized Controlled Trial of Mesalamine for Ulcerative Colitis

    DEFF Research Database (Denmark)

    Feagan, Brian G; Sandborn, William J; D'Haens, Geert

    2013-01-01

    Interobserver differences in endoscopic assessments contribute to variations in rates of response to placebo in ulcerative colitis (UC) trials. We investigated whether centralized review of images could reduce these variations.......Interobserver differences in endoscopic assessments contribute to variations in rates of response to placebo in ulcerative colitis (UC) trials. We investigated whether centralized review of images could reduce these variations....

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

    DEFF Research Database (Denmark)

    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...

  9. The effect of calendula officinalis in therapy of acetic Acid induced ulcerative colitis in dog as an animal model.

    Science.gov (United States)

    Mehrabani, D; Ziaei, M; Hosseini, S V; Ghahramani, L; Bananzadeh, A M; Ashraf, M J; Amini, A; Amini, M; Tanideh, N

    2011-12-01

    In patients with ulcerative colitis (UC), the repeated cycle of injury and repair of intestinal mucosa has been reported to increase the risk of colon cancer. So, a safe and efficient therapy is required for the treatment and prophylaxis for the disease.This study aims to investigate the efficacy of Calendula officinalis extract in treatment of experimentally induced ulcerative colitis in dog animal model. During fall 2010, 10 out-bred female German dogs (1-2 years old; weighs of 20-25 kg) were enrolled. Ulcerative colitis was induced with 6% acetic acid as enema and method of treatment was retrograde (via enema) too by C. officinalis. Loose stools, diarrhea, gross bleeding and loss of body weight happened after administration of acetic acid and crypt damage, loss of epithelium, infiltration of inflammatory cells and depletion of goblet cells were noticed histologically. C. officinalis could successfully resolve the damages of UC. Treatment with C. officinalis can broaden the current therapy options for UC.

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

    DEFF Research Database (Denmark)

    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...

  11. Long-term Efficacy of Vedolizumab for Ulcerative Colitis.

    Science.gov (United States)

    Loftus, Edward V; Colombel, Jean-Frédéric; Feagan, Brian G; Vermeire, Severine; Sandborn, William J; Sands, Bruce E; Danese, Silvio; D'Haens, Geert R; Kaser, Arthur; Panaccione, Remo; Rubin, David T; Shafran, Ira; McAuliffe, Megan; Kaviya, Arpeat; Sankoh, Serap; Mody, Reema; Abhyankar, Brihad; Smyth, Michael

    2017-04-01

    The GEMINI long-term safety [LTS] study is a continuing phase 3 trial investigating the safety and efficacy of vedolizumab, an α4β7 integrin antagonist for ulcerative colitis [UC] and Crohn's disease. We provide an interim analysis of efficacy in patients with UC. Patients from the C13004 and GEMINI 1 studies and a cohort of vedolizumab-naïve patients received open-label vedolizumab every 4 weeks. Interim data were collected from May 22, 2009 to June 27, 2013. Clinical response and remission, evaluated using partial Mayo scores, and health-related quality of life [HRQL] were assessed for up to 152 weeks of cumulative treatment in the efficacy population. As of June 27, 2013, 63% of the efficacy population [n = 532/845] were continuing treatment. Among patients who responded to vedolizumab induction and had data available, 88% [n = 120/136] were in remission after 104 weeks of exposure (96% [n = 70/73] after 152 weeks). Among patients who withdrew from every-8-week vedolizumab maintenance in GEMINI 1 [n = 32] before week 52, increased dosing to every 4 weeks in GEMINI LTS resulted in response and remission rates of 41% and 28%, respectively, after 52 weeks, an increase from 19% and 6%, respectively, from before the dose increase. Similar benefits were demonstrated regardless of prior tumour necrosis factor-antagonist exposure. Durable benefits on HRQL were also observed. Patients with UC experienced clinical and HRQL improvements with continued vedolizumab treatment. Increased dosing frequency to every 4 weeks was beneficial in patients who had loss of response to 8-weekly dosing.

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

    Science.gov (United States)

    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.

  13. Reduced total serum bilirubin levels are associated with ulcerative colitis.

    Directory of Open Access Journals (Sweden)

    Kathleen M Schieffer

    Full Text Available Chronic inflammation associated with inflammatory bowel disease (IBD results in increased oxidative stress that damages the colonic microenvironment. Low levels of serum bilirubin, an endogenous antioxidant, have been associated with increased risk for Crohn's disease (CD. Therefore, the aim of this study was to examine whether total serum bilirubin levels are associated with ulcerative colitis (UC. We identified a retrospective case-control population (n = 6,649 from a single tertiary care center, Penn State Hershey Medical Center (PSU and a validation cohort (n = 1,996 from Virginia Commonwealth University Medical Center (VCU. Cases were age- and sex-matched to controls (PSU: CD n = 254, UC n = 187; VCU: CD n = 233, UC n = 124. Total serum bilirubin levels were obtained from de-identified medical records and segregated into quartiles. Logistic regression analysis was performed on each quartile of total serum bilirubin compared to the last quartile (highest bilirubin levels to determine the association of total serum bilirubin with UC. Similar to CD patients, UC patients demonstrated reduced levels of total serum bilirubin compared to controls at PSU and VCU. The lowest quartile of total serum bilirubin was independently associated with UC for the PSU (OR: 1.98 [95% CI: 1.09-3.63] and VCU cohorts (OR: 6.07 [95% CI: 3.01-12.75]. Lower levels of the antioxidant bilirubin may reduce the capability of UC patients to remove reactive oxygen species leading to an increase in intestinal injury. Therapeutics that reduce oxidative stress may be beneficial for these patients.

  14. Postoperative complications following colectomy for ulcerative colitis: A validation study

    Directory of Open Access Journals (Sweden)

    Ma Christopher

    2012-04-01

    Full Text Available Abstract Background Ulcerative colitis (UC patients failing medical management require colectomy. This study compares risk estimates for predictors of postoperative complication derived from administrative data against that of chart review and evaluates the accuracy of administrative coding for this population. Methods Hospital administrative databases were used to identify adults with UC undergoing colectomy from 1996–2007. Medical charts were reviewed and regression analyses comparing chart versus administrative data were performed to assess the effect of age, emergent operation, and Charlson comorbidities on the occurrence of postoperative complications. Sensitivity, specificity, and positive/negative predictive values of administrative coding for identifying the study population, Charlson comorbidities, and postoperative complications were assessed. Results Compared to chart review, administrative data estimated a higher magnitude of effect for emergent admission (OR 2.52 [95% CI: 1.80–3.52] versus 1.49 [1.06–2.09] and Charlson comorbidities (OR 2.91 [1.86–4.56] versus 1.50 [1.05–2.15] as predictors of postoperative complications. Administrative data correctly identified UC and colectomy in 85.9% of cases. The administrative database was 37% sensitive in identifying patients with ≥ 1Charlson comorbidity. Restricting analysis to active comorbidities increased the sensitivity to 63%. The sensitivity of identifying patients with at least one postoperative complication was 68%; restricting analysis to more severe complications improved the sensitivity to 84%. Conclusions Administrative data identified the same risk factors for postoperative complications as chart review, but overestimated the magnitude of risk. This discrepancy may be explained by coding inaccuracies that selectively identifying the most serious complications and comorbidities.

  15. Enterohepatic helicobacter in ulcerative colitis: potential pathogenic entities?

    Directory of Open Access Journals (Sweden)

    John M Thomson

    2011-02-01

    Full Text Available Changes in bacterial populations termed "dysbiosis" are thought central to ulcerative colitis (UC pathogenesis. In particular, the possibility that novel Helicobacter organisms play a role in human UC has been debated but not comprehensively investigated. The aim of this study was to develop a molecular approach to investigate the presence of Helicobacter organisms in adults with and without UC.A dual molecular approach to detect Helicobacter was developed. Oligonucleotide probes against the genus Helicobacter were designed and optimised alongside a validation of published H. pylori probes. A comprehensive evaluation of Helicobacter genus and H. pylori PCR primers was also undertaken. The combined approach was then assessed in a range of gastrointestinal samples prior to assessment of a UC cohort. Archival colonic samples were available from 106 individuals for FISH analysis (57 with UC and 49 non-IBD controls. A further 118 individuals were collected prospectively for dual FISH and PCR analysis (86 UC and 32 non-IBD controls. An additional 27 non-IBD controls were available for PCR analysis. All Helicobacter PCR-positive samples were sequenced. The association between Helicobacter and each study group was statistically analysed using the Pearson Chi Squared 2 tailed test. Helicobacter genus PCR positivity was significantly higher in UC than controls (32 of 77 versus 11 of 59, p = 0.004. Sequence analysis indicated enterohepatic Helicobacter species prevalence was significantly higher in the UC group compared to the control group (30 of 77 versus 2 of 59, p<0.0001. PCR and FISH results were concordant in 74 (67.9% of subjects. The majority of discordant results were attributable to a higher positivity rate with FISH than PCR.Helicobacter organisms warrant consideration as potential pathogenic entities in UC. Isolation of these organisms from colonic tissue is needed to enable interrogation of pathogenicity against established criteria.

  16. Patient Preferences for Surgical Versus Medical Therapy for Ulcerative Colitis

    Science.gov (United States)

    Bewtra, Meenakshi; Kilambi, Vikram; Fairchild, Angelyn O.; Siegel, Corey A.; Lewis, James D.; Johnson, F. Reed

    2014-01-01

    Background Therapy options for mesalamine-refractory ulcerative colitis (UC) include immunosuppressive medications or surgery. Chronic immunosuppressive therapy increases risks of infection and cancer, whereas surgery produces a permanent change in bowel function. We sought to quantify the willingness of patients with UC to accept the risks of chronic immunosuppression to avoid colectomy. Methods We conducted a state-of-the-art discrete-choice experiment among 293 patients with UC who were offered a choice of medication or surgical treatments with different features. Random parameters logit was used to estimate patients’ willingness to accept trade-offs among treatment features in selecting surgery versus medical treatment. Results A desire to avoid surgery and the surgery type (ostomy versus J-pouch) influenced patients’ choices more than a specified range of 10-year mortality risks from lymphoma or infection, or disease activity (mild versus remission). To avoid an ostomy, patients were willing to accept a >5% 10-year risk of dying from lymphoma or infection from medical therapy, regardless of medication efficacy. However, data on patients’ stated choice indicated perceived equivalence between J-pouch surgery and incompletely effective medical therapy. Patient characteristics and disease history influenced patients’ preferences regarding surgery versus medical therapy. Conclusions Patients with UC are willing to accept relatively high risks of fatal complications from medical therapy to avoid a permanent ostomy and to achieve durable clinical remission. However, patients view J-pouch surgery, but not permanent ileostomy, as an acceptable therapy for refractory UC in which medical therapy is unable to induce a durable remission. PMID:24280881

  17. [Triple immunosuppressive therapy in the treatment of severe ulcerative colitis].

    Science.gov (United States)

    Castro, B; Crespo, J; García-Suárez, C; Fábrega, E; Casafont, F; Pons-Romero, F

    2004-01-01

    Severe episodes of steroid-refractory ulcerative colitis (UC) were considered an indication for surgery until the introduction of new immunosuppressive agents such as cyclosporine. 1) To confirm the efficacy of intravenous cyclosporine in inducing remission in severe episodes of steroid-refractory UC; 2) To analyze the efficacy of triple immunosuppressive therapy with cyclosporine, azathioprine and prednisone in the maintenance of remission induced by intravenous cyclosporine. Fourteen patients diagnosed with a severe episode of steroid-refractory UC were treated with intravenous cyclosporine at a dose of 4 mg/kg/day. In all patients, after response was induced, this regimen was substituted by oral cyclosporine plus azathioprine at a dose of 2-2.5 mg/kg/day and decreasing doses of corticoids. Neoral cyclosporine was progressively reduced until discontinuation within 3 months, coinciding with a simultaneous decrease of oral steroids. All patients showed response to intravenous cyclosporine with a significant reduction in the Truelove index calculated before and after treatment. After remission was induced, all patients followed triple immunosuppressive therapy for 3 months. In the follow-up for a mean of 24 months (range: 14-34) only two patients required admission for a new episode of UC and colectomy was finally indicated in only one. None of the 14 patients treated with cyclosporine showed severe adverse effects attributable to the drug. Intravenous cyclosporine is a safe and effective alternative in the treatment of severe episodes of steroid-refractory UC. Early initiation of oral administration associated with azathioprine is useful in maintaining response, reducing subsequent relapses and the need for colectomy during the follow-up of these patients.

  18. Seronegative spondyloarthropathies and allergic diseases in patients with ulcerative colitis

    Directory of Open Access Journals (Sweden)

    F. Ayala

    2011-09-01

    Full Text Available Seronegative spondyloarthropathy (SpA and allergic diseases are frequently observed in Ulcerative Colitis (UC. The aim of this study was to evaluate possible relationships between SpA, allergic contact dermatitis (ACD and IgE-mediated allergic disease (AD in patients with UC. Fifty consecutive UC patients were graded with clinical, endoscopic and histologic activity scores and classified on the basis of Rachmilewitz and Truelove & Richard criteria. The rheumatologic evaluation included history and physical examination. Axial and peripheral joint involvement was confirmed by radiographic and scintiscan examination. SpA was diagnosed according to the ESSG criteria. The allergologic evaluation included personal history of allergy, prick and patch exposition to airborne, food and contact allergens. AD was confirmed by specific provocation tests, while ACD was determined by using the European Standard Series. Fifty healthy subjects served as controls. Fourteen patients (28% and 1 control subject (2% showed SpA (p<0.001. Diagnosis of rhinitis, conjunctivitis or asthma was made in 19 patients (38% and 6 controls (12% (p=0.01, while ACD was found in 10 (20% and 3 (6% (p=0.03, respectively. Only 2 patients had a concurrence of SpA and AD (p=0.03, while SpA and ACD coexisted in 5 (p=n.s.. No patients contemporarily showed AD and ACD (p=0.008. Notwithstanding the high frequency of AD, SpA and ACD found in UC, the concurrence of AD with SpA or ACD is an unusual finding, while SpA and ACD may coexist. These data seem to indicate that AD and SpA, as well as AD and ACD, are strongly polarized conditions tending to mutual exclusion.

  19. Indirect costs of inflammatory bowel diseases: Crohn's disease and ulcerative colitis. A systematic review.

    Science.gov (United States)

    Kawalec, Paweł

    2016-04-01

    Crohn's disease and ulcerative colitis are lifelong illnesses which have a significant impact on quality of life and personal burden through a reduction in the ability to work, sick leave and restrictions of leisure time. The aim of this study was to conduct a systematic review of the indirect costs of Crohn's disease and ulcerative colitis. The search was carried out in Medline, EMBASE, the Centre for Reviews and Dissemination, and reference lists of identified articles and reference lists of identified articles were also handsearched. All costs were adjusted to 2013 USD values by using the consumer price index and purchasing power parity. Identified studies were then analysed in order to assess their heterogeneity and possibility of inclusion in the meta-analysis. Eleven of the identified publications presented indirect costs of Crohn's disease or ulcerative colitis. The range of estimated yearly indirect costs per patient was large, from $1 159.09 for loss of earnings to $14 135.64 for lost productivity and sick leave for Crohn's disease. The values for ulcerative colitis ranged from $926.49 to $6 583.17. Because of the imprecise definition of methods of indirect cost calculations as well as heterogeneity of indirect cost components, a meta-analysis was not performed. The indirect costs of ulcerative colitis seem to be slightly lower than in the case of Crohn's disease. A small number of studies referring to indirect costs of Crohn's disease and ulcerative colitis were identified, which indicates the need to conduct further investigations on this problem.

  20. Advances in treatment of ulcerative colitis with herbs: from bench to bedside.

    Science.gov (United States)

    Wan, Ping; Chen, Hao; Guo, Yuan; Bai, Ai-Ping

    2014-10-21

    Ulcerative colitis (UC), an idiopathic inflammatory disorder in the colon, has become a clinical challenge, owing to the increasing incidence and poor prognosis. The conventional treatments for UC including aminosalicylates, corticosteroids, and immunosuppressants, induce remission in only half of patients. Meanwhile, the treatments often come with serious side effects which can be life-threatening. Herbal medicine, one of the most common traditional Chinese medicine modalities, has been introduced for centuries into clinical treatment of many human diseases such as infections and functional disorders. Recently, the potential effectiveness of herbs has been suggested as the treatment of UC, as shown by a variety of clinical trials and experimental studies. The herbs reported in the literature include aloe vera gel, butyrate, tormentil extracts, wheat grass juice, and curcumin. In the review, bioactivity of the herbs and their involvement in UC treatment are discussed.

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

    DEFF Research Database (Denmark)

    Pedersen, G.; Brynskov, Jørn

    2010-01-01

    for 14 days. RESULTS: PPAR gamma expression was fourfold reduced in epithelial cells from inflamed compared with uninflamed mucosa and controls. Adipophillin levels were decreased in parallel. Rosiglitazone induced a concentration-dependent increase in adipophillin levels and restored PPAR gamma activity...... 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 ... gamma activation in vivo. CONCLUSIONS: Roziglitasone enemas improve impaired PPAR gamma activity in inflamed colonic epithelium and have beneficial clinical effect in patients with active distal ulcerative colitis. These findings raise interest in further studies of PPAR gamma ligands that exhibit...

  2. Refractory urticarial vasculitis as a complication of ulcerative colitis successfully treated with rituximab.

    Science.gov (United States)

    Swaminath, Arun; Magro, Cynthia M; Dwyer, Edward

    2011-08-01

    Ulcerative colitis can be complicated by the development of leukocytoclastic vasculitis, a cutaneous vasculitis with the potential for systemic involvement. We present a man with a history of ulcerative colitis complicated by end-stage liver disease secondary to sclerosing cholangitis requiring a liver transplant. The patient developed new-onset vasculitis and diarrhea refractory to therapy with standard immunosuppression. He was treated with anti-CD20 therapy with a positive response. The basis of the vasculitis was likely one related to an underlying monoclonal paraprotein with cryoprecitable properties. Treatment with anti-B-cell therapy may be a new treatment option for patients with gammopathy-associated leukocytoclastic vasculitis.

  3. Sex Differences in Experimentally Induced Colitis in Mice: a Role for Estrogens.

    Science.gov (United States)

    Bábíčková, Janka; Tóthová, Ľubomíra; Lengyelová, Eva; Bartoňová, Anastázie; Hodosy, Július; Gardlík, Roman; Celec, Peter

    2015-10-01

    Sex differences have been found in the incidence and progression of inflammatory bowel diseases (IBD) such as ulcerative colitis and Crohn's disease. The reported differences in observational studies are controversial, and the effects of sex hormones on the pathogenesis of IBD are not clear. The aim of this study was to analyze sex differences in the progression of experimentally induced colitis. Experimental colitis was induced in adult mice by adding 2% dextran sodium sulfate (DSS) into drinking water. Male and female mice were used as intact, gonadectomized, and supplemented with either estradiol or testosterone. In comparison to males, female mice with induced colitis had significantly longer colon (p < 0.05), lower decrease in body weight (p < 0.001), and lower stool consistency score (p < 0.05). Histopathological analysis showed less inflammatory infiltrates (p < 0.001) and crypt damage (p < 0.001) in female mice. Female mice with colitis had also lower concentration of TNF-α in colon homogenates (p < 0.01). Supplementation with estradiol in ovariectomized mice ameliorated the severity of colitis. Female mice are partially protected against chemically induced colitis. This protection seems to be mediated by estradiol.

  4. [Difficulties at work and work motivation of ulcerative colitis suffers].

    Science.gov (United States)

    Nasu, Ayami; Yamada, Kazuko; Morioka, Ikuharu

    2015-01-01

    Because ulcerative colitis (UC) repeats remission and relapse, it is necessary to keep the condition at the relapse time in mind when considering support to provide UC suffers with at the workplace. The aim of this survey was to clarify the difficulties at work and work motivation that UC suffers feel at present and experience at the worsening time, and the factors for maintaining work motivation. We carried out an anonymous questionnaire survey of patients with present or past work experience. The difficulties at work (17 items) and work motivation (4 items) in the past week and at the time when the symptoms were most intensive during work were investigated using a newly designed questionnaire. We regarded the time in the past week as the present, and the time when the symptoms were most intensive during work as the worsening time. There were 70 respondents (response rate 32.0%). Their mean age was 43.8 years, and their mean age at onset was 33.8 years. All subjects, except 2 subjects after surgery, took medicine. Fifty-three (75.7%) of the subjects were in remission at the present, and most of them (91.4%) managed their physical condition well. Difficulties at work that many subjects worried about at the present were relevant to work conditions, such as "Others at workplace do not understand having an intractable and relapsing disease" (41.4%) or "Feel delayed or lack of chance of promotion or career advancement due to the disease" (38.6%). At the worsening time, the management of physical condition went wrong, and the frequency of hospital visits was increased, but few subjects consulted with superiors or colleagues at workplace. Difficulties at work that many subjects underwent at the worsening time were relevant to symptoms, such as "Feel physically tired" (80.0%) or "Decline foods or alcoholic beverages offered at business parties" (72.9%). Those who maintained work motivation even at the worsening time received no work-related consideration and had an

  5. Gender-related and city- and countryside-related differences in patients with ulcerative colitis in a Chinese population.

    Science.gov (United States)

    Bai, Aiping; Guo, Yuan; Shen, Yuhuan; Xie, Yong; Lu, Nonghua

    2008-01-01

    The purpose of this study is to determine gender-related and city- and countryside-related differences of ulcerative colitis in a Chinese population, and to determine information on the role of lifestyle in the onset of ulcerative colitis. Patients with a diagnosis of ulcerative colitis established between Jan 2000 and Dec 2007 were investigated according to the age, gender and inductive factors of onset. Assessment of living condition of the patients was performed according to the place of living: city or countryside. Statistical analysis was performed using the chi-square test. A total of 293 ulcerative colitis patients were involved in the study. The onset age of the rural patients was earlier than that of the urban patients (p=0.00295), while there was no difference in onset age between male and female patients (p=0.067995). Some inductive factors, such as psychological stress, fatigue, cold catching, and spicy or unwashed food, may contribute to the progress of ulcerative colitis. Both gender-related and city- and countryside-related differences were found in the expression of ulcerative colitis in the Chinese population. Lifestyle factors such as psychological stress and fatigue may contribute to the expression of ulcerative colitis.

  6. Systematic Review and Meta-analysis: Placebo Rates in Induction and Maintenance Trials of Ulcerative Colitis

    NARCIS (Netherlands)

    Jairath, Vipul; Zou, Guangyong; Parker, Claire E.; Macdonald, John K.; Mosli, Mahmoud H.; Khanna, Reena; Shackelton, Lisa M.; Vandervoort, Margaret K.; AlAmeel, Turki; Al Beshir, Mohammad; AlMadi, Majid; Al-Taweel, Talal; Atkinson, Nathan S. S.; Biswas, Sujata; Chapman, Thomas P.; Dulai, Parambir S.; Glaire, Mark A.; Hoekman, Daniel; Koutsoumpas, Andreas; Minas, Elizabeth; Samaan, Mark A.; Travis, Simon; D'Haens, Geert; Levesque, Barrett G.; Sandborn, William J.; Feagan, Brian G.

    2016-01-01

    Minimisation of the placebo responses in randomised controlled trials [RCTs] is essential for efficient evaluation of new interventions. Placebo rates have been high in ulcerative colitis [UC] clinical trials, and factors influencing this are poorly understood. We quantify placebo response and

  7. Systematic review: second-generation vs. conventional corticosteroids for induction of remission in ulcerative colitis

    NARCIS (Netherlands)

    D'Haens, G.

    2016-01-01

    Oral corticosteroids are the mainstay treatment for induction of ulcerative colitis remission in patients failing or intolerant to aminosalicylate therapy, but the poor tolerability profile of these drugs limits their usefulness. Second-generation, gut-selective corticosteroids may offer a safe

  8. A patient with hereditary hemochromatosis, ulcerative colitis, and primary sclerosing cholangitis: genetic aspects

    NARCIS (Netherlands)

    Ponsioen, C. Y.; Stokkers, P. C.; van der Horst, A. R.; Tytgat, G. N.; van Deventer, S. J.

    2001-01-01

    This report describes a family in which the rare combination of hereditary hemochromatosis, ulcerative colitis and primary sclerosing cholangitis was found. Subsequent to the index patient, who had all three diseases, a screening was done in his parents and siblings that included HLA-DR, HLA-DQ and

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

    NARCIS (Netherlands)

    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

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

    NARCIS (Netherlands)

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

    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,

  11. Effects of active and passive smoking on disease course of Crohn's disease and ulcerative colitis

    NARCIS (Netherlands)

    van der Heide, Frans; Dijkstra, Arie; Weersma, Rinse K.; Albersnagel, Frans A.; van der Logt, Elise M. J.; Faber, Kloos Nico; Sluiter, Wim J.; Kleibeuker, Jan H.; Dijkstra, Gerard

    Background: Smoking is a remarkable risk factor for inflammatory bowel disease (IBD). aggravating Crohn's disease (CD) while having beneficial effects On Ulcerative colitis (UC). We Studied the effects of active and passive smoking in Dutch IBD patients. Methods: A questionnaire focusing Oil

  12. Systematic Review and Meta-analysis: Fecal Microbiota Transplantation for Treatment of Active Ulcerative Colitis

    NARCIS (Netherlands)

    Narula, Neeraj; Kassam, Zain; Yuan, Yuhong; Colombel, Jean-Frederic; Ponsioen, Cyriel; Reinisch, Walter; Moayyedi, Paul

    2017-01-01

    Background: Changes in the colonic microbiota may play a role in the pathogenesis of ulcerative colitis (UC) and restoration of healthy gut microbiota may ameliorate disease. A systematic review and meta-analysis was conducted to assess fecal microbiota transplantation (FMT) as a treatment for

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

    Directory of Open Access Journals (Sweden)

    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.

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

    DEFF Research Database (Denmark)

    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...

  15. Pouch Failures Following Ileal Pouch-anal Anastomosis for Ulcerative Colitis

    DEFF Research Database (Denmark)

    Mark-Christensen, Anders; Erichsen, Rune; Brandsborg, Søren

    2018-01-01

    BACKGROUND: The ileal pouch-anal anastomosis is a procedure offered to patients with ulcerative colitis who opt for restoration of bowel continuity. The aim of this study was to determine the risk of pouch failure and ascertain risk factors associated with failure. METHOD: 1,991 patients with ulc......BACKGROUND: The ileal pouch-anal anastomosis is a procedure offered to patients with ulcerative colitis who opt for restoration of bowel continuity. The aim of this study was to determine the risk of pouch failure and ascertain risk factors associated with failure. METHOD: 1,991 patients...... with ulcerative colitis operated with ileal pouch-anal anastomosis in Denmark in the period 1980-2013 were included. Pouch failure was defined as excision of the pouch or presence of a stoma un-reversed within one year after its creation. We used Cox proportional hazards regression to explore the association....... high-volume 2.30, 95% CI: 1.26-4.20) were also associated with a higher risk of failure. The risk of failure was not associated with calendar year, primary sclerosing cholangitis, synchronous colectomy, or laparoscopy. CONCLUSION: In a cohort of patients with ulcerative colitis and ileal pouch...

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

    DEFF Research Database (Denmark)

    Seidelin, Jakob B; Nielsen, Ole H

    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...

  17. Mucosal Barrier Depletion and Loss of Bacterial Diversity are Primary Abnormalities in Paediatric Ulcerative Colitis.

    Science.gov (United States)

    Alipour, Misagh; Zaidi, Deenaz; Valcheva, Rosica; Jovel, Juan; Martínez, Inés; Sergi, Consolato; Walter, Jens; Mason, Andrew L; Wong, Gane Ka-Shu; Dieleman, Levinus A; Carroll, Matthew W; Huynh, Hien Q; Wine, Eytan

    2016-04-01

    Ulcerative colitis [UC] is associated with colonic mucosa barrier defects and bacterial dysbiosis, but these features may simply be the result of inflammation. Therefore, we sought to assess whether these features are inherently abrogated in the terminal ileum [TI] of UC patients, where inflammation is absent. TI biopsies from paediatric inflammatory bowel disease [IBD] subsets [Crohn's disease [CD; n = 13] and UC [n = 10

  18. Protective effects of two Astragalus species on ulcerative colitis in rats

    African Journals Online (AJOL)

    Purpose: To investigate the anti-inflammatory activities of root extracts of Astragalus gummifera and. Astragalus kurdicus, as well as their protective effects against acetic acid-induced ulcerative colitis (UC) in rats. Methods: The roots of both species were shade-dried, pulverized to fine powder and extracted with 80.

  19. Radiologic and endoscopic diagnosis of ulcerative colitis and Crohn's disease

    Energy Technology Data Exchange (ETDEWEB)

    Pausch, J.; Holstege, A.; Brambs, J.

    1986-02-01

    The indication for radiologic or endoscopic examinations in ulcerative colitis and Crohn's disease depends on the stage of the disease. Advantages of the colonoscopy are the possibility of observation of colour and the avoidance of X-rays in the management of young patients. Radiology is superior to endoscopy in estimating shortening of the bowel, stenoses and fistulas. (orig.).

  20. Expression profiling of apoptosis-related genes in enterocytes isolated from patients with ulcerative colitis

    DEFF Research Database (Denmark)

    Seidelin, Jakob B; Nielsen, Ole H

    2013-01-01

    in normal and inflamed colonic epithelial cells. An apoptosis-specific gene array expression profiling system of 96 genes was used to determine the expression profile of apoptosis-related genes. Epithelial cells isolated from three patients with active ulcerative colitis were pooled and compared to pooled...

  1. Does infliximab prevent colectomy in acute and chronic active ulcerative colitis?

    DEFF Research Database (Denmark)

    Dan-Nielsen, Steffen; Wewer, Anne Vibeke; Paerregaard, Anders

    2014-01-01

    OBJECTIVES: The aim of the study was to evaluate clinical response, use of colectomy, and adverse events related to infliximab (IFX) treatment in acute and chronic active ulcerative colitis (UC) in children. METHODS: Children from 3 centers, who had received IFX for UC, were identified, and patie...

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

    DEFF Research Database (Denmark)

    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...

  3. Findings From a Randomized Controlled Trial of Fecal Transplantation for Patients With Ulcerative Colitis

    NARCIS (Netherlands)

    Rossen, Noortje G.; Fuentes, Susana; van der Spek, Mirjam J.; Tijssen, Jan G.; Hartman, Jorn H. A.; Duflou, Ann; Löwenberg, Mark; van den Brink, Gijs R.; Mathus-Vliegen, Elisabeth M. H.; de Vos, Willem M.; Zoetendal, Erwin G.; D'Haens, Geert R.; Ponsioen, Cyriel Y.

    2015-01-01

    Several case series have reported the effects of fecal microbiota transplantation (FMT) for ulcerative colitis (UC). We assessed the efficacy and safety of FMT for patients with UC in a double-blind randomized trial. Patients with mild to moderately active UC (n = 50) were assigned to groups that

  4. Microbial shifts and signatures of long-term remission in ulcerative colitis after faecal microbiota transplantation

    NARCIS (Netherlands)

    Fuentes Enriquez de Salamanca, Susana; Rossen, Noortje G.; Spek, van der Mirjam J.; Hartman, Jorn H.A.; Huuskonen, Laura; Korpela, Katri; Salojärvi, Jarkko; Aalvink, Steven; Vos, de Willem M.; Haens, D' Geert R.; Zoetendal, Erwin G.

    2017-01-01

    Faecal microbiota transplantation (FMT) may contribute towards disease remission in ulcerative colitis (UC), but it is unknown which factors determine long-term effect of treatment. Here, we aimed to identify bacterial signatures associated with sustained remission. To this end, samples from

  5. Microbial shifts and signatures of long-term remission in ulcerative colitis after faecal microbiota transplantation

    NARCIS (Netherlands)

    Fuentes, Susana; Rossen, Noortje G.; van der Spek, Mirjam J.; Hartman, Jorn Ha; Huuskonen, Laura; Korpela, Katri; Salojärvi, Jarkko; Aalvink, Steven; de Vos, Willem M.; D'Haens, Geert R.; Zoetendal, Erwin G.; Ponsioen, Cyriel Y.

    2017-01-01

    Faecal microbiota transplantation (FMT) may contribute towards disease remission in ulcerative colitis (UC), but it is unknown which factors determine long-term effect of treatment. Here, we aimed to identify bacterial signatures associated with sustained remission. To this end, samples from healthy

  6. Findings from a Randomized Controlled Trial of Fecal Transplantation for Patients with Ulcerative Colitis

    NARCIS (Netherlands)

    Rossen, N.G.; Fuentes Enriquez de Salamanca, S.; Spek, van der M.J.; Tijssen, J.; Hartman, J.H.A.; Duflou, A.; Löwenberg, M.; Brink, van den G.R.; Mathus-Vliegen, E.M.; Vos, de W.M.; Zoetendal, E.G.; Haens, D' G.R.; Ponsioen, C.Y.

    2015-01-01

    BACKGROUND: & Aims: Several case series have reported the effects of fecal microbiota transplantation (FMT) for ulcerative colitis (UC). We assessed the efficacy and safety of FMT for patients with UC in a double-blind randomized trial. METHODS: Patients with mild to moderately active UC (n=50)

  7. Clinical outcome of adalimumab therapy in patients with ulcerative colitis previously treated with infliximab

    DEFF Research Database (Denmark)

    Christensen, Katrine Risager; Steenholdt, Casper; Brynskov, Jørn

    2015-01-01

    clinical outcomes of ADL therapy in a clinical setting where infliximab (IFX) had been used as first choice of anti-TNF agent, and followed by ADL as second line agent. METHODS: Retrospective, observational single-center cohort study including all ulcerative colitis patients treated with ADL at a tertiary...

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

    NARCIS (Netherlands)

    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

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

    DEFF Research Database (Denmark)

    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...

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

    Directory of Open Access Journals (Sweden)

    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.

  11. Dietary intake, neutrophil fatty acid profile, serum antioxidant vitamins and oxygen radical absorbance capacity in patients with ulcerative colitis.

    Science.gov (United States)

    Kawakami, Yuko; Okada, Hiroyuki; Murakami, Yasuko; Kawakami, Takayo; Ueda, Yukiko; Kunii, Daisuke; Sakamoto, Yachiyo; Shiratori, Yasushi; Okita, Misako

    2007-04-01

    Nutrition may play an important role in the pathogenesis and treatment of ulcerative colitis. Several studies suggest an association between dietary factors and the onset of ulcerative colitis; however, only few studies have examined the relationship between dietary intake and relapse of ulcerative colitis. The aim of this study was to assess the dietary intake and antioxidative capacity of ulcerative colitis patients and to elucidate the efficacy of dietary therapy for ulcerative colitis. Dietary intake, fatty acid composition of phospholipids in plasma and neutrophils, serum fat-soluble vitamin levels, and oxygen radical absorbance capacity were analyzed in 29 ulcerative colitis patients (7 males and 22 females), who were treated at the Department of Gastroenterology, Okayama University Hospital. Total fat intake, fat energy ratio and linoleic acid intake were significantly lower, while protein and carbohydrate intakes were significantly higher, in the patients than age- and sex-matched controls. In the neutrophil phospholipids of ulcerative colitis patients, significantly higher levels of linoleic aicd and arachidonic acid and a lower level of eicosapentaenoic acid were observed. The concentrations of serum retinol and beta-carotene but not alpha-tocopherol were significantly lower and serum oxygen radical absorbance capacity was also lower than in the controls. Significant correlations between serum oxygen radical absorbance capacity and retinol (r = 0.567, p = 0.0031), alpha-tocopherol (r = 0.560, p = 0.0036) and beta-carotene (r = 0.440, p = 0.0279) concentrations were observed in the ulcerative colitis patients. A diet restricting the intake of linoleic acid and supplemented with eicosapentaenoic acid and antioxidative vitamins may be recommendable for the nutritional management of ulcerative colitis patients.

  12. Induction infliximab levels among patients with acute severe ulcerative colitis compared with patients with moderately severe ulcerative colitis.

    Science.gov (United States)

    Ungar, B; Mazor, Y; Weisshof, R; Yanai, H; Ron, Y; Goren, I; Waizbard, A; Yavzori, M; Fudim, E; Picard, O; Loebstein, R; Kopylov, U; Dotan, I; Chowers, Y; Eliakim, R; Ben-Horin, S

    2016-06-01

    Infliximab is effective as salvage therapy for patients with steroid refractory acute severe ulcerative colitis (UC). Although current data suggest that the pharmacokinetics of infliximab are influenced by inflammatory burden in patients with acute severe UC, data comparing infliximab trough levels in patients with acute severe UC vs. moderately severe UC are scarce. To compare infliximab trough and anti-infliximab antibody levels at a standard fixed time-point during induction between patients with acute severe and moderately severe UC. A multi-centre retrospective study comparing infliximab drug and antibody levels 14 days after the first infusion in hospitalised acute severe UC versus out-patients with moderately severe UC was performed. Sixteen acute severe UC patients, hospitalised between 2010-2015 and refractory to intravenous corticosteroids, were treated with infliximab 5 mg/kg salvage therapy. They were compared to 16 moderately severe UC out-patient controls. Mean infliximab trough levels at day 14 were significantly lower in patients with acute severe UC compared to moderately severe UC (7.15 ± 5.3 vs. 14.4 ± 11.2 μg/mL, P = 0.007). Seven patients (three acute severe and four moderate severe UC) were primary nonresponders to infliximab induction therapy. Infliximab level at day 14 did not differ between responders and nonresponders (9.8 ± 9 vs. 12.1 ± 10.6 μg/mL, respectively, P = N.S.). However, week 2 median antibody-to-infliximab levels were numerically higher among primary nonresponders (3.4 ± 5.7 vs. 1.2 ± 4 μg/mL-eq, respectively, P = 0.06). Infliximab trough levels at day 14 were lower in patients with acute severe UC compared to moderately severe UC, possibly due to a higher inflammatory burden and/or increased drug clearance. However, drug levels at day 14 were not lower among nonresponders compared with responders. Controlled trials are warranted to examine whether an a-priori-intensified infliximab induction protocol will lead to an

  13. Rarity of adenomatous polyps in ulcerative colitis and its implications for colonic carcinogenesis.

    Science.gov (United States)

    Ben-Horin, Shomron; Izhaki, Ziv; Haj-Natur, Ola; Segev, Shlomo; Eliakim, Rami; Avidan, Benjamin

    2016-03-01

    Despite ample research on the dysplasia to carcinoma risk in ulcerative colitis, there are scant data on the prevalence of adenomatous polyps in this population. The number and histology of all polyps detected at colonoscopies of ulcerative colitis patients aged > 50 during 2006 - 2012 were compared with similarly aged controls undergoing screening colonoscopy. There were 206 patients with ulcerative colitis and 624 controls included in the study (mean age 61.7 ± 8.7 vs. 60.8 ± 6.1, respectively; P = 0.15). Adenomatous polyps were detected in only 13/206 colonoscopies for ulcerative colitis compared with 162 /624 controls (6.3 % vs. 25.9 %, respectively; odds ratio [OR] 0.19, 95 % confidence interval [CI] 0.1 - 0.34; P  50 years, the rate of ever-adenomas in small-bowel Crohn's disease was similar to the controls (P = 0.8) and not influenced by 5-aminosalicylic acid use, whereas patients with colonic Crohn's disease had a significantly lower rate of adenomas compared with the controls (3.9 % vs. 25.9 %; P = 0.002). Unlike patients with small-bowel Crohn's disease, patients with ulcerative colitis or with colonic Crohn's disease seldom develop sporadic adenomatous polyps. These data may provide novel clues to a possible role for colonic immune activation in restricting the adenoma to carcinoma sequence while propagating the dysplasia to carcinoma pathway. © Georg Thieme Verlag KG Stuttgart · New York.

  14. Influence of dietary isoflavone intake on gastrointestinal symptoms in ulcerative colitis individuals in remission.

    Science.gov (United States)

    Głąbska, Dominika; Guzek, Dominika; Grudzińska, Dominika; Lech, Gustaw

    2017-08-07

    To analyse the association between isoflavone intake and ulcerative colitis motility symptoms in individuals in remission. Cross-sectional study was conducted in a group of ulcerative colitis remission individuals, in sub-groups characterised by various intestinal motility and functioning characteristics (abdominal pain, flatulence, constipations, tenesmus). Total of 56 individuals with ulcerative colitis in remission (19 males and 37 females) were recruited for the study. 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 d of the weekend). The daily isoflavone intake (daidzein, genistein, glycitein and total isoflavones) and daily isoflavone intake per 1000 kcal of diet were assessed. No correlations between isoflavone intake levels and number of bowel movements per day were observed both in the case of intake and intake per 1000 kcal of diet. In the group of individuals declaring lack of abdominal pain, the higher intakes of daidzein ( P = 0.0075), daidzein per 1000 kcal of diet ( P = 0.0358) and total isoflavone ( P = 0.0358) were stated, than in the group of individuals declaring abdominal pain. In the group of individuals declaring lack of constipations, the lower intakes of glycitein ( P = 0.0213) and glycitein per 1000 kcal of diet ( P = 0.0213) were stated, than in the group of individuals declaring presence of constipations. No differences were observed in isoflavone intake between groups of ulcerative colitis individuals declaring lack of flatulence and declaring presence of flatulence, as well as between groups declaring lack of tenesmus and declaring presence of tenesmus. The moderate dietary isoflavone intake may be beneficial for individuals with ulcerative colitis in remission, however, before including it into recommendations, further prospective studies are needed.

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

    Science.gov (United States)

    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.

  16. Concomitant herpes simplex virus colitis and hepatitis in a man with ulcerative colitis: Case report and review of the literature.

    Science.gov (United States)

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

    2016-10-01

    Herpesvirus infections often complicate the clinical course of patients with inflammatory bowel disease; however, invasive disease due to herpes simplex virus is distinctly uncommon. 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. 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. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  19. Dysplasia-Associated Polypoid Mucosal Lesion in a Pelvic Pouch after Restorative Proctocolectomy for Ulcerative Colitis

    Directory of Open Access Journals (Sweden)

    Hugh Freeman

    2001-01-01

    Full Text Available A 32-year-old man with ulcerative colitis had a colectomy for toxic colitis. Later, a rectal mucosectomy was performed along with the creation of a pelvic pouch. In 1998, approximately 10 years after this staged restorative proctocolectomy was completed, endoscopic examination of the pelvic pouch detected a small mucosal polypoid mass lesion. Although the lesion had the macroscopic appearance of an inflammatory polyp, microscopic sections of the resected lesion revealed dysplastic changes. Endoscopic polypectomy was performed to remove the lesion, and further histological surveillance examinations of the pelvic pouch have not detected additional dysplastic mucosal changes.

  20. Infliximab Salvage Therapy after Cyclosporine in an Acute Flare of Chronic Ulcerative Colitis

    Directory of Open Access Journals (Sweden)

    ECS Lam

    2003-01-01

    Full Text Available Although infliximab (Remicade, Schering Canada Inc, Quebec therapy has been well studied in steroid refractory Crohn’s disease, its use remains controversial in chronic ulcerative colitis. A 24-year-old woman with a 14-year history of well controlled left sided ulcerative colitis presented with an acute flare. Clinical, endoscopic and biopsy evidence of an acute flare of ulcerative pancolitis were present. There was no response to intravenous steroids but improvement was seen after receiving 14 days of intravenous cyclosporine (4 mg/kg/day continuous infusion. The patient was discharged from hospital with azathioprine (2.5 mg/kg/day and low dose oral cyclosporine (4 mg/kg/day. She presented with worsening symptoms seven days after discharge. Because of the patient’s unwillingness for surgery, she instead received two injections of infliximab 5 mg/kg at week 0 and week 2. An initial response occurred, but her clinical improvement was not durable. Colectomy was performed four weeks later. This is the first report of infliximab as a salvage therapy in an acute flare of chronic ulcerative colitis following failure of cyclosporine.

  1. Morphological study on colonic pathology in ulcerative colitis treated by moxibustion.

    Science.gov (United States)

    Wu, Huan-Gan; Zhou, Li-Bin; Shi, Da-Ren; Liu, Shi-Min; Liu, Hui-Rong; Zhang, Bi-Meng; Chen, Han-Ping; Zhang, Lin-Shan

    2000-12-01

    AIM:To observe the therapeutic effect of moxibustion on ulcerative colitis and its influence on the colonic mucosal morphology.METHODS:Forty-six patients with ulcerative colitis were randomly divided into the moxibustion with herbal medicine underneath group and the western medicine group. Thirty patients were treated with the above moxibustion and 16 patients with Salicylaye fapyridine (SASP).The colonic mucosa of 13 patients in the moxibustion group was observed by colonoscopy before and after the treatment. Mucin was also analyzed by H.E and AB-PAS staining.RESULTS:Seventeen patients were clinically cured,12 were improved and 1 unchanged in the moxibustion group. In the control group, 5 patients were clinically cured,7 improved and 4 unchanged. Thirteen patients with active UC were taken as the subjects for histopathologic analysis in this study. The colonic mucosal lesions were remarkably improved and the characteristic of the mucin also changed. In most sections, the chronic inflammation of mucosa was geatly ameliorated (Pcrypt paracrypt abscess or mucosal ulceration was seen(Pcure of ulcerative colitis by moxibustion with herbal medicine beneath is superior to that by SASP. This sort of moxibustion can effectively improve the colonic mucosal lesions and restore the proportion of mucoprotein to near normal.

  2. Impact on Experimental Colitis of Vitamin D Receptor Deletion in Intestinal Epithelial or Myeloid Cells.

    Science.gov (United States)

    Leyssens, Carlien; Verlinden, Lieve; De Hertogh, Gert; Kato, Shigeaki; Gysemans, Conny; Mathieu, Chantal; Carmeliet, Geert; Verstuyf, Annemieke

    2017-07-01

    Inflammatory bowel diseases are gastrointestinal diseases that include Crohn disease and ulcerative colitis. The chronic inflammation is thought to result from an excessive inflammatory response to environmental factors such as luminal bacteria in genetically predisposed individuals. Studies have revealed that mice with impaired vitamin D signaling are more susceptible to experimental colitis. To better understand the contribution of vitamin D signaling in different cells of the gut to this disease, we investigated the effects of intestinal-specific or myeloid vitamin D receptor deletion. Our study addressed the importance of vitamin D receptor expression in intestinal epithelial cells using intestine-specific vitamin D receptor null mice and the contribution of vitamin D receptor expression in macrophages and granulocytes using myeloid-specific vitamin D receptor null mice in a dextran sodium sulfate model for experimental colitis. Loss of intestinal vitamin D receptor expression had no substantial effect on the clinical parameters of colitis and did not manifestly change mucosal cytokine expression. Inactivation of the vitamin D receptor in macrophages and granulocytes marginally affected colitis-associated symptoms but resulted in increased proinflammatory cytokine and increased β-defensin-1 expression in the colon descendens of mice with colitis. Intestinal deletion of the vitamin D receptor did not aggravate symptoms of chemically induced colitis. Loss of the vitamin D receptor in macrophages and granulocytes mildly affected colitis-associated symptoms but greatly increased proinflammatory cytokine expression in the inflamed colon, suggesting a prominent role for innate immune cell vitamin D signaling in controlling gut inflammation. Copyright © 2017 Endocrine Society.

  3. An unusual complication in ulcerative colitis during treatment with azathioprine and infliximab: Isospora belli as ‘Casus belli’

    OpenAIRE

    Stein, Juergen; Tannich, Egbert; Hartmann, Franz

    2013-01-01

    The treatment of ulcerative colitis is based on systemic corticosteroids, immunomodulators such as cyclosporine and azathioprine and TNF-α antagonists. Patients undergoing such immunosuppressive treatment are more susceptible for infectious pathogens. Here, we report the case of a patient with a 13-year history of ulcerative colitis, treated initially with systemic corticosteroids in combination with immunomodulators, and subsequently with infliximab. The patient presented with severe watery ...

  4. Postpartum complications in a patient with a previous proctocolectomy and ileo-pouch-anal anastomosis (IPAA) for ulcerative colitis

    OpenAIRE

    Spina, Vincenzo; Giovannini, Massimo; Fabiani, Cristina; Vetrano, Giuseppe; Bagolan, Pietro; Colizza, Sergio; Aleandri, Vincenzo

    2012-01-01

    This case report regards pregnancy and delivery of a patient who had undergone proctocolectomy and ileo-pouch-anal-anastomosis (IPAA) for ulcerative colitis. The patient delivered through cesarean section and experienced serious complications postpartum. Such complications have been described in association with Chron’s disease and have never been described after proctocolectomy and IPAA for ulcerative colitis. This case report suggests that the limit between these two diseases is not sharp.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    DEFF Research Database (Denmark)

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

    2002-01-01

    rectal administration of a 200-mg dose of ropivacaine- or placebo-gel by use of radioimmunoassays. For comparison with normal conditions, concentrations of neuropeptides were measured in another 19 patients with relapsing ulcerative colitis and 14 controls with non-inflamed colon. RESULTS: No significant...... 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...

  7. A Clinicopathologic Study of Oral Changes in Gastroesophageal Reflux Disease, Gastritis, and Ulcerative Colitis.

    Science.gov (United States)

    Vinesh, E; Masthan, Kmk; Kumar, M Sathish; Jeyapriya, S Marytresa; Babu, Aravindha; Thinakaran, Meera

    2016-11-01

    The aim and objectives of this study are to identify oral changes in certain gastrointestinal (GI) diseases, namely gastroesophageal reflux disease (GERD), ulcerative colitis, gastritis, and to evaluate these oral symptoms as indicators for assessing GI disorders. In this study, the oral manifestations of various GI disorders were assessed in a varying age group of 250 patients in Government Stanley Medical College and Hospital, Chennai. Out of 250 patients, 142 were affected by GERD, 99 were affected by gastritis, and 9 patients were affected by ulcerative colitis. Of these patients, 177 were males and 73 were females. Evaluation of patients with gastritis revealed that 66.7% affected with gingivitis, 19.2% with dental erosion on the palatal and lingual aspects of maxillary and mandibular teeth predominantly in the anterior region, 10.1% with periodontitis, 2% with gingival erythema. Among the patients with GERD, 44% of the cases showed dental erosion, 25.5% periodontitis, 9.9% gingivitis, 5.7% gingival erythema, 2.8% palatal erythema, 2.1% gingival ulcers, glossitis 2%, 1.4% floor of the mouth erythema, and 0.7% erythema of the tongue. Patients with ulcerative colitis showed 44.4% of gingival erythema, 33.3% of dental erosions, and 22.2% of gingival ulcers and periodontitis. In our study of 250 patients, oral manifestations were observed in 88% of the patients. Both soft tissue and hard tissue changes were evident. There was a high correlation between various GI disease and dental erosion, erythema at various sites of the oral cavity, oral ulcers, gingivitis, periodontitis, and glossitis. Careful evaluation of oral cavity may unveil many GI disorders and help the patient by providing early diagnosis, which further facilitates the prognosis.

  8. Promoter polymorphism of transforming growth factor-beta1 gene and ulcerative colitis.

    Science.gov (United States)

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

    2008-01-14

    To elucidate the possible difference in two promoter polymorphisms of the transforming growth factor-beta1 (TGF-beta1) gene (-800G > A, -509C > T) between ulcerative colitis (UC) patients and normal subjects. 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-beta1 gene (-509C > T and -800G > A) were genotyped using PCR-RFLP. 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-beta1 gene (P A of TGF-beta1 gene promoter between Iranian patients with UC and normal subjects.

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

    Science.gov (United States)

    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

    2013-01-28

    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.

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

    Directory of Open Access Journals (Sweden)

    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

  11. A case of pyoderma gangrenosum with ulcerative colitis treated with combined approach: infliximab and surgery.

    Science.gov (United States)

    Andrisani, G; Guidi, L; Papa, A; Potenza, A E; Cervelli, D; Armuzzi, A

    2013-06-01

    Pyoderma gangrenosum (PG) is an ulcerating noninfectious disease of the skin seen in 1-2% of patients with inflammatory bowel disease (IBD). The pathogenesis of PG has yet to be determined, but may be related to abnormal T cell responses and the production of TNF-α, a pathway also involved in IBD pathogenesis. Infliximab, a chimeric monoclonal antibody to TNF-α, is used to treat moderate to severe IBD and several case reports and studies suggest the efficacy of infliximab in the treatment of PG. The surgical approach to PG is reserved to a few selected cases. We report here the case of a patient with ulcerative colitis (UC) and PG localized on the left breast, treated with a simultaneous combined medical and surgical approach. Copyright © 2012 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

  12. Listeria meningitis complicating a patient with ulcerative colitis on concomitant infliximab and hydrocortisone.

    Science.gov (United States)

    Parihar, V; Maguire, S; Shahin, A; Ahmed, Z; O'Sullivan, M; Kennedy, M; Smyth, C; Farrell, R

    2016-11-01

    Infliximab, a monoclonal antibody directed against tumour necrosis factor, is an effective therapy for moderate-to-severe ulcerative colitis and Crohn's disease. Uncommonly, serious opportunistic infections have occurred in patients after infliximab administration. Here, we describe meningitis caused by Listeria monocytogenes developing in a 37-year-old man with ulcerative colitis refractory to intravenous corticosteroids 10 days after receiving his first infusion of infliximab. With the increasing use of tumour necrosis factor-α-neutralizing agents, clinicians should be aware of the risk of opportunistic infections caused by L. monocytogenes in patients with inflammatory bowel disease following infliximab treatment. The half-life of infliximab is 9.5 days; therefore, patients tend to be more susceptible in the immediate period following infusion. Patients receiving anti-TNF therapy should be advised to avoid foods such as soft cheeses and unpasteurized dairy products.

  13. Factor XIII Transglutaminase Supports the Resolution of Mucosal Damage in Experimental Colitis

    Science.gov (United States)

    Andersson, Christina; Kvist, Peter H.; McElhinney, Kathryn; Baylis, Richard; Gram, Luise K.; Pelzer, Hermann; Lauritzen, Brian; Holm, Thomas L.; Hogan, Simon; Wu, David; Turpin, Brian; Miller, Whitney; Palumbo, Joseph S.

    2015-01-01

    The thrombin-activated transglutaminase factor XIII (FXIII) that covalently crosslinks and stablizes provisional fibrin matrices is also thought to support endothelial and epithelial barrier function and to control inflammatory processes. Here, gene-targeted mice lacking the FXIII catalytic A subunit were employed to directly test the hypothesis that FXIII limits colonic pathologies associated with experimental colitis. Wildtype (WT) and FXIII-/- mice were found to be comparable in their initial development of mucosal damage following exposure to dextran sulfate sodium (DSS) challenge. However, unlike FXIII-sufficient mice, FXIII-deficient cohorts failed to efficiently resolve colonic inflammatory pathologies and mucosal damage following withdrawal of DSS. Consistent with prior evidence of ongoing coagulation factor activation and consumption in individuals with active colitis, plasma FXIII levels were markedly decreased in colitis-challenged WT mice. Treatment of colitis-challenged mice with recombinant human FXIII-A zymogen significantly mitigated weight loss, intestinal bleeding, and diarrhea, regardless of whether cohorts were FXIII-sufficient or were genetically devoid of FXIII. Similarly, both qualitative and quantitative microscopic analyses of colonic tissues revealed that exogenous FXIII improved the resolution of multiple colitis disease parameters in both FXIII-/- and WT mice. The most striking differences were seen in the resolution of mucosal ulceration, the most severe histopathological manifestation of DSS-induced colitis. These findings directly demonstrate that FXIII is a significant determinant of mucosal healing and clinical outcome following inflammatory colitis induced mucosal injury and provide a proof-of-principle that clinical interventions supporting FXIII activity may be a means to limit colitis pathology and improve resolution of mucosal damage. PMID:26098308

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

    DEFF Research Database (Denmark)

    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...... potential biomarkers, and generate a better understanding of the pathophysiology. Samples were collected from patients with active UC (n = 41), quiescent UC (n = 33), and from controls (n = 25) and analyzed by NMR spectroscopy. Data analysis was carried out by principal component analysis and orthogonal...

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

    DEFF Research Database (Denmark)

    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 inflammation....

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

    OpenAIRE

    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...

  17. Clinical, Endoscopical and Histological Correlation and Measures of Association in Ulcerative Colitis.

    Science.gov (United States)

    Fluxá, Daniela; Simian, Daniela; Flores, Lilian; Ibáñez, Patricio; Lubascher, Jaime; Figueroa, Carolina; Quera, Rodrigo; Kronberg, Udo; Pizarro, Gonzalo; Castro, Magdalena; Piottante, Antonio; Vial, María Teresa

    2017-09-26

    To determine the correlation between clinical, fecal, endoscopic and histologic activity in patients with ulcerative colitis. A correlational analytic cross-sectional study was performed in patients with ulcerative colitis who underwent colonoscopy between February and December 2016. Clinical, endoscopic, fecal and histologic activities were determined using the Partial Mayo Subscore, Endoscopic Subscore and Mayo Modified Endoscopic Subscore, Fecal Calprotectin and Geboes Score and the presence of basal plasmacytosis, respectively. Scores were analyzed with Spearman's rank correlation coefficient test. To determine the association between scores and some clinical variables and active ulcerative colitis, univariate and multivariate logistic regression were used. 105 endoscopic procedures (91 patients), were included. In 65% of the procedures, the mucosa was inflamed; however, 15% did not show histological inflammation. Endoscopic remission was observed in the other 35% of procedures; however, 22% exhibited histologic inflammation in their biopsies. Mayo Endoscopic Subscore and Mayo Modified Endoscopic Score were well correlated but were only moderately correlated with clinical and histologic scores. Further, there was a moderate correlation between Mayo Endoscopic Score and Geboes Score. Conversely, histologic scores were poorly correlated with Partial Mayo Score. Using multivariate analysis, Geboes Score and basal plasmacytosis were predictive of active disease (OR 3.05; 95% CI: 1.54-7.95 and OR 3.24; 95% CI: 1.12-9.34, respectively), whereas biological therapy usage was found to be protective factor for ulcerative colitis (OR 0.02; 95% CI: 0.00-0.64). Clinical, endoscopic and histologic activities were moderately correlated, while Geboes Score and basal plasmacytosis were predictive of endoscopically active disease. This article is protected by copyright. All rights reserved.

  18. Severe steroid-unresponsive ulcerative colitis: outcomes of restorative proctocolectomy in patients undergoing cyclosporin treatment.

    Science.gov (United States)

    Pinna-Pintor, M; Arese, P; Bona, R; Falletto, E; Schieroni, R; Villata, E; Massaioli, N; Selvaggi, P; Actis, G C; Lagget, M; Marzano, A; Ottobrelli, A; Sostegni, R; Torrani-Cerenzia, M R; Rizzetto, M

    2000-05-01

    The recent introduction of the immune suppressor cyclosporin for treatment of steroid-refractory ulcerative colitis has required surgeons to perform a colectomy in those patients who eventually fail this rescue treatment, thus raising questions as to the safety of surgery as performed in patients with a heavily manipulated immune system. To assess the rates of mortality and morbidity in this setting, we studied a cohort of consecutive patients who had surgery after failing cyclosporin for refractory ulcerative colitis at our center. Between January 1991 and December 1996, 25 patients with ulcerative colitis underwent restorative proctocolectomy performed in three steps (21 patients) and in two steps (4 patients). Seventeen of the 25 patients (68 percent) were initial nonresponders to a dose of 2 mg/kg/day of intravenous cyclosporin and underwent surgery immediately, the remaining 8 (32 percent) relapsed as outpatients on oral cyclosporin and were readmitted for surgery. There was no operative mortality. Nine patients of the 25 developed postoperative (early) complications (36 percent). The three-step operation subset had a 28 percent complication rate, the two-step 75 percent. Three patients needed reoperation. A total of 11 patients (44 percent) reported with late complications: two patients required surgical treatment, one for obstruction and one for pouch-perianal fistula. Three cases of pouchitis were recorded. No patient required pouch removal. Given the absence of postoperative mortality and a low overall complication rate, restorative proctocolectomy can safely be performed in patients who fail rescue treatment with a dose of 2 mg/kg of cyclosporin for steroid-refractory ulcerative colitis. Corollary evidence in this article hints but does not prove that the three-step procedure is safer than the two-step operation.

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

    DEFF Research Database (Denmark)

    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....

  20. Ulcerative colitis: From inflammation to cancer. Do estrogen receptors have a role?

    OpenAIRE

    Principi, Mariabeatrice; Barone, Michele; Pricci, Maria; De Tullio, Nicola; Losurdo, Giuseppe; Ierardi, Enzo; Di Leo, Alfredo

    2014-01-01

    Ulcerative colitis (UC) is a condition at increased risk for colorectal carcinoma (CRC) development. Nowadays, screening and follow-up programs are routinely performed worldwide to promote the early detection of CRCs in subjects with well known risk factors (extent, duration and severity of the disorder). The diffusion of these procedures is presumably the main reason for the marked reduction of cancer incidence and mortality in the course of UC. In addition, chemoprevention has been widely i...

  1. Assessment of the quality of patient-orientated internet information on surgery for ulcerative colitis.

    Science.gov (United States)

    Sacchi, M; Yeung, T M; Spinelli, A; Mortensen, N J

    2015-06-01

    This study examines the quality of websites providing information on ulcerative colitis, including treatment options and surgery. Two search engines (Google and Yahoo) and the search term 'surgery for ulcerative colitis' were used. The first 50 sites obtained with each search engine were assessed. Sites were evaluated for content and scored using the DISCERN instrument, which evaluates the quality of health information on treatment choices. One hundred sites were examined, of which 14 were duplicates. Of the remainder, 58 provided patient-orientated information for adults and one site provided information for surgery in children. The other 27 sites included six scientific articles, three blogs, three links, six resources for clinicians, five fora, two video links and two dead links. Of the 58 websites that provided patient information for adults, only 26 (44.8%) had been updated within the last 2 years. Only 13/58 (22.4%) were affiliated to hospitals and clinics. Most sites (38/58, 65.5%) were associated with private companies with commercial interests. Although most websites contained information on symptoms and treatment options for ulcerative colitis, 37 (63.8%) did not describe any of the risks of surgery. Overall, only seven (12.1%) websites were identified as being 'good' or 'excellent' using the DISCERN criteria. The quality of patient information on surgery for ulcerative colitis is highly variable. There is potential for internet provision of valuable information and clinicians should guide patients with to access high-quality websites. Colorectal Disease © 2014 The Association of Coloproctology of Great Britain and Ireland.

  2. Irreversible optic neuritis after infliximab treatment in a patient with ulcerative colitis.

    Science.gov (United States)

    Clemmensen, Kaare; Akrawi, Neven; Stawowy, Marek

    2015-01-01

    This article reports the first known case of permanent blindness due to irreversible unilateral optic neuritis (ON) related to infliximab (Remicade) treatment of a patient with ulcerative colitis. A young male, with a family history of inflammatory bowel disease, was diagnosed with ulcerative colitis at the age of 20. He was treated with steroids and a 5-aminosalicylic acid drug without considerable effect, and later admitted to our hospital due to a relapse during reduction of the prednisolone dosage. A new colonoscopy showed moderate ulcerative colitis activity and the patient was declared as a steroid nonresponder. A treatment of 400 mg intravenous infliximab was initiated along with 150 mg/day of azathioprine (Imurel). Three days after the second infliximab treatment the patient woke up with no vision on the left eye and with pain during ocular movement. Brain and orbitae magnetic resonance imaging showed ON on the left optical nerve without any abscess or thrombosis. The patient was treated with 1000 mg methylprednisolone (Solu-Medrol) intravenous for 3 days and afterward with 75 mg prednisolone orally without any effect. At the 3-month follow up, the patient's vision had not improved, and he was declared permanently blind on the left eye. A neurologist also examined the patient, but no abnormality or cause of the ON was found.

  3. [Ozone therapy combined with sulfasalazine delivered via a colon therapy system for treatment of ulcerative colitis].

    Science.gov (United States)

    Geng, Yan; Wang, Wei; Ma, Qiang; Peng, Li-qiong; Liang, Zhong-hui

    2010-12-01

    To assess the therapeutic effect of ozone therapy combined with sulfasalazine sulfasalazine delivered via a colon therapy system in the treatment of distal ulcerative colitis. This prospective randomized controlled clinical trial involved 54 patients with mild to moderate active distal ulcerative colitis, who were randomize into 3 groups in accordance with the inclusion criteria (n=18). Each group was given sulfasalazine at the daily dose of 2 g, and in colon therapy group and ozone therapy plus sulfasalazine therapy group, sulfasalazine was delivered via a colon therapy system on a daily basis; the control group received sulfasalazine via retention enema only. At 0, 2, and 4 weeks of the treatment, colonoscopy was performed to evaluate the disease activity, and biopsy samples were obtained at 0 and 4 weeks for histological examination. In comparison with colon therapy group and control group, ozone therapy plus colon therapy resulted in more rapid alleviation of the clinical symptoms and better histological improvement without any adverse effects. Ozone therapy combined with sulfasalazine delivered via a colon therapy system is feasible and effective for treatment of ulcerative colitis.

  4. Ulcerative Colitis and Sweet’s Syndrome: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Massud Ali

    2008-01-01

    Full Text Available A 47-year-old man with a history of ulcerative colitis on prednisone and azathioprine was admitted to the hospital with a four-day history of fever, skin rash, arthralgias and leukocytosis. A skin biopsy demonstrated neutrophilic infiltration of the dermis that was consistent with Sweet’s syndrome. He improved after several days with an increase in his prednisone and azathioprine. Sweet’s syndrome is a rare cutaneous manifestation of inflammatory bowel disease, with approximately 40 cases reported in the literature. In a previously reported case of a patient with ulcerative colitis-associated Sweet’s syndrome who was on azathioprine at the time of the skin eruption, the azathioprine was stopped, raising the possibility of drug-induced Sweet’s syndrome. In the present case, the azathioprine was actually increased with complete resolution of the skin manifestations. This would support the theory that immunosuppressive therapy is the mainstay of therapy for this condition. In conclusion, Sweet’s syndrome is a neutrophilic dermatosis that is rarely associated with ulcerative colitis. It may occur while on immunosuppressive therapy and responds to an intensification of immunosuppression.

  5. Marine hydroquinone zonarol prevents inflammation and apoptosis in dextran sulfate sodium-induced mice ulcerative colitis.

    Directory of Open Access Journals (Sweden)

    Sohsuke Yamada

    Full Text Available We previously identified an anti-inflammatory compound, zonarol, a hydroquinone isolated from the brown algae Dictyopteris undulata as a marine natural product. To ascertain the in vivo functions of zonarol, we examined the pharmacological effects of zonarol administration on dextran sulfate sodium (DSS-induced inflammation in a mouse model of ulcerative colitis (UC. Our goal is to establish a safe and effective cure for inflammatory bowel disease (IBD using zonarol.We subjected Slc:ICR mice to the administration of 2% DSS in drinking water for 14 days. At the same time, 5-aminosalicylic acid (5-ASA at a dose of 50 mg/kg (positive control and zonarol at doses of 10 and 20 mg/kg, were given orally once a day. DSS-treated animals developed symptoms similar to those of human UC, such as severe bloody diarrhea, which were evaluated by the disease activity index (DAI. Treatment with 20 mg/kg of zonarol, as well as 5-ASA, significantly suppressed the DAI score, and also led to a reduced colonic ulcer length and/or mucosal inflammatory infiltration by various immune cells, especially macrophages. Zonarol treatment significantly reduced the expression of pro-inflammatory signaling molecules, and prevented the apoptosis of intestinal epithelial cells. Finally, zonarol protected against in vitro lipopolysaccharide (LPS-induced activation in the RAW264.7 mouse macrophage cell line.This is the first report that a marine bioproduct protects against experimental UC via the inhibition of both inflammation and apoptosis, very similar to the standard-of-care sulfasalazine, a well-known prodrug that releases 5-ASA. We believe that the oral administration of zonarol might offer a better treatment for human IBDs than 5-ASA, or may be useful as an alternative/additive therapeutic strategy against UC, without any evidence of side effects.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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

  8. Proteomic Analysis of Colonic Mucosal Tissue from Tuberculous and Ulcerative Colitis Patients

    Science.gov (United States)

    Kwon, Seong-Chun; Won, Kyung Jong; Jung, Seoung Hyo; Lee, Kang Pa; Lee, Dong-Youb; Park, Eun-Seok; Kim, Bokyung; Cheon, Gab Jin

    2012-01-01

    Changes in the expression profiles of specific proteins leads to serious human diseases, including colitis. The proteomic changes related to colitis and the differential expression between tuberculous (TC) and ulcerative colitis (UC) in colon tissue from colitis patients has not been defined. We therefore performed a proteomic analysis of human TC and UC mucosal tissue. Total protein was obtained from the colon mucosal tissue of normal, TC, and UC patients, and resolved by 2-dimensional electrophoresis (2-DE). The results were analyzed with PDQuest using silver staining. We used matrix-assisted laser desorption ionization time-of-flight/time-of-flight spectrometry (MALDI TOF/TOF) to identify proteins differentially expressed in TC and UC. Of the over 1,000 proteins isolated, three in TC tissue and two in UC tissue displayed altered expression when compared to normal tissue. Moreover, two proteins were differentially expressed in a comparative analysis between TC and UC. These were identified as mutant β-actin, α-enolase and Charcot-Leyden crystal protein. In particular, the expression of α-enolase was significantly greater in TC compared with normal tissue, but decreased in comparison to UC, implying that α-enolase may represent a biomarker for differential diagnosis of TC and UC. This study therefore provides a valuable resource for the molecular and diagnostic analysis of human colitis. PMID:22802701

  9. Crohn's disease in the ileal pouch after total colectomy for ulcerative colitis: findings on pouch enemas in six patients.

    Science.gov (United States)

    Wagner-Bartak, Nicolaus A; Levine, Marc S; Rubesin, Stephen E; Laufer, Igor; Rombeau, John L; Lichtenstein, Gary R

    2005-06-01

    The purpose of this study was to describe our experience with six patients who developed Crohn's disease in the ileal pouch or distal ileum after a total proctocolectomy and ileal pouch-anal anastomosis for ulcerative colitis. Pouch enemas showed characteristic findings of Crohn's disease, including nodularity, thickened folds, ulceration, cobblestoning, strictures, sinus tracks, and fistulas to the perianal region and vagina. It is important for radiologists to be aware of the findings of Crohn's disease in the ileal pouch and distal ileum on radiographic studies of the pouch after total proctocolectomy and ileal pouch-anal anastomosis for ulcerative colitis because of the implications for patient management.

  10. 5-Aminosalicylates reduce the risk of colorectal neoplasia in patients with ulcerative colitis: an updated meta-analysis.

    Directory of Open Access Journals (Sweden)

    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.

  11. The effect of menthol on acute experimental colitis in rats.

    Science.gov (United States)

    Ghasemi-Pirbaluti, Masoumeh; Motaghi, Ehsan; Bozorgi, Homan

    2017-06-15

    Menthol is an aromatic compound with high antiinflammatory activity. The purpose of the current research is to investigate the effectiveness of menthol on acetic acid induced acute colitis in rats. Animals were injected with menthol (20 and 50 and 80mg/kg, i.p.) 24h prior to induction of colitis for 3 consecutive days. Menthol at medium and higher doses similar to dexamethasone as a reference drug significantly reduced body weight loss, macroscopic damage score, ulcer area, colon weight, colon length and improved hematocrit in rats with colitis. The histopathological examination also confirmed anti-colitic effects of menthol. Menthol also reduced significantly the colonic levels of tumor necrosis factor-α (TNF-α), interleukin 1β (IL-1β), interleukin 6 (IL-6) and myeloperoxidase (MPO) activity in inflamed colons. Thus, the findings of the current study provide evidence that menthol may be beneficial in patients suffering from acute ulcerative colitis. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Inherited determinants of Crohn's disease and ulcerative colitis phenotypes: a genetic association study

    Science.gov (United States)

    Cleynen, Isabelle; Boucher, Gabrielle; Jostins, Luke; Schumm, L Philip; Zeissig, Sebastian; Ahmad, Tariq; Andersen, Vibeke; Andrews, Jane M; Annese, Vito; Brand, Stephan; Brant, Steven R; Cho, Judy H; Daly, Mark J; Dubinsky, Marla; Duerr, Richard H; Ferguson, Lynnette R; Franke, Andre; Gearry, Richard B; Goyette, Philippe; Hakonarson, Hakon; Halfvarson, Jonas; Hov, Johannes R; Huang, Hailang; Kennedy, Nicholas A; Kupcinskas, Limas; Lawrance, Ian C; Lee, James C; Satsangi, Jack; Schreiber, Stephan; Théâtre, Emilie; van der Meulen-de Jong, Andrea E; Weersma, Rinse K; Wilson, David C; Parkes, Miles; Vermeire, Severine; Rioux, John D; Mansfield, John; Silverberg, Mark S; Radford-Smith, Graham; McGovern, Dermot P B; Barrett, Jeffrey C; Lees, Charlie W

    2016-01-01

    Summary 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–phenotype associations across 156 154 genetic variants. We generated genetic risk scores by combining information from all known inflammatory bowel disease associations to summarise the total load of genetic risk for a particular phenotype. We used these risk scores to test the hypothesis that colonic Crohn's disease, ileal Crohn's disease, and ulcerative colitis are all genetically distinct from each other, and to attempt to identify patients with a mismatch between clinical diagnosis and genetic risk profile. Findings After quality control, the primary analysis included 29 838 patients (16 902 with Crohn's disease, 12 597 with ulcerative colitis). Three loci (NOD2, MHC, and MST1 3p21) were associated with subphenotypes of inflammatory bowel disease, mainly disease location (essentially fixed over time; median follow-up of 10·5 years). Little or no genetic association with disease behaviour (which changed dramatically over time) remained after conditioning on disease location and age at onset. The genetic risk score representing all known risk alleles for

  13. A pharmacokinetic approach to model-guided design of infliximab schedules in ulcerative colitis patients

    Directory of Open Access Journals (Sweden)

    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.

  14. Effect of Niacin on Inflammation and Angiogenesis in a Murine Model of Ulcerative Colitis

    OpenAIRE

    Salem, Hesham Aly; Wadie, Walaa

    2017-01-01

    Butyrate and niacin are produced by gut microbiota, however butyrate has received most attention for its effects on colonic health. The present study aimed at exploring the effect of niacin on experimental colitis as well as throwing some light on the ability of niacin to modulate angiogenesis which plays a crucial role of in the pathogenesis of inflammatory bowel disease. Rats were given niacin for 2 weeks. On day 8, colitis was induced by intrarectal administration of iodoacetamide. Rats we...

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

    Directory of Open Access Journals (Sweden)

    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

  16. Interactive effects of ethanol on ulcerative colitis and its associated testicular dysfunction in pubertal BALB/c mice.

    Science.gov (United States)

    Adedara, Isaac A; Ajayi, Babajide O; Awogbindin, Ifeoluwa O; Farombi, Ebenezer O

    2017-11-01

    Available epidemiological reports have indicated an increase in the incidence of ulcerative colitis, as well as alcohol consumption, globally. The present study investigated the possible interactive effects of ethanol consumption on ulcerative colitis and its associated testicular dysfunction using six groups of 12 pubertal mice each. Group I (Control) mice received drinking water alone. Group II mice received ethanol alone at 5 g/kg body weight. Group III mice received 2.5% dextran sulphate sodium (DSS) in drinking water followed by normal drinking water. Groups IV, V, and VI mice received DSS followed by ethanol at 1.25, 2.5, and 5 g/kg, respectively. Administration of ethanol to mice with ulcerative colitis intensified the disease-activity index with marked reduction in colon length, colon mass index, body weight gain, and organo-somatic indices of testes and epididymis when compared with the DSS-alone group. Moreover, ethanol exacerbated colitis-mediated decrease in enzymatic and non-enzymatic antioxidants but increased the oxidative stress and inflammatory biomarkers in the testes and epididymis. The diminution in luteinizing hormone, follicle stimulating hormone, and testosterone levels was intensified following administration of ethanol to mice with ulcerative colitis that were administered 5 g/kg ethanol alone. The decrease in sperm functional parameters and testicular spermatogenic indices as well as histopathological damage in colon, testes, and epididymis was aggravated following administration of ethanol to mice with ulcerative colitis. In conclusion, the exacerbating effects of ethanol on ulcerative colitis-induced testicular dysfunction are related to increased oxidative stress and inflammation in the treated mice. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Hydroalcoholic extract of Brazilian red propolis exerts protective effects on acetic acid-induced ulcerative colitis in a rodent model.

    Science.gov (United States)

    Barbosa Bezerra, Gislaine; de Menezes de Souza, Luana; Dos Santos, Adailma Santana; de Almeida, Grace Kelly Melo; Souza, Marília Trindade Santana; Santos, Sandra Lauton; Aparecido Camargo, Enilton; Dos Santos Lima, Bruno; de Souza Araújo, Adriano Antunes; Cardoso, Juliana Cordeiro; Gomes, Silvana Vieira Floresta; Gomes, Margarete Zanardo; de Albuquerque, Ricardo Luiz Cavalcanti

    2017-01-01

    Ulcerative colitis (UC) is a common intestinal inflammatory disease with an etiology that is not well understood. Although the anti-inflammatory and anti-oxidant effects of the hydroalcoholic extract of Brazilian red propolis (HERP) have been reported in various experimental models, its protective effect in models of UC have not been evaluated. The purpose of this study was to investigate the chemopreventive effect of hydroalcoholic extract of Brazilian red propolis (HERP) in acetic acid-induced colitis (AAIC) using a rodent model. The HERP was chemically characterised by HPLC/DAD analyses. Male rats were randomly assigned into four groups: sham, vehicle (with AAIC, treated with vehicle), P10 (with AAIC, treated with 10mg/kg HERP), and P100 (with AAIC, treated with 100mg/kg HERP). Treatments were performed for 7days, and colitis was induced on day seven. Animals were euthanized 24h after colitis induction and body weight, colon length, gross and histological scores, malondialdehyde (MDA) and myeloperoxidase (MPO) concentrations in colon tissue, and the immunohistochemical expression of inducible nitric oxide synthase (iNOS) were assessed. The major compounds found in HERP were liquiritigenin (68.8mg/g), formononetin (54.29mg/g), biochanin A (30.97mg/g), and daidzein (19.90mg/g). Rats treated with 10mg/kg HERP demonstrated significant decreases in MPO concentrations, gross and histological scores of tissue damage, and iNOS expression (p<0.05). Similarly, rats treated with 100mg/kg HERP demonstrated significant decreases in MPO levels (p<0.05) and histological scores of tissue damage (p<0.05). The results of this study indicate that oral administration of HERP attenuates AAIC in rats, which may be due to anti-inflammatory effects related to iNOS inhibition. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  18. Traditional Chinese medicine combination therapy for patients with steroid-dependent ulcerative colitis: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Zheng, Kai; Shen, Hong; Jia, Jia; Lu, Yuelin; Zhu, Lei; Zhang, Lu; Shen, Zhaofeng

    2017-01-10

    Approximately 20% of patients with ulcerative colitis become steroid dependent. Azathioprine is recommended in steroid-dependent ulcerative colitis, but its side effects limit its use. Chinese herbal medicine has been widely used to treat ulcerative colitis in China. However, its effectiveness in steroid-dependent patients has not been evaluated. This study aims to investigate the efficacy of traditional Chinese medicine combination therapy with 5-aminosalicylic acid in patients with steroid-dependent ulcerative colitis. This is a parallel, multicenter, randomized controlled trial. One hundred and twenty eligible patients will be randomly assigned to a traditional Chinese medicine group or azathioprine group. All patients will be given basic treatment, which includes steroids and 5-aminosalicylic acid. Patients allocated to the traditional Chinese medicine group will receive basic treatment plus Chinese herbal medicine granules, while patients in the azathioprine group will receive basic treatment plus azathioprine. The whole study will last 24 weeks. The primary outcome measure is the steroid-free remission rate. Secondary outcome measures are health-related quality of life, efficacy of endoscopic response, degree of mucosal healing, and inflammation indicators. Results from this study may provide evidence for the effectiveness of traditional Chinese medicine combined with 5-aminosalicylic acid in patients with steroid-dependent ulcerative colitis. The findings will provide a basis for further confirmatory studies. Chinese Clinical Trial Register, ChiCTR-IPR-15005760 . Registered on 2 January 2015.

  19. Long-term safety and efficacy of budesonide in the treatment of ulcerative colitis

    Directory of Open Access Journals (Sweden)

    Iborra M

    2014-02-01

    Full Text Available Marisa Iborra,1 Diego Álvarez-Sotomayor,2 Pilar Nos1 1Gastroenterology Unit, Department of Digestive Disease, Centro de investigación biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD, La Fe University and Polytechnic Hospital, Valencia, Spain; 2Gastroenterology Unit, Department of Digestive Disease, La Fe University and Polytechnic Hospital, Valencia, Spain Abstract: Ulcerative colitis (UC is a chronic, relapsing, and remitting inflammatory disease involving the large intestine (colon. Treatment seeks to break recurrent inflammation episodes by inducing and maintaining remission. Historically, oral systemic corticosteroids played an important role in inducing remission of this chronic disease; however, their long-term use is limited and can lead to adverse events. Budesonide is a synthetic steroid with potent local anti-inflammatory effects and low systemic bioavailability due to high first-pass hepatic metabolism. Several studies have demonstrated oral budesonide's usefulness in treating active mild to moderate ileocecal Crohn's disease and microscopic colitis and in an enema formulation for left sided UC. However, there is limited information regarding oral budesonide's efficacy in UC. A novel oral budesonide formulation using a multimatrix system (budesonide-MMX to extend drug release throughout the colon has been developed recently and seems to be an effective treatment in active left sided UC patients. This article summarizes budesonide's long-term safety and efficacy in treating UC. Keywords: budesonide, ulcerative colitis, Crohn's disease, safety

  20. Pyoderma gangrenosum associated with ulcerative colitis: response to infliximab Pioderma gangrenoso asociado a colitis ulcerosa: respuesta a infliximab

    Directory of Open Access Journals (Sweden)

    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.

  1. MANAGEMENT OF ACUTE SEVERE ULCERATIVE COLITIS: A CLINICAL UPDATE.

    Science.gov (United States)

    Sobrado, Carlos Walter; Sobrado, Lucas Faraco

    2016-01-01

    Acute severe colitis is a potentially lethal medical emergency and, even today, its treatment remains a challenge for clinicians and surgeons. Intravenous corticoid therapy, which was introduced into the therapeutic arsenal in the 1950s, continues to be the first-line treatment and, for patients who are refractory to this, the rescue therapy may consist of clinical measures or emergency colectomy. To evaluate the indications for and results from drug rescue therapy (cyclosporine, infliximab and tacrolimus), and to suggest a practical guide for clinical approaches. The literature was reviewed using the Medline/PubMed, Cochrane library and SciELO databases, and additional information from institutional websites of interest, by cross-correlating the following keywords: acute severe colitis, fulminating colitis and treatment. Treatments for acute severe colitis have avoided colectomy in 60-70% of the cases, provided that they have been started early on, with multidisciplinary follow-up. Despite the adverse effects of intravenous cyclosporine, this drug has been indicated in cases of greater severity with an imminent risk of colectomy, because of its fast action, short half-life and absence of increased risk of surgical complications. Therapy using infliximab has been reserved for less severe cases and those in which immunosuppressants are being or have been used (AZA/6-MP). Indication of biological agents has recently been favored because of their ease of therapeutic use, their good short and medium-term results, the possibility of maintenance therapy and also their action as a "bridge" for immunosuppressant action (AZA/6-MP). Colectomy has been reserved for cases in which there is still no response five to seven days after rescue therapy and in cases of complications (toxic megacolon, profuse hemorrhage and perforation). Patients with a good response to rescue therapy who do not undergo emergency operations should be considered for maintenance therapy using

  2. Pre-operative use of anti-TNF-α agents and the risk of post-operative complications in patients with ulcerative colitis - a nationwide cohort study

    DEFF Research Database (Denmark)

    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)....

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

    Directory of Open Access Journals (Sweden)

    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.

  4. RNase-L deficiency exacerbates experimental colitis and colitis-associated cancer

    Science.gov (United States)

    Long, Tiha M.; ArindamChakrabarti; Ezelle, Heather J.; E. Brennan-Laun, Sarah; Raufman, Jean-Pierre; Polyakova, Irina; H. Silverman, Robert; Hassel, Bret A.

    2013-01-01

    Background The endoribonuclease RNase-L is a type-I interferon (IFN)-regulatedcomponent of the innate immune response that functions in antiviral, antibacterial and antiproliferative activities. RNase-L produces RNA agonists of RIG-I-like receptors (RLRs), sensors of cytosolic pathogen-associated RNAs that induce cytokines including IFNβ. IFNβ and RLR signaling mediate protective responses against experimental colitis and colitis-associated cancer (CAC) and contribute to gastrointestinal (GI) homeostasis. Therefore, we investigated a role for RNase-L in murine colitis and CAC and its association with RLR signaling in response to bacterial RNA. Methods Colitis was induced in wild type (WT) and RNase-L-deficient mice (RNase-L−/−) by administration of dextran sulphate sodium (DSS). CAC was induced by DSS and azoxymethane (AOM). Histological analysis and immunohistochemistry were performed on colon tissue to analyze immune cell infiltration and tissue damage following induction of colitis. Expression of cytokines was measured by qRT-PCR and ELISA. Results DSS-treated RNase-L−/− mice exhibited a significantly higher clinical score, delayed leukocyte infiltration, reduced expression of IFNβ, TNFα, IL-1β and IL-18at early times post-DSS exposure and increased mortalityas compared to WT mice. DSS/AOM-treated RNase-L−/−mice displayed an increased tumor burden. Bacterial RNA triggeredIFNβproductionin an RNase-L-dependent manner and provided a potential mechanism by whichRNase-L contributes to the GI immune response to microbiota and protects against experimental colitis and CAC. Conclusions RNase-L promotes the innate immune response to intestinal damage and ameliorates murine colitis and CAC. The RNase-L-dependent production of IFNβ stimulated by bacterial RNA may be a mechanism to protectagainst GI inflammatory disease. PMID:23567782

  5. Protective effect of marine mangrove Rhizophora apiculata on acetic acid induced experimental colitis by regulating anti-oxidant enzymes, inflammatory mediators and nuclear factor-kappa B subunits.

    Science.gov (United States)

    V, Vinod Prabhu; C, Guruvayoorappan

    2014-01-01

    Ulcerative colitis is a disease that causes inflammation and ulcer in the lining of the large intestine. In this study we investigate the effect of Rhizophora apiculata (R. apiculata) on acetic acid induced colitis in mouse model. Experimental animals were randomized into four groups: normal untreated, colitis control, R. apiculata treated group and sulfasalazine treated group. R. apiculata significantly (p<0.01) decreased macroscopic score and wet weight of damaged colon compared to colitis control. This effect was confirmed biochemically by significant (p<0.01) reduction of colitis associated increase in myeloperoxidase activity. R. apiculata significantly (p<0.05) increased anti-oxidant enzymes such as superoxide dismutase (SOD) and glutathione (GSH) levels compared to colitis control. R. apiculata significantly (p<0.01) reduced lipid peroxides (LPO), nitric oxide (NO) and inflammatory mediators such as myeloperoxidase (MPO), lactate dehydrogenase (LDH), inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2) and tumor necrosis factor-α (TNF-α) expressions compared to colitis control. R. apiculata treatment significantly (p<0.01) inhibits the translocation of NF-kB p65 and p50 subunits. Taken together these findings suggest that R. apiculata prevents acetic acid induced colitis in experimental mouse model and may serve as an excellent anti-oxidant and anti-inflammatory agent that could potentially be useful as a (natural) therapy for inflammatory bowel disease (IBD). Copyright © 2013 Elsevier B.V. All rights reserved.

  6. Methionine synthase A2756G polymorphism may predict ulcerative colitis and methylenetetrahydrofolate reductase C677T pancolitis, in Central China

    Directory of Open Access Journals (Sweden)

    Bronowicki Jean-Pierre

    2008-08-01

    Full Text Available Abstract Background The association of genetic polymorphisms related to metabolism of homocysteine with inflammatory bowel disease has been evidenced in Crohn disease and remains an open question in ulcerative colitis. We evaluated the association of the polymorphisms of MTHFR, MTR, MTRR and TCN2 genes with ulcerative colitis in Central China. Methods 168 patients were genotyped for these polymorphisms and compared to 219 matched controls. Results Methionine synthase 2756G allele frequency was higher in ulcerative colitis than in controls 0.15 (95% C.I. 0.11–0.19 vs 0.09 (95% C.I. 0.07 – 0.12, (P = 0.0137 and predicted ulcerative colitis risk in logistic regression, with an Odds ratio at 1.8 (95% C.I. 1.15–2.84. Methylenetetrahydrofolate reductase 677TT genotype was 2.7-fold more prevalent in individuals with pancolitis than in those with left colitis or proctitis, with respective percentages of 27.3 (95% C.I.16.4–42.0 and 10.5 (95% C.I. 6.3–17.1 (P = 0.0123. The carriage of 677TT or 677CT/1298AC genotypes of methylenetetrahydrofolate reductase was more frequent in cases with pancolitis than in subjects with left colitis or proctitis (P = 0.0048, with an Odds ratio adjusted by age and sex at 3.3 (95% C.I. 1.4–7.9, P = 0.0084 in logistic regression. Conclusion Methionine synthase and methylenetetrahydrofolate reductase are genes of vitamin B12 and folate cellular metabolism associated respectively with risk and extent of ulcerative colitis, at least in Central China. This finding may open new insights, particularly for the potential interest in treating patients carrying the 677TT MTHFR genetic trait and a deficit in folate.

  7. ADHESION MOLECULES IN INTESTINAL DESTRUCTIVE-INFLAMMATORY PROCESS IN THE CHILDREN WITH ULCERATIVE COLITIS

    Directory of Open Access Journals (Sweden)

    V. I. Ashkinazi

    2013-01-01

    Full Text Available Aim: to study the content of serum soluble cell adhesion molecules in children with ulcerative colitis that mediate the initial and final stages of the migration of leukocytes to the focus of inflammation: sP-selectin (soluble platelet selectin and Specam-1 (soluble platelet-endothelial cell adhesion molecule 1 as well some earlier unexplored factors associated with their level. Patients and methods: we examined 107 patients with ulcerative colitis aged from 6 up to 17 years. The diagnosis was set on the base of a comprehensive examination. The content of serum soluble adhesion molecules sP-selectin and sPECAM-1 as well cytokine status and neopterin were evaluated by ELISA. Respiratory metabolism was investigated by using chemiluminescent reactions. Results: it was shown that the content of sP-selectin and sPECAM-1 is significantly higher in patients than in the control group, which may influence on the migration of leukocytes into tissues for realization of their effector potential. It is confirmed by morphological analyses of the intestine biopsies, where it was observed the increasing of the number of leukocytes in vascular endothelium and epithelial layer. At the same time strengthening of the oxygen-dependent metabolism of neutrophils, the increase of the concentration of neopterin and tumor necrosis factor α were noted. Conclusions: the correlation of the studied adhesion molecules with a number of inflammatory markers (TNFα (tumor necrosis factor α, free radicals, neopterin was revealed, which indicates the diagnostic value of serum levels of the membrane antigens. The increase of the concentration of adhesion molecules sP-selectin and sPECAM-1 may be one of the links of the pathogenesis of ulcerative colitis

  8. Once-daily, high-concentration MMX mesalamine in active ulcerative colitis.

    Science.gov (United States)

    Kamm, Michael A; Sandborn, William J; Gassull, Miguel; Schreiber, Stefan; Jackowski, Lechoslaw; Butler, Todd; Lyne, Andrew; Stephenson, David; Palmen, Mary; Joseph, Raymond E

    2007-01-01

    SPD476 (LIALDA in the US; MEZAVANT in the EU; otherwise known as MMX mesalamine; Shire Pharmaceuticals Inc., Wayne, PA, under license from Giuliani SpA, Milan, Italy) is a novel, once-daily, high-strength (1.2 g/tablet) formulation of mesalamine, utilizing MMX Multi Matrix System (MMX) technology designed to deliver the active drug throughout the colon. We performed a double-blind, multicenter study, comparing MMX mesalamine vs placebo for the treatment of active ulcerative colitis. A delayed-release oral mesalamine (ASACOL; Procter & Gamble, Cincinnati, OH) reference arm was included. Three hundred forty-three patients with active, mild-to-moderate ulcerative colitis received MMX mesalamine 2.4 g/day or 4.8 g/day given once daily, ASACOL 2.4 g/day given in 3 divided doses, or placebo for 8 weeks. The primary end point was the proportion of patients in clinical and endoscopic remission (modified ulcerative colitis disease activity index of or =1-point reduction in sigmoidoscopy score from baseline). A significantly greater proportion of patients receiving MMX mesalamine 2.4 g/day given once daily (40.5%; P = .01) and 4.8 g/day given once daily (41.2%; P = .007) achieved clinical and endoscopic remission at week 8, vs placebo (22.1%). The clinical and endoscopic remission rate for ASACOL (32.6%; P = .124) was not significantly superior to placebo. All active treatments were well-tolerated. Once-daily MMX mesalamine was efficacious and well-tolerated for the induction of clinical and endoscopic remission. MMX mesalamine offers effective and convenient mesalamine therapy, potentially improving treatment compliance.

  9. Onset of Ulcerative Colitis after Helicobacter pylori Eradication Therapy: A Case Report.

    Science.gov (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    Jing-Mei Tuo

    2016-01-01

    Full Text Available 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.

  11. An unusual case of an ulcerative colitis flare resulting in disseminated intravascular coagulopathy and a bladder hematoma: a case report

    Directory of Open Access Journals (Sweden)

    Christie Dennis

    2004-10-01

    Full Text Available Abstract Background Disorders of coagulation have long been associated with inflammatory bowel disease. Children, as well as adults, with both active and inactive ulcerative colitis have been found to have abnormal coagulation and fibrinolysis. Disseminated intravascular coagulation arises from an overwhelming of the haemostatic regulatory mechanisms leading to an excessive generation of thrombin and a failure of the normal inhibitory pathways to prevent systemic effects of this enzyme. Ulcerative colitis has been associated with disseminated intravascular coagulation in conjunction with septicemia, toxic megacolon and surgery. Case presentation A fourteen-year-old boy with a history of poorly controlled ulcerative colitis presented with nonbilious emesis, hematochezia, and hematuria. Laboratory workup revealed disseminated intravascular coagulation. He was placed on triple antibiotics therapy. An infectious workup came back negative. A computerized tomography (CT scan of the abdomen revealed a marked thickening and irregularity of the bladder wall as well as wall thickening of the rectosigmoid, ascending, transverse, and descending colon. Patient's clinical status remained stable despite a worsening of laboratory values associated with disseminated intravascular coagulation. Patient was begun on high dose intravenous steroids with improvement of the disseminated intravascular coagulation laboratory values within 12 hours and resolution of disseminated intravascular coagulopathy within 4 days. A thorough infectious workup revealed no other causes to his disseminated intravascular coagulation. Conclusions The spectrum of hypercoagulable states associated with ulcerative colitis varies from mild to severe. Although disseminated intravascular coagulation associated with ulcerative colitis is usually related to septicemia, toxic megacolon or surgery, we present a case of an ulcerative colitis flare resulting in disseminated intravascular coagulation

  12. Intra-aortic mural thrombosis and splenic infarction in association with ulcerative colitis.

    LENUS (Irish Health Repository)

    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.

  13. Azathioprine-associated myelodysplastic syndrome in two patients with ulcerative colitis.

    Science.gov (United States)

    Ahmad, Omer F; Keane, Margaret G; McCartney, Sara; Khwaja, Asim; Bloom, Stuart L

    2013-07-01

    Azathioprine is a commonly used immunosuppressive agent in post-transplantation regimens and autoimmune diseases. An increased risk of lymphoma with thiopurine therapy in patients with inflammatory bowel disease has been described previously; however, there are few reported cases of azathioprine therapy-related myelodysplastic syndrome and acute myeloid leukaemia. We report two patients with ulcerative colitis who subsequently developed azathioprine-related myelodysplastic syndrome. It is imperative that gastroenterologists remain vigilant for this rare complication as this subset of patients has a particularly poor prognosis. These cases are also important in considering the risk of open-ended thiopurine therapy.

  14. Animal models of ulcerative colitis and their application in drug research

    Science.gov (United States)

    Low, Daren; Nguyen, Deanna D; Mizoguchi, Emiko

    2013-01-01

    The specific pathogenesis underlying inflammatory bowel disease is complex, and it is even more difficult to decipher the pathophysiology to explain for the similarities and differences between two of its major subtypes, Crohn’s disease and ulcerative colitis (UC). Animal models are indispensable to pry into mechanistic details that will facilitate better preclinical drug/therapy design to target specific components involved in the disease pathogenesis. This review focuses on common animal models that are particularly useful for the study of UC and its therapeutic strategy. Recent reports of the latest compounds, therapeutic strategies, and approaches tested on UC animal models are also discussed. PMID:24250223

  15. Randomised clinical trial: yoga vs written self-care advice for ulcerative colitis.

    Science.gov (United States)

    Cramer, H; Schäfer, M; Schöls, M; Köcke, J; Elsenbruch, S; Lauche, R; Engler, H; Dobos, G; Langhorst, J

    2017-06-01

    Perceived stress seems to be a risk factor for exacerbation of ulcerative colitis. Yoga has been shown to reduce perceived stress. To assess the efficacy and safety of yoga for improving quality of life in patients with ulcerative colitis. A total of 77 patients (75% women; 45.5 ± 11.9 years) with ulcerative colitis in clinical remission but impaired quality of life were randomly assigned to yoga (12 supervised weekly sessions of 90 min; n = 39) or written self-care advice (n = 38). Primary outcome was disease-specific quality of life (Inflammatory Bowel Disease Questionnaire). Secondary outcomes included disease activity (Rachmilewitz clinical activity index) and safety. Outcomes were assessed at weeks 12 and 24 by blinded outcome assessors. The yoga group had significantly higher disease-specific quality of life compared to the self-care group after 12 weeks (Δ = 14.6; 95% confidence interval=2.6-26.7; P = 0.018) and after 24 weeks (Δ = 16.4; 95% confidence interval=2.5-30.3; P = 0.022). Twenty-one and 12 patients in the yoga group and in the self-care group, respectively, reached a clinical relevant increase in quality of life at week 12 (P = 0.048); and 27 and 17 patients at week 24 (P = 0.030). Disease activity was lower in the yoga group compared to the self-care group after 24 weeks (Δ = -1.2; 95% confidence interval=-0.1-[-2.3]; P = 0.029). Three and one patient in the yoga group and in the self-care group, respectively, experienced serious adverse events (P = 0.317); and seven and eight patients experienced nonserious adverse events (P = 0.731). Yoga can be considered as a safe and effective ancillary intervention for patients with ulcerative colitis and impaired quality of life. ClinicalTrials.gov identifier: NCT02043600. © 2017 John Wiley & Sons Ltd.

  16. Ulcerative Colitis and Crohn's Disease Are Associated with Decreased Serum Selenium Concentrations and Increased Cardiovascular Risk.

    Science.gov (United States)

    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 nutritional (protein, albumin, prealbumin, cholinesterase and total cholesterol) and iron status-related (hemoglobin, Fe and hematocrit) parameters (p 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.

  17. ASSESSMENT OF INFLAMMATORY RESPONSE INDICATORS AND PERIPHERAL HEMOPOIESIS AT NON-SPECIFIC ULCERATIVE COLITIS IN CHILDREN

    Directory of Open Access Journals (Sweden)

    V. V. Botvinyeva

    2013-01-01

    Full Text Available The article presents the analysis of laboratory tests, which indicate the response of the body to systemic inflammation. The revealed interconnection of these parameters with peripheral hematosis alterations at chronic inflammatory diseases will allow objectively approaching the diagnostics of functional disorders at non-specific ulcerative colitis in children. The authors attempted to develop new approaches to the analysis of laboratory indicators, which will help to evaluate individual dynamics of processes at the systemic inflammatory response of the body and select adequate therapy of the primary disease.

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

    Directory of Open Access Journals (Sweden)

    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.

  19. Risk of ulcerative colitis and Crohn's disease among offspring of patients with chronic inflammatory bowel disease

    DEFF Research Database (Denmark)

    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...

  20. Effect of piperine on inhibition of FFA induced TLR4 mediated inflammation and amelioration of acetic acid induced ulcerative colitis in mice.

    Science.gov (United States)

    Gupta, Rohit A; Motiwala, Meha N; Dumore, Nitin G; Danao, Kishor R; Ganjare, Anjali B

    2015-04-22

    Piperine, a main component of Piper longum Linn. and Piper nigrum Linn., is a plant alkaloid with a long history of medicinal use. Piperine exhibits antidepressant, hepatoprotective, anti-metastatic, anti-thyroid, immunomodulatory, antitumor and anti-inflammatory activities, However its therapeutic potential in amelioration of ulcerative colitis and the underlying mechanism for anti-inflammatory activity remains unknown.The objective of the present investigation was to unravel the therapeutic potential of piperine on amelioration of IBD using acetic acid induced experimental animal model for ulcerative colitis and to determine the role of TLR4 receptor in signalling pathway of inflammatory gene expression in ulcerative colitis. We induced colitis using acetic acid (150µl of 5% once, intrarectally) in mice and estimated disease activity index (DAI), which took into account weight loss, stool consistency, and occult/gross bleeding. Colon length, spleen weights, ulcer area and ulcer index were measured; histological changes were observed by H&E staining. Effect of piperine on various antioxidant parameter of mice colon such as tissue myeloperoxidase (MPO) accumulation, SOD concentrations, reduced GSH and lipid peroxidation were determined. Pro-inflammatory mediators, namely, nitric oxide (NO), tumour necrosis factor-α (TNF-α) were determined by a TNF-α ELISA kit obtained from Thermo fisher scientific India Pvt. Ltd. Effect of piperine on haematological parameters of mice in acetic acid induced IBD was also determined which involves the estimation of FFA using a commercial free fatty acid fluorometric assay kit. Piperine significantly attenuated acetic acid induced DAI score which implies that it suppresses weight loss, diarrhoea, gross bleeding and infiltration of immune cells. Piperine administration also effectively and dose dependently prevented shortening of colon length and enlargement of spleen size. Histological examination indicated that piperine reduces

  1. Ixeris dentata NAKAI Reduces Clinical Score and HIF-1 Expression in Experimental Colitis in Mice

    Directory of Open Access Journals (Sweden)

    Dae-Seung Kim

    2013-01-01

    Full Text Available Ixeris dentata (ID is an herbal medicine used in Asian countries to treat indigestion, pneumonia, hepatitis, contusions, and tumors; however, its effect on intestinal inflammation is unknown. Thus, we investigated the effect of ID in the dextran sulfate sodium (DSS model of colitis in female BALB/c mice; animals were evaluated after seven days of DSS treatment. DSS-treated mice showed considerable clinical signs, including weight loss, reduced colon length, colonic epithelial injury, infiltration of inflammatory cells in the colon tissue, and upregulation of inflammatory mediators. However, administration of ID attenuated body weight loss, colon shortening, and the increase in disease activity index score. ID also significantly decreased the colonic mucosal injury and the number of infiltrating mast cells. Moreover, ID inhibited the expressions of cyclooxygenase-2 and hypoxia-inducible factor-1α in colon tissue. Taken together, the results provide experimental evidence that ID might be a useful therapy for patients with ulcerative colitis.

  2. Ixeris dentata NAKAI Reduces Clinical Score and HIF-1 Expression in Experimental Colitis in Mice

    Science.gov (United States)

    Ko, Jang-Ho; Jeon, Yong-Deok; Han, Yo-Han; Kim, Hyun-Ju; Poudel, Amrit; Jung, Hyun-Ju; Ku, Sae-Kwang; Kim, Su-Jin; Park, Sang-Hyun; Choi, Byung-Min; Park, Sung-Joo; Um, Jae-Young; Hong, Seung-Heon

    2013-01-01

    Ixeris dentata (ID) is an herbal medicine used in Asian countries to treat indigestion, pneumonia, hepatitis, contusions, and tumors; however, its effect on intestinal inflammation is unknown. Thus, we investigated the effect of ID in the dextran sulfate sodium (DSS) model of colitis in female BALB/c mice; animals were evaluated after seven days of DSS treatment. DSS-treated mice showed considerable clinical signs, including weight loss, reduced colon length, colonic epithelial injury, infiltration of inflammatory cells in the colon tissue, and upregulation of inflammatory mediators. However, administration of ID attenuated body weight loss, colon shortening, and the increase in disease activity index score. ID also significantly decreased the colonic mucosal injury and the number of infiltrating mast cells. Moreover, ID inhibited the expressions of cyclooxygenase-2 and hypoxia-inducible factor-1α in colon tissue. Taken together, the results provide experimental evidence that ID might be a useful therapy for patients with ulcerative colitis. PMID:24194783

  3. Alterations of testosterone metabolism in microsomes from rats with experimental colitis induced by dextran sulfate sodium.

    Science.gov (United States)

    Huang, Yanjuan; Hu, Nan; Gao, Xuejiao; Yan, Zhixiang; Li, Sai; Jing, Wanghui; Yan, Ru

    2015-05-05

    Down-regulation of some hepatic cytochrome P450s (CYP450s) was observed in patients and animals with ulcerative colitis (UC). This study examined changes of CYP450s activities in microsomes of liver (RLMs), intestine (RIMs) and kidney (RRMs) from rats with experimental acute colitis induced by 5% dextran sulfate sodium (DSS) for 7days and those receiving DSS treatment followed by 7-d cessation through measuring 6α-(CYP1A1), 7α-(CYP2A1), 16α-(CYP2C11) and 2β-/6β-(CYP3A2) hydroxytestosterone (OHT) formed from testosterone. Both pro-(IL-1β, IL-6, TNF-α) and anti-(IL-4, IL-10) inflammatory cytokines were elevated in acute colitis, while the production of the former was enhanced and that of the latter declined by DSS withdrawal. In RLMs, the CYP2A1 activity was significantly increased at DSS stimulation and partially returned to normal level when DSS treatment was terminated. Activity of other CYP450s were decreased by acute colitis and remained after DSS withdrawal. In RRMs, formations of 6α-, 16α- and 2β-OHT significantly declined in acute colitis and DSS termination further potentiated the down-regulation, while 7α-OHT formation was suppressed at DSS stimulation and remained after DSS withdrawal. The formation of 6β-OHT only showed significant decrease after DSS withdrawal. Two metabolites (6α- and 6β-OHT) formed in RIMs and 6β-OHT formation was significantly decreased by DSS stimulation and continued after DSS treatment halted. These findings indicate that the alterations of CYP450s activities vary with organ, CYP isoforms and colitis status, which arouse cautions on efficacy and toxicity of drug therapy during disease progression. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

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

    DEFF Research Database (Denmark)

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

    2002-01-01

    rectal administration of a 200-mg dose of ropivacaine- or placebo-gel by use of radioimmunoassays. For comparison with normal conditions, concentrations of neuropeptides were measured in another 19 patients with relapsing ulcerative colitis and 14 controls with non-inflamed colon.Results: No significant...... 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...

  5. High- and low-dose oral delayed-release mesalamine in children with mild-to-moderately active ulcerative colitis

    OpenAIRE

    Heyman, Melvin; Winter, HS; Krzeski, P; Heyman, MB; Ibarguen-Secchia, E; Iwanczak, B; Kaczmarski, M; Kierkus, J.; Kolaček, S; Osuntokun, B; Quiros, JA

    2014-01-01

    ABSTRACT Objective: The aim of the study was to assess the safety and efficacy of high- and low-dose oral, delayed-release mesalamine in a randomized, double-blind, active control study of children with mild-to-moderately active ulcerative colitis. Methods: Patients ages 5 to 17 years, with a Pediatric Ulcerative Colitis Activity Index (PUCAI) score of ≥10 to ≤55 and a truncated Mayo Score of ≥1 for both rectal bleeding and stool frequency, were enrolled. They received body weight–dependent d...

  6. Overlap syndrome consisting of PSC-AIH with concomitant presence of a membranous glomerulonephritis and ulcerative colitis.

    Science.gov (United States)

    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.

  7. The role of coloscopy in the differential diagnosis between idiopathic ulcerative colitis and Crohn's disease of the colon.

    Science.gov (United States)

    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.

  8. Experimental Colitis Is Attenuated by Cardioprotective Diet Supplementation That Reduces Oxidative Stress, Inflammation, and Mucosal Damage

    Directory of Open Access Journals (Sweden)

    Hilda Vargas Robles

    2016-01-01

    Full Text Available Inflammatory bowel diseases (IBD such as ulcerative colitis (UC and Crohn’s disease (CD are multifactorial, relapsing disorders of the gastrointestinal tract. However, the etiology is still poorly understood but involves altered immune responses, epithelial dysfunction, environmental factors, and nutrition. Recently, we have shown that the diet supplement corabion has cardioprotective effects due to reduction of oxidative stress and inflammation. Since oxidative stress and inflammation are also prominent risk factors in IBD, we speculated that corabion also has beneficial effects on experimental colitis. Colitis was induced in male mice by administration of 3.5% (w/v dextran sulfate sodium (DSS in drinking water for a period of 3 or 7 days with or without daily gavage feeding of corabion consisting of vitamin C, vitamin E, L-arginine, and eicosapentaenoic and docosahexaenoic acid. We found that corabion administration attenuated DSS-induced colon shortening, tissue damage, and disease activity index during the onset of colitis. Mechanistically, these effects could be explained by reduced neutrophil recruitment, oxidative stress, production of proinflammatory cytokines, and internalization of the junctional proteins ZO-1 and E-cadherin leading to less edema formation. Thus, corabion may be a useful diet supplement for the management of chronic inflammatory intestinal disorders such as IBD.

  9. Experimental Colitis Is Attenuated by Cardioprotective Diet Supplementation That Reduces Oxidative Stress, Inflammation, and Mucosal Damage.

    Science.gov (United States)

    Vargas Robles, Hilda; Citalán Madrid, Alí Francisco; García Ponce, Alexander; Silva Olivares, Angelica; Shibayama, Mineko; Betanzos, Abigail; Del Valle Mondragón, Leonardo; Nava, Porfirio; Schnoor, Michael

    2016-01-01

    Inflammatory bowel diseases (IBD) such as ulcerative colitis (UC) and Crohn's disease (CD) are multifactorial, relapsing disorders of the gastrointestinal tract. However, the etiology is still poorly understood but involves altered immune responses, epithelial dysfunction, environmental factors, and nutrition. Recently, we have shown that the diet supplement corabion has cardioprotective effects due to reduction of oxidative stress and inflammation. Since oxidative stress and inflammation are also prominent risk factors in IBD, we speculated that corabion also has beneficial effects on experimental colitis. Colitis was induced in male mice by administration of 3.5% (w/v) dextran sulfate sodium (DSS) in drinking water for a period of 3 or 7 days with or without daily gavage feeding of corabion consisting of vitamin C, vitamin E, L-arginine, and eicosapentaenoic and docosahexaenoic acid. We found that corabion administration attenuated DSS-induced colon shortening, tissue damage, and disease activity index during the onset of colitis. Mechanistically, these effects could be explained by reduced neutrophil recruitment, oxidative stress, production of proinflammatory cytokines, and internalization of the junctional proteins ZO-1 and E-cadherin leading to less edema formation. Thus, corabion may be a useful diet supplement for the management of chronic inflammatory intestinal disorders such as IBD.

  10. Evaluation of enterochromaffin cells and melatonin secretion exponents in ulcerative colitis.

    Science.gov (United States)

    Chojnacki, Cezary; Wiśniewska-Jarosińska, Maria; Kulig, Grażyna; Majsterek, Ireneusz; Reiter, Russel J; Chojnacki, Jan

    2013-06-21

    To study an assessment of the number of enterochromaffin cells and expression of hydroxyindole-O-methyltransferase in colonic mucosa and urine excretion of 6-sulfatoxymelatonin in patients with ulcerative colitis. The study included 30 healthy subjects (group I-C), 30 patients with ulcerative proctitis [group II-ulcerative proctitis (UP)] and 30 patients with ulcerative colitis [group III-ulcerative colitis (UC)] in acute phases of these diseases. The number of enterochromaffin cells (EC) was estimated in rectal and colonic mucosa. Bioptates were assembled from many different parts of the large intestine. Immunorective cells collected from various parts of the colon were counted according to the Eurovision DAKO (Dako A/S, Copenhagen, Denmark) System in the range of 10 fields in each bioptate at × 200 magnification. The level of mRNA expression of hydroxyindole-O-methyltransferase (HIOMT) in colonic mucosa was estimated with RT-PCR. Urine 6-sulfatoxymelatonin (6-HMS) excretion was determined immunoenzymatically using an IBL (IBL International GmbH, Hamburg, Germany) kit (RE 54031). The number of EC cells in healthy subjects (C) was 132.40 ± 31.26. In patients of group II (UP) and group III (UC) the number of these cells was higher--225.40 ± 37.35 (P < 0.001) and--225.24 ± 40.50 (P < 0.001) respectively. Similar differences were related to HIOMT expression, which was 1.04 ± 0.36 in group C, 1.56 ± 0.56 (P < 0.01) in group UP and 2.00 ± 0.35 (P < 0.001) in group UC. Twenty-four hour 6-HMS urinary excretion was as follows: C--6.32 ± 4.95 μg/24 h, UP - 26.30 ± 7.29 μg/24 h (P < 0.01), UC--2.30 ± 12.56 μg/24 h (P < 0.001). A correlation between number of EC cells and 6-HMS excretion was noted in all groups: r = 0.766 in patients with UP, r = 0.703 with UC and r = 0.8551 in the control group; the correlation between the results is statistically significant. In the acute phases of both UP and UC, proliferation of EC cells and high expression of HIOMT and

  11. [Acute "pseudo-angiocholitis" due to colonic adenocarcinoma in a man with primary sclerosis cholangitis and ulcerative colitis].

    Science.gov (United States)

    Coatmeur, Olivier; Rassiat, Emmanuel; Bonniaud, Pierre; Jouve, Jean-Louis; Minello, Anne; Bedenne, Laurent; Faivre, Jean; Hillon, Patrick

    2003-12-01

    We report the case of a 49-Year-old-man with primary sclerosis cholangitis (PSC) and ulcerative colitis who developed two acute episodes of pseudo-angiocholitis. Both episodes were triggered by septic hepatitis translocated from ulcerative colonic adenocarcinoma. The biliary MRI did not show any signs of lithiasis or cholangiocarcinoma. cholangiocarcinoma, intra-hepatic lithiasis and colonic cancer are potential diagnoses in patients with PSC who develop angiocholitis.

  12. Benefit–risk assessment of golimumab in the treatment of refractory ulcerative colitis

    Directory of Open Access Journals (Sweden)

    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 

  13. Initial diagnosis of Wegener’s granulomatosis mimicking severe ulcerative colitis: a case report

    Science.gov (United States)

    2013-01-01

    Introduction We describe the case of a woman with an unusual presentation of Wegener’s granulomatosis. Case presentation A 20-year old Caucasian woman presented with the principal feature of a pancolonic, superficial microulceration mimicking severe ulcerative colitis. Our patient was refractory to therapy and had persisting signs of septic shock as well as being at risk of perforation, so we performed a subtotal colectomy and a cholecystectomy due to the incipient necrosis of her gallbladder. Histologic analysis of her colon showed multiple superficial microulcera of the mucosa, lamina propria mucosae and, to a lesser extent, the lamina submucosa. The medium-sized arteries and arterioles of her entire colon, appendix and gallbladder showed acute vasculitic changes with fibrinoid necrosis of the walls and diffuse infiltration with neutrophil granulocytes, accompanied by a strong perivascular histiocyte-rich and partially granulomatous reaction. These findings strongly suggested an autoimmune multisystem disease like Wegener’s granulomatosis or microscopic polyangiitis. A diagnosis of Wegener’s granulomatosis was confirmed by the results of serologic antibody tests: her cytoplasmic antineutrophil cytoplasmic antibody titer was considerably elevated at 1:2560 specific for subclass proteinase 3 (>200kU/L). After the histopathological diagnosis and serological tests, immunosuppression with high doses of corticosteroids and plasmapheresis was started. Conclusion In critically ill patients with severe, therapy-refractory ulcerative colitis, Wegener´s granulomatosis should be considered and serologic antibody testing should be performed. PMID:23718545

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

    Directory of Open Access Journals (Sweden)

    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

  15. Variation in severity assessment and initial mesalamine dose selection for ulcerative colitis in community practice.

    Science.gov (United States)

    Sands, Bruce E; Kilgore, Karl M; Bloomfeld, Richard S; Sandborn, William J

    2006-08-01

    Ulcerative colitis treatment is based largely on anatomic extent of inflammation and severity. Clinical severity is designated by the terms mild, moderate, or severe. The aims of this study are to assess consistency between: (1) community physicians and established treatment guidelines in their respective operational definitions of severity and (2) clinical severity ratings and resulting treatment. Medical records of 411 patients who were successfully treated with mesalamine delayed release tablets without requiring steroids were reviewed. Data recorded included the prescribed dose of mesalamine, clinical symptoms, and physician's global assessment (PGA). Physicians were moderately consistent with the American College of Gastroenterology Guidelines in their assignments of PGA (kappa=0.57, Pmesalamine dose yielded tau statistics of 0.13, 0.16, and 0.14 (all P<0.001), respectively for PGA, number of stools per day and percentage of stools with blood. Ulcerative colitis treatment quality may be enhanced by promoting a more consistent terminology for disease severity and reducing the unexplained variation in treatment dosing.

  16. Quantitative Analysis of Intestinal Flora of Uygur and Han Ethnic Chinese Patients with Ulcerative Colitis.

    Science.gov (United States)

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

    Science.gov (United States)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

  19. Preventive and curative effect of Pistacia lentiscus oil in experimental colitis.

    Science.gov (United States)

    Naouar, Mustafa S; Mekki, Lilia Zouiten; Charfi, Lamia; Boubaker, Jalel; Filali, Azza

    2016-10-01

    to investigate the anti-inflammatory effect of the Pistacia lentiscus oil in experimental colitis model. Colitis was induced in male rats by instillation of 2,4,6-trinitrobenzenesulfonic acid (TNBS) in all groups. The experimental groups consisted of: 5 rats received Lentisc oil 2months before colitis induction (preventive group), 5 rats received the oil on the day of colitis induction (curative group) and 5 control rats. Lentisc oil was extracted from the ripe fruit of the plant by the cold press method and was analyzed by spectro-chromatography. Lentisc oil has been inserted with a standard diet at the dose of 30mg oil/100g of food/rat. The lentisc oil sample is composed mainly by Oleic acid (47.96%), Palmitic acid (27.94%) and Linoleic acid (20.22%).There was a significant difference between control rats and treated rats with lentisc oil concerned body mass (p=0.009), bleeding index (p=0.005 and p=0.018) and diarrhea (p=0.012). Histological examination revealed a clear difference between the control and preventive groups with disappearance of erosion, decreased of cryptitis, irregular crypts and crypt loss in the preventive group. Curative group showed a significant decrease of ulceration, hyperplasia, cryptitis, irregular crypts and crypt loss compared to the control group. There was an attenuation of inflammation in the preventive group compared to the curative group without statistically significant. Lentisc oil administration could provide a protective effect on intestinal inflammation in colitis rats induced by TNBS mainly when it is administered at a young age in preventive mode. This beneficial effect would involve a modification of arachidonic acid metabolism. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  20. Disease activity, quality of life, and indirect costs of ulcerative colitis in Poland.

    Science.gov (United States)

    Kawalec, Paweł; Stawowczyk, Ewa; Mossakowska, Małgorzata; Pilc, Andrzej

    2017-01-01

    Ulcerative colitis (UC) require expensive, lifelong treatment, which generates huge direct costs and has a significant impact on the quality of life, especially in the active state of the disease. To assess the indirect costs, health-related quality of life, and clinical characteristics of patients with UC in Poland. Additionally, we investigated the association between activity of UC and productivity loss of patients in a Polish setting. A questionnaire survey was conducted using the Patient Simple Clinical Colitis Activity Index (P-SCCAI) to assess disease activity, as well as the modified Work Productivity and Activity Impairment Questionnaire to assess productivity loss. The quality of life was presented as utility calculated with the EQ-5D-3L questionnaire. Indirect costs were assessed with the Human Capital Approach and were expressed in Polish zlotys (PLN) as well as in euros (€). Correlations were presented using the Spearman coefficient. We performed our analysis based on 202 full questionnaires collected. Mean patient age and age at disease onset were 33.14 years (standard deviation (SD): 9.90) and 26.35 years (SD: 8.89), respectively. The mean P-SCCAI score in the analysed group of patients was 8.26, and the mean utility was 0.8651. Average and median annual indirect costs per working person were €2043 and €1389 (8543 PLN and 5808 PLN), respectively, calculated using the gross domestic product, as well as €4791 and €3257 (20,026 PLN and 13,615 PLN), respectively, calculated using the gross value added. Total productivity loss was significantly correlated with the disease activity. Ulcerative colitis causes a decrease in the quality of life as well as patients' productivity loss associated with both absenteeism and with presenteeism.

  1. Heme oxygenase-1-generated biliverdin ameliorates experimental murine colitis.

    Science.gov (United States)

    Berberat, Pascal O; A-Rahim, Yousif I; Yamashita, Kenichiro; Warny, Michel M; Csizmadia, Eva; Robson, Simon C; Bach, Fritz H

    2005-04-01

    Heme oxygenase-1 (HO-1) seems to have an important protective role in acute and chronic inflammation. The products of heme catalysis, biliverdin/bilirubin, carbon monoxide (CO), and iron (that induces apoferritin) mediate the beneficial effects of HO-1. Blockade of HO-1 activity results in exacerbation of experimental colitis. We tested whether HO-1 has protective effects in the development of colitis and determined that specific enzymatic products of HO-1 are responsible for these effects. Colitis was induced by oral administration of dextran sodium sulfate (5%) to C57BL/6 mice for 7 days. HO-1 was up-regulated by cobalt-protoporphyrin (5 mg/kg, intraperitoneally). Biliverdin, exogenous CO, or the iron chelator desferrioxamine was administered to other groups. Cobalt-protoporphyrin treatment resulted in significant up-regulation of HO-1 protein in mucosal and submucosal cells. Induction of HO-1 was associated with significantly less loss of body weight in mice with induced colitis (-12% versus -22% in the control animals, P biliverdin administration (50 micromol/kg, 3 times per day, intraperitoneally). We conclude that heightened HO-1 expression or administration of biliverdin ameliorates dextran sodium sulfate-induced experimental colitis. Novel therapeutic strategies based on HO-1 and/or biliverdin administration may have use in inflammatory bowel disease.

  2. Colorectal Cancer and Precancerous Lesions Associated with Ulcerative Colitis in Thailand

    Science.gov (United States)

    Chotivitayatarakorn, Peranart; Vilaichone, Ratha-Korn

    2017-08-27

    Background: Ulcerative colitis(UC) is important risk factor of colorectal cancer. Many evidences from western countries confirmed this relationship but limited studies were reported in ASEAN. This study was aimed to investigate prevalence, clinical presentations, endoscopic findings, histopathology, disease progression and risk for colorectal cancer(CRC) of UC patients in Thailand. Methods: We conducted a retrospective cohort study using computer data base from Thammasat University Hospital, Pathumthani, Thailand between September 2011 and December 2015, follow-up through May 2016. Diagnosis of UC was confirmed by histopathology and whole clinical course. Results: We identified 6,082 patients who diagnosed with colitis during the study period. Of whom, only 22 patients(history of malnutrition was significantly higher in patients with dysplasia than those without dysplastic lesions(50%vs.0%, P-value=0.045). There was no difference in duration and disease extension between 2 groups. Interestingly, subgroup analysis demonstrated that pancolitis was significantly more common in female than male (55.6%vs.7.7%,P-value=0.02,OR=15.0, 95%CI=1.3- 169.9). Furthermore, patients’ age> 35 years had significantly more severe colitis than younger group (81.25%vs.0%, P-value=0.0006) Conclusions: Although UC is rare disease in ASEAN, precancerous lesions for CRC were not uncommon. UC with pancolitis was common in female whereas severe colitis was common in elderly patients. Proper screening program and careful surveillance for precancerous lesions in patients at risk might be appropriate approach for early detection and improvement the treatment outcome. Creative Commons Attribution License

  3. Maintenance treatment with azathioprine in ulcerative colitis: outcome and predictive factors after drug withdrawal.

    Science.gov (United States)

    Cassinotti, Andrea; Actis, Giovanni C; Duca, Piergiorgio; Massari, Alessandro; Colombo, Elisabetta; Gai, Elisa; Annese, Vito; D'Albasio, Giuseppe; Manes, Gianpiero; Travis, Simon; Porro, Gabriele Bianchi; Ardizzone, Sandro

    2009-11-01

    Whether the duration of maintenance treatment with azathioprine (AZA) affects the outcome of ulcerative colitis (UC) is unclear. We investigated clinical outcomes and any predictive factors after withdrawal of AZA in UC. In this multicenter observational retrospective study, 127 Italian UC patients, who were in steroid-free remission at the time of withdrawal of AZA, were followed-up for a median of 55 months or until relapse. The frequency of clinical relapse or colectomy after AZA withdrawal was analyzed according to demographic, clinical, and endoscopic variables. After drug withdrawal, a third of the patients relapsed within 12 months, half within 2 years and two-thirds within 5 years. After multivariable analysis, predictors of relapse after drug withdrawal were lack of sustained remission during AZA maintenance (hazard ratio, HR 2.350, confidence interval, CI 95% 1.434-3.852; P=0.001), extensive colitis (HR 1.793, CI 95% 1.064-3.023, P=0.028 vs. left-sided colitis; HR 2.024, CI 95% 1.103-3.717, P=0.023 vs. distal colitis), and treatment duration, with short treatments (3-6 months) more disadvantaged than >48-month treatments (HR 2.783, CI 95% 1.267-6.114, P=0.008). Concomitant aminosalicylates were the only predictors of sustained remission during AZA therapy (P=0.009). The overall colectomy rate was 10%. Predictors of colectomy were drug-related toxicity as the cause of AZA withdrawal (P=0.041), no post-AZA drug therapy (P=0.031), and treatment duration (P<0.0005). Discontinuation of AZA while UC is in remission is associated with a high relapse rate. Disease extent, lack of sustained remission during AZA, and discontinuation due to toxicity could stratify relapse risk. Concomitant aminosalicylates were advantageous. Prospective randomized controlled trials are needed to confirm whether treatment duration is inversely associated with outcome.

  4. Dietary and other risk factors of ulcerative colitis. A case-control study in Japan. Epidemiology Group of the Research Committee of Inflammatory Bowel Disease in Japan.

    Science.gov (United States)

    1994-09-01

    A multisite, hospital-based, case-control study examined the risk of ulcerative colitis in relation to dietary factors, smoking and drinking habits, past history of diseases, and childhood factors. Information was obtained from self-administered patient questionnaires. Study subjects included 101 ulcerative colitis patients who were 10-39 years old at the time of disease onset, which was within the previous 3 years, and 143 control subjects. Combined consumption of Western foods (bread for breakfast, butter, margarine, cheese, meats, and ham and sausage) was significantly related to an increased risk of ulcerative colitis (trend, p = 0.04). Margarine (as an individual Western food item) was positively associated with ulcerative colitis (trend, p = 0.005). There was also a tendency toward positive association of bread for breakfast with ulcerative colitis (trend, p = 0.07). The risk did not measurably vary with the consumption of typical Japanese foods, vegetables and fruits, confectioneries, or soft drinks. As compared with lifelong nonsmokers, current smokers tended to have a decreased risk of ulcerative colitis and former smokers had an increased risk. There was no association between breastfeeding in infancy and the risk of ulcerative colitis.

  5. Live birth and adverse birth outcomes in women with ulcerative colitis and Crohn's disease receiving assisted reproduction

    DEFF Research Database (Denmark)

    Nørgård, Bente Mertz; Larsen, P V; Fedder, J

    2016-01-01

    OBJECTIVE: To examine the chance of live births and adverse birth outcomes in women with ulcerative colitis (UC) and Crohn's disease (CD) compared with women without inflammatory bowel disease (IBD) who have undergone assisted reproductive technology (ART) treatments. METHODS: This was a nationwide...

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

    DEFF Research Database (Denmark)

    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 re...

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

    DEFF Research Database (Denmark)

    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...... Gastroenterol Hepatol 22: 912-916 (C) 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins...

  8. Ca2+ response in neutrophils after exposure to bacterial N-formyl-methionyl-leucyl-phenylalanine: delayed response in ulcerative colitis

    DEFF Research Database (Denmark)

    Vainer, Ben; Lamberth, Kasper; Brimnes, Jens

    2003-01-01

    In acute stages of ulcerative colitis (UC), neutrophils migrate from the circulation into inflamed colonic tissue, initiated by yet unknown stimuli. The bacterial peptide N-formyl-methionyl-leucyl-phenylalanine (FMLP) is a component of the surface membrane of colonic bacteria such as Escherichia...

  9. High- and low-dose oral delayed-release mesalamine in children with mild-to-moderately active ulcerative colitis.

    Science.gov (United States)

    Winter, Harland S; Krzeski, Piotr; Heyman, Melvin B; Ibarguen-Secchia, Eduardo; Iwanczak, Barbara; Kaczmarski, Maciej; Kierkus, Jaroslaw; Kolaček, Sanja; Osuntokun, Bankole; Quiros, J Antonio; Shah, Manoj; Yacyshyn, Bruce; Dunnmon, Preston M

    2014-12-01

    The aim of the study was to assess the safety and efficacy of high- and low-dose oral, delayed-release mesalamine in a randomized, double-blind, active control study of children with mild-to-moderately active ulcerative colitis. Patients ages 5 to 17 years, with a Pediatric Ulcerative Colitis Activity Index (PUCAI) score of ≥ 10 to ≤ 55 and a truncated Mayo Score of ≥ 1 for both rectal bleeding and stool frequency, were enrolled. They received body weight-dependent doses of oral, delayed-release mesalamine for 6 weeks in a low- (27-71 mg · g(-1) · day(-1)) or high-dose group (53-118 mg · g(-1) · day(-1)). The primary endpoint was treatment success, defined as the proportion of patients who achieved remission (PUCAI score mesalamine low- and high-dose groups, respectively (P = 0.924). Truncated Mayo Score (low-dose 30 [73%] and high-dose 28 [70%] patients) and other efficacy results did not differ between the groups. The type and severity of adverse events were consistent with those reported in previous studies of adults with ulcerative colitis and did not differ between groups. Both low- and high-dose oral, delayed-release mesalamine doses were equally effective as short-term treatment of mild-to-moderately active ulcerative colitis in children, without a specific benefit or risk to using either dose.

  10. Randomised clinical study: discrepancies between patient-reported outcomes and endoscopic appearance in moderate to severe ulcerative colitis

    NARCIS (Netherlands)

    Jharap, B.; Sandborn, W. J.; Reinisch, W.; D'Haens, G.; Robinson, A. M.; Wang, W.; Huang, B.; Lazar, A.; Thakkar, R. B.; Colombel, J.-F.

    2015-01-01

    BackgroundAssociations between patient-reported outcomes and mucosal healing have not been established in ulcerative colitis (UC). AimTo evaluate relationships of rectal bleeding and stool frequency with mucosal healing and quality of life (QoL) in patients with UC in two Phase 3 studies (ULTRA 1

  11. The role of centralized reading of endoscopy in a randomized controlled trial of mesalamine for ulcerative colitis

    NARCIS (Netherlands)

    Feagan, Brian G.; Sandborn, William J.; D'Haens, Geert; Pola, Suresh; McDonald, John W. D.; Rutgeerts, Paul; Munkholm, Pia; Mittmann, Ulrich; King, Debra; Wong, Cindy J.; Zou, Guangyong; Donner, Allan; Shackelton, Lisa M.; Gilgen, Denise; Nelson, Sigrid; Vandervoort, Margaret K.; Fahmy, Marianne; Loftus, Edward V.; Panaccione, Remo; Travis, Simon P.; van Assche, Gert A.; Vermeire, Séverine; Levesque, Barrett G.

    2013-01-01

    Interobserver differences in endoscopic assessments contribute to variations in rates of response to placebo in ulcerative colitis (UC) trials. We investigated whether centralized review of images could reduce these variations. We performed a 10-week, randomized, double-blind, placebo-controlled

  12. Once-daily budesonide MMX in active, mild-to-moderate ulcerative colitis: results from the randomised CORE II study

    NARCIS (Netherlands)

    Travis, Simon P. L.; Danese, Silvio; Kupcinskas, Limas; Alexeeva, Olga; D'Haens, Geert; Gibson, Peter R.; Moro, Luigi; Jones, Richard; Ballard, E. David; Masure, Johan; Rossini, Matteo; Sandborn, William J.

    2014-01-01

    Budesonide MMX is a novel oral formulation of budesonide that uses Multi-Matrix System (MMX) technology to extend release to the colon. This study compared the efficacy of budesonide MMX with placebo in patients with active, mild-to-moderate ulcerative colitis (UC). Patients were randomised 1:1:1:1

  13. Intestinal amebiasis in a group of patients with ulcerative colitis: influence on clinical course of the disease.

    Science.gov (United States)

    Vukobrat-Bijedic, Zora; Husic-Selimovic, Azra; Bijedic, Nina; Bjelogrlic, Ivana; Djuran, Aleksandra

    2013-01-01

    Ulcerative colitis (UC) is a common disease with a chronic and relapsing presentation requiring regular clinical follow up. Epidemiological and microbiologic studies suggest that enteropathogenic microorganisms play a substantial role in the clinical presentation and extent of inflammatory bowel disease. To evaluate the presence of intestinal infections by Entamoeba hystolitica in patients with ulcerative colitis, their impact on clinical outcome, and to identify associated risk factors. A total of 31 patients hospitalized on Gastroenterohepatology Department with patohystologically proved ulcerative colitis were studied. Fresh feces samples taken from 20 patients were examined immediately using Eosin and Lugol-staining methods and analyzing the presence of vegetative and MIFC (Meriolat and Iod staining). A total of 16 female and 15 male hospitalized UC patients were analysed in a period of two years (2010-2011). The mean age at diagnosis was 43 years. We analyzed relation of amoeba infection with localization of ulcerative colitis. Our results indicate that amoeba infection is related to extent of disease (they were mostly present in pancolitis). Presence of amoeba is not related to age nor gender. Furthermore, presence of amoeba was not associated with more severe clinical course of disease. Similarly, higher value of serum marker of inflammation was not associated with amoeba infection. Amoeba infections in UC patients treated at Gastroenterohepatology Department was not related to the grade of disease activity, and other clinical variables such as gender, age and parameters of inflammation. These microorganisms could be a contributing cause of extended localization of disease.

  14. Colitis

    Science.gov (United States)

    ... 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). ...

  15. Monitoring of Chemically Induced Colitis.

    Science.gov (United States)

    Reißig, Sonja; Weigmann, Benno

    2017-01-01

    Inflammation is a common symptom of inflammatory bowel disease (IBD). Actually, many experimental models of colitis exist and try to mimic the human situation in order to understand the pathogenesis of Crohn's disease and ulcerative colitis. These experimental models of inflammation can be characterized by specific parameters, which illustrate the proceeding inflammatory process. By use of these models potentially new reagents for improved therapeutic approaches can be analyzed. Here, we describe the TNBS-mediated colitis model and specify different parameters for the detailed characterization of the inflammatory process in experimental colitis models.

  16. CMV - gastroenteritis/colitis

    Science.gov (United States)

    Colitis - cytomegalovirus; Gastroenteritis - cytomegalovirus; Gastrointestinal CMV disease ... or after bone marrow or organ transplant Ulcerative colitis or Crohn disease Rarely, serious CMV infection involving ...

  17. Antioxidative potential of a combined therapy of anti TNFα and Zn acetate in experimental colitis

    Science.gov (United States)

    Barollo, Michela; Medici, Valentina; D’Incà, Renata; Banerjee, Antara; Ingravallo, Giuseppe; Scarpa, Marco; Patak, Surajit; Ruffolo, Cesare; Cardin, Romilda; Sturniolo, Giacomo Carlo

    2011-01-01

    AIM: To evaluate whether combination therapy with anti-tumour necrosis factor α (TNFα) antibody and Zn acetate is beneficial in dextran sodium sulphate (DSS) colitis. METHODS: Colitis was induced in CD1-Swiss mice with 5% DSS for 7 d. The experimental mice were then randomised into the following subgroups: standard diet + DSS treated (induced colitis group); standard diet + DSS + subcutaneous 25 μg anti-TNFα treated group; Zn acetate treated group + DSS + subcutaneous 25 μg anti-TNFα; standard diet + DSS + subcutaneous 6.25 μg anti-TNFα treated group and Zn acetate treated group + DSS + subcutaneous 6.25 μg anti-TNFα. Each group of mice was matched with a similar group of sham control animals. Macroscopic and histological features were scored blindly. Homogenates of the colonic mucosa were assessed for myeloperoxidase activity as a biochemical marker of inflammation and DNA adducts (8OH-dG) as a measure of oxidative damage. RESULTS: DSS produced submucosal erosions, ulcers, inflammatory cell infiltration and cryptic abscesses which were reduced in both groups of mice receiving either anti-TNFα alone or combined with zinc. The effect was more pronounced in the latter group (vs Zn diet, P < 0.02). Myeloperoxidase activity (vs controls, P < 0.02) and DNA adducts, greatly elevated in the DSS fed colitis group (vs controls, P < 0.05), were significantly reduced in the treated groups, with a more remarkable effect in the group receiving combined therapy (vs standard diet, P < 0.04). CONCLUSION: DSS induces colonic inflammation which is modulated by the administration of anti-TNFα. Combining anti-TNFα with Zn acetate offers marginal benefit in colitis severity. PMID:22039323

  18. Antioxidative potential of a combined therapy of anti TNFα and Zn acetate in experimental colitis.

    Science.gov (United States)

    Barollo, Michela; Medici, Valentina; D'Incà, Renata; Banerjee, Antara; Ingravallo, Giuseppe; Scarpa, Marco; Patak, Surajit; Ruffolo, Cesare; Cardin, Romilda; Sturniolo, Giacomo Carlo

    2011-09-28

    To evaluate whether combination therapy with anti-tumour necrosis factor α (TNFα) antibody and Zn acetate is beneficial in dextran sodium sulphate (DSS) colitis. Colitis was induced in CD1-Swiss mice with 5% DSS for 7 d. The experimental mice were then randomised into the following subgroups: standard diet + DSS treated (induced colitis group); standard diet + DSS + subcutaneous 25 μg anti-TNFα treated group; Zn acetate treated group + DSS + subcutaneous 25 μg anti-TNFα; standard diet + DSS + subcutaneous 6.25 μg anti-TNFα treated group and Zn acetate treated group + DSS + subcutaneous 6.25 μg anti-TNFα. Each group of mice was matched with a similar group of sham control animals. Macroscopic and histological features were scored blindly. Homogenates of the colonic mucosa were assessed for myeloperoxidase activity as a biochemical marker of inflammation and DNA adducts (8OH-dG) as a measure of oxidative damage. DSS produced submucosal erosions, ulcers, inflammatory cell infiltration and cryptic abscesses which were reduced in both groups of mice receiving either anti-TNFα alone or combined with zinc. The effect was more pronounced in the latter group (vs Zn diet, P < 0.02). Myeloperoxidase activity (vs controls, P < 0.02) and DNA adducts, greatly elevated in the DSS fed colitis group (vs controls, P < 0.05), were significantly reduced in the treated groups, with a more remarkable effect in the group receiving combined therapy (vs standard diet, P < 0.04). DSS induces colonic inflammation which is modulated by the administration of anti-TNFα. Combining anti-TNFα with Zn acetate offers marginal benefit in colitis severity.

  19. Biologics in the management of ulcerative colitis – comparative safety and efficacy of TNF-α antagonists

    Directory of Open Access Journals (Sweden)

    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

  20. Mucoadhesive chitosan hydrogels as rectal drug delivery vessels to treat ulcerative colitis.

    Science.gov (United States)

    Xu, Jinke; Tam, Mifong; Samaei, Sepideh; Lerouge, Sophie; Barralet, Jake; Stevenson, Mary M; Cerruti, Marta

    2017-01-15

    Mucoadhesive drug delivery systems stick to mucosal tissues and prolong the local retention time of drugs. Since the colon is covered by a mucosal layer, mucoadhesive rectal formulations may improve treatment of such diseases as hypertension or colon cancer. Ulcerative colitis (UC) is an inflammatory bowel disease characterized by chronic inflammation of the colonic mucosa. It is commonly treated with sulfasalazine (SSZ), which is metabolized by the intestinal flora into the therapeutic 5-aminosalicylic acid (5-ASA) and a toxic by-product sulfapyridine (SP). SSZ can be administered orally or rectally. The latter route avoids unintended absorption of the drug or its degradation products in the upper gastrointestinal tract, but often fails due to limited retention time. Here, we propose a mucoadhesive hydrogel to improve the efficacy of rectal SSZ administration. The gel is made of catechol modified-chitosan (Cat-CS) crosslinked by genipin. After loading the gel with SSZ, we evaluated its efficacy in a mouse model of UC. Compared to oral SSZ treatment, rectal SSZ/Cat-CS delivery was more therapeutic, showed equivalent histological scores, and induced a lower plasma concentration of the potentially toxic SP by-product. These results show SSZ/Cat-CS rectal hydrogels are more effective and safer formulations for UC treatment than oral SSZ. Ulcerative colitis affects the colon by causing chronic inflammation on the mucosa. One of the most common drugs to treat mild to moderate UC is sulfasalazine, which can be administrated both orally and rectally. Rectal formulations are preferable, since their therapeutic effect happens topically, and they prevent side effects related to absorption of the drug in the small intestine. However, the efficacy of rectal sulfasalazine formulations is decreased by their limited colon residence time. Here we propose a chitosan-catechol mucoadhesive gel that allows delivering sulfasalazine more effectively and safely than oral administration

  1. Preventive and therapeutic effects of blueberry (Vaccinium corymbosum) extract against DSS-induced ulcerative colitis by regulation of antioxidant and inflammatory mediators.

    Science.gov (United States)

    Pervin, Mehnaz; Hasnat, Md Abul; Lim, Ji-Hong; Lee, Yoon-Mi; Kim, Eun Ok; Um, Byung-Hun; Lim, Beong Ou

    2016-02-01

    Inflammatory bowel disease (IBD) is an inflammatory disorder caused by hyperactivation of effector immune cells that produce high levels of proinflammatory cytokines. The aims of our study were to determine whether orally administered blueberry extract (BE) could attenuate or prevent the development of experimental colitis in mice and to elucidate the mechanism of action. Female Balb/C mice (n=7) were randomized into groups differing in treatment conditions (prevention and treatment) and dose of BE (50 mg/kg body weight). Acute ulcerative colitis was induced by oral administration of 3% dextran sodium sulfate for 7 days in drinking water. Colonic mucosal injury was assessed by clinical, macroscopic, biochemical and histopathological examinations. BE significantly decreased disease activity index and improved the macroscopic and histological score of colons when compared to the colitis group (P<.05). BE markedly attenuated myeloperoxidase accumulation (colitis group 54.97±2.78 nmol/mg, treatment group 30.78±1.33 nmol/mg) and malondialdehyde in colon and prostaglandin E2 level in serum while increasing the levels of superoxide dismutase and catalase (colitis group 11.94±1.16 U/ml, BE treatment group 16.49±0.39 U/ml) compared with the colitis group (P<.05). mRNA levels of the cyclooxygenase (COX)-2, interferon-γ, interleukin (IL)-1β and inducible nitric oxide synthase cytokines were determined by reverse transcriptase polymerase chain reaction. Immunohistochemical analysis showed that BE attenuates the expression of COX-2 and IL-1β in colonic tissue. Moreover, BE reduced the nuclear translocation of nuclear transcription factor kappa B (NF-κB) by immunofluorescence analysis. Thus, the anti-inflammatory effect of BE at colorectal sites is a result of a number of mechanisms: antioxidation, down-regulation of the expression of inflammatory mediators and inhibition of the nuclear translocation of NF-κB. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Isothiocyanate-enriched moringa seed extract alleviates ulcerative colitis symptoms in mice.

    Directory of Open Access Journals (Sweden)

    Youjin Kim

    Full Text Available Moringa (Moringa oleifera Lam. seed extract (MSE has anti-inflammatory and antioxidant activities. We investigated the effects of MSE enriched in moringa isothiocyanate-1 (MIC-1, its putative bioactive, on ulcerative colitis (UC and its anti-inflammatory/antioxidant mechanism likely mediated through Nrf2-signaling pathway. Dextran sulfate sodium (DSS-induced acute (n = 8/group; 3% DSS for 5 d and chronic (n = 6/group; cyclic rotations of 2.5% DSS/water for 30 d UC was induced in mice that were assigned to 4 experimental groups: healthy control (water/vehicle, disease control (DSS/vehicle, MSE treatment (DSS/MSE, or 5-aminosalicyic acid (5-ASA treatment (positive control; DSS/5-ASA. Following UC induction, water (vehicle, 150 mg/kg MSE, or 50 mg/kg 5-ASA were orally administered for 1 or 2 wks. Disease activity index (DAI, spleen/colon sizes, and colonic histopathology were measured. From colon and/or fecal samples, pro-inflammatory biomarkers, tight-junction proteins, and Nrf2-mediated enzymes were analyzed at protein and/or gene expression levels. Compared to disease control, MSE decreased DAI scores, and showed an increase in colon lengths and decrease in colon weight/length ratios in both UC models. MSE also reduced colonic inflammation/damage and histopathological scores (modestly in acute UC. MSE decreased colonic secretions of pro-inflammatory keratinocyte-derived cytokine (KC, tumor necrosis factor (TNF-α, nitric oxide (NO, and myeloperoxidase (MPO in acute and chronic UC; reduced fecal lipocalin-2 in acute UC; downregulated gene expression of pro-inflammatory interleukin (IL-1, IL-6, TNF-α, and inducible nitric oxide synthase (iNOS in acute UC; upregulated expression of claudin-1 and ZO-1 in acute and chronic UC; and upregulated GSTP1, an Nrf2-mediated phase II detoxifying enzyme, in chronic UC. MSE was effective in mitigating UC symptoms and reducing UC-induced colonic pathologies, likely by suppressing pro-inflammatory biomarkers and

  3. Isothiocyanate-enriched moringa seed extract alleviates ulcerative colitis symptoms in mice.

    Science.gov (United States)

    Kim, Youjin; Wu, Alex G; Jaja-Chimedza, Asha; Graf, Brittany L; Waterman, Carrie; Verzi, Michael P; Raskin, Ilya

    2017-01-01

    Moringa (Moringa oleifera Lam.) seed extract (MSE) has anti-inflammatory and antioxidant activities. We investigated the effects of MSE enriched in moringa isothiocyanate-1 (MIC-1), its putative bioactive, on ulcerative colitis (UC) and its anti-inflammatory/antioxidant mechanism likely mediated through Nrf2-signaling pathway. Dextran sulfate sodium (DSS)-induced acute (n = 8/group; 3% DSS for 5 d) and chronic (n = 6/group; cyclic rotations of 2.5% DSS/water for 30 d) UC was induced in mice that were assigned to 4 experimental groups: healthy control (water/vehicle), disease control (DSS/vehicle), MSE treatment (DSS/MSE), or 5-aminosalicyic acid (5-ASA) treatment (positive control; DSS/5-ASA). Following UC induction, water (vehicle), 150 mg/kg MSE, or 50 mg/kg 5-ASA were orally administered for 1 or 2 wks. Disease activity index (DAI), spleen/colon sizes, and colonic histopathology were measured. From colon and/or fecal samples, pro-inflammatory biomarkers, tight-junction proteins, and Nrf2-mediated enzymes were analyzed at protein and/or gene expression levels. Compared to disease control, MSE decreased DAI scores, and showed an increase in colon lengths and decrease in colon weight/length ratios in both UC models. MSE also reduced colonic inflammation/damage and histopathological scores (modestly) in acute UC. MSE decreased colonic secretions of pro-inflammatory keratinocyte-derived cytokine (KC), tumor necrosis factor (TNF)-α, nitric oxide (NO), and myeloperoxidase (MPO) in acute and chronic UC; reduced fecal lipocalin-2 in acute UC; downregulated gene expression of pro-inflammatory interleukin (IL)-1, IL-6, TNF-α, and inducible nitric oxide synthase (iNOS) in acute UC; upregulated expression of claudin-1 and ZO-1 in acute and chronic UC; and upregulated GSTP1, an Nrf2-mediated phase II detoxifying enzyme, in chronic UC. MSE was effective in mitigating UC symptoms and reducing UC-induced colonic pathologies, likely by suppressing pro-inflammatory biomarkers

  4. Ulcerative Colitis

    Science.gov (United States)

    ... Pancolitis often affects the entire colon and causes bouts of bloody diarrhea that may be severe, abdominal ... fight off an invading virus or bacterium, an abnormal immune response causes the immune system to attack ...

  5. Ulcerative Colitis

    Science.gov (United States)

    ... directly treats inflammation of the large intestine. rectal foam—a foamy substance the person puts into the ... an IV; adalimumab and golimumab are given by injection. Health care providers will screen patients for tuberculosis ...

  6. Fifteen-year-old colon cancer patient with a 10-year history of ulcerative colitis.

    Science.gov (United States)

    Noh, Seung Yeon; Oh, Seung Young; Kim, Soo-Hong; Kim, Hyun-Young; Jung, Sung-Eun; Park, Kwi-Won

    2013-04-21

    Inflammatory bowel disease (IBD) is regarded as one of the risk factors for colorectal cancer, and early detection of cancer in these patients may be difficult, especially in pediatric patients. Prognosis of pediatric colorectal cancer is known to be poor, because of delayed diagnosis and unfavorable differentiation. We report a case of a pediatric patient with a 10-year history of ulcerative colitis who was diagnosed with sigmoid colon cancer when he was 15 years old. He underwent proctocolectomy with ileal pouch anal anastomosis. Postoperative pathological examination of the tumor revealed adenocarcinoma. The pericolic tissue layer was infiltrated, but metastases were not found in either of the two lymph nodes. Children with a long history of predisposing factors such as IBD need particular attention to the possibility of colorectal cancer. Early diagnosis through regular screening with colonoscopy is one of the most important critical factors for a good prognosis.

  7. From basic science to future medical options for treatment of ulcerative colitis

    DEFF Research Database (Denmark)

    Rask-Madsen, J

    1997-01-01

    Both ulcerative colitis (UC) and Crohn's disease are considered the result of an unrestrained inflammatory reaction, but an explanation for the aetiopathogenesis has still not emerged. Until the predisposing and trigger factors have been clearly defined, therapeutic and preventive strategies...... effects. Future medical options for treatment of UC aim at removing perpetuating antigens, blocking entry of inflammatory cells by manipulating adhesion molecules, targeting soluble mediators of inflammation by blocking proinflammatory molecules or by preserving endogenous suppressive molecules......, or correcting genetic defects. It remains, however, to be determined whether targeting multi-inflammatory actions or a single key pivotal process is the better therapeutic strategy and whether subgroups of UC with different clinical courses will require different treatment approaches....

  8. Fecal Microbiota-based Therapeutics for Recurrent Clostridium difficile Infection, Ulcerative Colitis and Obesity

    Directory of Open Access Journals (Sweden)

    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.

  9. Flare-up of ulcerative colitis after systemic corticosteroids: A strong case for Strongyloides

    Science.gov (United States)

    Ben-Horin, Shomron; Barshack, Iris; Chowers, Yehuda; Mouallem, Meir

    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. PMID:18666337

  10. Influence of Microbiota on Intestinal Immune System in Ulcerative Colitis and Its Intervention

    Directory of Open Access Journals (Sweden)

    Sai-Long Zhang

    2017-11-01

    Full Text Available Ulcerative colitis (UC is an inflammatory bowel disease (IBD with chronic and recurrent characteristics caused by multiple reasons. Although the pathogenic factors have not been clarified yet, recent studies have demonstrated that intestinal microbiota plays a major role in UC, especially in the immune system. This review focuses on the description of several major microbiota communities that affect UC and their interactions with the host. In this review, eight kinds of microbiota that are highly related to IBD, including Faecalibacterium prausnitzii, Clostridium clusters IV and XIVa, Bacteroides, Roseburia species, Eubacterium rectale, Escherichia coli, Fusobacterium, and Candida albicans are demonstrated on the changes in amount and roles in the onset and progression of IBD. In addition, potential therapeutic targets for UC involved in the regulation of microbiota, including NLRPs, vitamin D receptor as well as secreted proteins, are discussed in this review.

  11. The Full Picture of Ulcerative Colitis: The Burden, the Patient, the Treatment

    Directory of Open Access Journals (Sweden)

    Julián Panés

    2015-12-01

    Full Text Available Ulcerative colitis (UC carries a significant, progressive disease burden that is often underestimated or misinterpreted by healthcare providers. Adverse outcomes have a major impact on patient quality of life, with a significant burden of symptoms both during and between inflammation flares. Chronic, uncontrolled disease leads to epithelial fibrosis and ‘lead pipe’ colon, dysplasia, and potential colonic cancer. Healthcare providers and patients share similar treatment goals, even if these are not verbalised in the same way, and clinicians need to fully understand the issues most important to patients. Understanding and collaboration can improve identification of meaningful treatment goals and overall disease management. In real-world practice, patients should be categorised according to disease characteristics and prognosis, and managed with appropriate, optimised therapies. Early, top-down management should be implemented in high-risk patients and all patient-centric therapeutic decisions made within the context of a full benefit/risk assessment.

  12. Catheter-Related Acremonium kiliense Fungemia in a Patient with Ulcerative Colitis under Treatment with Infliximab

    Directory of Open Access Journals (Sweden)

    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.

  13. Influences of the colonic microbiome on the mucous gel layer in ulcerative colitis.

    LENUS (Irish Health Repository)

    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.

  14. Linear IgA Bullous Dermatosis Secondary to Infliximab Therapy in a Patient with Ulcerative Colitis.

    Science.gov (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  16. Yellow fever vaccination during treatment with infliximab in a patient with ulcerative colitis: A case report.

    Science.gov (United States)

    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. © Georg Thieme Verlag KG Stuttgart · New York.

  17. Pancolonic indigo carmine dye spraying for the detection of dysplasia in ulcerative colitis.

    Science.gov (United States)

    Rutter, M D; Saunders, B P; Schofield, G; Forbes, A; Price, A B; Talbot, I C

    2004-02-01

    Colonoscopic surveillance for cancer in longstanding extensive ulcerative colitis relies heavily on non-targeted mucosal biopsies. Chromoendoscopy can aid detection of subtle mucosal abnormalities. We hypothesised that routine pancolonic indigo carmine dye spraying would improve the macroscopic detection of dysplasia and reduce the dependence on non-targeted biopsies. One hundred patients with longstanding extensive ulcerative colitis attending for colonoscopic surveillance underwent "back to back" colonoscopies. During the first examination, visible abnormalities were biopsied, and quadrantic non-targeted biopsies were taken every 10 cm. Pancolonic indigo carmine (0.1%) was used during the second colonoscopic examination, and any additional visible abnormalities were biopsied. Median extubation times for the first and second colonoscopies were 11 and 10 minutes, respectively. The non-targeted biopsy protocol detected no dysplasia in 2904 biopsies. Forty three mucosal abnormalities (20 patients) were detected during the pre-dye spray colonoscopy of which two (two patients) were dysplastic: both were considered to be dysplasia associated lesions/masses. A total of 114 additional abnormalities (55 patients) were detected following dye spraying, of which seven (five patients) were dysplastic: all were considered to be adenomas. There was a strong trend towards statistically increased dysplasia detection following dye spraying (p = 0.06, paired exact test). The targeted biopsy protocol detected dysplasia in significantly more patients than the non-targeted protocol (p = 0.02, paired exact test). No dysplasia was detected in 2904 non-targeted biopsies. In comparison, a targeted biopsy protocol with pancolonic chromoendoscopy required fewer biopsies (157) yet detected nine dysplastic lesions, seven of which were only visible after indigo carmine application. Careful mucosal examination aided by pancolonic chromoendoscopy and targeted biopsies of suspicious lesions may be

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

    Directory of Open Access Journals (Sweden)

    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

  19. Pancolonic indigo carmine dye spraying for the detection of dysplasia in ulcerative colitis

    Science.gov (United States)

    Rutter, M D; Saunders, B P; Schofield, G; Forbes, A; Price, A B; Talbot, I C

    2004-01-01

    Background and aims: Colonoscopic surveillance for cancer in longstanding extensive ulcerative colitis relies heavily on non-targeted mucosal biopsies. Chromoendoscopy can aid detection of subtle mucosal abnormalities. We hypothesised that routine pancolonic indigo carmine dye spraying would improve the macroscopic detection of dysplasia and reduce the dependence on non-targeted biopsies. Patients and methods: One hundred patients with longstanding extensive ulcerative colitis attending for colonoscopic surveillance underwent “back to back” colonoscopies. During the first examination, visible abnormalities were biopsied, and quadrantic non-targeted biopsies were taken every 10 cm. Pancolonic indigo carmine (0.1%) was used during the second colonoscopic examination, and any additional visible abnormalities were biopsied. Results: Median extubation times for the first and second colonoscopies were 11 and 10 minutes, respectively. The non-targeted biopsy protocol detected no dysplasia in 2904 biopsies. Forty three mucosal abnormalities (20 patients) were detected during the pre-dye spray colonoscopy of which two (two patients) were dysplastic: both were considered to be dysplasia associated lesions/masses. A total of 114 additional abnormalities (55 patients) were detected following dye spraying, of which seven (five patients) were dysplastic: all were considered to be adenomas. There was a strong trend towards statistically increased dysplasia detection following dye spraying (p = 0.06, paired exact test). The targeted biopsy protocol detected dysplasia in significantly more patients than the non-targeted protocol (p = 0.02, paired exact test). Conclusions: No dysplasia was detected in 2904 non-targeted biopsies. In comparison, a targeted biopsy protocol with pancolonic chromoendoscopy required fewer biopsies (157) yet detected nine dysplastic lesions, seven of which were only visible after indigo carmine application. Careful mucosal examination aided by

  20. Genesis of anxiety, depression, and ongoing abdominal discomfort in ulcerative colitis-like colon inflammation.

    Science.gov (United States)

    Chen, Jinghong; Winston, John H; Fu, Yu; Guptarak, Jutatip; Jensen, Kathryn L; Shi, Xuan-Zheng; Green, Thomas A; Sarna, Sushil K

    2015-01-01

    Psychological disorders are prevalent in patients with inflammatory bowel disease; the underlying mechanisms remain unknown. We tested the hypothesis that ulcerative colitis-like inflammation induced by dextran sodium sulfate (DSS) exacerbates the ongoing spontaneous activity in colon-projecting afferent neurons that induces abdominal discomfort and anxiety, and depressive-like behaviors in rats. In this study, we used the conditioned place preference and standard tests for anxiety- and depression-like behaviors. DSS rats developed anxiety- and depression-like behaviors 10 to 20 days after the start of inflammation. Single-fiber recordings showed an increase in the frequency of spontaneous activity in L6-S1 dorsal root ganglion (DRG) roots. Prolonged desensitization of transient receptor potential vanilloid 1 (TRPV1)-expressing colonic afferents by resiniferatoxin (RTX) suppressed the spontaneous activity, as well as the anxiety- and depressive-like behaviors. Reduction in spontaneous activity in colon afferents by intracolonic administration of lidocaine produced robust conditioned place preference (CPP) in DSS rats, but not in control rats. Patch-clamp studies demonstrated a significant decrease in the resting membrane potential, lower rheobase, and sensitization of colon-projecting L6-S1 DRG neurons to generate trains of action potentials in response to current injection in DSS rats. DSS inflammation upregulated the mRNA levels of transient receptor potential ankyrin 1 and TRPV1 channels and downregulated that of Kv1.1 and Kv1.4 channels. Ulcerative colitis-like inflammation in rats induces anxiety- and depression-like behaviors, as well as ongoing abdominal discomfort by exacerbating the spontaneous activity in the colon-projecting afferent neurons. Alterations in the expression of voltage- and ligand-gated channels are associated with the induction of mood disorders following colon inflammation. Copyright © 2015 the American Physiological Society.

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

    LENUS (Irish Health Repository)

    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.

  2. Generalized Pyoderma Gangrenosum Associated with Ulcerative Colitis: Successful Treatment with Infliximab and Azathioprine.

    Science.gov (United States)

    Chatzinasiou, Foteini; Polymeros, Dimitrios; Panagiotou, Maro; Theodoropoulos, Konstadinos; Rigopoulos, Dimitrios

    2016-04-01

    Pyoderma gangrenosum (PG) is a rare ulcerative skin disease, part of the spectrum of neutrophilic and auto-inflammatory dermatoses. Its pathogenesis is unknown, although immune pathways have been implicated. Lesion biopsies show a predominantly neutrophilic infiltrate. The incidence of PG is uncertain, but it is estimated to be 3-10 per million per year, occurring at any age but most commonly between 20 and 50 years with a possible slightly higher incidence in women. Approximately 50% of patients with PG also have another disease associated with PG. The most common is inflammatory bowel disease (IBD), particularly Crohn's and ulcerative colitis (UC). Local treatment may be sufficient for mild cases, while for severe cases systemic immunosuppressants are the mainstay (1,2). We report the case of a patient with bullous PG and UC successfully treated with infliximab and azathioprine. A 32-year-old male Caucasian patient presented with painful violaceous vesicles and enlarging bullae of various sizes and with acute onset, located on the trunk and bilaterally on both the lower and the upper extremities. Lesions on the trunk were composed of hemorrhagic pustules with a surrounding erythematous overhanging border. Some of the lesions had undergone central necrosis and ulceration (Figure 1, a-d). The patient reported of the lesions had appeared one week ago, simultaneously with the exacerbation of a known inflammatory bowel disease with hemorrhagic mucoid diarrhea and fever of up to 38.5°C. The patient's medical history included UC affecting the whole colon (pancolitis), diagnosed 5 months prior to the onset of the epidermal lesions, for which the patient was receiving treatment with oral prednisolone 10 mg/day and mesalazine granules. Blood tests showed severe anemia, leukocytosis, and increased inflammatory markers (C-reactive protein, erythrocyte sedimentation rate). Antinuclear antibodies (ANA), anti-double stranded DNA (anti-dsDNA) andtibodies, antineutrophil

  3. Management of ulcerative colitis in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease.

    Science.gov (United States)

    Wei, Shu-Chen; Chang, Ting-An; Chao, Te-Hsin; Chen, Jinn-Shiun; Chou, Jen-Wei; Chou, Yenn-Hwei; Chuang, Chiao-Hsiung; Hsu, Wen-Hung; Huang, Tien-Yu; Hsu, Tzu-Chi; Lin, Chun-Chi; Lin, Hung-Hsin; Lin, Jen-Kou; Lin, Wei-Chen; Ni, Yen-Hsuan; Shieh, Ming-Jium; Shih, I-Lun; Shun, Chia-Tung; Tsang, Yuk-Ming; Wang, Cheng-Yi; Wang, Horng-Yuan; Weng, Meng-Tzu; Wu, Deng-Chyang; Wu, Wen-Chieh; Yen, Hsu-Heng; Wong, Jau-Min

    2017-07-01

    Ulcerative colitis (UC) is an inflammatory bowel disease characterized by chronic mucosal inflammation of the colon, and the prevalence and incidence of UC have been steadily increasing in Taiwan. A steering committee was established by the Taiwan Society of Inflammatory Bowel Disease to formulate statements on the diagnosis and management of UC taking into account currently available evidence and the expert opinion of the committee. Accurate diagnosis of UC requires thorough clinical, endoscopic, and histological assessment and careful exclusion of differential diagnoses, particularly infectious colitis. The goals of UC therapy are to induce and maintain remission, reduce the risk of complications, and improve quality of life. As outlined in the recommended treatment algorithm, choice of treatment is dictated by severity, extent, and course of disease. Patients should be evaluated for hepatitis B virus and tuberculosis infection prior to immunosuppressive treatment, especially with steroids and biologic agents, and should be regularly monitored for reactivation of latent infection. These consensus statements are also based on current local evidence with consideration of factors, and could be serve as concise and practical guidelines for supporting clinicians in the management of UC in Taiwan.

  4. Profound loss of neprilysin accompanied by decreased levels of neuropeptides and increased CRP in ulcerative colitis.

    Directory of Open Access Journals (Sweden)

    Zeynep Gök Sargın

    Full Text Available Neprilysin (NEP, CD10 acts to limit excessive inflammation partly by hydrolyzing neuropeptides. Although deletion of NEP exacerbates intestinal inflammation in animal models, its role in ulcerative colitis (UC is not well explored. Herein, we aimed to demonstrate changes in NEP and associated neuropeptides at the same time in colonic tissue. 72 patients with UC and 27 control patients were included. Patients' demographic data and laboratory findings, five biopsy samples from active colitis sites and five samples from uninvolved mucosa were collected. Substance P (SP, calcitonin gene related peptide (CGRP and vasoactive intestinal peptide (VIP were extracted from freshly frozen tissues and measured using ELISA. Levels of NEP expression were determined using immunohistochemistry and immunoreactivity scores were calculated. GEBOES grading system was also used. We demonstrated a profound loss (69.4% of NEP expression in UC, whereas all healthy controls had NEP expression. Patients with UC had lower neuronal SP; however non-neuronal SP remained similar. UC patients had also lower neuronal and non-neuronal VIP levels. CGRP were low in general and no significant changes were observed. Additionally, CRP positive patients with UC had higher rates of NEP loss (80% vs 51.9% and lower SP levels when compared with CRP negative patients with UC. Concurrent decreases in SP and VIP with profound loss of NEP expression observed in UC is likely to be one of the factors in pathogenesis. Further studies are required to define the role of neuropeptides and NEP in UC.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

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

    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 (τ = 0.2145, P = 0.0281) and histologic grade (τ = 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. PMID:18350607

  7. 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

    DEFF Research Database (Denmark)

    Wildt, Signe; Nordgaard, Inge; Hansen, Ulla

    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....

  8. The Potential Role of a Self-Management Intervention for Ulcerative Colitis: A Brief Report From the Ulcerative Colitis Hypnotherapy Trial

    Science.gov (United States)

    Keefer, Laurie; Kiebles, Jennifer L.; Kwiatek, Monika A.; Palsson, Olafur; Taft, Tiffany H.; Martinovich, Zoran; Barrett, Terrence A.

    2013-01-01

    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. PMID:21362636

  9. Decrease of peripheral and intestinal NKG2A-positive T cells in patients with ulcerative colitis.

    Directory of Open Access Journals (Sweden)

    Takehiko Katsurada

    Full Text Available To investigate the role of inhibitory natural killer receptors (iNKRs in inflammatory bowel disease (IBD, we analyzed the expression of NKG2A, one of the iNKRs, on T cells in a mouse colitis model and human IBD. During the active phase of dextran sulfate sodium (DSS-induced mouse colitis, the frequency of NKG2A+ T cells was significantly decreased in the peripheral blood, and increased in the intestine, suggesting the mobilization of this T cell subset to the sites of inflammation. Administration of anti-NKG2A antibody increased the number of inflammatory foci in DSS-induced colitis, suggesting the involvement of NKG2A+ T cells in this colitis model. In ulcerative colitis (UC patients, the frequency of peripheral blood NKG2A+ T cells was significantly decreased, compared with Crohn's disease (CD patients and healthy controls, regardless of clinical conditions such as treatment modalities and disease activity. Notably, in sharp contrast to the DSS-induced mouse colitis model, the frequency of NKG2A+ cells among intestinal T cells was also decreased in UC patients. These results suggest that inadequate local infiltration of NKG2A+ T cells may be involved in the pathogenesis of UC.

  10. Use of Cordia dichotoma bark in the treatment of ulcerative colitis.

    Science.gov (United States)

    Ganjare, Anjali B; Nirmal, Sunil A; Rub, Ruksana A; Patil, Anuja N; Pattan, Shashikant R

    2011-08-01

    The plant Cordia dichotoma Forst. f. (Boraginaceae) is commonly known as "Bhokar" in Marathi. This tree species has been of interest to researchers because traditionally its bark is reported in the treatment of ulcer and colic pain. The present work was undertaken to validate its folk use in the treatment of ulcerative colitis (UC) by using scientific methods. Dried bark powder was extracted with methanol and this crude methanol extract was fractionated using various solvents. These fractions were tested for effectiveness against UC. Macroscopical study and histopathology of the colon, level of myeloperoxidase (MPO) and malondialdehyde (MDA) in colon and blood were studied for the assessment of the activity. Antioxidant activity of these fractions was screened by using various methods. Animals treated with the methanol fraction of the crude methanol extract showed lower pathological scores and good healing. This fraction reduced MPO and MDA levels significantly in blood and tissue. It showed antioxidant potential [in DPPH (1,1-diphenyl-2-picrylhydrazyl) assay IC₅₀ value is 26.25; trolox equivalent (TE) antioxidant capacity µg/ml TE/g of plant material on dry basis in ABTS (2,2'-azinobis[3-ethylbenzthiazoline]-6-sulfonic acid) and FRAP (ferric reducing antioxidant potential) assay is 2.03 and 2.45, respectively]. The fraction contains a high level of phenolics. The methanol fraction of crude methanol extract of C. dichotoma bark is effective in the treatment of UC.

  11. Crohn disease and ulcerative colitis in children: an update for 2014.

    Science.gov (United States)

    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. © 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  12. The potential of volatile organic compounds for the detection of active disease in patients with ulcerative colitis.

    Science.gov (United States)

    Smolinska, A; Bodelier, A G L; Dallinga, J W; Masclee, A A M; Jonkers, D M; van Schooten, F-J; Pierik, M J

    2017-05-01

    To optimise treatment of ulcerative colitis (UC), patients need repeated assessment of mucosal inflammation. Current non-invasive biomarkers and clinical activity indices do not accurately reflect disease activity in all patients and cannot discriminate UC from non-UC colitis. Volatile organic compounds (VOCs) in exhaled air could be predictive of active disease or remission in Crohn's disease. To investigate whether VOCs are able to differentiate between active UC, UC in remission and non-UC colitis. UC patients participated in a 1-year study. Clinical activity index, blood, faecal and breath samples were collected at each out-patient visit. Patients with clear defined active faecal calprotectin >250 μg/g and inactive disease (Simple Clinical Colitis Activity Index colitis was confirmed by stool culture or radiological evaluation. Breath samples were analysed by gas chromatography time-of-flight mass spectrometry and kernel-based method to identify discriminating VOCs. In total, 72 UC (132 breath samples; 62 active; 70 remission) and 22 non-UC-colitis patients (22 samples) were included. Eleven VOCs predicted active vs. inactive UC in an independent internal validation set with 92% sensitivity and 77% specificity (AUC 0.94). Non-UC colitis patients could be clearly separated from active and inactive UC patients with principal component analysis. Volatile organic compounds can accurately distinguish active disease from remission in UC and profiles in UC are clearly different from profiles in non-UC colitis patients. VOCs have demonstrated potential as new non-invasive biomarker to monitor inflammation in UC. © 2017 John Wiley & Sons Ltd.

  13. An unusual complication in ulcerative colitis during treatment with azathioprine and infliximab: Isospora belli as ‘Casus belli’

    Science.gov (United States)

    Stein, Juergen; Tannich, Egbert; Hartmann, Franz

    2013-01-01

    The treatment of ulcerative colitis is based on systemic corticosteroids, immunomodulators such as cyclosporine and azathioprine and TNF-α antagonists. Patients undergoing such immunosuppressive treatment are more susceptible for infectious pathogens. Here, we report the case of a patient with a 13-year history of ulcerative colitis, treated initially with systemic corticosteroids in combination with immunomodulators, and subsequently with infliximab. The patient presented with severe watery diarrhoea, abdominal cramps, weight loss and low-grade fever. Stool examinations for cytomegalovirus, bacteria and parasites were negative. Following detection of numerous oocytes of Isospora belli (IB) in direct smear preparations of the diarrhoeic stool samples, the patient was successfully treated with trimethoprim-sulfamethoxazole (co-trimoxazole). PMID:23709557

  14. Birth outcome in women with ulcerative colitis and Crohn's disease, and pharmacoepidemiological aspects of anti-inflammatory drug therapy

    DEFF Research Database (Denmark)

    Nørgård, Bente Mertz

    2011-01-01

    risk of preterm birth and stillbirth in ulcerative colitis women, compared to women with no prescription of reimbursed medicine in pregnancy - and also after comparing with women with chronic inflammatory bowel disease not taking 5-aminosalicylic acid during pregnancy. It is not clear whether...... birth outcome. We learned from the studies in this thesis that the traditional way of reporting birth outcome in women with chronic inflammatory bowel disease, i.e. without having valid information on the type of underlying disease, concurrent therapeutic drug treatment and disease activity......The clinical epidemiological studies included in this thesis fall into three parts. The first part includes studies on birth outcome in women with ulcerative colitis. The second part includes pharmacoepidemiological studies on birth outcome after anti-inflammatory drug therapy in pregnancy...

  15. Treatment of ulcerative colitis with oral mesalamine: advances in drug formulation, efficacy expectations and dose response, compliance, and chemoprevention.

    Science.gov (United States)

    Sandborn, William J

    2006-01-01

    Sulfasalazine, olsalazine, balsalazide, delayed-release mesalamine, controlled-release mesalamine, mesalamine pellets, and Multi-Matrix System mesalamine are effective first-line therapies for the treatment of mildly to moderately active ulcerative colitis and for subsequent maintenance of remission. For induction therapy it is unclear if there is a dose response above 1.5 g, and for maintenance therapy existing data do not support a dose response above 1.5 g. Sulfasalazine has more frequent side effects than olsalazine, balsalazide, and mesalamine formulations. Once-daily dosing with multi-matrix system mesalamine 1.2 g tablets may lead to optimal compliance. Mesalamine >/= 1.2 g and sulfasalazine >/= 2 g reduce the risk of colorectal cancer in patients with ulcerative colitis. Drug formulations, efficacy expectations and dose response, toxicity expectations, compliance considerations, and chemoprevention considerations are reviewed.

  16. Laparoscopic colectomy with transanal ileal descent in a singles surgical stage for the treatment of ulcerative colitis

    Directory of Open Access Journals (Sweden)

    Mejìa Camacho David

    2014-07-01

    Full Text Available Ulcerative colitis (UC is an inflammatory disease of the rectal and colonic mucosa and submucosa. Some patients may require surgical treatment. Classically colectomy and ileostomy is recom- mended as a first stage and ileoanal anastomosis in a second surgical stage. We report the case of a patient with UC treated with laparoscopic total colectomy and ileoanal anastomosis in a single surgical stage.

  17. Medication adherence and persistence in the treatment of Canadian ulcerative colitis patients: analyses with the RAMQ database

    OpenAIRE

    Lachaine Jean; Yen Linnette; Beauchemin Catherine; Hodgkins Paul

    2013-01-01

    Abstract Background Although high non-adherence to medication has been noticed for ulcerative colitis (UC), little is known about adherence to mesalamine treatments and determinants that can predict adherence. The objective of this study was to assess adherence and persistence to mesalamine treatments and their potential determinants in mild to moderate UC patients in a real-life setting in Quebec, Canada. Methods A retrospective prescription and medical claims analysis was conducted using a ...

  18. Randomised clinical study: discrepancies between patient?reported outcomes and endoscopic appearance in moderate to severe ulcerative colitis

    OpenAIRE

    Jharap, B.; Sandborn, W J; Reinisch, W.; D'Haens, G; Robinson, A M; Wang, W; Huang, B; A. Lazar; Thakkar,R B; Colombel, J.F.

    2015-01-01

    Summary Background Associations between patient?reported outcomes and mucosal healing have not been established in ulcerative colitis (UC). Aim To evaluate relationships of rectal bleeding and stool frequency with mucosal healing and quality of life (QoL) in patients with UC in two Phase 3 studies (ULTRA 1 and 2). Methods Associations of patient?reported rectal bleeding and stool frequency subscores with mucosal healing (Mayo endoscopy subscore?=?0 or 0/1) and QoL [inflammatory bowel disease ...

  19. Fecal Bacteriotherapy: A Case Report in an Immunosuppressed Patient with Ulcerative Colitis and Recurrent  Clostridium difficile Infection

    Directory of Open Access Journals (Sweden)

    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.

  20. The Mutyh base excision repair gene influences the inflammatory response in a mouse model of ulcerative colitis.

    Directory of Open Access Journals (Sweden)

    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.

  1. Fecal Microbial Transplant In Children With Ulcerative Colitis: A Randomized, Double-Blinded, Placebo-Controlled Pilot Study.

    Science.gov (United States)

    Michail, Sonia

    2017-10-06

    Ulcerative colitis (UC) is a condition characterized by chronic inflammation of the colon and is related to a genetically and environmentally-generated altered immune response to the enteric microbiome. Previous work in the PI laboratory suggests that children with UC harbor a unique gut microbial profile, which can predict therapeutic response. We hypothesized that children with ulcerative colitis will benefit from fecal transplant therapy (FMT). To this date there have been a number of reports describing the role of FMT in this disease albeit without uniform success and without controlled pediatric studies. Therefore, there is a strong need to determine its safety and efficacy in controlled trials. We report pilot data in a randomized, double-blinded, controlled study to evaluate the safety and efficacy of FMT from healthy donor versus placebo (subject's own stools) in combination with 5-ASA in mild to moderate disease. Twelve children were randomized to receive FMT or placebo. Subjects were monitored for 12 months. Remission or a 20-point improvement of PUCAI scores were seen in 60% of children receiving FMT versus 28% receiving placebo. More importantly, children receiving FMT did not require escalation of therapy in contrast to 71% receiving placebo. No serious adverse events related to FMT. Bloating and fever were adverse events that were considered related to FMT. To summarize, there appears to be a prospect of benefit in this small number of children receiving FMT for mild to moderate ulcerative colitis. FMT appeared to be safe in this patient population.

  2. Epidemiology of Crohn's disease and ulcerative colitis in a central Canadian province: a population-based study.

    Science.gov (United States)

    Bernstein, C N; Blanchard, J F; Rawsthorne, P; Wajda, A

    1999-05-15

    The aim of this study was to assess the accuracy and utility of administrative health data in identifying persons with inflammatory bowel disease on a population basis and to determine the incidence and prevalence of this disease in the Canadian province of Manitoba. The data from Manitoba Health (the province's single insurer) were used to identify residents with physician and/or hospital contacts for Crohn's disease or ulcerative colitis based on International Classification of Diseases, Ninth Revision, Clinical Modification, codes between 1984 and 1995. Of 5,182 eligible individuals, 4,514 were mailed questionnaires and 2,725 responded. Cases were defined as individuals with five or more separate medical contacts with one of these diagnoses or three or more such contacts if they were resident for less than 2 years. The accuracy of the study case definitions was high when compared with either self-report or chart review. The 1989-1994 age- and sex-adjusted annual incidence was 14.6/100,000 for Crohn's disease and 14.3/100,000 for ulcerative colitis. The prevalence of Crohn's disease in 1994 was 198.5/100,000, and that of ulcerative colitis was 169.7/100,000. In conclusion, the authors have successfully established and validated a population-based database of inflammatory bowel disease based on administrative data. The high incidence rates and dynamic epidemiology of inflammatory bowel disease in Manitoba indicate the presence of important environmental risk factors, which warrants further investigation.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  4. Analysis of Postoperative Venous Thromboembolism in Patients With Chronic Ulcerative Colitis: Is It the Disease or the Operation?

    Science.gov (United States)

    McKenna, Nicholas P; Behm, Kevin T; Ubl, Daniel S; Glasgow, Amy E; Mathis, Kellie L; Pemberton, John H; Habermann, Elizabeth B; Cima, Robert R

    2017-07-01

    Patients with IBD have a higher baseline risk of venous thromboembolism, which further increases with surgery. Therefore, extended venous thromboembolism chemoprophylaxis has been suggested in certain high-risk cohorts. The purpose of this study was to determine whether the underlying diagnosis, operative procedure, or both influence the incidence of postoperative venous thromboembolism. This was a retrospective review. The American College of Surgeons-National Surgical Quality Improvement Project database was analyzed. The NSQIP database was queried for patients with chronic ulcerative colitis and non-IBD undergoing colorectal resections using surgical Current Procedural Terminology codes modeled after the 3 stages used for the surgical management of chronic ulcerative colitis from 2005 to 2013. We measured 30-day postoperative venous thromboembolism risk in patients with chronic ulcerative colitis based on operative stage and risk factors for development of venous thromboembolism. A total of 18,833 patients met inclusion criteria, with an overall rate of venous thromboembolism of 3.8. Among procedure risk groups, venous thromboembolism rates were high risk, 4.4%; intermediate risk, 1.6%; and low risk, 0.7% (across risk groups, p operative procedure are the 2 highest risk factors for postoperative venous thromboembolism. Extended venous thromboembolism prophylaxis might be appropriate for patients undergoing these high-risk procedures or any emergent colorectal procedures. See Video Abstract at http://links.lww.com/DCR/A339.

  5. Effects of Moxibustion Stimulation on the Intensity of Infrared Radiation of Tianshu (ST25 Acupoints in Rats with Ulcerative Colitis

    Directory of Open Access Journals (Sweden)

    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.

  6. Efficacy of Infliximab Biosimilar CT-P13 Induction Therapy on Mucosal Healing in Ulcerative Colitis.

    Science.gov (United States)

    Farkas, Klaudia; Rutka, Mariann; Golovics, Petra A; Végh, Zsuzsanna; Lovász, Barbara D; Nyári, Tibor; Gecse, Krisztina B; Kolar, Martin; Bortlik, Martin; Duricova, Dana; Machkova, Nadezda; Hruba, Veronika; Lukas, Martin; Mitrova, Katarina; Malickova, Karin; Bálint, Anita; Nagy, Ferenc; Bor, Renáta; Milassin, Ágnes; Szepes, Zoltán; Palatka, Károly; Lakatos, Péter L; Lukas, Milan; Molnár, Tamás

    2016-11-01

    CT-P13 is the first biosimilar to infliximab that has been approved for the same indications as its originator infliximab. No data are available on the effect of infliximab biosimilar on mucosal healing. The aim of this study was to evaluate the efficacy of CT-P13 induction therapy on mucosal healing in patients with ulcerative colitis [UC]. UC patients, who received CT-P13 therapy from its local introduction at three Hungarian and one Czech inflammatory bowel disease centres, were prospectively enrolled. Sigmoidoscopy was performed after the end of the induction therapy at week 14. Mucosal healing was defined as Mayo endoscopic subscore 0 or 1. Complete mucosal healing was defined as Mayo endoscopic subscore 0. Trough level of CT-P13 was measured at week 14. Sixty-three UC patients who underwent CT-P13 induction therapy were enrolled in the study. Indication for the therapy was acute, severe flare up and chronic, refractory activity in 24 and 39 patients, respectively. Cumulative clinical response and steroid-free remission at week 14 were achieved in 82.5% and 47.6% of the patients, respectively. Sigmoidoscopy revealed steroid-free mucosal healing in 47.6% of the patients, and complete mucosal healing was present in 27%. Mayo endoscopic subscore decreased significantly at week 14 compared to baseline. Trough levels of infliximab correlated with mucosal healing. This is, to our knowledge, the first study examining the efficacy of CT-P13 induction therapy on mucosal healing in UC. The results indicate that mucosal healing is achieved in two-thirds of UC patients by the end of the induction treatment with CT-P13. Copyright © 2016 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  7. Infliximab to Treat Refractory Inflammation After Pelvic Pouch Surgery for Ulcerative Colitis.

    Science.gov (United States)

    Kelly, Orlaith B; Rosenberg, Morgan; Tyler, Andrea D; Stempak, Joanne M; Steinhart, A Hillary; Cohen, Zane; Greenberg, Gordon R; Silverberg, Mark S

    2016-04-01

    Inflammatory pouch complications refractory to first-line therapies remain problematic following ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). We evaluated infliximab efficacy and associations with therapeutic response. Data from individuals who underwent colectomy and IPAA for UC (2000-2014) were reviewed. Patients with chronic refractory pouchitis (CP) and Crohn's disease (CD)-like outcomes treated with infliximab were included. Pre-treatment parameters and response at median 8 (initial) and 48 weeks (sustained) were measured. Complete response was defined as symptomatic and endoscopic resolution with modified Pouchitis Disease Activity Index (mPDAI) 2. Serum was analysed for Anti-Saccharomyces cerevisiae antibodies (ASCA), anti-OmpC, anti-CBir1 and perinuclear Anti-Neutrophil Cytoplasmic Antibodies (pANCA). One hundred and fifty-two patients with CP or a CD-like phenotype were identified. Forty-two were treated with infliximab (33% male; age 32.6±2.6 years, 28.5% CD-like). Post-induction response was achieved in 74% (48% complete) and sustained response in 62.6% (29.6% complete). Mean mPDAI and C-reactive protein declined from 8.5±0.3 to 2±3.4 (p infliximab use (p Infliximab can effectively treat inflammatory pouch complications. Pre-treatment mPDAI <10 and early endoscopy may identify responders. Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  8. Long-Term Outcome of Patients with Ulcerative Colitis and Primary Non-response to Infliximab.

    Science.gov (United States)

    Papamichael, Konstantinos; Rivals-Lerebours, Oliviane; Billiet, Thomas; Vande Casteele, Niels; Gils, Ann; Ferrante, Marc; Van Assche, Gert; Rutgeerts, Paul J; Mantzaris, Gerassimos J; Peyrin-Biroulet, Laurent; Vermeire, Severine

    2016-09-01

    We studied the long-term outcome of patients with ulcerative colitis [UC] and primary non response [PNR] to infliximab and searched for predictors of colectomy in these patients. This retrospective, multi-centre study included UC patients from three European referral centres, with PNR to infliximab defined as a lack of clinical improvement after the induction therapy, leading to drug discontinuation. Relapse, for patients who continued on biologicals after PNR to infliximab, was defined as drug discontinuation for PNR, loss of response, or serious adverse event. Serum infliximab concentrations at Weeks 2 and 6 were evaluated using an enzyme-linked immunosorbent assay [ELISA] developed in house. The study population consisted of 99 anti-tumour necrosis factor [TNF]-naïve patients with UC and PNR to infliximab. At the end of follow-up (median: 3.2 [interquartile range 1-6.3] years), 55 [55.6%] of these patients underwent colectomy. Multiple Cox regression analysis identified acute severe UC (hazard ratio [HR]: 24; 95% confidence interval [CI]: 2.5-231; p = 0.006], baseline C-reactive protein [CRP] > 5mg/l [HR: 11; 95% CI: 2.1-58.8; p = 0.005], baseline albumin infliximab concentration at Week 2 infliximab, there was a marginally higher cumulative probability for relapse in patients switching to another anti-TNF agent compared with those swapping to vedolizumab [p logrank = 0.08]. About half of UC patients with PNR to infliximab will undergo colectomy. Patients with severe inflammation and low serum infliximab concetrations during the induction phase are at greatest risk. Copyright © 2016 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  9. Cause-specific mortality and 30-year relative survival of Crohn's disease and ulcerative colitis.

    Science.gov (United States)

    Selinger, Christian P; Andrews, Jane; Dent, Owen F; Norton, Ian; Jones, Brian; McDonald, Charles; Cowlishaw, James; Barr, Gavin; Selby, Warwick; Leong, Rupert W

    2013-08-01

    Data from the northern hemisphere suggest that patients with ulcerative colitis (UC) have similar survival to the general population, whereas mortality in Crohn's disease (CD) is increased by up to 50%. There is a paucity of data from the southern hemisphere, especially in Australia. A prevalence cohort (1977-1992) of patients with inflammatory bowel disease (IBD) diagnosed after 1970 was studied. Survival status data and causes of death up to December 2010 were extracted from the National Death Index. Relative survival analysis was carried out separately for men and women. Of 816 cases (384 men, 432 women; 373 CD, 401 UC, 42 indeterminate colitis), 211 (25.9%) had died by December 2010. Median follow-up was 22.2 years. Relative survival of all patients with IBD was not significantly different from the general population at 10, 20, and 30 years of follow-up. Separate analyses of survival in CD and UC also showed no differences from the general population. There was no difference in survival between patients diagnosed earlier (1971-1979) or later (1980-1992). At least 17% of the deaths were caused by IBD. Fatal cholangiocarcinomas were more common in IBD (P < 0.001), and fatal colorectal cancers more common in UC (P = 0.047). In Australia, IBD patient survival is similar to the general population. In contrast to data from Europe and North America, survival in CD is not diminished in Australia. IBD caused direct mortality in 17%, especially as biliary and colorectal cancers are significant causes of death.

  10. Synthesis and evaluation of anti-inflammatory properties of silver nanoparticle suspensions in experimental colitis in mice.

    Science.gov (United States)

    Siczek, Krzysztof; Zatorski, Hubert; Chmielowiec-Korzeniowska, Anna; Pulit-Prociak, Jolanta; Śmiech, Magdalena; Kordek, Radzisław; Tymczyna, Leszek; Banach, Marcin; Fichna, Jakub

    2017-04-01

    The aim of our study was to investigate the effect of newly developed silver nanoparticle aqueous suspensions NanoAg1 and NanoAg2 in the mouse models mimicking ulcerative colitis and Crohn's disease. NanoAg1 and NanoAg2 were synthesized in aqueous medium with the involvement of tannic acid. To elucidate their anti-inflammatory activity, semi-chronic mouse models of inflammation induced by dextrane sulfate sodium addition to drinking water and intracolonic (i.c.) administration of 2,4,6-trinitrobenzenesulfonic acid were used. NanoAg1 and NanoAg2 (500 mg/dm3, 100 μl/animal, i.c., once daily) significantly ameliorated colitis in dextrane sulfate sodium- and 2,4,6-trinitrobenzenesulfonic acid-induced mouse models of colonic inflammation, as indicated by reduced macroscopic, ulcer and microscopic scores. The anti-inflammatory effect was dependent on the shape and diameter of silver nanoparticles, as indicated by weaker effect of NanoAg1 than NanoAg2. In addition, administration of NanoAg2, but not NanoAg1, modulated colonic microbiota, as indicated by reduced number of Escherichia coli and Clostridium perfringens, and increased number of Lactobacillus sp. Summarizing, NanoAg1 and NanoAg2 after administered i.c. effectively alleviate colitis in experimental models of ulcerative colitis and Crohn's disease in mice. Therefore, NanoAg1 and NanoAg2 administered i.c. have the potential to become valuable agents for the treatment of inflammatory bowel diseases. © 2016 John Wiley & Sons A/S.

  11. Cost-effectiveness of vedolizumab compared with conventional therapy for ulcerative colitis patients in the UK

    Directory of Open Access Journals (Sweden)

    Wilson MR

    2017-10-01

    Full Text Available Michele R Wilson,1 Ismail Azzabi Zouraq,2 Helene Chevrou-Severac,2 Ross Selby,3 Matthew C Kerrigan4 1RTI Health Solutions, Research Triangle Park, NC, USA; 2Takeda Pharmaceuticals International AG, Zurich, Switzerland; 3Takeda UK Ltd., Bucks, UK; 4PHMR Limited, London, UK Objective: To examine the clinical and economic impact of vedolizumab compared with conventional therapy in the treatment of moderately-to-severely active ulcerative colitis (UC in the UK based on results of the GEMINI I trial. Methods: A decision-analytic model in Microsoft Excel was used to compare vedolizumab with conventional therapy (aminosalicylates, corticosteroids, immunomodulators for the treatment of patients with UC in the UK. We considered the following three populations: the overall intent-to-treat population from the GEMINI I trial, patients naïve to anti-TNF therapy, and those who had failed anti-TNF-therapy. Population characteristics and efficacy data were obtained from the GEMINI I trial. Other inputs (eg, unit costs, probability of surgery, mortality were obtained from published literature. Time horizon was a lifetime horizon, with costs and outcomes discounted by 3.5% per year. One-way and probabilistic sensitivity analyses were conducted to measure the impact of parameter uncertainty. Results: Vedolizumab had incremental cost-effectiveness ratios of £4,095/quality-adjusted life-year (QALY, £4,423/QALY, and £5,972/QALY compared with conventional therapy in the intent-to-treat, anti-TNF-naïve, and anti-TNF-failure populations, respectively. Patients on vedolizumab accrued more QALYs while incurring more costs than patients on conventional therapy. The sensitivity analyses showed that the results were most sensitive to induction response and transition probabilities for each treatment. Conclusion: The results suggest that vedolizumab results in more QALYs and may be a cost-effective treatment option compared with conventional therapy for both anti

  12. Epithelial markers of colorectal carcinogenesis in ulcerative colitis and primary sclerosing cholangitis

    Science.gov (United States)

    Wohl, Pavel; Hucl, Tomas; Drastich, Pavel; Kamenar, David; Spicak, Julius; Honsova, Eva; Sticova, Eva; Lodererova, Alena; Matous, Jan; Hill, Martin; Wohl, Petr; Kucera, Milos

    2013-01-01

    AIM: To evaluate the expression of epithelial markers of colorectal carcinogenesis in patients with long-term ulcerative colitis (UC) and primary sclerosing cholangitis (PSC) before and after transplantation. METHODS: Eight patients with UC and PSC prior to liver transplantation (PSC-UC), 22 patients with UC after liver transplantation for PSC (OLT), 9 patients with active ulcerative colitis without PSC (UCA), 7 patients with UC in remission (UCR) and 10 controls (N) underwent colonoscopy with multiple biopsies. Specimens were analysed histologically and semi-quantitatively immunohistochemically for p53, Bcl-2 and cyclooxygenase-2 (COX-2) markers. Statistical analysis was performed by Kruskal-Wallis and Fisher’s exact tests. RESULTS: PSC-UC had a statistically significantly higher expression of p53 in the nondysplastic mucosa as compared to OLT, UCA, UCR and N (P < 0.05). We also found a statistically significant positive correlation between the incidence of PSC and the expression of p53 (P < 0.001). UCA had a higher p53 expression as compared to UCR. OLT had a significantly lower expression of p53 as compared with PSC-UC (P < 0.001). Bcl-2 had a significant higher bcl-2 expression as compared with controls. No difference in COX-2 expression between PSC-UC, UCR and UCA was found. UCA had higher COX-2 expression as compared to UCR. We also found a statistically significant positive correlation between the expression of COX-2 and p53. Patients after liver transplantation for PSC had a statistically significantly lower expression of the p53 compared with PSC-UC (P < 0.001). PSC-UC had the same inflammatory endoscopic activity as OLT and UCR when evaluated with the Mayo score. CONCLUSION: Our study shows that the nondysplatic mucosa of UC patients with PSC is characterised by a higher expression of the tumour suppressor gene p53, suggesting a higher susceptibility of cancer. This p53 overexpression correlates with the presence of PSC whilst it is not present in

  13. Heat shock factor 2 levels are associated with the severity of ulcerative colitis.

    Directory of Open Access Journals (Sweden)

    Jiarong Miao

    Full Text Available BACKGROUND AND AIMS: The morbidity of ulcerative colitis (UC is increasing in China every year. In addition, there is a lack of accurate diagnostic indices with which to evaluate the activity of the disease. The aim of this study was to identify UC-associated proteins as biomarkers for the diagnosis, and objective assessment of disease activity. METHODS: Differential expression of serum proteins from UC patients compared to normal controls was analyzed by two-dimensional electrophoresis (2-DE and matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF-MS. The expression of heat shock factor 2(HSF2in colonic mucosa in Crohn's disease, Behcet's disease, ulcerative colitis, intestinal tuberculosis, infective enteritis, intestinal lymphoma, and normal controls was investigated by immunohistochemistry (IHC. The expression of the HSF2 in colonic mucosa of UC subjects with varying severity of disease was measured by real time-PCR and Western Blots. The expression of HSF2 was inhibited by HSF2 small interfering RNA (siRNA transfection in Caco-2 cells. The concentrations of HSF2, IL-1β, and TNF-α in serum and IL-1β, and TNF-α in the supernatants of transfected Caco-2 cells were determined by ELISA. RESULTS: HSF2 was differentially expressed in UC patients compared to normal controls. HSF2 expression was significantly higher in the intestinal mucosa of UC patients compared to other six groups. The results of immunohistochemistry, real time-PCR, Western Blots, and ELISA showed that the expression of HSF2 increased in parallel with the severity of UC. The serum concentration of HSF2 also positively correlated with levels of IL-1β and TNF-α. After down-regulation expression of HSF2 in Caco-2 cells by RNA interference, the productions of IL-1β and TNF-α stimulated by lipopolysaccharide (LPS increased dramatically. CONCLUSIONS: HSF2 appears to be a potential novel molecular marker for UC activity, and may provide a basis

  14. Enhanced mucosal re-epithelialization induced by short chain fatty acids in experimental colitis

    Directory of Open Access Journals (Sweden)

    Aguilar-Nascimento J.E.

    1999-01-01

    Full Text Available The short chain fatty acids (SCFA are the best nutrients for the colonocytes. Glucose is poorly used as a fuel but may be transformed into SCFA by colonic bacteria. The aim of this study was to investigate the effect of SCFA or glucose on experimental colitis. Colitis was induced in 30 Wistar rats by colonic instillation of 4% acetic acid. Five days later they were randomized to receive twice a day colonic lavage containing saline (controls, N = 10, 10% hypertonic glucose (N = 10 or SCFA (N = 10 until day 8 when they were killed. At autopsy, the colon was removed and weighed and the mucosa was evaluated macro- and microscopically and stripped out for DNA assay. Data are reported as mean ± SD or median [range] as appropriate. All animals lost weight but there was no difference between groups. Colon weight was significantly lower in the SCFA group (3.8 ± 0.5 g than in the control (5.3 ± 2.1 g and glucose (5.2 ± 1.3 g groups (P<0.05. Macroscopically, the severity of inflammation was less in SCFA (grade 2 [1-5] than in control (grade 9 [4-10] and glucose-treated (grade 9 [2-10] animals (P<0.01. Microscopically, ulceration of the mucosa was more severe in the glucose and control groups than in the SCFA group. The DNA content of the mucosa of SCFA-treated animals (8.2 [5.0-20.2] mg/g of tissue was higher than in glucose-treated (5.1 [4.2-8.5] mg/g of tissue; P<0.01 and control (6.2 [4.5-8.9] mg/g of tissue; P<0.05 animals. We conclude that SCFA may enhance mucosal re-epithelialization in experimental colitis, whereas hypertonic glucose is of no benefit.

  15. Prophylactic and curative anti-ulcerative colitis activity and the possible mechanisms of action of some desert plants.

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    El-Meligy, Reham M; Awaad, Amani S; Soliman, Gamal A; Bacha, Abir B; Alafeefy, Ahmed M; Kenawy, Sanaa A

    2015-04-01

    The aim of the present study was to evaluate both prophylactic and curative anti-ulcerative colitis activity and the possible mechanism of action of seven desert plant extracts. Seven desert plants from different families; Conyza dioscoridis (L.) Desf. (Asteraceae), Euphorbia hirta L. (Euphorpiaceae), Origanum syriacum L. and Salvia lanigera L. (Lamiaceae), Sisymbrium irio L., Solanum nigrum Linn. (Solanaceae) and Solenostemma arghel (Del.) Hayne. (Asclepiadaceae) were separately evaluated at three doses (125, 250, and 500 mg/kg) using the acetic acid-induced colitis model. The investigated extracts possessed prophylactic and curative anti-ulcerative colitis activities in a dose-dependent manner, where Salvia lanigera (87.9) and Solenostemma arghel (89.2) were the most effective extracts whereas the dexamesathone produced 68%. These extracts were further investigated for estimation of their mechanism of action. The in vitro potential radical (DPPH) scavenging activities of the investigated extracts were well supported with the reduction of colonic MDA content for both extracts. Suppression of the inflammatory mediator TNF-α and inhibition of both PLA2 and protease enzymes may play an important role in the anti-ulcerative colitis activities. The investigated extracts were safe for use up to 5 g/kg and the total alcohol extracts of Salvia lanigera and Solenostemma arghel (400 mg/kg for 35 d) showed no alteration on liver and kidney functions. Phytochemical screening of the investigated extracts revealed the presence of flavonoids, tannins, unsaturated sterols, and proteins which could be responsible for the activities.

  16. Tacrolimus Therapy for Three Patients with Elderly-Onset Ulcerative Colitis: Report of Three Cases

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    Rumiko Kobayashi

    2016-07-01

    Full Text Available In recent years, cases of elderly-onset ulcerative colitis (UC have been increasing in number and are currently reported to account for 10–15% of all cases of UC. Although the treatment of UC is essentially similar between older and younger patients, evidence of the therapeutic efficacy of tacrolimus in elderly-onset UC patients is still limited. Herein, we report our attempt to induce remission using tacrolimus in three patients with elderly-onset UC. A 75-year-old Japanese woman, a 71-year-old Japanese man and a 76-year-old Japanese woman with severe elderly-onset UC of the pancolitis type were treated with tacrolimus. Although all three patients showed response to the drug, the eventual outcome was poor in the first patient, who developed toxic megacolon, underwent surgery, and suffered from recurrent infections and hemorrhage after the surgery. However, clinical remission was successfully achieved in the second and third patient. Tacrolimus shows some indication of effectiveness in the treatment of elderly-onset UC. However, in elderly-onset UC patients, it is necessary to keep in mind the higher risk of adverse effects of medical therapy and postoperative complications because of the high comorbidity rates. Moreover, in situations where surgery needs to be considered, it is important to ensure appropriate timing of the surgery.

  17. Effects of oral tacrolimus as a rapid induction therapy in ulcerative colitis

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    Kawakami, Ken; Inoue, Takuya; Murano, Mitsuyuki; Narabayashi, Ken; Nouda, Sadaharu; Ishida, Kumi; Abe, Yosuke; Nogami, Koji; Hida, Nobuyuki; Yamagami, Hirokazu; Watanabe, Kenji; Umegaki, Eiji; Nakamura, Shiro; Arakawa, Tetsuo; Higuchi, Kazuhide

    2015-01-01

    AIM: To determine the efficacy and safety of rapid induction therapy with oral tacrolimus without a meal in steroid-refractory ulcerative colitis (UC) patients. METHODS: This was a prospective, multicenter, observational study. Between May 2010 and August 2012, 49 steroid-refractory UC patients (55 flare-ups) were consecutively enrolled. All patients were treated with oral tacrolimus without a meal at an initial dose of 0.1 mg/kg per day. The dose was adjusted to maintain trough whole-blood levels of 10-15 ng/mL for the first 2 wk. Induction of remission at 2 and 4 wk after tacrolimus treatment initiation was evaluated using Lichtiger’s clinical activity index (CAI). RESULTS: The mean CAI was 12.6 ± 3.6 at onset. Within the first 7 d, 93.5% of patients maintained high trough levels (10-15 ng/mL). The CAI significantly decreased beginning 2 d after treatment initiation. At 2 wk, 73.1% of patients experienced clinical responses. After tacrolimus initiation, 31.4% and 75.6% of patients achieved clinical remission at 2 and 4 wk, respectively. Treatment was well tolerated. CONCLUSION: Rapid induction therapy with oral tacrolimus shortened the time to achievement of appropriate trough levels and demonstrated a high remission rate 28 d after treatment initiation. Rapid induction therapy with oral tacrolimus appears to be a useful therapy for the treatment of refractory UC. PMID:25684955

  18. Gut-directed hypnotherapy significantly augments clinical remission in quiescent ulcerative colitis

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    Keefer, Laurie; Taft, Tiffany H; Kiebles, Jennifer L; Martinovich, Zoran; Barrett, Terrence A; Palsson, Olafur S

    2013-01-01

    Summary Background Psychotherapy is not routinely recommended for in ulcerative colitis (UC). Gut-directed hypnotherapy (HYP) has been linked to improved function in the gastrointestinal tract and may operate through immune-mediated pathways in chronic diseases. Aims To determine the feasibility and acceptability of hypnotherapy and estimate the impact of hypnotherapy on clinical remission status over a 1 year period in patients with an historical flare rate of 1.3 times per year. Methods 54 patients were randomized at a single site to 7 sessions of gut-directed hypnotherapy (N = 26) or attention control (CON; N = 29) and followed for 1 year. The primary outcome was the proportion of participants in each condition that had remained clinically asymptomatic (clinical remission) through 52 weeks post-treatment. Results One-way ANOVA comparing hypnotherapy and control subjects on number of days to clinical relapse favored the hypnotherapy condition [F = 4.8 (1, 48), p = .03] by 78 days. Chi square analysis comparing the groups on proportion maintaining remission at 1 year was also significant [X2(1) = 3.9, p = .04], with 68% of hypnotherapy and 40% of control patients maintaining remission for 1 year. There were no significant differences between groups over time in quality of life, medication adherence, perceived stress or psychological factors. Conclusions This is the first prospective study that has demonstrated a significant effect of a psychological intervention on prolonging clinical remission in patients with quiescent UC. Clinical Trial # NCT00798642 PMID:23957526

  19. A New Chinese Medicine Intestine Formula Greatly Improves the Effect of Aminosalicylate on Ulcerative Colitis

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    Baohai Liu

    2017-01-01

    Full Text Available Ulcerative colitis (UC is a chronic lifelong inflammatory disorder of the colon. Current medical treatment of UC relies predominantly on the use of traditional drugs, including aminosalicylates, corticosteroids, and immunosuppressants, which failed to effectively control this disease’s progression and produced various side effects. Here, we report a new Chinese medicine intestine formula (CIF which greatly improved the effect of mesalazine, an aminosalicylate, on UC. In the present study, 60 patients with chronic UC were treated with oral mesalazine alone or in combination with CIF enema. The combination of mesalazine and CIF greatly and significantly improved the clinical symptoms and colon mucosal condition and improved the Mayo Clinic Disease Activity Index and health-related quality of life, when compared to mesalazine alone. In particular, the addition of CIF further decreased serum levels of tumor necrosis factor-alpha and hypersensitivity C-reactive protein but in contrast increased interleukin-4. Thus, the results demonstrate the beneficial role of CIF in UC treatment, which may be mediated by the regulation of inflammation.

  20. Fatal ulcerative colitis in a western lowland gorilla (Gorilla gorilla gorilla).

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    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.

  1. Hsp10, Hsp70, and Hsp90 immunohistochemical levels change in ulcerative colitis after therapy

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    Tomasello, G.; Sciumè, C.; Rappa, F.; Rodolico, V.; Zerilli, M.; Martorana, A.; Cicero, G.; De Luca, R.; Damiani, P.; Accardo, F.M.; Romeo, M.; Farina, F.; Bonaventura, G.; Modica, G.; Zummo, G.; Conway de Macario, E.; Macario, A.J.L.; Cappello, F.

    2011-01-01

    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). PMID:22297444

  2. Infections Requiring Hospitalization as Predictors of Pediatric-Onset Crohn’s Disease and Ulcerative Colitis

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    Susan Hutfless

    2015-01-01

    Full Text Available Objectives. To assess the relationship between infections and the risk of pediatric-onset inflammatory bowel disease (IBD. Methods. We conducted a nested case-control study of 501 incident cases aged ≤17 years and 9,442 controls who were members of Kaiser Permanente Northern California for at least one consecutive year between 1996 and 2006. IBD was confirmed and the incidence date was adjudicated by pediatric gastroenterologists. Hospitalized infections were identified from the principal diagnosis code of electronic inpatient records. Medications to treat infections were identified during the hospitalization. Conditional logistic regression was used to assess the associations between hospitalized infections, medications, and Crohn’s disease and ulcerative colitis. Results. In the year prior to diagnosis, both hospitalized infection of any system (OR 6.3; 95% CI 1.6–23.9 and hospitalized intestinal infection (OR 19.4; 95% CI 2.6–143.2 were associated with CD. Hospitalized infections of any system were inversely associated with UC after excluding the year prior to diagnosis (OR 0.4; 95% CI 0.2–0.9. No UC case had a hospitalized gastrointestinal infection prior to diagnosis. Conclusion. Infections appear to play opposite roles prior to the diagnosis of CD and UC. Infections may be associated with an increased risk of CD and a decreased risk of UC.

  3. Oral delivery of Bifidobacterium longum expressing α-melanocyte-stimulating hormone to combat ulcerative colitis.

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    Wei, Pijin; Yang, Yan; Ding, Qing; Li, Xiuying; Sun, Hanxiao; Liu, Zhaobing; Huang, Junli; Gong, Yahui

    2016-02-01

    α-Melanocyte-stimulating hormone (α-MSH) is a tridecapeptide derived from pro-opiomelanocortin that exhibits potent anti-inflammatory properties by regulating the production of inflammatory mediators. This peptide has been well established in several inflammatory models, including inflammatory bowel disease (IBD). However, its extremely short duration in vivo limits its clinical application. To address this limitation, Bifidobacterium was used here as a carrier to deliver α-MSH. We utilized α-MSH-engineered Bifidobacterium against IBD, which is closely linked to immune and intestinal microbiota dysfunction. First, we constructed a Bifidobacterium longum secreting α-MSH (B. longum-α-MSH). We then tested the recombinant α-MSH expression and determined its bioactivity in HT-29 cells. To assess its effectiveness, B. longum-α-MSH was used against an ulcerative colitis (UC) model in rats induced by dextran sulfate sodium. The data showed that α-MSH expression in B. longum-α-MSH was effective, and its biological activity was similar to the synthesized one. This UC model experiment indicated that B. longum-α-MSH successfully colonized the intestinal gut, expressed bioactive α-MSH and had a significant anti-inflammatory effect. The results demonstrate the feasibility of preventing IBD by using B. longum-α-MSH.

  4. Fecal Microbiota Transplantation for Ulcerative Colitis: A Systematic Review and Meta-Analysis.

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    Yanqiang Shi

    Full Text Available Fecal microbiota transplantation (FMT has been recognized as a novel treatment for ulcerative colitis (UC. However, its efficacy and safety remain unclear.We conducted this systematic review to assess the efficacy and safety of FMT in UC.PubMed, EMBASE, Cochrane Central, Web of Science Core Collection, and three other Chinese databases were searched for reports of FMT in UC with clear outcomes.We estimated pooled rates [with 95% confidence interval (CI] of clinical remission among 15 cohort studies and clinical response among 16 cohort studies.Twenty five studies (2 randomized controlled trials, 15 cohort studies, and 8 case studies with 234 UC patients were included. Overall, 41.58% (84/202 patients achieved clinical remission (CR and 65.28% (126/193 achieved clinical response. Among the cohort studies, the pooled estimate of patients who achieved CR and clinical response were 40.5% (95% CI 24.7%-58.7%, and 66.1% (95% CI 43.7%-83.0%. Most adverse events were slight and self-resolving. The analyses of gut microbiota in 7 studies showed that FMT could increase microbiota diversity and richness, similarity, and certain change of bacterial composition.FMT provides a promising effect for UC with few adverse events. Successful FMT may be associated with an increase in microbiota diversity and richness, similarity, and certain change of bacterial composition.

  5. Computational Prediction and Validation of BAHD1 as a Novel Molecule for Ulcerative Colitis

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    Zhu, Huatuo; Wan, Xingyong; Li, Jing; Han, Lu; Bo, Xiaochen; Chen, Wenguo; Lu, Chao; Shen, Zhe; Xu, Chenfu; Chen, Lihua; Yu, Chaohui; Xu, Guoqiang

    2015-07-01

    Ulcerative colitis (UC) is a common inflammatory bowel disease (IBD) producing intestinal inflammation and tissue damage. The precise aetiology of UC remains unknown. In this study, we applied a rank-based expression profile comparative algorithm, gene set enrichment analysis (GSEA), to evaluate the expression profiles of UC patients and small interfering RNA (siRNA)-perturbed cells to predict proteins that might be essential in UC from publicly available expression profiles. We used quantitative PCR (qPCR) to characterize the expression levels of those genes predicted to be the most important for UC in dextran sodium sulphate (DSS)-induced colitic mice. We found that bromo-adjacent homology domain (BAHD1), a novel heterochromatinization factor in vertebrates, was the most downregulated gene. We further validated a potential role of BAHD1 as a regulatory factor for inflammation through the TNF signalling pathway in vitro. Our findings indicate that computational approaches leveraging public gene expression data can be used to infer potential genes or proteins for diseases, and BAHD1 might act as an indispensable factor in regulating the cellular inflammatory response in UC.

  6. Infliximab therapy for moderately severe Crohn's disease and ulcerative colitis: a retrospective comparison over 6 years.

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    Alzafiri, Raed; Holcroft, Christina A; Malolepszy, Paula; Cohen, Albert; Szilagyi, Andrew

    2011-01-01

    Infliximab has shown benefit in Crohn's disease (CD) and ulcerative colitis (UC). Evaluation of long-term outcome of therapy for both diseases. We analyzed retrospectively patients treated at infusion centers from one institution. Demographic, laboratory parameters leading up to biologic therapy and the subsequent pattern of outcomes in either disease were established as a database. Initial failure, subsequent need to change therapy, or need to adjust therapy were evaluated. Kruskal-Wallis (nonparametric) tests to compare two groups and Kaplan-Meier survival curve analysis were used to compare outcomes. Over approximately 6 years, 71 CD and 26 UC patients received 999 and 215 infusions, respectively, for a median of 62 months. Of these, 17% for CD and 19% for UC patients were primary failures. Following the start of infliximab, 18% of CD and 11% of UC patients required stoppage and switching to another type of therapy. In either CD or UC patients, 54% or 62%, respectively, continued therapy without the need to change to other treatments. Few serious side effects were noted. No important statistically significant differences in treatment patterns or outcome were observed between the groups. Long-term treatment of both inflammatory bowel diseases reflects outcomes of clinical trials. This study emphasizes similarities between CD and UC and reports therapeutic success for an extended time.

  7. Leukocytapheresis Therapy Improved Cholestasis in a Patient Suffering from Primary Sclerosing Cholangitis with Ulcerative Colitis

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    Minoru Itou

    2009-04-01

    Full Text Available Primary sclerosing cholangitis (PSC is an autoimmune disease of the hepatobiliary system for which effective therapy has not been established. Leukocytapheresis (LCAP therapy is known to effective in patients with ulcerative colitis (UC. In addition, effects of LCAP therapy were reported on some autoimmune diseases such as Crohn’s disease, rheumatoid arthritis and rapidly progressive glomerulonephritis. Here we report the case of a 29-year-old man with PSC associated with UC who was treated with LCAP therapy. He had a 16-year history of UC and a 12-year history of PSC. Although he was under treatment with prednisolone and ursodeoxycholic acid, exacerbation of UC and PSC-associated cholestasis were seen. Since he showed side effects of prednisolone, he was treated with LCAP. Not only improvement of UC, but also decreased serum alkaline phosphatase, γ-guanosine triphosphate and total bile acids, suggesting improvement of PSC-associated cholestaisis, were seen after treatment with LCAP. Our experience with this case suggests that LCAP therapy could be a new effective therapeutic strategy for patients with PSC associated with UC.

  8. Steroid-refractory ulcerative colitis treated with corticosteroids, metronidazole and vancomycin: a case report

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    Alex Philip

    2005-01-01

    Full Text Available Abstract Background Increasing evidence elucidating the pathogenic mechanisms of ulcerative colitis (UC has accumulated and the disease is widely assumed to be the consequence of genetic susceptibility and an abnormal immune response to commensal bacteria. However evidence regarding an infectious etiology in UC remains elusive. Case presentation We report a provocative case of UC with profound rheumatologic involvement directly preceded by Clostridium difficile infection and accompanying fever, vomiting, bloody diarrhea, and arthritis. Colonic biopsy revealed a histopathology suggestive of UC. Antibiotic treatment eliminated detectable levels of enteric pathogens but did not abate symptoms. Resolution of symptoms was procurable with oral prednisone, but tapering of corticosteroids was only achievable in combination therapy with vancomycin and metronidazole. Conclusions An infectious pathogen may have both precipitated and exacerbated autoimmune disease attributes in UC, symptoms of which could be resolved only with a combination of corticosteroids, vancomycin and metronidazole. This may warrant the need for more perceptive scrutiny of C. difficile and the like in patients with UC.

  9. Analysis ulcerative colitis for presence Epstein-Barr virus DNA sequences by polymerase chain reaction technique

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    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.

  10. Serum Fatty Acids Are Correlated with Inflammatory Cytokines in Ulcerative Colitis.

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    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.

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

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    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.

  12. Advancement of Buried Muco- Subcutaneous Sutures for Ostomy Creation in Surgery for Ulcerative Colitis.

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    Uchino, Motoi; Ikeuchi, Hiroki; Matsuoka, Hiroki; Bando, Toshihiro; Okayamaz, Kanako; Takesue, Yoshio; Tomita, Naohiro

    2015-06-01

    Ostomy creation is a fundamental technique. However, little information is available concerning the procedure and the associated complications. We reviewed the relationship between the ostomy procedure and complications. The records of patients who were diagnosed with ulcerative colitis and underwent ostomy creation between January 2007 and July 2012 were reviewed. Stoma complications, including muco-cutaneous dehiscence, fistula and granulation were also reviewed. The study included 176 patients who received interrupted sutures with removal of the stitches and 202 patients who received subcutaneous sutures without removal of the stitches. Among the patients with buried sutures, 108 received braided absorbable sutures and 94 received with mono filament absorbable sutures. The incidence of dehiscence was significantly higher with the interrupted sutures (43.2%) than with the buried sutures (31.2%), although the granulation and fistula rates were not significantly different. Among the patients with buried sutures, fistula (6.4%) and granulation (21.3%) rates were slightly increased with the mono filament sutures compared with the braided sutures, although the differences were not significant. CONCLUSIONS. Suture removal appeared to be an unnecessary manipulation at ostomy creation. Further study for all colorectal surgery is needed to investigate whether the incidence of fistula increases with buried sutures.

  13. Hsp10, Hsp70, and Hsp90 immunohistochemical levels change in ulcerative colitis after therapy

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    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.

  14. Review of Clinical Studies of the Treatment of Ulcerative Colitis Using Acupuncture and Moxibustion

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    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.

  15. Changes in cytokine profile may predict therapeutic efficacy of infliximab in patients with ulcerative colitis.

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    Sato, Shoko; Chiba, Toshimi; Nakamura, Shotaro; Matsumoto, Takayuki

    2015-10-01

    Infliximab is an established therapy for ulcerative colitis (UC). The aim of this study was to examine various serum cytokine levels and to identify possible markers predictive of therapeutic efficacy of infliximab for UC patients. Twenty-one patients with moderately active UC were given intravenous infliximab (5 mg/kg) at 0, 2, and 6 weeks as induction therapy. The serum levels of 17 cytokines were determined using a Bio-Plex suspension array system before and 8 weeks after induction therapy. Partial Mayo score (PMS) and serum C-reactive protein levels were used for the determination of clinical activities at 0 and 8 weeks after the treatment. The overall therapeutic effect was determined at 26 weeks according to the PMS. The median value of the PMS decreased significantly 8 weeks after the treatment (from 6 to 1.5, P infliximab, while IL-6 at 8 weeks after induction therapy may be predictive of subsequent response to infliximab. © 2015 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

  16. Infliximab Dose Escalation as an Effective Strategy for Managing Secondary Loss of Response in Ulcerative Colitis.

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    Taxonera, Carlos; Barreiro-de Acosta, Manuel; Calvo, Marta; Saro, Cristina; Bastida, Guillermo; Martín-Arranz, María D; Gisbert, Javier P; García-Sánchez, Valle; Marín-Jiménez, Ignacio; Bermejo, Fernando; Chaparro, María; Ponferrada, Ángel; Martínez-Montiel, María P; Pajares, Ramón; de Gracia, Celia; Olivares, David; Alba, Cristina; Mendoza, Juan L; Fernández-Blanco, Ignacio

    2015-10-01

    The outcomes of infliximab dose escalation in ulcerative colitis (UC) have not been well evaluated. To assess the short- and long-term outcomes of infliximab dose escalation in a cohort of patients with UC. This was a multicenter, retrospective, cohort study. All consecutive UC patients who had lost response to infliximab maintenance infusions and who underwent infliximab dose escalation were included. Post-escalation short-term clinical response and remission were evaluated. In the long term, the cumulative probabilities of infliximab failure-free survival and colectomy-free survival were calculated. Predictors of short-term response and event-free survival were estimated using logistic regression analysis and Cox proportional hazard regression analysis. Seventy-nine patients were included. Fifty-four patients (68.4%) achieved short-term clinical response and 41 patients (51.9%) entered in clinical remission. After a median follow-up of 15 months [interquartile range (IQR) 8-26], 33 patients (41.8%) had infliximab failure. Patients with short-term response had a significantly lower adjusted rate of infliximab failure [hazard ratio (HR) 0.24, 95% confidence interval (CI) 0.12-0.49; p infliximab during maintenance, infliximab dose escalation enabled recovery of short-term response in nearly 70% of patients. In the long term, 58% of patients maintained sustained clinical benefit, and 9 of 10 avoided colectomy. Short-term response was associated with an 86% reduction in the relative risk of colectomy.

  17. Effect of extended MMX mesalamine therapy for acute, mild-to-moderate ulcerative colitis.

    Science.gov (United States)

    Kamm, Michael A; Lichtenstein, Gary R; Sandborn, William J; Schreiber, Stefan; Lees, Kirstin; Barrett, Karen; Joseph, Raymond

    2009-01-01

    Many patients with ulcerative colitis (UC) respond to mesalamine therapy within 8 weeks. Those not achieving remission after 8 weeks are often treated with steroids or other immunosuppressive therapies. This study aimed to determine the effect of 8 weeks' high-dose MMX mesalamine extension therapy in patients with active, mild-to-moderate UC who had previously failed to achieve complete remission in 2 phase III, double-blind, placebo-controlled studies of MMX mesalamine (SPD476-301 and -302). Patients with active, mild-to-moderate UC who did not achieve clinical and endoscopic remission after mesalamine (2.4 or 4.8 g/day), ASACOL (mesalamine) delayed-release tablets 2.4 g/day, or placebo in the phase III studies received MMX mesalamine 4.8 g/day for 8 weeks. The aim was to assess remission at week 8, defined as a total modified UC Disease Activity Index score of or=1 point reduction from baseline in sigmoidoscopy score. Overall, 304 patients who entered this acute extension study were evaluated; 59.5% achieved remission at week 8. Remission rates were similar irrespective of prior treatment in the initial acute phase III studies. Most patients with mild-to-moderate UC who fail to achieve remission with up to 8 weeks' initial mesalamine therapy can achieve clinical and endoscopic remission following a further 8 weeks' treatment with high-dose MMX mesalamine therapy, thereby avoiding step-up therapy.

  18. The incidence of postoperative venous thrombosis among patients with ulcerative colitis.

    LENUS (Irish Health Repository)

    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.

  19. Clinical and immunological features of chronic non-specific non-ulcerative colitis in infants.

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    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.

  20. Clinical Response to Vedolizumab in Ulcerative Colitis Patients Is Associated with Changes in Integrin Expression Profiles

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    Friederike Fuchs

    2017-07-01

    Full Text Available BackgroundDespite large clinical success, deeper insights into the immunological effects of vedolizumab therapy for inflammatory bowel diseases are scarce. In particular, the reasons for differential clinical response in individual patients, the precise impact on the equilibrium of integrin-expressing T cell subsets, and possible associations between these issues are not clear.MethodsBlood samples from patients receiving clinical vedolizumab therapy were sequentially collected and analyzed for expression of integrins and chemokine receptors on T cells. Moreover, clinical and laboratory data from the patients were collected, and changes between homing marker expression and clinical parameters were analyzed for possible correlations.ResultsWhile no significant correlation of changes in integrin expression and changes in outcome parameters were identified in Crohn’s disease (CD, increasing α4β7 levels in ulcerative colitis (UC seemed to be associated with favorable clinical development, whereas increasing α4β1 and αEβ7 correlated with negative changes in outcome parameters. Changes in α4β1 integrin expression after 6 weeks were significantly different in responders and non-responders to vedolizumab therapy as assessed after 16 weeks with a cutoff of +4.2% yielding 100% sensitivity and 100% specificity in receiver-operator-characteristic analysis.DiscussionOur data show that clinical response to vedolizumab therapy in UC but not in CD is associated with specific changes in integrin expression profiles opening novel avenues for mechanistic research and possibly prediction of response to therapy.

  1. Clinical Response to Vedolizumab in Ulcerative Colitis Patients Is Associated with Changes in Integrin Expression Profiles.

    Science.gov (United States)

    Fuchs, Friederike; Schillinger, Daniela; Atreya, Raja; Hirschmann, Simon; Fischer, Sarah; Neufert, Clemens; Atreya, Imke; Neurath, Markus F; Zundler, Sebastian

    2017-01-01

    Despite large clinical success, deeper insights into the immunological effects of vedolizumab therapy for inflammatory bowel diseases are scarce. In particular, the reasons for differential clinical response in individual patients, the precise impact on the equilibrium of integrin-expressing T cell subsets, and possible associations between these issues are not clear. Blood samples from patients receiving clinical vedolizumab therapy were sequentially collected and analyzed for expression of integrins and chemokine receptors on T cells. Moreover, clinical and laboratory data from the patients were collected, and changes between homing marker expression and clinical parameters were analyzed for possible correlations. While no significant correlation of changes in integrin expression and changes in outcome parameters were identified in Crohn's disease (CD), increasing α4β7 levels in ulcerative colitis (UC) seemed to be associated with favorable clinical development, whereas increasing α4β1 and αEβ7 correlated with negative changes in outcome parameters. Changes in α4β1 integrin expression after 6 weeks were significantly different in responders and non-responders to vedolizumab therapy as assessed after 16 weeks with a cutoff of +4.2% yielding 100% sensitivity and 100% specificity in receiver-operator-characteristic analysis. Our data show that clinical response to vedolizumab therapy in UC but not in CD is associated with specific changes in integrin expression profiles opening novel avenues for mechanistic research and possibly prediction of response to therapy.

  2. Selective biologics for ulcerative colitis and Crohn's disease – clinical utility of vedolizumab

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    Petkau JM

    2016-03-01

    Full Text Available Jill MV Petkau, Bertus Eksteen Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada Abstract: Inflammatory bowel disease (IBD encompasses a cluster of different disease phenotypes which are broadly classified into ulcerative colitis and Crohn's disease. Disease pathogenesis is driven by abnormal host immune responses to their resident gut microbiome in genetically susceptible individuals. Clinical disease features and outcomes are heterogenous and not unexpected as over 163 genetic loci are associated with disease susceptibility, and there are great variability in environmental exposures. Despite this variability, there has been relatively few efficacious therapies for particularly moderate-to-severe IBD. Treatment has been dominated by antitumor necrosis alpha agents with significant success but equally potentially serious adverse events. Therapeutic targeting of leucocyte trafficking has emerged as a viable alternative therapy, with vedolizumab being the lead compound. This review focuses primarily on its biological function as a selective gut immunotherapy, its safety and efficacy, and its emerging role as a mainstream therapy in managing IBD. Keywords: adhesion molecule antagonist, anti-α4β7 integrin, inflammatory bowel disease, leukocyte trafficking, monoclonal antibody, selective gut immunotherapy, tumor necrosis factor alpha

  3. Lung and Intestine: A Specific Link in an Ulcerative Colitis Rat Model

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    Yuan Liu

    2013-01-01

    Full Text Available Background. To investigate the link and mechanisms between intestine and lung in the ulcerative colitis (UC rat model. Materials and Methods. We used the UC rat model by immunological sensitization combined with local 2, 4, 6-trinitrobenzene sulfonic acid (TNBS in 50% ethanol enema, observed dynamically animal general state and body weight, examined the histological and functional changes in the colon, lung, liver, and kidney tissues, and detected microvascular endothelium response towards inflammation characterized with the expression of iNOS, TXB2, P-selectin, ICAM-1, and vascular endothelial growth factor A (VEGF-A in the colon and lung tissue. Results. Pulmonary function results suggested ventilator disorder, and pathological findings showed interstitial pneumonia. There were no significant changes in the liver and kidney function and histopathology. The colon and lung tissue iNOS, TXB2, P-selectin, ICAM-1, and VEGF-A expression of the model rats was significantly higher than the normal rats at both time points. Conclusions. Our study is the first to demonstrate the close association between the large intestine and lung in the immune-TNBS-ethanol-induced UC rat model. Different organs and tissues with the same embryonic origin may share the same pathological specificities in a disease. The present study provided a new way of thinking for pathological changes in clinical complex diseases manifested with multiorgan damage.

  4. Upregulation of basolateral small conductance potassium channels (KCNQ1/KCNE3) in ulcerative colitis.

    Science.gov (United States)

    Al-Hazza, Adel; Linley, John; Aziz, Qadeer; Hunter, Malcolm; Sandle, Geoffrey

    2016-02-05

    Basolateral K(+) channels hyperpolarize colonocytes to ensure Na(+) (and thus water) absorption. Small conductance basolateral (KCNQ1/KCNE3) K(+) channels have never been evaluated in human colon. We therefore evaluated KCNQ1/KCNE3 channels in distal colonic crypts obtained from normal and active ulcerative colitis (UC) patients. KCNQ1 and KCNE3 mRNA levels were determined by qPCR, and KCNQ1/KCNE3 channel activity in normal and UC crypts, and the effects of forskolin (activator of adenylate cyclase) and UC-related proinflammatory cytokines on normal crypts, studied by patch clamp recording. Whereas KCNQ1 and KCNE3 mRNA expression was similar in normal and UC crypts, single 6.8 pS channels were seen in 36% of basolateral patches in normal crypts, and to an even greater extent (74% of patches, P KCNQ1/KCNE3 channels make only a small contribution to basolateral conductance in normal colonic crypts, with increased channel activity in UC appearing insufficient to prevent colonic cell depolarization in this disease. This supports the proposal that defective Na(+) absorption rather than enhanced Cl(-) secretion, is the dominant pathophysiological mechanism of diarrhea in UC. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  5. Immunohistochemical Studies on Galectin Expression in Colectomised Patients with Ulcerative Colitis

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    Mattias Block

    2016-01-01

    Full Text Available Introduction. The aetiology and pathogenesis of ulcerative colitis (UC are essentially unknown. Galectins are carbohydrate-binding lectins involved in a large number of physiological and pathophysiological processes. Little is known about the role of galectins in human UC. In this immunohistochemical exploratory study, both epithelial and inflammatory cell galectin expression were studied in patients with a thoroughly documented clinical history and were correlated with inflammatory activity. Material and Methods. Surgical whole intestinal wall colon specimens from UC patients (n=22 and controls (n=10 were studied. Clinical history, pharmacological treatment, and modified Mayo-score were recorded. Tissue inflammation was graded, and sections were stained with antibodies recognizing galectin-1, galectin-2, galectin-3, and galectin-4. Results. Galectin-1 was undetectable in normal and UC colonic epithelium, while galectin-2, galectin-3, and galectin-4 were strongly expressed. A tendency towards diminished epithelial expression with increased inflammatory grade for galectin-2, galectin-3, and galectin-4 was also found. In the inflammatory cells, a strong expression of galectin-2 and a weak expression of galectin-3 were seen. No clear-cut correlation between epithelial galectin expression and severity of the disease was found. Conclusion. Galectin expression in patients with UC seems to be more dependent on disease focality and individual variation than on degree of tissue inflammation.

  6. The Correlation Between Liver Fat Content and Ulcerative Colitis Disease Severity

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    Raika Jamali

    2017-07-01

    Full Text Available To evaluate the association between disease severity and hepatic steatosis in patients with ulcerative colitis (UC and non-alcoholic steatohepatitis (NASH. Consecutively selected UC patients admitted to the gastroenterology clinic were enrolled in the study. UC severity was assessed by Truelove and Witts classification. Patients with severe UC were excluded from the study. NASH was determined based on persistently elevated serum aminotransferase levels and detection of fatty liver ultrasound. Patients with other etiologies for elevated aminotransferase levels were excluded. Liver fat content (LFC was assessed by measuring liver fat score (LFS. One hundred patients (42% male were included in the study. According to liver ultrasound examination, 62 (% patients were identified with grade 1 fatty liver disease, and 38 (% patients were classified as advanced (grade 2 and 3 fatty liver disease. Sixty-one patients had left-sided UC and (46% had mild UC disease severity index. LFS was significantly higher in UC patients with the moderate disease than patients with mild disease (3.53±2.68 vs. 5.89±2.85, respectively; P<0.01. Nevertheless, no significant difference was observed in LFS regarding UC extension. There was no significant difference between NASH ultrasound grades in view of UC severity and extension. LFC might be associated with UC severity.

  7. Health-related quality of life in Chinese patients with mild and moderately active ulcerative colitis.

    Science.gov (United States)

    Zheng, Kai; Zhang, Shengsheng; Wang, Chuijie; Zhao, Wenxia; Shen, Hong

    2015-01-01

    Ulcerative colitis (UC) impairs the health-related quality of life (HRQOL). The difference in HRQOL between patients with mild and moderately active UC is not well-defined. Few studies have been conducted to explore the factors that influence HRQOL in Chinese patients. Our study aims were to (1) compare HRQOL of mildly active UC patients with moderate patients; (2) explore the factors that influence HRQOL in Chinese patients with UC; and (3) analyze demographic and disease characteristics of UC in China. A total of 110 mild and 114 moderate patients with UC were enrolled. The demographic and disease characteristics were recorded. HRQOL was measured by the Chinese version of the inflammatory bowel disease questionnaire (IBDQ) between mild and moderate patients, male and female patients, and different disease distributions. Stepwise regression analysis was used to assess factors influencing the IBDQ score. Patients with moderate UC had significantly lower IBDQ total scores compared to patients with mild UC (P=0.001). The IBDQ total score had a negative correlation with the Mayo score (r=-0.263, Pimpairment of HRQOL in Chinese patients with UC. Chinese females may benefit from increased psychological care as part of UC therapy.

  8. Nitric oxide-releasing aspirin but not conventional aspirin improves healing of experimental colitis

    Science.gov (United States)

    Zwolinska-Wcislo, Malgorzata; Brzozowski, Tomasz; Ptak-Belowska, Agata; Targosz, Aneta; Urbanczyk, Katarzyna; Kwiecien, Slawomir; Sliwowski, Zbigniew

    2011-01-01

    AIM: To determine the effect of non-selective cyclooxygenase (COX) inhibitors, selective COX-2 inhibitors and nitric oxide (NO)-releasing aspirin in the healing of ulcerative colitis. METHODS: Rats with 2,4,6 trinitrobenzenesulfon-ic acid (TNBS)-induced colitis received intragastric (ig) treatment with vehicle, aspirin (ASA) (a non-selective COX inhibitor), celecoxib (a selective COX-2 inhibitor) or NO-releasing ASA for a period of ten days. The area of colonic lesions, colonic blood flow (CBF), myeloperoxidase (MPO) activity and expression of proinflammatory markers COX-2, inducible form of nitric oxide synthase (iNOS), IL-1β and tumor necrosis factor (TNF)-α were assessed. The effects of glyceryl trinitrate (GTN), a NO donor, and 2-(4-carboxyphenyl)-4,5-dihydro-4,4,5,5-​tetramethyl-1H-imidazolyl-1-oxy-3-oxide, onopotassium salt (carboxy-PTIO), a NO scavenger, administered without and with ASA or NO-ASA, and the involvement of capsaicin-sensitive afferent nerves in the mechanism of healing the experimental colitis was also determined. RESULTS: Rats with colitis developed macroscopic and microscopic colonic lesions accompanied by a significant decrease in the CBF, a significant rise in colonic weight, MPO activity and plasma IL-1β and TNF-α levels. These effects were aggravated by ASA and 5-(4-chlorophenyl)-1-(4-methoxyphenyl)-3-(trifluoromethyl)-1H-pyrazole (SC-560), but not celecoxib and counteracted by concurrent treatment with a synthetic prostaglandin E2 (PGE2) analog. Treatment with NO-ASA dose-dependently accelerated colonic healing followed by a rise in plasma NOx content and CBF, suppression of MPO and downregulation of COX-2, iNOS, IL-1β and TNF-α mRNAs. Treatment with GTN, the NO donor, significantly inhibited the ASA-induced colonic lesions and increased CBF, while carboxy-PTIO or capsaicin-denervation counteracted the NO-ASA-induced improvement of colonic healing and the accompanying increase in the CBF. These effects were restored by co

  9. Preventive and therapeutic euphol treatment attenuates experimental colitis in mice.

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    Rafael C Dutra

    Full Text Available BACKGROUND: The tetracyclic triterpene euphol is the main constituent found in the sap of Euphorbia tirucalli. This plant is widely known in Brazilian traditional medicine for its use in the treatment of several kinds of cancer, including leukaemia, prostate and breast cancers. Here, we investigated the effect of euphol on experimental models of colitis and the underlying mechanisms involved in its action. METHODOLOGY/PRINCIPAL FINDINGS: Colitis was induced in mice either with dextran sulfate sodium (DSS or with 2,4,6-trinitrobenzene sulfonic acid (TNBS, and the effect of euphol (3, 10 and 30 mg/kg on colonic injury was assessed. Pro-inflammatory mediators and cytokines were measured by immunohistochemistry, enzyme-Linked immunoabsorbent assay (ELISA, real time-polymerase chain reaction (RT-PCR and flow cytometry. Preventive and therapeutic oral administration of euphol attenuated both DSS- and TNBS-induced acute colitis as observed by a significant reduction of the disease activity index (DAI, histological/microscopic damage score and myeloperoxidase (MPO activity in colonic tissue. Likewise, euphol treatment also inhibited colon tissue levels and expression of IL-1β, CXCL1/KC, MCP-1, MIP-2, TNF-α and IL-6, while reducing NOS2, VEGF and Ki67 expression in colonic tissue. This action seems to be likely associated with inhibition of activation of nuclear factor-κB (NF-κB. In addition, euphol decreased LPS-induced MCP-1, TNF-α, IL-6 and IFN-γ, but increased IL-10 secretion from bone marrow-derived macrophages in vitro. Of note, euphol, at the same schedule of treatment, markedly inhibited both selectin (P- and E-selectin and integrin (ICAM-1, VCAM-1 and LFA-1 expression in colonic tissue. CONCLUSIONS/SIGNIFICANCE: Together, these results clearly demonstrated that orally-administered euphol, both preventive or therapeutic treatment were effective in reducing the severity of colitis in two models of chemically-induced mouse colitis and suggest

  10. Preventive and Therapeutic Euphol Treatment Attenuates Experimental Colitis in Mice

    Science.gov (United States)

    Bento, Allisson F.; Marcon, Rodrigo; Schmidt, Éder C.; Bouzon, Zenilda L.; Pianowski, Luiz F.; Calixto, João B.

    2011-01-01

    Background The tetracyclic triterpene euphol is the main constituent found in the sap of Euphorbia tirucalli. This plant is widely known in Brazilian traditional medicine for its use in the treatment of several kinds of cancer, including leukaemia, prostate and breast cancers. Here, we investigated the effect of euphol on experimental models of colitis and the underlying mechanisms involved in its action. Methodology/Principal Findings Colitis was induced in mice either with dextran sulfate sodium (DSS) or with 2,4,6-trinitrobenzene sulfonic acid (TNBS), and the effect of euphol (3, 10 and 30 mg/kg) on colonic injury was assessed. Pro-inflammatory mediators and cytokines were measured by immunohistochemistry, enzyme-Linked immunoabsorbent assay (ELISA), real time-polymerase chain reaction (RT-PCR) and flow cytometry. Preventive and therapeutic oral administration of euphol attenuated both DSS- and TNBS-induced acute colitis as observed by a significant reduction of the disease activity index (DAI), histological/microscopic damage score and myeloperoxidase (MPO) activity in colonic tissue. Likewise, euphol treatment also inhibited colon tissue levels and expression of IL-1β, CXCL1/KC, MCP-1, MIP-2, TNF-α and IL-6, while reducing NOS2, VEGF and Ki67 expression in colonic tissue. This action seems to be likely associated with inhibition of activation of nuclear factor-κB (NF-κB). In addition, euphol decreased LPS-induced MCP-1, TNF-α, IL-6 and IFN-γ, but increased IL-10 secretion from bone marrow-derived macrophages in vitro. Of note, euphol, at the same schedule of treatment, markedly inhibited both selectin (P- and E-selectin) and integrin (ICAM-1, VCAM-1 and LFA-1) expression in colonic tissue. Conclusions/Significance Together, these results clearly demonstrated that orally-administered euphol, both preventive or therapeutic treatment were effective in reducing the severity of colitis in two models of chemically-induced mouse colitis and suggest this plant

  11. Effects of dextran sulfate sodium induced experimental colitis on cytochrome P450 activities in rat liver, kidney and intestine.

    Science.gov (United States)

    Hu, Nan; Huang, Yanjuan; Gao, Xuejiao; Li, Sai; Yan, Zhixiang; Wei, Bin; Yan, Ru

    2017-06-01

    Dextran sulfate sodium (DSS) induced experimental colitis presents a histologic resemblance to human ulcerative colitis (UC). Altered cytochrome P450s (CYPs) have been reported in this model and patients with UC. In this study, six CYPs activities were quantitatively determined in microsomes of liver (RLMs), kidney (RRMs) and intestine (RIMs) from rats with colitis at acute (5% DSS for 7 days, UCA) and remission (7-day DSS treatment followed by 7-day cessation, UCR) phases and compared with normal rats. Generally, CYPs activities varied with isoform, organ, and disease status. Hepatic CYP1A2, 2B1, 2C6/11, 2E1 and 3A1/2 activities were reduced by acute colitis and completely or partially restored after DSS was halted. Although DSS treatment decreased the Vmax of renal CYP2C6/11 and increased that of CYP2D2, their CLint, in vitro were comparable among normal, acute and remission stages. DSS treatment changed the kinetics of CYP3A1/2-mediated nifedipine metabolism in RRMs from biphasic to classical kinetics. Notably, CYP2D2 activity was elevated in liver and kidney in acute UC, while enhanced in liver and decreased in kidney in remission. In intestine, CYP3A1/2 activity was increased in UCA and further enhanced after DSS withdrawal. These findings highlight the necessity of quantifying enzyme activity for precision drug therapy. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. The Role of Enteropathogenic E.coli in the Development and Progression of Chronic Non-Ulcerative Colitis

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    L.I. Sydorchuk

    2016-04-01

    Full Text Available Objective. The analysis of the literature has shown that in patients with chronic non-ulcerative colitis, there were isolated E.coli that cause dysentery-like, cholera-like diseases and escherichioses. Thus, the aim of our study was to establish the level of persistence of enteropathogenic Escherichia in the colon of patients with chronic non-ulcerative colitis and their importance in the ecological system «macroorganism — microbiota». Material and methods. During 2000–2015, there has been conducted a bacteriological examination of the colon content in patients with chronic non-ulcerative colitis aged 27–41 years (average age 37.74 ± 3.62 years. The resulting cultures were examined in the indicative agglutination tests with OKA polyvalent serum. Positive cultures were tested with polyvalent serum of narrow spectrum ОКВ, ОКС, ОКD and ОКЕ. Results. In patients, in colon cavity of which E.coli O18ac:K77; O26:K60; O55:K59; O128ab:K67 were detected, the disease occurs by nosology of colienteritis. In those patients, in whom O25:K11; O144:K; O124:K72 serotypes have been identified, disease occurred as bacterial dysentery, and O25:K11 and O128:K67 — in chole­ra-like form. Discussion. In 94.50 % of patients, common E.coli were detected, but in 55 (35.03 % of them enteropathogenic Escherichia persist, in 41 (26.11 % — E.coli Hly+, in 37 (23.57 % — E.coli Lac–, in 18 (11.46 % — enterotoxigenic E.coli, in 14 (8.42 % — enteroinvasive, and in 11 (7.01 % — enterohemorragic Escherichia. Conclusions. It was determined that the main serotypes of opportunistic Escherichia, which colonize and persist in the colon cavity of patients with chronic non-ulcerative colitis, were O114:K90; O25:K11; O124:K72; O128:K67; O18ac:K77, the persistence of which affects clinical manifestation from colitis to dysentery-like or cholera-like disease.

  13. EFFICACY OF TACROLIMUS FOR INDUCTION OF REMISSION IN PATIENTS WITH MODERATE-TO-SEVERE ULCERATIVE COLITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS.

    Science.gov (United States)

    Lasa, Juan; Olivera, Pablo

    2017-01-01

    There is evidence that shows that calcineurin inhibitors may be useful for the treatment of severe ulcerative colitis. However, evidence regarding the efficacy of tacrolimus for remission induction in this setting is scarce. To develop a systematic review on the existing evidence regarding the clinical efficacy of tacrolimus for the induction of remission in patients with moderate-to-severe ulcerative colitis. A literature search was undertaken from 1966 to August 2016 using MEDLINE, Embase, LILACS and the Cochrane Library. The following MeSH terms were used: "Inflammatory Bowel Diseases" or "Ulcerative Colitis" and "Calcineurin Inhibitors" or "Tacrolimus" or "FK506". Studies performed in adult ulcerative colitis patients that evaluated the clinical efficacy of tacrolimus for the induction of remission were considered for revision. A meta-analysis was performed with those included studies that were also placebo-controlled and randomized. Clinical response as well as clinical remission and mucosal healing were evaluated. Overall, 755 references were identified, from which 22 studies were finally included. Only two of them were randomized, placebo-controlled trials. A total of 172 patients were evaluated. A significantly lower risk of failure in clinical response was found for tacrolimus versus placebo [RR 0.58 (0.45-0.73)]; moreover, a lower risk of failure in the induction of remission was also found versus placebo [RR 0.91 (0.82-1)]. Tacrolimus seems to be a valid therapeutic alternative for the induction of remission in patients with moderate-to-severe ulcerative colitis.

  14. [Adherence to the H1N1 vaccination recommendation in patients with Crohn's disease or ulcerative colitis].

    Science.gov (United States)

    2011-05-01

    In September 2009, the German "Standing Committee for Vaccination" (STIKO) recommended the H1N1 influenza vaccination to all patients with chronic diseases. We investigated the adherence to this recommendation in patients with the inflammatory bowel diseases (IBD) Crohn's disease or ulcerative colitis. Special attention was paid to arguments for vaccination refusal. In an explorative multicenter study we asked adult patients to answer a questionnaire about their participation in the H1N1 vaccination campaign, their arguments for and against this vaccination and disease specific parameters. Out of 1389 participating patients, 226 (16 %) received the H1N1 vaccination. Among patients who were vaccinated against the seasonal flu as well as patients who were treated with anti-TNF-treatment and members of the German Crohn's and Colitis Association, the participation rates were significantly higher (32 %, 26 %, 25 %, respectively). The main argument against the H1N1 vaccination was fear of side effects (59 %). However, 77 % of all vaccinated patients judged the vaccine as very well tolerated. The non-adherence to general vaccination recommendations against tetanus and seasonal flu was also high (25 % and 66 %, respectively). Only a minority of patients with Crohn's disease or ulcerative colitis had adhered to the official recommendation concerning vaccination against H1N1. In order to reach higher acceptance, further vaccination campaigns must focus on the safety of the recommended vaccine. © Georg Thieme Verlag KG Stuttgart · New York.

  15. Vancomycin pre-treatment impairs tissue healing in experimental colitis: Importance of innate lymphoid cells.

    Science.gov (United States)

    Zhao, Di; Cai, Chenwen; Zheng, Qing; Jin, Shuang; Song, Dongjuan; Shen, Jun; Ran, Zhihua

    2017-01-29

    The interplay between luminal microbes and innate immunity during colonic epithelial repair has been well noted. At the same time, antibiotic has widely been used during flare-ups of ulcerative colitis. The possible effects of luminal microbiota disruption caused by antibiotics usage on epithelial repairing have been scarcely discussed. Innate lymphoid cells (ILCs) embedded in the lamina propria can be modulated by gut microbes, resulting in altered colonic IL-22/pSTAT3 levels, which is considered a prominent molecular axis in tissue repairing after epithelium damage. This study aimed to investigate whether antibiotics could interfere with ILCs-dependent tissue repair. Dextran sodium sulfate (DSS)-induced colitis was established in mice pre-treated with reagent of different antibiotic spectrum. Both morphological and molecular markers of tissue repair after DSS cessation were detected. ILCs population and function status were also recorded. Further attention was paid to the response of dendritic cells after antibiotics treatment, which were claimed to regulate colonic ILC3s in an IL-23 dependent way. Using of vancomycin resulted in delayed tissue repairing after experimental colitis. Both colonic IL-22/pSTAT3 axis and ILC3 population were found decreased in this situation. Vancomycin treatment diminished the upstream IL-23 and producer dendritic cell population. The reduced dendritic cell number may due to inadequate chemokines and colony-stimulating factors supply. Presence of vancomycin-sensitive microbiota is required for the maturation of ILC3-activating dendritic cells hence maintain the sufficient IL-22/pSTAT3 level in the colon during tissue healing. Manipulation of colonic microbiota may help achieve colonic mucosal healing post inflammation and injury. Copyright © 2016. Published by Elsevier Inc.

  16. Protective effect of Agave americana Linn. leaf extract in acetic acid-induced ulcerative colitis in rats

    Science.gov (United States)

    Mannasaheb, Basheerahmed A.A.; Kulkarni, Preeti V.; Sangreskopp, Mashood Ahmed; Savant, Chetan; Mohan, Anjana

    2015-01-01

    Introduction: Natural plants always provide core compounds for new drug development. In the present life and food style, inflammatory bowel disease has become common and needs a lead compound for its drug development. Aim: To evaluate the effect of Agave americana Linn. leaf extract in acetic acid-induced ulcerative colitis in rats based on its traditional anti-inflammatory use. Materials and Methods: Male Wistar rats were pretreated with A. americana leaf extract in the dose of 200 and 400 mg/kg p.o. daily for 7 days. On 8th day, 2 ml of 4% v/v acetic acid in saline was instilled into rats’ rectum. Prednisolone was used as standard drug and it was administered on the day of acetic acid instillation and continued for 3 days. Extract treatment was continued till 11th day. Body weight, ulcer score, colonic muscle contraction, antioxidant activity and histopathology were studied. Statistical analysis was performed using Parametric one-way analysis of variance followed by Tukey's posttest. Results: A. americana have retained total body weight significantly (P < 0.01) and decreased colon weight/length ratio. Extract have shown a significant decrease (P < 0.001) in ulcer scores, myeloperoxidase, lipid peroxidase activity. Further, extract have shown significant improvement in colonic muscle contraction, histopathology of colon etc., which is comparable with standard drug. Conclusion: A. americana possess protective effect against acetic acid-induced colitis in rats. PMID:26730148

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

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    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

  18. Genetic variation in the familial Mediterranean fever gene (MEFV and risk for Crohn's disease and ulcerative colitis.

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    Alexandra-Chloé Villani

    2009-09-01

    Full Text Available The familial Mediterranean fever (FMF gene (MEFV encodes pyrin, a major regulator of the inflammasome platform controlling caspase-1 activation and IL-1beta processing. Pyrin has been shown to interact with the gene product of NLRP3, NALP3/cryopyrin, also an important active member of the inflammasome. The NLRP3 region was recently reported to be associated with Crohn's disease (CD susceptibility. We therefore sought to evaluate MEFV as an inflammatory bowel disease (IBD susceptibility gene.MEFV colonic mucosal gene expression was significantly increased in experimental colitis mice models (TNBS p<0.0003; DSS p<0.006, in biopsies from CD (p<0.02 and severe ulcerative colitis (UC patients (p<0.008. Comprehensive genetic screening of the MEFV region in the Belgian exploratory sample set (440 CD trios, 137 UC trios, 239 CD cases, 96 UC cases, and 107 healthy controls identified SNPs located in the MEFV 5' haplotype block that were significantly associated with UC (rs224217; p = 0.003; A allele frequency: 56% cases, 45% controls, while no CD associations were observed. Sequencing and subsequent genotyping of variants located in this associated haplotype block identified three synonymous variants (D102D/rs224225, G138G/rs224224, A165A/rs224223 and one non-synonymous variant (R202Q/rs224222 located in MEFV exon 2 that were significantly associated with UC (rs224222: p = 0.0005; A allele frequency: 32% in cases, 23% in controls. No consistent associations were observed in additional Canadian (256 CD trios, 91 UC trios and Scottish (495 UC, 370 controls sample sets. We note that rs224222 showed marginal association (p = 0.012; G allele frequency: 82% in cases, 70% in controls in the Canadian sample, but with a different risk allele. None of the NLRP3 common variants were associated with UC in the Belgian-Canadian UC samples and no significant interactions were observed between NLRP3 and MEFV that could explain the observed flip-flop of the rs224222 risk

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    , 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......], 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...... significantly with increasing clinical (SIBDQ [χ(2) = 61.8, p SHS [χ(2) = 63.4, p SHS [χ(2) = 40.3, p

  20. Dimethyl Fumarate Reduces Inflammatory Responses in Experimental Colitis

    Science.gov (United States)

    Casili, Giovanna; Cordaro, Marika; Impellizzeri, Daniela; Bruschetta, Giuseppe; Paterniti, Irene; Cuzzocrea, Salvatore

    2016-01-01

    Background and Aims: Fumaric acid esters have been proven to be effective for the systemic treatment of psoriasis and multiple sclerosis. We aimed to develop a new treatment for colitis. Methods: We investigated the effect of dimethylfumarate [DMF, 10-30-100mg/kg] on an experimental model of colitis induced by dinitrobenzene sulphuric acid [DNBS]. We also evaluated the therapeutic activity of 7 weeks’ treatment with DMF [30mg/kg] on 9-week-old IL-10KO mice that spontaneously develop a T helper-1 [Th1]-dependent chronic enterocolitis after birth, that is fully established at 8–10 weeks of age. The mechanism of this pharmacological potential of DMF [10 μM] was investigated in colonic epithelial cell monolayers [Caco-2] exposed to H2O2. The barrier function was evaluated by the tight junction proteins. Results: The treatment with DMF significantly reduced the degree of haemorrhagic diarrhoea and weight loss caused by administration of DNBS. DMF [30 and 100mg/kg] also caused a substantial reduction in the degree of colon injury, in the rise in myeloperoxidase [MPO] activity, and in the increase in tumour necrosis factor [TNF]-α expression, as well as in the up-regulation of ICAM-1 caused by DNBS in the colon. Molecular studies demonstrated that DMF impaired NF-κB signalling via reduced p65 nuclear translocalisation. DMF induced a stronger antioxidant response as evidenced by a higher expression of Mn-superoxide dismutase. Moreover, DMF protected human intestinal epithelial cells against H2O2-induced barrier dysfunction, restoring ZO-1 occludin expression, via the HO-1 pathway. Conclusions: DMF treatment reduces the degree of colitis caused by DNBS. We propose that DMF treatment may be useful in the treatment of inflammatory bowel disease. PMID:26690241

  1. Technetium-99m scintigraphy: more accurate assessment of ulcerative colitis with exametazime-labelled leucocytes than with antigranulocyte antibodies

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    Almers, S. [Department of Internal Medicine, Faculty of Health Sciences, Linkoeping University, Linkoeping (Sweden)]|[Department of Medico-Surgical Gastroenterology, University Hospital, S-581 85 Linkoeping (Sweden); Granerus, G. [Department of Nuclear Medicine, University Hospital, Linkoeping (Sweden); Franzen, L. [Department of Pathology 2, University Hospital, Linkoeping (Sweden); Stroem, M. [Department of Internal Medicine, Faculty of Health Sciences, Linkoeping University, Linkoeping (Sweden)]|[Department of Medico-Surgical Gastroenterology, University Hospital, S-581 85 Linkoeping (Sweden)

    1996-03-01

    To compare two technetium-99m scintigraphic techniques - {sup 99m}Tc-labelled antibodies against granulocyte non-specific cross-reacting antigen-95 and {sup 99m}Tc-exametazime labelled leucocytes in ulcerative colitis - 23 consecutive patients undergoing colonoscopy were investigated in a prospective and randomized study. In each patient the two scans and colonoscopy and biopsy were performed within 10 days. Scans, endoscopy and histology were independently graded for degree of inflammation in eight different colorectal segments for each patient. Active inflammation in one or more segments was present on endoscopy in 22 patients and on histology in 17 patients. Twenty-two patients had increased uptake on the antibody scan and 21 patients on the exametazime scan. Twelve patients showed the same disease extent with both scan methods (total colitis, n=10; distal colitis, n=2). Compared with endoscopy, sensitivity for inflammation in individual segments was 0.51 for antibody scan and 0.87 for exametazime scan; specificity was 0.67 and 0.55, respectively. The predictive value for presence of inflammation was 0.66 for antibody scan and 0.72 for exametazime; the predictive value for absence of inflammation was 0.52 and 0.77, respectively. Segmental scan uptake of endoscopically or histologically visualized inflammation was consistently lower for antigranulocyte antibodies than for exametazime. It is concluded that in patients with active ulcerative colitis, inflammation is better visualized with {sup 99m}Tc-exametazime labelled leucocytes than with {sup 99m}Tc-labelled antigranulocyte antibodies. The antibody technique offers the advantage of in vivo labelling, but is less reliable than the exametazime method for imaging of colonic inflammation. (orig.). With 4 figs., 7 tabs.

  2. The surgical treatment of patients with ulcerative colitis from an university hospital at Natal, Brazil

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    Suelene Suassuna Silvestre de Alencar

    2012-09-01

    Full Text Available INTRODUCTION: Ulcerative colitis (UC is a chronic inflammatory disease that affects the rectum and colon, involving periods of exacerbation and remission. A considerable number of patients requires surgery during the course of this disease. OBJECTIVE: The purpose of this study is to analyze the profile and therapeutic approach of patients with UC. METHODS: This is a retrospective study that analyzed medical records of patients diagnosed with UC between 1999 and 2010. We selected 45 patients and analyzed the following variables: age, gender, ethnic group, interval between onset of symptoms and diagnosis, extraintestinal manifestations, extent of colonic involvement, disease complications, pharmacological treatment, indication for surgery, time between diagnosis and indication, surgical procedures, early and late complications and pathological results of surgical specimens. Data were analyzed descriptively and compared with other studies. RESULTS: The clinical profile of the patients was consistent with the literature. Nine patients underwent surgical treatment: seven were submitted to proctocolectomy with anastomosis in the ileo-anal pouch and two were submitted to total colectomy; in addition, eight were submitted to ileostomy. Postoperative complications occurred in 55.5% of patients. CONCLUSIONS: The study confirms data from the literature regarding the profile and therapeutic approach of patients with ulcerative colitis.INTRODUÇÃO: A retocolite ulcerativa (RCU é uma doença inflamatória crônica que acomete reto e cólon, cursando com períodos de exacerbação e remissão. Uma parcela considerável de pacientes necessita de procedimento cirúrgico ao longo do curso dessa enfermidade. OBJETIVO: Este estudo objetiva analisar perfil e abordagem terapêutica de portadores de RCU. MÉTODOS: Trata-se de estudo retrospectivo realizado por meio da análise de prontuários de pacientes acompanhados com diagnóstico de RCU no período de 1999 a

  3. SOCS2 and SOCS3 expression in ulcerative colitis and their correlation with inflammatory response and immune response

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    Le Huang1

    2017-05-01

    Full Text Available Objective: To study the correlation of SOCS2 and SOCS3 expression in ulcerative colitis tissue with inflammatory response and immune response. Methods: Ulcerative colitis lesions and normal mucosa from colonoscopic biopsy in Central Hospital of Zibo Mining Refco Group Ltd between May 2014 and July 2016 were selected and enrolled in UC group and control group respectively. RNA was extracted to determine mRNA expression of SOCS2 and SOCS3 as well as inflammatory response JAKs/STATs pathway molecules; protein was extracted to determine the contents of immune response cytokines. Results: SOCS2 mRNA expression in intestinal mucosa of UC group was not significantly different from that of control group, and SOCS3 mRNA expression was significantly lower than that of control group; JAK1, JAK2, JAK3, STAT1, STAT3 and STAT5 mRNA expression as well as IFN-γ and IL-17 protein contents in intestinal mucosa of UC group were significantly higher than those of control group while IL-4 and IL-10 protein contents were significantly lower than those of control group; JAK1, JAK2, JAK3, STAT1, STAT3 and STAT5 mRNA expression as well as IFN-γ and IL-17 protein contents in UC group of intestinal mucosa with low SOCS3 expression were significantly higher than those of intestinal mucosa with high SOCS3 expression while IL-4 and IL-10 protein contents were significantly lower than those of intestinal mucosa with high SOCS3 expression. Conclusion: Low expression of SOCS3 in ulcerative colitis can aggravate the inflammatory reaction and cause the imbalance of Th1/Th2 and Th17/Treg immune response.

  4. Observation on the efficacy of Etiasa in combined with mesalazine suppository in the treatment of ulcerative colitis

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    Min Zhao

    2016-06-01

    Full Text Available Objective: To analyze the clinical effect of Etiasa (mesalazine slow-release granules in combined with mesalazine suppository in the treatment of ulcerative colitis and the medication safety. Methods: A total of 82 patients with ulcerative colitis who were admitted in our hospital from June, 2013 to January, 2015 were included in the study and randomized into the observation group (n=42 and the control group (n=40. The patients in the two groups were orally given Etiasa. The patients in the observation group were given additional mesalazine suppository. Medication for 4-6 weeks was regarded as one course. The symptom relieving, the total remission rate of mucosal lesions after one course, the change of DAI 3 and 6 months after treatment, and the serum IL-8 and IL-10 levels before and after treatment in the two groups were compared. Results: The comparison of quantitative scoring of clinical efficacy and DAI before treatment between the two groups was not statistically significant. The above indicators after treatment in the observation group were significantly reduced and the reduced degree was significantly greater than that in the control group. The total effective rate in the observation group was significantly higher than that in the control group. IL-8 level after treatment in the observation group was significantly lower than that in the control group, while IL-10 level was significantly higher than that in the control group. The comparison of the occurrence rate of adverse reactions during the treatment process between the two groups was not statistically significant. Conclusions: Etiasa in combined with mesalazine suppository in the treatment of ulcerative colitis can increase the local drug concentration, and correct the imbalance of anti-inflammatory cytokines and proinflammatory cytokines, with a significant efficacy.

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

    Science.gov (United States)

    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

  6. Low HtrA1 expression in patients with long‑standing ulcerative colitis and colorectal cancer.

    Science.gov (United States)

    Altobelli, Emma; Latella, Giovanni; Morroni, Manrico; Licini, Caterina; Tossetta, Giovanni; Mazzucchelli, Roberta; Profeta, Valerio F; Coletti, Gino; Leocata, Pietro; Castellucci, Mario; Guerrieri, Mario; Petrocelli, Reimondo; De Berardis, Berardo; De Padova, Marina; Di Leonardo, Gabriella; Paladini, Antonella; Mignosi, Filippo; Quaglione, Gina; Fagnano, Roberto; Marzioni, Daniela

    2017-07-01

    The association between inflammatory bowel disease (IBD) and colorectal cancer (CRC) is being increasingly investigated. HtrA1 overexpression inhibits cell growth and proliferation by influencing apoptosis, invasiveness and migration of tumour cells. In the present study, HtrA1 expression was analysed in 228 colon tissue samples from patients with CRC, adenoma with high-grade dysplasia (AHD), adenoma with low-grade dysplasia (ALD), ulcerative colitis of >10 year duration (UCL), ulcerative colitis of <5 year duration (UCS) and colonic diverticulitis (D), and was compared with its expression in normal colon tissues (NCTs) collected 5 cm from the CRC lesion and in healthy colon mucosa (HC), to establish whether HtrA1 can serve as a biomarker for these conditions. All tissue specimens came from Italian Caucasian subjects. The main finding of the present study was that HtrA1 expression was significantly reduced in CRC and UCL tissues compared with that observed in both NCT and HC samples and with tissues from the other patients. In particular, a similar HtrA1 expression was detected in the stromal compartment of UCL and CRC samples. In contrast, the HtrA1 level was significantly lower (p=0.0008) in UCL compared with UCS tissues, suggesting an inverse relationship between HtrA1 expression and ulcerative colitis duration. HtrA1 immunostaining in the stromal compartment of AHD and ALD tissues showed no differences compared with the HC tissues. No data are available on the immunohistochemical localization of HtrA1 in CRC or IBD. The present findings suggest that HtrA1 could serve as a marker to identify UCL patients at high risk of developing CRC.

  7. Selective Allosteric Inhibition of MMP9 Is Efficacious in Preclinical Models of Ulcerative Colitis and Colorectal Cancer.

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    Derek C Marshall

    Full Text Available Expression of matrix metalloproteinase 9 (MMP9 is elevated in a variety of inflammatory and oncology indications, including ulcerative colitis and colorectal cancer. MMP9 is a downstream effector and an upstream mediator of pathways involved in growth and inflammation, and has long been viewed as a promising therapeutic target. However, previous efforts to target matrix metalloproteinases (MMPs, including MMP9, have utilized broad-spectrum or semi-selective inhibitors. While some of these drugs showed signs of efficacy in patients, all MMP-targeted inhibitors have been hampered by dose-limiting toxicity or insufficient clinical benefit, likely due to their lack of specificity. Here, we show that selective inhibition of MMP9 did not induce musculoskeletal syndrome (a characteristic toxicity of pan-MMP inhibitors in a rat model, but did reduce disease severity in a dextran sodium sulfate-induced mouse model of ulcerative colitis. We also found that MMP9 inhibition decreased tumor growth and metastases incidence in a surgical orthotopic xenograft model of colorectal carcinoma, and that inhibition of either tumor- or stroma-derived MMP9 was sufficient to reduce primary tumor growth. Collectively, these data suggest that selective MMP9 inhibition is a promising therapeutic strategy for treatment of inflammatory and oncology indications in which MMP9 is upregulated and is associated with disease pathology, such as ulcerative colitis and colorectal cancer. In addition, we report the development of a potent and highly selective allosteric MMP9 inhibitor, the humanized monoclonal antibody GS-5745, which can be used to evaluate the therapeutic potential of MMP9 inhibition in patients.

  8. Real-life outcome of anti-tumor necrosis factor α in the ambulatory treatment of ulcerative colitis.

    Science.gov (United States)

    Baki, Enayatullah; Zwickel, Philipp; Zawierucha, Anna; Ehehalt, Robert; Gotthardt, Daniel; Stremmel, Wolfgang; Gauss, Annika

    2015-03-21

    To evaluate the outcome of anti-tumor necrosis factor alpha (anti-TNFα) therapy in outpatients with ulcerative colitis at a tertiary referral center. All patients with a confirmed diagnosis of ulcerative colitis undergoing therapy with infliximab and/or adalimumab at the outpatient clinic for inflammatory bowel diseases at the University Hospital Heidelberg between January 2011 and February 2014 were retrospectively enrolled. Patients with a follow-up period of less than 6 mo from start of anti-TNFα therapy were excluded. Medical records of all eligible individuals were carefully reviewed. Steroid-free clinical remission of a duration of at least 3 mo, colectomy rate, duration of anti-TNFα therapy, need for anti-TNFα dose escalation, and the occurrence of adverse events were evaluated as the main outcome parameters. Seventy-two patients were included (35 treated with infliximab, 17 with adalimumab, 20 with both consecutively). Median follow-up was 27 mo (range: 6-87 mo). Steroid-free clinical remission was achieved by 22.2% of the patients (median duration: 21 mo until end of follow-up; range: 3-66 mo). Patients attaining steroid-free clinical remission displayed lower hemoglobin and albumin blood levels at the start of treatment than those who did not achieve remission. The overall colectomy rate was 20.8%. Nearly 50% of the patients underwent anti-TNFα dose escalation during the follow-up period. For both the infliximab and the adalimumab treated patients, non-response to anti-TNFα therapy was the major reason for treatment discontinuation. 18.2% of the infliximab-treated patients and 13.5% of the adalimumab-treated patients had to discontinue their therapy due to adverse events. Real-life remission rates of ulcerative colitis under anti-TNFα are overall low, but some patients have a clear long-term benefit.

  9. Carbohydrate Intake in the Etiology of Crohn's Disease and Ulcerative Colitis

    Science.gov (United States)

    Luben, Robert; van Schaik, Fiona; Oldenburg, Bas; Bueno-de-Mesquita, H. Bas; Hallmans, Göran; Karling, Pontus; Lindgren, Stefan; Grip, Olof; Key, Timothy; Crowe, Francesca L.; Bergmann, Manuela M.; Overvad, Kim; Palli, Domenico; Masala, Giovanna; Khaw, Kay-Tee; Racine, Antoine; Carbonnel, Franck; Boutron-Ruault, Marie-Christine; Olsen, Anja; Tjonneland, Anne; Kaaks, Rudolf; Tumino, Rosario; Trichopoulou, Antonia; Hart, Andrew R.

    2014-01-01

    Background: Diet may have a role in the etiology of inflammatory bowel disease. In previous studies, the associations between increased intakes of carbohydrates, sugar, starch, and inflammatory bowel disease are inconsistent. However, few prospective studies have investigated the associations between these macronutrients and incident Crohn's disease (CD) or ulcerative colitis (UC). Methods: A total of 401,326 men and women were recruited between 1991 and 1998. At recruitment, dietary intakes of carbohydrate, sugar, and starch were measured using validated food frequency questionnaires. The cohort was monitored identifying participants who developed incident CD or UC. Cases were matched with 4 controls, and odds ratios were calculated for quintiles of total carbohydrate, sugar, and starch intakes adjusted for total energy intake, body mass index, and smoking. Results: One hundred ten participants developed CD, and 244 participants developed UC during follow-up. The adjusted odds ratio for the highest versus the lowest quintiles of total carbohydrate intake for CD was 0.87, 95% CI = 0.24 to 3.12 and for UC 1.46, 95% CI = 0.62 to 3.46, with no significant trends across quintiles for either (CD, Ptrend = 0.70; UC, Ptrend = 0.41). Similarly, no associations were observed with intakes of total sugar (CD, Ptrend = 0.50; UC, Ptrend = 0.71) or starch (CD, Ptrend = 0.69; UC, Ptrend = 0.17). Conclusions: The lack of associations with these nutrients is in agreement with many case–control studies that have not identified associations with CD or UC. As there is biological plausibility for how specific carbohydrates could have an etiological role in inflammatory bowel disease, future epidemiological work should assess individual carbohydrates, although there does not seem to be a macronutrient effect. PMID:25265262

  10. Examining maintenance care following infliximab salvage therapy for acute severe ulcerative colitis.

    Science.gov (United States)

    Seah, Dean; Choy, Matthew C; Gorelik, Alexandra; Connell, William R; Sparrow, Miles P; Van Langenberg, Daniel; Hebbard, Geoffrey; Moore, Gregory; De Cruz, Peter

    2018-01-01

    Data supporting the optimal maintenance drug therapy and strategy to monitor ongoing response following successful infliximab (IFX) induction, for acute severe ulcerative colitis (ASUC), are limited. We aimed to evaluate maintenance and monitoring strategies employed in patients post-IFX induction therapy. Patients in six Australian tertiary centers treated with IFX for steroid-refractory ASUC between April 2014 and May 2015 were identified via hospital IBD and pharmacy databases. Patients were followed up for 1 year with clinical data over 12 months recorded. Analysis was limited to patient outcomes beyond 3 months. Forty one patients were identified. Five of the 41 (12%) patients underwent colectomy within 3 months, and one patient was lost to follow-up. Six of 35 (17%) of the remaining patients progressed to colectomy by 12 months. Maintenance therapy: Patients maintained on thiopurine monotherapy (14/35) versus IFX/thiopurine therapy (15/35) were followed up. Two of 15 (13%) patients who received combination maintenance therapy underwent a colectomy at 12 months, compared with 1/14 (7%) patients receiving thiopurine monotherapy (P = 0.610). Monitoring during maintenance: Post-discharge, thiopurine metabolites were monitored in 15/27 (56%); fecal calprotectin in 11/32 (34%); and serum IFX levels in 4/20 (20%). Twenty of 32 (63%) patients had an endoscopic evaluation after IFX salvage with median time to first endoscopy of 109 days (interquartile range 113-230). Following IFX induction therapy for ASUC, the uptake of maintenance therapy in this cohort and strategies to monitor ongoing response were variable. These data suggest that the optimal maintenance and monitoring strategy post-IFX salvage therapy remains to be defined. © 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  11. Fecal microbiota transplantation is a rescue treatment modality for refractory ulcerative colitis.

    Science.gov (United States)

    Uygun, Ahmet; Ozturk, Kadir; Demirci, Hakan; Oger, Cem; Avci, Ismail Yasar; Turker, Turker; Gulsen, Mustafa

    2017-04-01

    Fecal microbial transplantation (FMT) provides to replace beneficial bacteria with more favorable microbiomes in recipient with dysbiosis. The aim of the present study was to prospectively investigate the efficacy of FMT by assessing the clinical and endoscopic response in patients with ulcerative colitis (UC) who had failed anti-inflammatory and immunosuppressive therapy. In this prospective and uncontrolled study, 30 patients with UC were included. All medications except mesalazine were stopped 4 weeks before FMT. Colonoscopy was performed both before and after FMT. To assess the efficacy of FMT, Mayo scores were calculated at week 0 and week 12. A total of 500 mL extracted fresh fecal suspension was administered into the 30 to 40 cm proximal of terminal ileum of recipients. After FMT, 21 of the (70%) 30 patients showed clinical response, and 13 of the 30 (43.3%) patients achieved clinical and endoscopic remission at the week 12. Nine patients (30%) were accepted as a nonresponder at the end of the week 12. There was no significant difference among donors concerning both the rate of clinical remission and clinical response. No adverse events were observed in the majority of patients during FMT and 12 weeks follow-up. Seven patients (23.3%) experienced mild adverse events such as nausea, vomiting, abdominal pain, diarrhea, and fewer after FMT. FMT could be considered as a promising rescue treatment modality before surgery in patients with refractory UC. Besides, FMT also appears to be definitely safer and more tolerable than the immunosuppressive therapy in patients with UC (NCT02575040).

  12. Sleep duration affects risk for ulcerative colitis: a prospective cohort study.

    Science.gov (United States)

    Ananthakrishnan, Ashwin N; Khalili, Hamed; Konijeti, Gauree G; Higuchi, Leslie M; de Silva, Punyanganie; Fuchs, Charles S; Richter, James M; Schernhammer, Eva S; Chan, Andrew T

    2014-11-01

    Sleep deprivation is associated with production of inflammatory cytokines. Disturbed sleep quality has been associated with increased risk of disease flare in patients with Crohn's disease (CD) or ulcerative colitis (UC). However, the association between sleep and risk of incident CD and UC has not been previously examined. We conducted a prospective study of women who were enrolled in the Nurses' Health Study (NHS) I since 1976 and NHS II since 1989 and followed through detailed biennial questionnaires with >90% follow-up. We examined the association of sleep duration reported in 1986 in NHS I and 2001 in NHS II with incident CD and UC, diagnosed through 2010, in NHS I and 2009 in NHS II. Cox proportional hazards models adjusting for potential confounders were used to calculate hazard ratios and 95% confidence intervals (CIs). Among 151,871 women, we confirmed 191 cases of CD (incidence, 8/100,000 person-years) and 230 cases of UC (incidence, 10/100,000 person-years) over 2,292,849 person-years. Compared with women with reported usual sleep durations of 7-8 h/day (incidence, 8/100,000 person-years), women with reported sleep duration 9 h/day (20/100,000 person-years) had a higher incidence of UC (P sleep durations sleep durations >9 h/day, compared with sleep durations of 7-8 h/day. In contrast, sleep duration did not modify risk of CD. Duration of rotating night shift work was not associated with CD or UC. On the basis of data from the NHS I and II, less than 6 hours sleep/day and more than 9 hours sleep/day are each associated with an increased risk of UC. Further studies are needed to evaluate sleep as a modifiable risk factor in the pathogenesis and progression of IBD. Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.

  13. Epidermal growth factor enemas for induction of remission in left-sided ulcerative colitis

    Directory of Open Access Journals (Sweden)

    Hugo Nodarse-Cuní

    2013-03-01

    Full Text Available Introduction: ulcerative colitis is a little known chronic inflammatory disease in colonic mucosa. The positive effect of epidermal growth factor was shown in a previous report, with enema use for treatment of mild to moderate left-sided manifestation of the disease. This evidence provided the basis for evaluating the efficacy and safety profile of a viscous solution of this product. Methods: thirty-one patients were randomized to three groups for daily medications during 14 days. Twelve received one 10 mg enema of epidermal growth factor dissolved in 100 mL of viscous solution whereas nine were treated with placebo enema; both groups also received 1.2 g of oral mesalamine per day. The other group included ten patients with 3 g / 100 mL of mesalamine enema. Primary end point was clinical responses after two weeks of treatment, defined as a decreased of, at least three points from baseline, the Disease Activity Index and endoscopic or histological evidences of improvement. Results: remission of disease was observed in all patients in the epidermal growth factor group, and six in both, mesalamine enema and placebo group. All the comparisons between groups showed statistically significant superiority for epidermal growth factor, the only product with significant reduction in disease activity index as well as the presence and intensity of digestive symptoms in patients after treatment. None adverse event was reported. Conclusions: the results agree with previous molecular and clinical evidences, indicating that the epidermal growth factor is effective to reduce disease activity and to induce remission. A new study involving more patients should be conducted to confirm the efficacy of the epidermal growth factor enemas.

  14. Frequency, predictors, and consequences of maintenance infliximab therapy intensification in ulcerative colitis

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    Luis Fernández-Salazar

    2015-09-01

    Full Text Available Introduction: Infliximab (IFX therapy intensification in ulcerative colitis (UC is more common than established in pivotal studies. Objectives: To establish the frequency and form of intensification for UC in clinical practice, as well as predictors, and to compare outcomes between intensified and non-intensified treatment. Methods: A retrospective study of 10 hospitals and 144 patients with response to infliximab (IFX induction. Predictive variables for intensification were analyzed using a Cox regression analysis. Outcome, loss of response to IFX, and colectomy were compared between intensified and non-intensified therapy. Results: Follow-up time from induction to data collection: 38 months [interquartile range (IQR, 20-62]. Time on IFX therapy: 24 months (IQR, 10-44. In all, 37% of patients required intensification. Interval was shortened for 36 patients, dose was increased for 7, and 10 subjects received both. Concurrent thiopurine immunosuppressants (IMM and IFX initiation was an independent predictor of intensification [Hazard ratio, 0.034; p, 0.006; CI, 0.003-0.371]. In patients on intensified therapy IFX discontinuation for loss of response (30.4% vs. 10.2%; p, 0.002, steroid reintroduction (35% vs. 18%; p, 0.018, and colectomy (22% vs. 6.4%; p, 0.011 were more common. Of patients on intensification, 17% returned to receiving 5 mg/kg every 8 weeks. Conclusions: Intensification is common and occasionally reversible. IMM initiation at the time of induction with IFX predicts non-intensification. Intensification, while effective, is associated with poorer outcome.

  15. Ulcerative colitis induces changes on the expression of the endocannabinoid system in the human colonic tissue.

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    Lucia Marquéz

    Full Text Available BACKGROUND: Recent studies suggest potential roles of the endocannabinoid system in gastrointestinal inflammation. Although cannabinoid CB(2 receptor expression is increased in inflammatory disorders, the presence and function of the remaining proteins of the endocannabinoid system in the colonic tissue is not well characterized. METHODOLOGY: Cannabinoid CB(1 and CB(2 receptors, the enzymes for endocannabinoid biosynthesis DAGLalpha, DAGLbeta and NAPE-PLD, and the endocannabinoid-degradating enzymes FAAH and MAGL were analysed in both acute untreated active ulcerative pancolitis and treated quiescent patients in comparison with healthy human colonic tissue by immunocytochemistry. Analyses were carried out according to clinical criteria, taking into account the severity at onset and treatment received. PRINCIPAL FINDINGS: Western blot and immunocytochemistry indicated that the endocannabinoid system is present in the colonic tissue, but it shows a differential distribution in epithelium, lamina propria, smooth muscle and enteric plexi. Quantification of epithelial immunoreactivity showed an increase of CB(2 receptor, DAGLalpha and MAGL expression, mainly in mild and moderate pancolitis patients. In contrast, NAPE-PLD expression decreased in moderate and severe pancolitis patients. During quiescent pancolitis, CB(1, CB(2 and DAGLalpha expression dropped, while NAPE-PLD expression rose, mainly in patients treated with 5-ASA or 5-ASA+corticosteroids. The number of immune cells containing MAGL and FAAH in the lamina propria increased in acute pancolitis patients, but dropped after treatment. CONCLUSIONS: Endocannabinoids signaling pathway, through CB(2 receptor, may reduce colitis-associated inflammation suggesting a potential drugable target for the treatment of inflammatory bowel diseases.

  16. Rhinosinusitis derived Staphylococcal enterotoxin B possibly associates with pathogenesis of ulcerative colitis

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    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.

  17. Interleukin 35 Rescues Regulatory B Cell Function, but the Effect Is Dysregulated in Ulcerative Colitis.

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    Wang, Shaoxuan; Qin, Chengyong

    2017-05-01

    Ulcerative colitis (UC) is a long-time inflammatory condition arising from aberrant immune activation in the colon and the rectum. Interleukin (IL)-35 plays critical roles in autoimmune disorders. In this study, we explored the pathways of IL-35 in affecting UC. First, peripheral blood mononuclear cells (PBMCs) from UC patients were obtained. Pretreating PBMCs with IL-35 resulted in significantly elevated IL-10 production from whole PBMCs as well as B cells, whereas pretreating PBMCs with IL-12 or IL-27 did not demonstrate a similar effect. IL-35 suppressed the proliferation of CD4 + CD25 - conventional T cells, CD4 + CD25 + regulatory T (Treg) cells, and CD8 + T cells, but did not inhibit the proliferation of B cells. IL-35-mediated IL-10 secretion in B cells did not require the presence of Treg cells. After treatment with IL-35, B cells from UC patients presented significantly enhanced regulatory function, characterized by inhibiting cell proliferation and interferon (IFN)-γ, IL-17, and tumor necrosis factor (TNF)-α secretion from autologous CD4 + CD25 - T cells and CD8 + T cells, which was dependent on IL-10 signaling. However, IL-35-treatment did not demonstrate an effect on regulating IL-5 and IL-13 responses. These discoveries identified a Th1, Th17, and CD8 + T cell-targeting role of IL-35 in UC patients. Next, we examined the IL-35 expression in the intestinal mucosal in UC patients. Data showed that both noninflamed and inflamed tissues from UC patients presented significantly lower IL-35 secretion compared to healthy control tissues, which was associated with suppressed p35 transcription. UC patients with higher IL-35 also presented higher IL-10 secretion in gut mucosa. Together, our study identified that IL-35 could mediate anti-inflammatory function through promoting regulatory B cell functions, but this effect was suppressed in UC patients.

  18. Epidemiological, Demographic, and Colonic Extension ofUlcerative Colitis in Iran: A Systematic Review.

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    Shayesteh, Ali Akbar; Saberifirozi, Mehdi; Abedian, Shifteh; Sebghatolahi, Vahid

    2013-01-01

    Ulcerative colitis (UC), as the prototype of inflammatory bowel disease of the large bowel, is increasing in Iran and other developing countries. There are few studies that discuss the properties of this disease Iran. The result of this review may provide a general consensus about the epidemiological features of UC in Iran. This was a qualitative, systematic review that investigated the incidence, prevalence, and demographic properties of UC in Iran. We evaluated all published studies in the PubMed database, IranMedex, Magiran, and Scientific Information Database (SID) that pertained to the epidemiology and demographic features of UC in Iran from January 1987 to January 2012. After searching with defined keywords and implementing the inclusion and exclusion criteria, 11 case series and 2 case-control studies fulfilled the criteria for inclusion. The estimated prevalence of UC is 15 per 105 persons, and the reported incidences were 3.04 and 3.25 per 105 persons in two Iranian provinces. The disease was more commonly observed in women and people in their fourth decade of life. Cigarette smoking conferred protection and familial association seemed to be similar to developed countries. UC did not appear to be more common among the higher socioeconomic class. In addition the proximal colon and rectum were less commonly involved. Although the data is limited, the prevalence and incidence of UC in Iran shows an increasing pattern similar to other countries in the region. There is no clear association with socioeconomic status. Milder forms of the disease are common in Iran. A comprehensive nationwide data bank is needed for a better definition of the disease characteristics.

  19. Sulphate-reducing bacteria from ulcerative colitis patients induce apoptosis of gastrointestinal epithelial cells.

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    Coutinho, Cláudia Mara Lara Melo; Coutinho-Silva, Robson; Zinkevich, Vitally; Pearce, Callum B; Ojcius, David M; Beech, Iwona

    2017-11-01

    The human microbiome consists of a multitude of bacterial genera and species which continuously interact with one another and their host establishing a metabolic equilibrium. The dysbiosis can lead to the development of pathology, such as inflammatory bowel diseases. Sulfide-producing prokaryotes, including sulphate-reducing bacteria (SRB) constituting different genera, including the Desulfovibrio, are commonly detected within the human microbiome recovered from fecal material or colonic biopsy samples. It has been proposed that SRB likely contribute to colonic pathology, for example ulcerative colitis (UC). The interaction of SRB with the human colon and intestinal epithelial cell lines has been investigated using Desulfovibrio indonesiensis as a model mono-culture and in a co-culture with E. coli isolate, and with SRB consortia from human biopsy samples. We find that D. indonesiensis, whether as a mono- or co-culture, was internalized and induced apoptosis in colon epithelial cells. This effect was enhanced in the presence of E. coli. The SRB combination obtained through enrichment of biopsies from UC patients induced apoptosis of a human intestinal epithelial cell line. This response was not observed in SRB enrichments from healthy (non-UC) controls. Importantly, apoptosis was detected in epithelial cells from UC patients and was not seen in epithelial cells of healthy donors. Furthermore, the antibody raised against exopolysaccharides (EPS) of D. indonesiensis cross reacted with the SRB population from UC patients but not with the SRB combination from non-UC controls. This study reinforces a correlation between the presence of sulphate-reducing bacteria and an inflammatory response in UC sufferers. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Systematic review: the financial burden of surgical complications in patients with ulcerative colitis.

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    Lindsay, J O; Bergman, A; Patel, A S; Alesso, S M; Peyrin-Biroulet, L

    2015-06-01

    Patients undergoing colectomy for ulcerative colitis (UC) may experience complications associated with reduced quality of life (QoL), and maybe a considerable economic burden to healthcare systems. Appreciation of these burdens is important to evaluate the cost effectiveness of newer interventions for UC vs. colectomy. To identify data representing resource utilisation or costs of complications arising from colorectal procedures in patients with UC, and data representing patient QoL, as reported by health state utility values (HSUVs). Embase, MEDLINE and The Cochrane Library were searched for studies (1995-2014) reporting resource use/costs of surgical complications, and HSUVs data in adult patients with UC, undergoing colorectal procedures. Conference proceedings (January 2011-January 2014) were hand-searched. Twelve studies reported resource use/costs, and three reported HSUVs data in patients with UC experiencing surgical complications. Additional mean costs of postoperative complications ranged from $18 650/patient with complications at a 6-month follow-up (46% incidence) to $34 714/patient with complications over a 5-year period (49% incidence). Pouchitis, pouch failure and small bowel obstruction carried the greatest burden. Marked reductions in HSUVs were observed for patients with UC experiencing surgical complications, vs. patients with UC in a remission state. There is a paucity of well reported studies on resource use/cost, and QoL burden of surgical complications in patients with UC. However, surgical complications represent a substantial burden both in terms of cost and of quality of life, with reoperations, physician fees, additional in-patient hospital stays and infertility treatment being the main cost drivers. © 2015 John Wiley & Sons Ltd.

  1. Infliximab in steroid-dependent ulcerative colitis: effectiveness and predictors of clinical and endoscopic remission.

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    Armuzzi, Alessandro; Pugliese, Daniela; Danese, Silvio; Rizzo, Gianluca; Felice, Carla; Marzo, Manuela; Andrisani, Gialuca; Fiorino, Gionata; Sociale, Orsola; Papa, Alfredo; De Vitis, Italo; Rapaccini, Gian Lodovico; Guidi, Luisa

    2013-04-01

    Up to 20% of patients with ulcerative colitis (UC) become steroid-dependent during their course. Thiopurines are recommended in steroid-dependent UC, but their efficacy is debated. Data exploring the use of infliximab in these patients are scarce. Aims of this study were to evaluate the effectiveness of infliximab in steroid-dependent UC and identify predictors of steroid-free remission, mucosal healing (MH), and colectomy. Steroid-dependent UC patients were enrolled and intentionally treated with infliximab. The prospectively designed analyses evaluated (1) steroid-free clinical remission at 6 and 12 months, (2) steroid-free clinical remission and MH at 12 months, and (3) colectomy within 12 months. One hundred and twenty-six active steroid-dependent UC patients were studied. Of the 126 patients, 36 patients were retrospectively included and 90 patients prospectively enrolled. Steroid-free remission was 53% and 47% at 6 and 12 months, respectively. Predictors of steroid-free remission at 6 and 12 months were thiopurine-naive status (hazard ratio [HR], 2.5 and HR, 2.8, respectively) and combination therapy (HR, 2.1 and HR, 2.2, respectively). At 12 months, 32% were in steroid-free remission and MH. Thiopurine-naive status predicted steroid-free remission and MH (odds ratio, 3.6). C-reactive protein drop to normal after infliximab induction was predictive of steroid-free remission at 6 (HR, 5.9) and 12 months (HR, 4.6) and steroid-free remission and MH at 12 months (odds ratio, 6.0). Twelve patients underwent colectomy after a median of 4.7 months. Steroid sparing significantly reduced the risk of colectomy within 12 months (HR, 0.14). Infliximab seems effective in steroid-dependent UC. Thiopurine-naive status and combination therapy significantly increase the rate of steroid-free remission up to 12 months.

  2. Neutrophil-to-Lymphocyte Ratio for Predicting Loss of Response to Infliximab in Ulcerative Colitis.

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    Nishida, Yu; Hosomi, Shuhei; 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

    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. 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. 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). 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.

  3. Induction and maintenance infliximab therapy in children with moderate to severe ulcerative colitis: Retrospective, multicenter study.

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    Iwańczak, Barbara M; Kierkuś, Jarosław; Ryżko, Józef; Szczepanik, Mariusz; Więcek, Sabina; Czaja-Bulsa, Grażyna; Kacperska, Magdalena; Korczowski, Bartosz; Maślana, Jolanta; Iwańczak, Franciszek

    2017-01-01

    Pediatric ulcerative colitis (UC) is a severe disease characterised by the presence of extensive inflammatory lesions in the colon. The administration of intravenous corticosteroids is recommended in patients with acute relapse of the disease, whereas early treatment with cyclosporine, tacrolimus or infliximab is recommended if there is no improvement. The aim of this study was to retrospectively evaluate the efficacy and safety of infliximab therapy in the treatment of moderate-to-severe and severe relapse of pediatric UC. The analysis included 42 children aged 4-18 years (23 girls, 19 boys) treated in 7 pediatric gastroenterology departments in Poland during the past 4 years. The disease duration ranged from 2 to 100 months. The clinical activity of UC ranged from 35 to 85 points according to the PUCAI scale. Twenty-one children were diagnosed with pancolitis, 10 children with extensive UC, and the remaining with the left-sided UC. In the induction therapy infliximab was administered at doses of 5 mg/kg in the 0.2 and 6 weeks, and after the clinical response every 8 weeks to 12 months. Treatment results were assessed in 10 and 54 weeks. After the induction therapy the clinical response was achieved in 14 children (33.33%) and clinical remission in 11 children (26.19%). Two children required surgical treatment, and the remaining 2 suffered from anaphylactic shock. After the maintenance therapy clinical remission was maintained in 12 children (57.14%), whereas 3 children required surgery (colectomy). Infliximab therapy in children with moderate-to-severe UC induces remission and, in some children, proves to be effective in preventing early colectomy.

  4. Review article: dose optimisation of infliximab for acute severe ulcerative colitis.

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    Hindryckx, P; Novak, G; Vande Casteele, N; Laukens, D; Parker, C; Shackelton, L M; Narula, N; Khanna, R; Dulai, P; Levesque, B G; Sandborn, W J; D'Haens, G; Feagan, B G; Jairath, V

    2017-03-01

    Although optimal medical management of acute severe ulcerative colitis (UC) is ill-defined, infliximab has become a standard of care. Accumulating evidence suggests an increased rate of infliximab clearance in patients with acute severe UC and a reduced colectomy rate with an intensified infliximab induction regimen. To assess the strength of the current evidence for the relationship between infliximab pharmacokinetics, dosing strategies and disease behaviour in patients with acute severe UC. We systematically searched MEDLINE and conference proceedings from 2000 to 2016 for relevant articles describing the pharmacokinetics of infliximab in acute severe UC and/or infliximab dose intensification strategies in acute severe UC. Eligible articles described randomised controlled trials, and cohort, cross-sectional, and case-controlled studies. Of 400 citations identified, 76 studies were eligible. Increased infliximab clearance occurs in patients with acute severe UC, and is driven by the total inflammatory burden and leakage of drug into the colonic lumen. Several cohort studies suggest that infliximab dose intensification is beneficial to at least 50% of acute severe UC patients and the results of case-controlled studies indicate that an intensified infliximab dosing regimen with 1-2 additional infusions in the first 3 weeks of treatment could reduce the early (3-month) colectomy rate by up to 80%, although these data require prospective validation. Uncontrolled studies suggest a benefit for infliximab dose optimisation in patients with acute severe UC. A randomised controlled trial in acute severe UC patients comparing a personalised infliximab dose-optimisation strategy with conventional dosing is a research priority. © 2017 John Wiley & Sons Ltd.

  5. Need for infliximab dose intensification in Crohn’s disease and ulcerative colitis

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    Taxonera, Carlos; Olivares, David; Mendoza, Juan L; Díaz-Rubio, Manuel; Rey, Enrique

    2014-01-01

    AIM: To compare the need for infliximab dose intensification in two cohorts of patients with Crohn’s disease (CD) or ulcerative colitis (UC). METHODS: Single centre, uncontrolled, observational study. Consecutive patients with CD and UC who responded to infliximab induction doses were included. Data collected in a prospectively maintained database were retrospectively analysed. Differences in the rates of dose intensification per patient-month and the intensification-free survival time were compared. We also evaluated the interval between the first infliximab induction dose and the first infliximab escalated dose. The weight-adjusted infliximab administration costs were also calculated. RESULTS: Fifty nine patients with CD and 38 patients with UC were enrolled. The rate of intensification per patient-month was 3.9% for UC and 1.4% for CD (P = 0.005). The median time from baseline to intensification was significantly shorter in UC compared to CD [6.6 mo (IQR: 4.2-9.5 mo) vs 10.7 mo (IQR: 8.9-11.7 mo), P = 0.005]. In the survival analysis, the cumulative probability of avoiding infliximab dose intensification was significantly higher in CD (P = 0.002). In the multivariate analysis, disease (UC vs CD) was the only factor significantly associated with dose intensification. The infiximab administration costs during the first year were significantly higher for UC compared to CD (mean ± SD 234.9 ± 53.3 Euros/kg vs 212.3 ± 15.1 Euros/kg, P = 0.03). CONCLUSION: The rate of infliximab dose intensification per patient-month is significantly higher in UC patients. The infliximab administration costs are also significantly higher in patients with UC. PMID:25083091

  6. [Value of adhesion molecules for evaluating the efficiency of therapy for ulcerative colitis and Crohn's disease].

    Science.gov (United States)

    Parfenov, A I; Boldyreva, O N; Ruchkina, I N; Knyazev, O V; Sagynbaeva, V E; Shcherbakov, P L; Khomeriki, S G; Lazebnik, L B; Konoplyannikov, A G

    2014-01-01

    To define the value of adhesion molecules (sVCAM-1 integrin, P-selectin, E-selectin, and L-selectin) for the prediction and evaluation of the efficiency of treatment in patients with ulcerative colitis (UC) and Crohn's disease. Twenty-six patients with UC and 14 patients with CD were examined. Of them, 16 patients took infliximab (INF) in a dose of 5 mg/kg of body weight according to the standard scheme; 14 patients received cultured mesenchymal stem stromal cells (MSSCs) in a quantity of 150 x 10(8) cells, and 10 had azathioprine (AZA) 2 mg/kg and glucocorticosteroids (GCS) 1 mg/kg of body weight. Enzyme immunoassay was used to determine the serum concentration of the adhesion molecules (L-selectin, E-selectin, P-selectin, and sVCAM-1 integrin) before and 2 months after treatment. The signs of bowel inflammatory disease activity and the elevated levels of adhesion molecules whose synthesis did not occur under normal conditions remained in the patients receiving GCS and AZA. INF treatment caused a decrease in P-selectin, E-selectin, and sVCAM-1 levels to 8.9 +/- 1.0, 5.5 +/- 1.7, and 9.5 +/- 4.4 ng/ml, respectively (p 0.1); that of L-selectin did not drop after MSSC administration and INF induction therapy. P-selectin, E-selectin, L-selectin, and sVCAM-1 integrin are current inflammatory markers and may be used to evaluate the efficiency of standard and biological therapies for inflammatory bowel diseases and to predict disease course.

  7. YouTube as a source of information for patients considering surgery for ulcerative colitis.

    Science.gov (United States)

    Baker, Daniel Mark; Marshall, Jack H; Lee, Matthew J; Jones, Georgina L; Brown, Steven R; Lobo, Alan J

    2017-12-01

    With the range of health information online, assessing the resources that patients access may improve the content of preoperative information. Our aim was to assess the content of the most viewed videos on YouTube related to surgery for ulcerative colitis (UC). YouTube was searched for videos containing information on surgery for UC. The 50 most viewed videos were identified and user interaction analyzed. Upload source was classified as patient, individual health care professional (HCP), or hospital/professional association. Video content was categorized using an inductive thematic analysis on a purposive sample list of videos. The overarching theme of each video was classified once data saturation was achieved. Thirty videos were uploaded by patients, 15 by hospitals and 5 by HCPs. Seventeen videos (34%) discussed life after surgery. Sixteen of these were uploaded by patients who had previously undergone surgery for UC. No videos of this theme were uploaded by HCPs. Ten videos (20%) described a number of different operations. Other themes identified were alternative health therapies (12%), colonoscopy (12%), life with UC (8%), miscellaneous (8%), and education for HCPs (6%). Patient uploaded videos had significantly more comments (P = 0.0079), with 28% of comments on patient videos being users requesting further information. Understanding the sequelae of surgery is most important to preoperative patients. There are a lack of professional videos addressing this topic on YouTube. HCPs must participate in the production of videos and adapt preoperative consultations to address common preoperative concerns. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. In Vitro Fertilization Is Successful in Women With Ulcerative Colitis and Ileal Pouch Anal Anastomosis.

    Science.gov (United States)

    Pabby, Vikas; Oza, Sveta Shah; Dodge, Laura E; Hacker, Michele R; Moragianni, Vasiliki A; Correia, Katherine; Missmer, Stacey A; Fox, Janis H; Ibrahim, Yetunde; Penzias, Alan; Burakoff, Robert; Cheifetz, Adam; Friedman, Sonia

    2015-06-01

    Women with ulcerative colitis (UC), who require ileal pouch anal anastomosis (IPAA), have up to a threefold increased incidence of infertility. To better counsel patients who require colectomy, we examined the success rates of in vitro fertilization (IVF) among women who have undergone IPAA. This was a retrospective cohort study conducted at the Brigham and Women's Hospital and Beth Israel Deaconess Medical Center. Female patients with UC were identified via ICD-9 codes and cross-referenced with those presenting for IVF from 1998 through 2011. UC patients with IPAA were compared with the following two unexposed groups that underwent IVF: (1) patients with UC, who had not undergone IPAA, and (2) patients without inflammatory bowel disease (IBD). The primary outcome was the cumulative live birth rate. Secondary outcomes included number of oocytes retrieved, proportion of patients who underwent embryo transfer, pregnancy rate, and live birth rate at first cycle. There were 22 patients with UC and IPAA, 49 patients with UC and without IPAA, and 470 patients without IBD. The cumulative live birth rate after six cycles in the UC and IPAA groups was 64% (95% confidence interval (CI): 44-83%). This rate did not differ from the cumulative live birth rate in the UC without IPAA group (71%, 95% CI: 59-83%; P=0.63) or the group without IBD (53%, 95% CI: 48-57%; P=0.57). This study demonstrates that in our cohort, women who undergo IPAA achieve live births following IVF at comparable rates to women with UC without IPAA and to women without IBD.

  9. Dysregulation of innate immunity in ulcerative colitis patients who fail anti-tumor necrosis factor therapy.

    Science.gov (United States)

    Baird, Angela C; Mallon, Dominic; Radford-Smith, Graham; Boyer, Julien; Piche, Thierry; Prescott, Susan L; Lawrance, Ian C; Tulic, Meri K

    2016-11-07

    To study the innate immune function in ulcerative colitis (UC) patients who fail to respond to anti-tumor necrosis factor (TNF) therapy. Effects of anti-TNF therapy, inflammation and medications on innate immune function were assessed by measuring peripheral blood mononuclear cell (PBMC) cytokine expression from 18 inflammatory bowel disease patients pre- and 3 mo post-anti-TNF therapy. Toll-like receptor (TLR) expression and cytokine production post TLR stimulation was assessed in UC "responders" (n = 12) and "non-responders" (n = 12) and compared to healthy controls (n = 12). Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were measured in blood to assess disease severity/activity and inflammation. Pro-inflammatory (TNF, IL-1β, IL-6), immuno-regulatory (IL-10), Th1 (IL-12, IFNγ) and Th2 (IL-9, IL-13, IL-17A) cytokine expression was measured with enzyme-linked immunosorbent assay while TLR cellular composition and intracellular signalling was assessed with FACS. Prior to anti-TNF therapy, responders and non-responders had similar level of disease severity and activity. PBMC's ability to respond to TLR stimulation was not affected by TNF therapy, patient's severity of the disease and inflammation or their medication use. At baseline, non-responders had elevated innate but not adaptive immune responses compared to responders (P innate cytokine responses to all TLRs compared to healthy controls (P innate immune dysfunction was associated with reduced number of circulating plasmacytoid dendritic cells (pDCs) (P innate immunity in non-responders may explain reduced efficacy to anti-TNF therapy. These serological markers may prove useful in predicting the outcome of costly anti-TNF therapy.

  10. Characteristics of pediatric ulcerative colitis in Saudi Arabia: a multicenter national study.

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    AlSaleem, Khalid; El Mouzan, Mohammad Issa; Saadah, Omar I; AlSaleem, Bader; Al-Hussaini, Abdulrahman; Hassosa, Mohammed; Ali, Al-Mehaidib; Banemai, Mohammed Othman; Halaby, Hana; El Edreesi, Mohammed

    2015-01-01

    Despite the extensive reporting of pediatric ulcerative colitis (UC) from industrialized developed countries, reports from developing countries are limited to small-case series from single centers. The objective of our large multicenter study was to determine the clinical, laboratory, endoscopic characteristics of UC in children from a developing country, Saudi Arabia. A retrospective study of children diagnosed with UC under the age of 18 years during the period from 2003 to 2012. Patients enrolled from 15 medical centers from different regions in Saudi Arabia. A unified database collection form specifically designed for this study was completed by all participating centers. A total of 188 children were diagnosed with UC during the study period (97 males [51.6%] and 91 females [48.4%]). The mean age at diagnosis was 9.1 years, and the mean duration of symptoms before diagnosis was 8.7 months. Consanguinity was present in 57 cases (32.6%), and the family history of inflammatory bowel disease (IBD) was noted in 16 cases (9%). The most common clinical presentation was blood in stool (90%), followed by diarrhea (86%) and abdominal pain (62%). Laboratory investigations revealed elevated erythrocyte sedimentation rate (82%), anemia (75%), thrombocytosis (72%), and hypoalbuminemia (33%). The extent of the disease was pan colonic in 46.1%, and confined to left side of colon and rectum in 23% and 9.6% of the cases, respectively. This demographically pediatric IBD retrospective study revealed age-related variation in the distribution of IBD. Clinical presentation, with a high prevalence of positive consanguinity and positive family history, was noted in young patients with UC. The data from this study indicate that UC is increasingly recognized in Saudi Arabia and show many similarities to data from North America and Europe.

  11. Bilberry-Derived Anthocyanins Modulate Cytokine Expression in the Intestine of Patients with Ulcerative Colitis.

    Directory of Open Access Journals (Sweden)

    Sofia Roth

    Full Text Available We previously demonstrated that anthocyanin-rich bilberry extract (ARBE inhibits IFN-γ-induced signalling and downstream effects in human monocytic cells and ameliorates disease activity in ulcerative colitis (UC patients. Here, we studied the molecular mechanisms of ARBE-mediated effects in vitro and by analysing colonic tissue and serum samples of UC patients treated with an oral anthocyanin-rich bilberry preparation during an open label clinical trial.Colon specimens obtained during an open pilot study using ARBE for the treatment of mild-to-moderate UC were analyzed by immunohistochemistry. Cytokine levels in patients' serum were quantified by ELISA. Cell culture experiments were performed using THP-1 monocytic cells.ARBE treatment inhibited the expression of IFN-γ-receptor 2 in human THP-1 monocytic cells. Colon biopsies of UC patients who responded to the 6-week long ARBE treatment revealed reduced amounts of the pro-inflammatory cytokines IFN-γ and TNF-α. Levels of phosphorylated (activated p65-NF-κB were reduced in these patients. Further, patients with successful ARBE treatment featured enhanced levels of Th17-cell specific cytokine IL-22 and immunoregulatory cytokine IL-10 as well as reduced serum levels of TNF-α and MCP-1, but enhanced levels of IL-17A, in contrast to patients that did not reach remission after ARBE treatment.Our data suggest a molecular mechanism underlying the anti-inflammatory effects of ARBE treatment in UC patients by modulating T-cell cytokine signalling and inhibiting IFN-γ signal transduction. These data are of particular interest, since ARBE is a promising therapeutic approach for the treatment of IBD.

  12. Sexuality and fertility outcomes after hand sewn versus stapled ileal pouch anal anastomosis for ulcerative colitis.

    Science.gov (United States)

    Harnoy, Yann; Desfourneaux, Véronique; Bouguen, Guillaume; Rayar, Michel; Meunier, Bernard; Siproudhis, Laurent; Boudjema, Karim; Sulpice, Laurent

    2016-01-01

    Ileal pouch anal anastomosis (IPAA) may alter sexuality and fertility in women. The laparoscopic approach seems to reduce infertility rates in women after IPAA. However, the impact of hand sewn versus stapled IPAA on sexuality and fertility has never been assessed in patients with ulcerative colitis (UC). The objective of this study was to analyze the impact of the IPAA technique on sexuality and fertility in UC. All UC patients who underwent an IPAA between May 1996 and April 2011 were included. The patients answered mailed questionnaires including sexuality validated questionnaires and fertility questionnaires. The risk factors of sexual dysfunction were explored. A total of 135 patients were included. Eighty-eight patients (65%) answered the questionnaires. Their mean age and follow-up were 37.2 ± 13.4 y and 109.7 ± 57.5 mo. The rates of female and male sexual dysfunction were 50% and 29%, respectively. Intestinal transit disorders were identified as risk factors in both men and women and anastomotic stricture in women sexual dysfunction, in univariate analyses. The IPAA technique did not impact sexual function in women but there was a trend for less erectile dysfunction after hand sewn IPAA (16.7% versus 44.4%). The fertility rate was 47% in women and 75% in men, with a trend for a better fertility in women after hand sewn IPAA (P = 0.07). In this preliminary study, the hand sewn or stapled IPAA technique did not impact the sexuality or fertility outcomes of UC patients, but there was a trend for better female fertility and male erectile function after hand sewn IPAA. Intestinal transit disorders contributed to male and female sexual dysfunction after IPAA. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Activation of NLRP3 Inflammasome in Inflammatory Bowel Disease: Differences Between Crohn's Disease and Ulcerative Colitis.

    Science.gov (United States)

    Lazaridis, Lazaros-Dimitrios; Pistiki, Aikaterini; Giamarellos-Bourboulis, Evangelos J; Georgitsi, Marianna; Damoraki, Georgia; Polymeros, Dimitrios; Dimitriadis, George D; Triantafyllou, Konstantinos

    2017-09-01

    NLRP3 inflammasome is a multimolecular cytosol complex that, when activated, contributes to the cleavage of pro-interleukin (IL)-1β to IL-1β. To investigate NLRP3 inflammasome activation in inflammatory bowel disease. Peripheral blood mononuclear cells from Crohn's disease (CD), ulcerative colitis (UC) patients and controls were stimulated with LPS in the absence or presence of MSU. After incubation, concentrations of IL-1β, IL-6, and TNFα were measured in cell supernatants and concentration of pro-IL-1β was measured in cell lysates. NLRP3 activation was defined as more than 30% increase in IL-1β production after MSU addition. In separate experiments, PBMCs were lysed for RNA isolation transcripts of IL-1β, TNFα, NLRP3, and CASP1 were measured by RT-PCR. DNA was isolated from CD patients for ATG16L1 gene genotyping. NLRP3 inflammasome was activated in 60% of CD patients compared to 28.6% of controls (p = 0.042); no significant difference was detected between UC and controls. Among UC patients, NLRP3 activation was associated (p = 0.008) with long-standing disease (>1.5 years). IL-1β levels were significantly higher in CD patents in comparison with controls (p = 0.032). No difference was detected in the levels of IL-6, TNFα, pro-IL-1β and in the numbers IL-1β, TNFα, NLRP3, and CASP1 transcripts among groups. IL-1β production was similar between carriers of wild-type and of SNP alleles of the rs2241880. NLRP3 inflammasome is activated in CD patients and in UC patients with long-standing disease.

  14. Genetic variants in the region harbouring IL2/IL21 associated with ulcerative colitis.

    Science.gov (United States)

    Festen, E A M; Goyette, P; Scott, R; Annese, V; Zhernakova, A; Lian, J; Lefèbvre, C; Brant, S R; Cho, J H; Silverberg, M S; Taylor, K D; de Jong, D J; Stokkers, P C; Mcgovern, D; Palmieri, O; Achkar, J-P; Xavier, R J; Daly, M J; Duerr, R H; Wijmenga, C; Weersma, R K; Rioux, J D

    2009-06-01

    Genetic susceptibility is known to play a large part in the predisposition to the inflammatory bowel diseases (IBDs) known as Crohn's disease (CD) and ulcerative colitis (UC). The IL2/IL21 locus on 4q27 is known to be a common risk locus for inflammatory disease (shown in coeliac disease, type 1 diabetes, rheumatoid arthritis, systemic lupus erythematosus and psoriasis), while the roles that interleukin 2 (IL2) and IL21 play in the immune response also make them attractive candidates for IBD. The objective of this study was to test for association between the IL2/IL21 locus and the IBDs. The four single nucleotide polymorphisms (SNPs) in the IL2/IL21 locus most associated with coeliac disease were genotyped in 1590 subjects with IBD and 929 controls from The Netherlands, and then replicated in a North American cohort (2387 cases and 1266 controls) and an Italian cohort (805 cases and 421 controls), yielding a total of 4782 cases (3194 UC, 1588 CD) and 2616 controls. Allelic association testing and a pooled analysis using a Cochran-Mantel-Haenszel test were performed. All four SNPs were strongly associated with UC in all three cohorts and reached genome-wide significance in the pooled analysis (rs13151961 p = 1.35 x 10(-10), rs13119723 p = 8.60 x 10(-8), rs6840978 p = 3.0 7x 10(-8), rs6822844 p = 2.77 x 10(-9)). A moderate association with CD was also found in the pooled analysis (p value range 0.0016-9.86 x 10(-5)). A strong association for the IL2/IL21 locus with UC was found, which also confirms it as a general susceptibility locus for inflammatory disease.

  15. Beyond Histological Remission: Intramucosal Calprotectin as a Potential Predictor of Outcomes in Ulcerative Colitis.

    Science.gov (United States)

    Guirgis, Marianne; Wendt, Emily; Wang, Lai Mun; Walsh, Alissa; Burger, Daniel; Bryant, Robert V; Kent, Alex; Adamson, Rebecca; Brain, Oliver; Travis, Simon P L; Keshav, Satish

    2017-04-01

    Histological remission and low faecal calprotectin are positive prognostic factors in ulcerative colitis [UC]. Intramucosal calprotectin [iMC], which can be readily determined by immunohistochemistry, has not so far been evaluated as a predictor of outcome in UC. We aimed to investigate the relationship between iMC and clinical, endoscopic, and histological measures of remission in UC, and the independent prognostic value of iMC. Ambulant patients with UC were recruited for a study comparing clinical activity indices. Sigmoidoscopy and biopsy were performed at the index visit. Clinical, endoscopic, and histological activity were scored and iMC semi-quantitatively measured using immunohistochemistry for the S100A8/9 heterodimer on colonic biopsies, scored as the mean number of positive cells in five high-power fields [HPF]. At the end of follow-up [6 years], data on steroid use, hospitalisation, and colectomy ['adverse outcomes'] were collected. iMC was determined in 83 patients and 20 controls, and correlated with clinical, endoscopic, and histological activity [r = 0.51, 0.65, 0.53, p > 0.001, respectively]. iMC was lowest (median 2.4, interquartile range [IQR]: 5.2-5, p iMC > 5/HPF was associated with adverse outcome (hazard ratio [HR] 3.36, confidence interval [CI] 1.58, 7.15, p iMC > 5 cells/HPF avoided an adverse outcome after 1, 3, and 6 years, respectively. iMC was lowest in patients with concordant clinical, endoscopic, and histological remission. Median iMC > 5/HPF was associated with adverse outcomes despite histological remission. Therefore iMC is a potentially useful independent marker of activity.

  16. Level of Fecal Calprotectin Correlates With Endoscopic and Histologic Inflammation and Identifies Patients With Mucosal Healing in Ulcerative Colitis

    DEFF Research Database (Denmark)

    Theede, Klaus; Holck, Susanne; Ibsen, Per

    2015-01-01

    or inactive UC who underwent sigmoidoscopy at Copenhagen University Hospital Hvidovre from September 2012 through 2014. Endoscopic inflammation was evaluated by using the Mayo Endoscopic Score (MES) and Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and histologic inflammatory activity by a slightly...... modified Harpaz Index, which measures acute inflammation. The Partial Mayo Score was used to measure the clinical disease activity. RESULTS: A cutoff level of FC of 192 mg/kg identified patients with endoscopic evidence of mucosal healing, which was based on the MES and UCEIS, with positive predictive...

  17. Achievement of sustained deep remission with adalimumab in a patient with both refractory ulcerative colitis and seronegative erosive rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    G. Andrisani

    2013-05-01

    Full Text Available Inflammatory bowel disease (IBD is commonly associated with peripheral inflammatory arthritis, and it has been estimated that as many as 12% of IBD patients report these manifestations. However, rheumatoid arthritis (RA is rarely associated with ulcerative colitis (UC. Among all the biological agents available, nine have been currently approved for the treatment of RA. Conversely, only Infliximab and recently Adalimumab have been approved for UC. In particular, the efficacy of Adalimumab in UC has been demonstrated by both recent randomized controlled trials and real-life studies. Moreover, Adalimumab is a well-established treatment for RA. Herein, we describe a patient with RA and UC treated successfully with ADA.

  18. Achievement of sustained deep remission with adalimumab in a patient with both refractory ulcerative colitis and seronegative erosive rheumatoid arthritis.

    Science.gov (United States)

    Andrisani, G; Gremese, E; Guidi, L; Papa, A; Marzo, M; Felice, C; Pugliese, D; Armuzzi, A

    2013-05-27

    Inflammatory bowel disease (IBD) is commonly associated with peripheral inflammatory arthritis, and it has been estimated that as many as 12% of IBD patients report these manifestations. However, rheumatoid arthritis (RA) is rarely associated with ulcerative colitis (UC). Among all the biological agents available, nine have been currently approved for the treatment of RA. Conversely, only Infliximab and recently Adalimumab have been approved for UC. In particular, the efficacy of Adalimumab in UC has been demonstrated by both recent randomized controlled trials and real-life studies. Moreover, Adalimumab is a well-established treatment for RA. Herein, we describe a patient with RA and UC treated successfully with ADA.

  19. The optimal dose of 5-aminosalicylic acid in active ulcerative colitis: a dose-finding study with newly developed mesalamine.

    Science.gov (United States)

    Kruis, Wolfgang; Bar-Meir, Simon; Feher, Janos; Mickisch, Oliver; Mlitz, Horst; Faszczyk, Marek; Chowers, Yehuda; Lengyele, Gabriella; Kovacs, Agotá; Lakatos, László; Stolte, Manfred; Vieth, Michael; Greinwald, Roland

    2003-01-01

    5-Aminosalicylate is the gold standard for inducing remission in patients with mildly to moderately active ulcerative colitis. The optimal dose is as yet not defined. Despite some recent developments, the ideal formulation for 5-aminosalicylic acid is still awaited. A new pellet preparation was designed combining slow and delayed release properties. Aims of the study were to find the optimal dose and to test efficacy and safety of a new 5-aminosalicylic acid formulation. Three hundred twenty-one patients were included in a double-blind multicenter trial. Inclusion criteria were active ulcerative colitis (Clinical Activity Index [CAI] and Endoscopic Index [EI] according to Rachmilewitz, CAI 6-12; EI >/=4). Three different doses of 5-aminosalicylic acid (0.5 g 3 times a day, 1.0 g 3 times a day, and 1.5 g 3 times a day) were studied for 8 weeks. Clinical remission rate (CAI mesalamine doses. In addition, times to first clinical response were similar: 26.5 days (1.0 g 3 times a day), 27.5 days (0.5 g 3 times a day), and 21.5 days (1.5 g 3 times a day). Endoscopic improvement was better with 1.0 g mesalamine 3 times a day than with 0.5 g 3 times a day, but overall endoscopic and histologic improvement was not different between treatment groups. Baseline activity, duration, and localization of ulcerative colitis did have some influence on the therapeutic activity, but there was no significant interaction with the dose of the study drug. Safety, with special focus on kidney function, was excellent in all 3 groups. There is no significant dose response between mesalamine 1.5 g/day, 3.0 g/day, and 4.5 g/day. The optimal dose to induce remission of ulcerative colitis is 0.5 g 5-aminosalicylic acid 3 times a day. Patients failing with this dose may benefit from an increase of the dose up to 1.0 g 3 times a day, but should also be considered for alternative treatment. A newly developed pellet formulation of 5-aminosalicylic acid has promising efficacy and excellent safety.

  20. Diagnosis of ulcerative colitis before onset of inflammation by multivariate modeling of genome-wide gene expression data

    DEFF Research Database (Denmark)

    Olsen, Jørgen; Gerds, Thomas A; Seidelin, Jakob B

    2009-01-01

    Background: Endoscopically obtained mucosal biopsies play an important role in the differential diagnosis between ulcerative colitis (UC) and Crohn's disease (CD), but in some cases where neither macroscopic nor microscopic signs of inflammation are present the biopsies provide only inconclusive...... information. Previous studies indicate that CD cannot be diagnosed by molecular and histological diagnostic tools using colonic biopsies without microscopic signs of inflammation, but it is unknown if this is also the case for UC.Methods: The aim of the present study was to apply multivariate modeling...

  1. Long-term Compliance with Oral 5-aminosalicylic Acid Therapy and Risk of Disease Recurrence in Patients with Ulcerative Colitis

    DEFF Research Database (Denmark)

    Prosberg, Michelle V; Vester-Andersen, Marianne K; Andersson, Mikael

    2016-01-01

    BACKGROUND: Noncompliance to long-term medical therapy is a well-known problem among patients treated for ulcerative colitis, but studies of long-term consequences in unselected patients are lacking. The authors aimed to determine the risk of recurrence according to long-term compliance with oral 5......-aminosalicylic acid. Data were collected from medical records and the Danish National Prescription Database. They performed Cox regression analysis with adjustments for demographic and clinical characteristics to examine risk of recurrence (defined by increased use of oral 5-Aminosalicylic Acid, other additional...... not to take their medication....

  2. Faecal lactoferrin is a useful biomarker for mucosal healing in patients with ulcerative colitis during granulocyte and monocyte adsorptive apheresis therapy.

    Science.gov (United States)

    Sagawa, T; Kakizaki, S; Tomizawa, T; Nakayama, T; Tanaka, H; Tojima, H; Sato, K; Kusano, M; Okamura, S; Yamada, M

    2016-07-01

    The study investigated the value of faecal lactoferrin as a follow-up biomarker for mucosal healing of ulcerative colitis during granulocyte and monocyte adsorptive apheresis (GMA) therapy. Patients with ulcerative colitis exhibiting a moderate or severe disease activity with a partial Mayo Score (pMS) of over 4 were enrolled in this study. The patients received 10 courses of GMA therapy. The pMS value and faecal lactoferrin level were monitored and compared with the findings of endoscopy until 12 months after the last dose of GMA therapy. Twenty patients (male:female 11:9) were enrolled in this study. Twelve had total colitis, while six had left-sided involvement and two had distal proctitis. Thirteen (65.0%) responded to GMA therapy. The faecal lactoferrin levels were significantly decreased in patients who responded to GMA therapy (P lactoferrin levels correlated with the endoscopic findings (r = 0.792, P lactoferrin levels and mucosal findings were higher than those observed between the pMS score and mucosal findings. The faecal lactoferrin level is a useful biomarker of the mucosal findings in ulcerative colitis. Although endoscopy is the gold standard, the faecal lactoferrin level can be used as a biomarker during GMA therapy in patients with ulcerative colitis. Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland.

  3. ANTIBODIES TO THE CYTOPLASM OF NEUTROPHILS: A MARKER OF UNFAVORABLE CLINICAL COURSE IN NON-SPECIFIC ULCERATIVE COLITIS

    Directory of Open Access Journals (Sweden)

    A. G. Kharitonov

    2010-01-01

    Full Text Available Antibodies to the cytoplasm of neutrophils (p-ANCA are detectable in 67% of patients with ulcerative colitis (UC. We have revealed typical clinical features of the patients with diagnostic p-ANCA titer, i.e., longer disease duration, prolonged fevers, and increased stool frequency. Moreover, thrombocytosis, leukocytosis and hypoalbuminemia are more common in this group. By endoscopic examination, mucosal ulcers of the colon are significantly more frequent in this group of patients. We have also noted higher rates of severe and relapsing cases among p-ANCA-positive patients. The data obtained allow us to suggest that the diagnostic titers of p-ANCA are predictive for unfavorable prognosis in UC.

  4. Genetic identification of Entamoeba polecki subtype 3 from pigs in Japan and characterisation of its pathogenic role in ulcerative colitis.

    Science.gov (United States)

    Matsubayashi, Makoto; Murakoshi, Naoko; Komatsu, Tetsuya; Tokoro, Masaharu; Haritani, Makoto; Shibahara, Tomoyuki

    2015-12-01

    To date, three Entamoeba spp. (E. suis, zoonotic E. polecki and E. histolytica) have been identified in pigs, but their pathogenicity and molecular classification have not been fully determined. Examination and pathological analysis of pigs (n=3) with diarrhoea was conducted and revealed the presence of Entamoeba organisms. We performed a genetic analysis of the isolate using the small-subunit ribosomal RNA (SSU rRNA) gene region to identify the species. A severe ulcerative colitis was observed histopathologically with inflammatory cells, including macrophages and neutrophils, infiltrating the mucous membranes of the cecum and colon. Many Entamoeba trophozoites were found at the erosion site or at ulcerative lesions. Pathogenic viruses or bacteria were not detected. The SSU rRNA sequence of the Entamoeba isolate was found to be completely homologous to that of E. polecki subtype 3. Copyright © 2015 Elsevier B.V. All rights reserved.

  5. Experimental colitis delays and reduces the severity of collagen-induced arthritis in mice.

    Science.gov (United States)

    Hablot, Julie; Peyrin-Biroulet, Laurent; Kokten, Tunay; El Omar, Reine; Netter, Patrick; Bastien, Claire; Jouzeau, Jean-Yves; Sokol, Harry; Moulin, David

    2017-01-01

    Amongst extraintestinal manifestations (EIM) occurring in IBD patients, rheumatologic manifestations are the most frequent. Understanding the relationships between arthritis and colitis is a prerequisite to improving the management of these patients. Microbiota of patients with IBD or rheumatologic diseases, like spondyloarthritis (SpA) is modified compared to healthy individual. Thus, we have evaluated the impact of colitis in the development of arthritis in mice and we have analyzed microbiota changes. Collagen-induced arthritis (CIA) was induced at day 0 in DBA1 mice exposed or not to Dextran Sodium Sulfate (DSS) to induce colitis between day 14 and day 21. Animals were monitored regularly for arthritis and colitis severity (clinical score, hindpaw edema). Fecal microbiota was studied by 16S rRNA deep sequencing at critical time points (D14, D14, D21 & D41). At day 41, histological scoring of the intestines and ankles were performed at the end of experiment. Induction of colitis slightly delayed arthritis onset (2 ± 1 days of delay) and reduced its severity (5.75 ± 1.62 in arthritis only group vs 4.00 ± 1.48 in arthritis + colitis group (p = 0.02 at day 28) macroscopically and histologically. In contrast, colitis severity was not influenced by arthritis development. Induction of colitis promoted a modification of microbiota composition and a decrease of α-diversity. Fecal microbiota composition was different between "colitis" and "arthritis+colitis" groups during colitis development. Interestingly a milder decrease of bacterial diversity in the "arthritis+colitis" group was observed. Concomitant experimental colitis protects mice against collagen-induced arthritis and this is associated with changes in gut microbiome composition.

  6. Pharmaceutical Activation or Genetic Absence of ClC-2 Alters Tight Junctions During Experimental Colitis.

    Science.gov (United States)

    Jin, Younggeon; Pridgen, Tiffany A; Blikslager, Anthony T

    2015-12-01

    We have previously reported that the ClC-2 chloride channel has an important role in regulation of tight junction barrier function during experimental colitis, and the pharmaceutical ClC-2 activator lubiprostone initiates intestinal barrier repair in ischemic-injured intestine. Thus, we hypothesized that pharmaceutical ClC-2 activation would have a protective and therapeutic effect in murine models of colitis, which would be absent in ClC-2 mice. We administered lubiprostone to wild-type or ClC-2 mice with dextran sulfate sodium (DSS) or 2, 4, 5-trinitrobenzene sulfonic acid-induced colitis. We determined the severity of colitis and assessed intestinal permeability. Selected tight junction proteins were analyzed by Western blotting and immunofluorescence/confocal microscopy, whereas proliferative and differentiated cells were examined with special staining and immunohistochemistry. Oral preventive or therapeutic administration of lubiprostone significantly reduced the severity of colitis and reduced intestinal permeability in both DSS and trinitrobenzene sulfonic acid-induced colitis. Preventive treatment with lubiprostone induced significant recovery of the expression and distribution of selected sealing tight junction proteins in mice with DSS-induced colitis. In addition, lubiprostone reduced crypt proliferation and increased the number of differentiated epithelial cells. Alternatively, when lubiprostone was administered to ClC-2 mice, the protective effect against DSS colitis was limited. This study suggests a central role for ClC-2 in restoration of barrier function and tight junction architecture in experimental murine colitis, which can be therapeutically targeted with lubiprostone.

  7. Pharmacological activity of 6-gingerol in dextran sulphate sodium-induced ulcerative colitis in BALB/c mice.

    Science.gov (United States)

    Ajayi, Babajide O; Adedara, Isaac A; Farombi, Ebenezer O

    2015-04-01

    Gingerols are phenolic compounds in ginger (Zingiber officinale), which have been reported to exhibit antiinflammatory, antioxidant, and anticancer properties. The present study aimed at evaluating the possible pharmacologic activity of 6-gingerol in a mouse model of dextran sulphate sodium (DSS)-induced ulcerative colitis. Adult male mice were exposed to DSS in drinking water alone or co-treated with 6-gingerol orally at 50, 100, and 200 mg/kg for 7 days. Disease activity index, inflammatory mediators, oxidative stress indices, and histopathological examination of the colons were evaluated to monitor treatment-related effects of 6-gingerol in DSS-treated mice. Administration of 6-gingerol significantly reversed the DSS-mediated reduction in body weight, diarrhea, rectal bleeding, and colon shrinkage to near normal. Moreover, 6-gingerol significantly suppressed the circulating concentrations of interleukin-1β and tumor necrosis factor alpha and restored the colonic nitric oxide concentration and myeloperoxidase activity to normal in DSS-treated mice. 6-Gingerol efficiently prevented colonic oxidative damage by increasing the activities of antioxidant enzymes and glutathione content, decreasing the hydrogen peroxide and malondialdehyde levels, and ameliorated the colonic atrophy in DSS-treated mice. 6-Gingerol suppressed the induction of ulcerative colitis in mice via antioxidant and antiinflammatory activities, and may thus represent a potential anticolitis drug candidate. Copyright © 2015 John Wiley & Sons, Ltd.

  8. Protective effect of Agave americana Linn. leaf extract in acetic acid-induced ulcerative colitis in rats.

    Science.gov (United States)

    Mannasaheb, Basheerahmed A A; Kulkarni, Preeti V; Sangreskopp, Mashood Ahmed; Savant, Chetan; Mohan, Anjana

    2015-01-01

    Natural plants always provide core compounds for new drug development. In the present life and food style, inflammatory bowel disease has become common and needs a lead compound for its drug development. To evaluate the effect of Agave americana Linn. leaf extract in acetic acid-induced ulcerative colitis in rats based on its traditional anti-inflammatory use. Male Wistar rats were pretreated with A. americana leaf extract in the dose of 200 and 400 mg/kg p.o. daily for 7 days. On 8(th) day, 2 ml of 4% v/v acetic acid in saline was instilled into rats' rectum. Prednisolone was used as standard drug and it was administered on the day of acetic acid instillation and continued for 3 days. Extract treatment was continued till 11(th) day. Body weight, ulcer score, colonic muscle contraction, antioxidant activity and histopathology were studied. Statistical analysis was performed using Parametric one-way analysis of variance followed by Tukey's posttest. A. americana have retained total body weight significantly (P weight/length ratio. Extract have shown a significant decrease (P acetic acid-induced colitis in rats.

  9. Induction with NCB-02 (curcumin) enema for mild-to-moderate distal ulcerative colitis - a randomized, placebo-controlled, pilot study.

    Science.gov (United States)

    Singla, Vikas; Pratap Mouli, Venigalla; Garg, Sushil Kumar; Rai, Tarun; Choudhury, Bikash Narayan; Verma, Prashant; Deb, Rachana; Tiwari, Veena; Rohatgi, Sarika; Dhingra, Rajan; Kedia, Saurabh; Sharma, Piyush Kumar; Makharia, Govind; Ahuja, Vineet

    2014-03-01

    Curcumin, an active ingredient of turmeric with anti-inflammatory properties, has been demonstrated to be useful in experimental models of ulcerative colitis (UC). It's efficacy in humans needs to be investigated. A randomized, double-blind, single-centre pilot trial was conducted in patients with distal UC (NCB-02 (standardized curcumin preparation) enema plus oral 5-ASA or placebo enema plus oral 5-ASA. Primary end point was disease response, defined as reduction in Ulcerative Colitis Diseases Activity Index by 3 points at 8 weeks, and secondary end points were improvement in endoscopic activity and disease remission at 8 weeks. Response to treatment was observed in 56.5% in NCB-02 group compared to 36.4% (p=0.175) in placebo group. At week 8, clinical remission was observed in 43.4% of patients in NCB-02 group compared to 22.7% in placebo group (p=0.14) and improvement on endoscopy in 52.2% of patients in NCB-02 group compared to 36.4% of patients in placebo group (p=0.29). Per protocol analysis revealed significantly better outcomes in NCB-02 group, in terms of clinical response (92.9% vs. 50%, p=0.01), clinical remission (71.4% vs. 31.3%, p=0.03), and improvement on endoscopy (85.7% vs. 50%, p=0.04). In this pilot study we found some evidence that use of NCB-02 enema may tend to result in greater improvements in disease activity compared to placebo in patients with mild-to-moderate distal UC. The role of NCB-02 as a novel therapy for UC should be investigated further. © 2013.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  11. L-arginine augments the antioxidant effect of garlic against acetic acid-induced ulcerative colitis in rats.

    Science.gov (United States)

    Harisa, Gamal Eldin I; Abo-Salem, Osama M; El-Sayed, El-Sayed M; Taha, Ehab I; El-Halawany, Nermin

    2009-10-01

    Garlic contains many sulfhydryl compounds that act as antioxidants. However, the role of nitric oxide (NO) in inflammation is controversial. The aim of the present study is to investigate the possible protective effect of garlic against acetic acid-induced ulcerative colitis in rats, as well as the probable modulatory effect of L-arginine (NO precursor) on garlic activity. Intra-rectal inoculation of rats with 4% acetic acid for 3 consecutive days caused a significant increase in the colon weight and marked decrease in the colon length. In addition, acetic acid induced a significant increase in serum levels of nitrate as well as colonic tissue content of malondialdehyde (MDA). Moreover, colonic tissue contents of glutathione (GSH), superoxide dismutase (SOD) and catalase (CAT) were markedly reduced. On the other hand, pre-treatment of rats with garlic (0.25 g/kgbwt, orally) for 4 consecutive weeks and 3 days during induction of colitis significantly reduced the increase in the colon weight induced by acetic acid and ameliorated alterations in oxidant and antioxidant parameters. Interestingly, oral co-administration of garlic (0.25 g/kgbwt) and L-arginine (625 mg/kgbwt) for the same period of garlic administration mitigated the changes in both colon weight and length induced by acetic acid and increased garlic effect on colon tissue contents of MDA and GSH. In conclusion, L-arginine can augment the protective effect of garlic against ulcerative colitis; an effect that might be mainly attributed to its NO donating property resulting in enhancement of garlic antioxidant effect. Further studies will be needed to determine which one of the active ingredients of garlic has the main antioxidant effect to be used with L-arginine.

  12. Lycopene Ameliorates Experimental Colitis in Rats via Reducing Apoptosis and Oxidative Stress.

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    Gul Baykalir, Burcu; Aksit, Dilek; Dogru, Mustafa Selim; Hanım Yay, Arzu; Aksit, Hasan; Seyrek, Kamil; Attesahin, Ahmet

    2017-07-19

    Inflammatory bowel disease (IBD) is an inflammatory disorder involving colitis. Lycopene is a naturally occurring carotenoid that has attracted considerable attention as a potential chemopreventive agent. The impact of lycopene on colitis is currently unknown. The aim of this study was to investigate the protective effects of lycopene in a rat model of colitis induced by acetic acid. The animals were randomly divided into the following five groups: the control group, colitis group, colitis + sulfasalazine group as a positive control group, colitis + lycopene and lycopene groups. Colonic mucosal injury was assessed by biochemical and histopathological examinations. Malondialdehyde (MDA), superoxide dismutase (SOD) activity, total antioxidant status (TAS), ceruloplasmin (CPN), total sialic acid and iron (Fe) levels were evaluated in blood samples. MDA, SOD, TAS and DNA fragmentation levels were also measured in colon tissues. MDA (p lycopene in the colitis decreased MDA, total sialic acid and DNA fragmentation levels, while SOD activity (p lycopene ameliorated the biochemical and pathological alterations caused by colitis. The results obtained in this study indicate that lycopene may exert protective effects in experimental colitis and might, therefore, be useful for treatment of IBD.

  13. U.S. Patients with Ulcerative Colitis Do Not Have a Decreased Risk of Diverticulosis.

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    Kinnucan, Jami; Tomal, Justin; Rubin, David T

    2015-09-01

    Studies outside the United States have described a lower prevalence of diverticulosis in patients with inflammatory bowel disease (IBD) than in patients without IBD. The aim of this study was to assess the prevalence of diverticulosis and associated risk factors in patients with ulcerative colitis (UC) at a U.S. tertiary care center. We performed a retrospective review of patients over 50 years of age who underwent screening or surveillance colonoscopy from January 2006 to December 2013. We first assessed the prevalence of diverticulosis in patients with UC compared with patients without IBD. Then, we performed a nested case-control study comparing UC patients with diverticulosis (cases) with UC patients without diverticulosis (controls). We identified 544 patients with UC and 16,705 patients without IBD who underwent colonoscopy. On univariate analysis, 23.5% of patients with UC had diverticulosis, and 46.7% of patients without IBD had diverticulosis, P diverticulosis in UC = 1.02 (95% CI, 1.02-1.03). In the nested case-control study, there were no differences between UC cases and UC controls in disease duration (16.7 versus 18.7 yr; P = 0.27), extent of disease (pancolitis 50% versus 60.1%; P = 0.24), obesity (34.5% versus 29.2%; P = 0.40), or ethnicity (86.3% white versus 79.8%; P = 0.20). There was a trend toward history of smoking in patients with UC and diverticulosis (49.5% versus 35.5%; P = 0.09). In this U.S.-based study, patients with UC had a slightly increased of diverticulosis compared with patients without IBD undergoing screening or surveillance colonoscopy. There were no identified predictors for diverticular disease in patients with UC, but there was a trend toward previous smoking status and development of diverticulosis. These results are different than previously reported data in patients with IBD in other countries and may represent unique dietary differences that contribute to the development of diverticulosis.

  14. Interleukin-17 SNPs and serum levels increase ulcerative colitis risk: A meta-analysis

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    Li, Juan; Tian, Hao; Jiang, Hui-Jun; Han, Bin

    2014-01-01

    AIM: To investigate the associations of interleukin-17 (IL-17) genetic polymorphisms and serum levels with ulcerative colitis (UC) risk. METHODS: Relevant articles were identified through a search of the following electronic databases, excluding language restriction: (1) the Cochrane Library Database (Issue 12, 2013); (2) Web of Science (1945-2013); (3) PubMed (1966-2013); (4) CINAHL (1982-2013); (5) EMBASE (1980-2013); and (6) the Chinese Biomedical Database (1982-2013). Meta-analysis was conducted using STATA 12.0 software. Crude odds ratios and standardized mean differences (SMDs) with corresponding 95% confidence intervals (CIs) were calculated. All of the included studies met all of the following five criteria: (1) the study design must be a clinical cohort or a case-control study; (2) the study must relate to the relationship between IL-17A/F genetic polymorphisms or serum IL-17 levels and the risk of UC; (3) all patients must meet the diagnostic criteria for UC; (4) the study must provide sufficient information about single nucleotide polymorphism frequencies or serum IL-17 levels; and (5) the genotype distribution of healthy controls must conform to the Hardy-Weinberg equilibrium (HWE). The Newcastle-Ottawa Scale (NOS) criteria were used to assess the methodological quality of the studies. The NOS criteria included three aspects: (1) subject selection: 0-4; (2) comparability of subjects: 0-2; and (3) clinical outcome: 0-3. NOS scores ranged from 0 to 9, with a score ≥ 7 indicating good quality. RESULTS: Of the initial 177 articles, only 16 case-control studies met all of the inclusion criteria. A total of 1614 UC patients and 2863 healthy controls were included in this study. Fourteen studies were performed on Asian populations, and two studies on Caucasian populations. Results of the meta-analysis revealed that IL-17A and IL-17F genetic polymorphisms potentially increased UC risk under both allele and dominant models (P IL-17 levels than healthy controls

  15. Challenges in the design of a Home Telemanagement trial for patients with ulcerative colitis.

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    Cross, Raymond K; Finkelstein, Joseph

    2009-12-01

    Nonadherence, inadequate monitoring, and side-effects result in suboptimal outcomes in ulcerative colitis (UC). We hypothesize that telemanagement for UC will improve symptoms, quality of life, adherence, and decrease costs. This article describes the challenges encountered in the design of the home telemanagement in patients with UC trial. In a randomized trial to assess the effectiveness of telemanagement for UC compared to best available care, 100 patients will be enrolled. Subjects in the intervention arm will complete self-testing with telemanagement weekly; best available care subjects will receive scheduled follow up, educational fact sheets, and written action plans. Telemanagement consists of a home-unit, decision support server, and web-based clinician portal. The home-unit includes a scale and laptop. Subjects will respond to questions about symptoms, side-effects, adherence, and knowledge weekly; subjects will receive action plans after self-testing. Outcome variables to be assessed every 4 months include: disease activity, using the Seo index; quality of life, using the Inflammatory Bowel Disease Questionnaire; adherence, using pharmacy refill data and the Morisky Medication Adherence Scale; utilization of healthcare resources, using urgent care visits and hospitalizations. We encountered several challenges during design and implementation of our trial. First, we selected a randomized controlled trial design. We could have selected a quasiexperimental design to decrease the sample size needed and costs. Second, identification of a control group was challenging. Telemanagement patients received self-care plans and an educational curriculum. Since controls would not receive these interventions, we thought our results would be biased in favor of telemanagement. In addition, we wanted to evaluate the mode of delivery of these components of care. Therefore, we included written action plans and educational materials for patients in the control group ('best

  16. The GRADE approach for assessing new technologies as applied to apheresis devices in ulcerative colitis

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    Cabriada-Nuño Jose

    2010-06-01

    Full Text Available Abstract Background In the last few years, a new non-pharmacological treatment, termed apheresis, has been developed to lessen the burden of ulcerative colitis (UC. Several methods can be used to establish treatment recommendations, but over the last decade an informal collaboration group of guideline developers, methodologists, and clinicians has developed a more sensible and transparent approach known as the Grading of Recommendations, Assessment, Development and Evaluation (GRADE. GRADE has mainly been used in clinical practice guidelines and systematic reviews. The aim of the present study is to describe the use of this approach in the development of recommendations for a new health technology, and to analyse the strengths, weaknesses, opportunities, and threats found when doing so. Methods A systematic review of the use of apheresis for UC treatment was performed in June 2004 and updated in May 2008. Two related clinical questions were selected, the outcomes of interest defined, and the quality of the evidence assessed. Finally, the overall quality of each question was taken into account to formulate recommendations following the GRADE approach. To evaluate this experience, a SWOT (strengths, weaknesses, opportunities and threats analysis was performed to enable a comparison with our previous experience with the SIGN (Scottish Intercollegiate Guidelines Network method. Results Application of the GRADE approach allowed recommendations to be formulated and the method to be clarified and made more explicit and transparent. Two weak recommendations were proposed to answer to the formulated questions. Some challenges, such as the limited number of studies found for the new technology and the difficulties encountered when searching for the results for the selected outcomes, none of which are specific to GRADE, were identified. GRADE was considered to be a more time-consuming method, although it has the advantage of taking into account patient

  17. Impact of the age of diagnosis on the natural history of ulcerative colitis

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    Tiago Cúrdia Gonçalves

    2015-10-01

    Full Text Available Background: Ulcerative colitis (UC has a recognized phenotypic heterogeneity. Some studies suggest that age at diagnosis may influence features and natural history of the disease. Aim: This study aimed to compare patients', disease's and treatment's features between Portuguese patients diagnosed before and after the age of 40-years-old. Methods: Retrospective single-center study that included 310 patients with UC, divided in two groups: Those diagnosed before the age of 40-years-old (early onset UC and those diagnosed later than that (late onset UC. In each group features of the patients (gender, family history, smoking, of the disease (duration, extension, severity, clinical course, hospitalization, extraintestinal manifestations, and of treatment (oral aminosalicylates, systemic steroids or immunomodulators were analyzed. Statistical analysis was performed using SPSSv22.0. Univariate and multivariate analyses were performed to assess factors associated with early and late onset UC. Results: From the analyzed patients, 207 had UC diagnosed before the age of 40 years old (43.5% men; mean age at diagnosis 29.4 ± 6.9 years and 103 were diagnosed after that age (61.2% men; mean age at diagnosis 51.8 ± 8.1 years. In the group diagnosed before 40 years old, female gender (p = 0.003, severe disease (p = 0.002, chronic intermittent clinical course (p = 0.026, and hospitalizations (p = 0.001 were significantly more frequent. The use of oral aminosalicylates (p = 0.032, systemic steroids (p = 0.003 and immunomodulators (p = 0.012 were also more common in the early onset UC group. No differences between groups were found in family history, smoking, disease's extension, extraintestinal manifestations, and use of biological agents. Multivariate analysis pointed early onset UC to be significantly associated with female gender (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.08-2.91; p = 0.024, chronic intermittent symptoms (OR, 2.34; 95% CI, 1

  18. Detection of Campylobacter concisus and Other Campylobacter Species in Colonic Biopsies from Adults with Ulcerative Colitis

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    Mukhopadhya, Indrani; Thomson, John M.; Hansen, Richard; Berry, Susan H.; El-Omar, Emad M.; Hold, Georgina L.

    2011-01-01

    Introduction The critical role of bacteria in the pathogenesis of ulcerative colitis (UC) is well recognized, but an individual causative microorganism has not been singled out so far. Campylobacter concisus and other non-jejuni species of Campylobacter have been implicated as putative aetiological agents in inflammatory bowel disease in children, but such studies have not been addressed in adults. This study investigated the prevalence of Campylobacter species in colonic biopsy samples from adults with UC and healthy controls. Methods Adult patients who were undergoing diagnostic colonoscopy were recruited for the study, which included 69 patients with histologically proven UC and 65 healthy controls. DNA was extracted from the biopsy samples and subjected to Campylobacter genus specific and Campylobacter concisus specific polymerase chain reaction and sequencing. Results Detection of all Campylobacter DNA utilising genus specific primers was significantly higher in cases of UC, with a prevalence of 73.9% (51/69) compared to 23.1% (15/65) in controls (p = 0.0001). Nested PCR for C. concisus DNA was positive in 33.3% (23/69) of biopsy samples from subjects with UC, which was significantly higher than the prevalence rate of 10.8% (7/65) from controls (p = 0.0019). Sequencing of the remaining Campylobacter positive samples revealed that Campylobacter ureolyticus was positive in 21.7% (15/69) of samples from UC subjects as opposed to 3.1% (2/65) in controls (p = 0.0013). Mixed Campylobacter species were more common in UC patients, 20.3% (14/69) as compared to controls 4.6% (3/65) (p = 0.0084). Conclusion The higher prevalence of Campylobacter genus and more specifically C. concisus and C. ureolyticus in biopsy samples from adults with UC suggests these genera of bacteria may be involved in the chronic inflammation that is characteristically seen in UC. To the best of our knowledge this is the first report of this association of C. concisus and C

  19. [Ulcerative colitis in children. Levels of salicylazosulfapyridine and sulfapyridine during treatment].

    Science.gov (United States)

    Guastavino, E; Litwin, N H; Heffes Nahmod, L; Licastro, R

    1988-01-01

    Salicylazosulfapyridine (SASP) is a drug used in the treatment of ulcerative colitis (UC) owing to the therapeutic action of the 5-aminosalicylic acid produced by the splitting of the molecule in the cecum, which also yields the absorbable compound Sulphapyridine (SP). The aim of our work was to assess the levels of the drug in blood (SASP and SP), to correlate them with undesirable effects in any, to verify their fluctuations in the dosing interval and to investigate the extent of the excretion of the drug in the children who were studied. 10 children (6 to 16 years) with UC, who were treated with SASP (dOsage schedule 0.5-2.0 g/day in a 12 hours interval), were studied. Blood levels of SASP and SP were assessed at 6 and 12 hours after doses, and total fecal excretion of SASP was determines in 24 hs specimens. All the determinations were performed according to Hansson and Sandberg. SP plasma levels were 17.7 +/- 9.0 ug/ml (range 6.8-36.3 ug/ml) at 6 hours after doses. and 14.1 +/- 7.2 ug/ml (range 5.7-25.0 ug/ml) at 12 hours after doses. SASP plasma levels were 15.5 +/- 15.4 ug/ml (range 2.1-53.4 ug/ml) at 6 hours after doses, and 14.0 +/- 20.4 ug/ml (range 3.9-70.7 ug/ml) at 12 hours after doses. The 24 hours fecal excretion was 17.4 to 236 mg. These values were correlated with the given doses (r = 0.88) calculated as SASP g/m2 body surface 24 hs. There was no statistical correlation between doses and SP or SASP levels in this group, and the respective levels of SASP and SP at 6 and 12 hours after doses showed no significative differences.(ABSTRACT TRUNCATED AT 250 WORDS)

  20. Detection of Campylobacter concisus and other Campylobacter species in colonic biopsies from adults with ulcerative colitis.

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    Indrani Mukhopadhya

    Full Text Available INTRODUCTION: The critical role of bacteria in the pathogenesis of ulcerative colitis (UC is well recognized, but an individual causative microorganism has not been singled out so far. Campylobacter concisus and other non-jejuni species of Campylobacter have been implicated as putative aetiological agents in inflammatory bowel disease in children, but such studies have not been addressed in adults. This study investigated the prevalence of Campylobacter species in colonic biopsy samples from adults with UC and healthy controls. METHODS: Adult patients who were undergoing diagnostic colonoscopy were recruited for the study, which included 69 patients with histologically proven UC and 65 healthy controls. DNA was extracted from the biopsy samples and subjected to Campylobacter genus specific and Campylobacter concisus specific polymerase chain reaction and sequencing. RESULTS: Detection of all Campylobacter DNA utilising genus specific primers was significantly higher in cases of UC, with a prevalence of 73.9% (51/69 compared to 23.1% (15/65 in controls (p = 0.0001. Nested PCR for C. concisus DNA was positive in 33.3% (23/69 of biopsy samples from subjects with UC, which was significantly higher than the prevalence rate of 10.8% (7/65 from controls (p = 0.0019. Sequencing of the remaining Campylobacter positive samples revealed that Campylobacter ureolyticus was positive in 21.7% (15/69 of samples from UC subjects as opposed to 3.1% (2/65 in controls (p = 0.0013. Mixed Campylobacter species were more common in UC patients, 20.3% (14/69 as compared to controls 4.6% (3/65 (p = 0.0084. CONCLUSION: The higher prevalence of Campylobacter genus and more specifically C. concisus and C. ureolyticus in biopsy samples from adults with UC suggests these genera of bacteria may be involved in the chronic inflammation that is characteristically seen in UC. To the best of our knowledge this is the first report of this association of C. concisus

  1. Haplotype analyses of DNA repair gene polymorphisms and their role in ulcerative colitis.

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    Avinash Bardia

    Full Text Available Ulcerative colitis (UC is a major clinical form of inflammatory bowel disease. UC is characterized by mucosal inflammation limited to the colon, always involving the rectum and a variable extent of the more proximal colon in a continuous manner. Genetic variations in DNA repair genes may influence the extent of repair functions, DNA damage, and thus the manifestations of UC. This study thus evaluated the role of polymorphisms of the genes involved in DNA repair mechanisms. A total of 171 patients and 213 controls were included. Genotyping was carried out by ARMS PCR and PCR-RFLP analyses for RAD51, XRCC3 and hMSH2 gene polymorphisms. Allelic and genotypic frequencies were computed in both control & patient groups and data was analyzed using appropriate statistical tests. The frequency of 'A' allele of hMSH2 in the UC group caused statistically significant increased risk for UC compared to controls (OR 1.64, 95% CI 1.16-2.31, p = 0.004. Similarly, the CT genotype of XRCC3 gene was predominant in the UC group and increased the risk for UC by 1.75 fold compared to controls (OR 1.75, 95% CI 1.15-2.67, p = 0.03, further confirming the risk of 'T' allele in UC. The GC genotype frequency of RAD51 gene was significantly increased (p = 0.02 in the UC group (50.3% compared to controls (38%. The GC genotype significantly increased the risk for UC compared to GG genotype by 1.73 fold (OR 1.73, 95% CI 1.14-2.62, p = 0.02 confirming the strong association of 'C' allele with UC. Among the controls, the SNP loci combination of hMSH2:XRCC3 were in perfect linkage. The GTC and ACC haplotypes were found to be predominant in UC than controls with a 2.28 and 2.93 fold significant increase risk of UC.

  2. Colonic cytomegalovirus detection by mucosal PCR and antiviral therapy in ulcerative colitis.

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    Okahara, Koki; Nagata, Naoyoshi; Shimada, Takayuki; Joya, Akane; Hayashida, Tsunefusa; Gatanaga, Hiroyuki; Oka, Shinichi; Sakurai, Toshiyuki; Uemura, Naomi; Akiyama, Junichi

    2017-01-01

    We aimed to identify the risk factors associated with colonic cytomegalovirus (CMV) infection in ulcerative colitis (UC) and to compare the clinical course between antiviral therapy-treated and -untreated groups in mucosal CMV-polymerase chain reaction (PCR) -positive cases. We retrospectively selected 46 UC patients (>15 years old) in active phase who underwent colonoscopy with biopsy and were analyzed for CMV infection by mucosal PCR between October 2011 and December 2015 at our institution. Colonic CMV in inflamed mucosa was detected using quantitative real-time PCR. The clinical course was evaluated, including need for drug therapy/surgery or drug therapy intensification. In addition, we evaluated the clinical course between CMV-DNA- cases and CMV-DNA+ cases with low viral load. At baseline, CMV-DNA+ patients were significantly older, had higher endoscopic scores, and required higher corticosteroid doses during the past 4 weeks than CMV-DNA- patients (p< 0.05). No significant differences were observed in disease duration, disease distribution, laboratory data, or use of other medication between CMV-DNA+ and CMV-DNA- patients. In the anti-CMV-treated group with a median (range) DNA load of 16,000 (9,000-36,400), 3patients achieved remission without additional UC therapy, 2 required additional UC therapy, and 1 required colectomy despite azathioprine and infliximab therapy. In the CMV-untreated group with a median (range) DNA load of 919 (157-5,480), all patients achieved remission with UC therapy alone. No significant difference was observed in the clinical course between CMV-DNA- cases and CMV-DNA+ cases with low viral loads. Aging, endoscopic UC activity, and corticosteroid dose predispose to colonic CMV infection, as determined by mucosal PCR, in UC. UC treatment without anti-CMV therapy may be warranted, particularly in patients with low-load CMV-DNA. Anti-CMV therapy alone does not always achieve clinical response in UC even in cases with high-load PCR.

  3. Colonic cytomegalovirus detection by mucosal PCR and antiviral therapy in ulcerative colitis.

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    Koki Okahara

    Full Text Available We aimed to identify the risk factors associated with colonic cytomegalovirus (CMV infection in ulcerative colitis (UC and to compare the clinical course between antiviral therapy-treated and -untreated groups in mucosal CMV-polymerase chain reaction (PCR -positive cases.We retrospectively selected 46 UC patients (>15 years old in active phase who underwent colonoscopy with biopsy and were analyzed for CMV infection by mucosal PCR between October 2011 and December 2015 at our institution. Colonic CMV in inflamed mucosa was detected using quantitative real-time PCR. The clinical course was evaluated, including need for drug therapy/surgery or drug therapy intensification. In addition, we evaluated the clinical course between CMV-DNA- cases and CMV-DNA+ cases with low viral load.At baseline, CMV-DNA+ patients were significantly older, had higher endoscopic scores, and required higher corticosteroid doses during the past 4 weeks than CMV-DNA- patients (p< 0.05. No significant differences were observed in disease duration, disease distribution, laboratory data, or use of other medication between CMV-DNA+ and CMV-DNA- patients. In the anti-CMV-treated group with a median (range DNA load of 16,000 (9,000-36,400, 3patients achieved remission without additional UC therapy, 2 required additional UC therapy, and 1 required colectomy despite azathioprine and infliximab therapy. In the CMV-untreated group with a median (range DNA load of 919 (157-5,480, all patients achieved remission with UC therapy alone. No significant difference was observed in the clinical course between CMV-DNA- cases and CMV-DNA+ cases with low viral loads.Aging, endoscopic UC activity, and corticosteroid dose predispose to colonic CMV infection, as determined by mucosal PCR, in UC. UC treatment without anti-CMV therapy may be warranted, particularly in patients with low-load CMV-DNA. Anti-CMV therapy alone does not always achieve clinical response in UC even in cases with high

  4. Once-daily MMX(®) mesalamine for endoscopic maintenance of remission of ulcerative colitis.

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    D'Haens, Geert; Sandborn, William J; Barrett, Karen; Hodgson, Ian; Streck, Paul

    2012-07-01

    Treatment with mesalamine to maintain endoscopic remission (mucosal healing) of ulcerative colitis (UC) has been shown to reduce the risk of relapse and is the recommended first-line maintenance therapy. To improve treatment adherence, a mesalamine formulation that can be administered once-daily, MMX(®) mesalamine (Lialda; Shire Pharmaceuticals LLC, Wayne, PA), was developed. This study was conducted to determine the efficacy and safety of once-daily MMX mesalamine compared with twice-daily delayed-release mesalamine (Asacol; Warner Chilcott, Dublin, Ireland) for maintaining endoscopic remission in patients with UC. A multicenter, randomized, double-blind, 6-month, active-control trial was conducted to assess the non-inferiority of once-daily MMX mesalamine 2.4 g/day compared with twice-daily delayed-release mesalamine at a total daily dose of 1.6 g/day in patients with UC in endoscopic remission. The primary end point was maintenance of endoscopic remission at month 6 in the per-protocol (PP) population. Overall, 826 patients were randomized and dosed. The primary objective (non-inferiority) was met. At month 6, 83.7 and 77.8% of patients receiving MMX mesalamine in the PP and intent-to-treat (ITT) populations, respectively, had maintained endoscopic remission compared with 81.5% (PP) and 76.9% (ITT) of patients receiving delayed-release mesalamine (95% confidence interval for difference: -3.9%, 8.1% (PP); -5.0%, 6.9% (ITT)). Time to relapse was not significantly different between the two treatment groups (log-rank test, P=0.5116 (PP); P=0.5455 (ITT)). The proportion of patients with adverse events was 37.1 and 36.0% in patients receiving MMX mesalamine and delayed-release mesalamine, respectively. Once-daily dosing of MMX mesalamine 2.4 g/day was shown to be well tolerated and non-inferior to twice-daily dosing with delayed-release mesalamine 1.6 g/day for maintenance of endoscopic remission in patients with UC.

  5. Evidence for association of OCTN genes and IBD5 with ulcerative colitis

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    Waller, S; Tremelling, M; Bredin, F; Godfrey, L; Howson, J; Parkes, M

    2006-01-01

    Background and aims Genetic association between Crohn's disease (CD) and OCTN1 (SLC22A4) C1672T/OCTN2 (SLC22A5) G−207C variants in IBD5 has recently been reported. These genes encode solute carriers and the association was suggested to be distinct from the background IBD5 risk haplotype. There have been conflicting reports of the association between markers in the IBD5 region and ulcerative colitis (UC) and interaction (epistasis) between this locus and CARD15. Our aim was to ascertain the contribution of OCTN variants to UC and CD in a large independent UK dataset, to seek genetic evidence that the OCTN association is distinct from the IBD5 risk haplotype and to identify interactions between the IBD5 and CARD15 loci. Methods A total of 1104 unrelated Caucasian subjects with inflammatory bowel disease (IBD) (496 CD, 512 UC, 96 indeterminate) and 750 ethnically matched controls were genotyped for three single nucleotide polymorphisms (SNPs) in the CD associated genes (OCTN1+1672, OCTN2−207, and IGR2230), and two flanking IBD5 tagging SNPs, IGR2096 and IGR3096. Data were analysed by logistic regression methods within STATA. Results OCTN variants were as strongly associated with UC and IBD overall as they were with CD (p = 0.0001; OR 1.3 (95% confidence interval 1.1–1.5)). OCTN variants were in tight linkage disequilibrium with the extended IBD5 risk haplotype D′ 0.79 and 0.88, and r2 = 0.62 and 0.72 for IGR2096 and 3096, respectively. There was no deviation from a multiplicative model of interaction between CARD15 and IBD5 on the penetrance scale. Conclusions The OCTN variants were associated with susceptibility to IBD overall. The effect was equally strong in UC and CD. Although OCTN variants may account for the increased risk of IBD associated with IBD5, a role for other candidate genes within this extended haplotype was not excluded. There was no statistical evidence of interaction between CARD15 and either OCTN or IBD5 variants in susceptibility

  6. Development of a rectal nicotine delivery system for the treatment of ulcerative colitis.

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    Dash, A K; Gong, Z; Miller, D W; Huai-Yan, H; Laforet, J

    1999-11-10

    The aims of this investigation were: i. to develop a rectal nicotine delivery system with bioadhesives for the treatment of ulcerative colitis and ii. to evaluate nicotine transport and cytotoxicity of the delivery system using Caco-2 cell culture systems. Rectal nicotine suppository formulations were prepared in semi-synthetic glyceride bases (Suppocire AM and AI, Gattefosse Inc.) by fusion method. The in vitro release of nicotine was carried out in modified USP dissolution apparatus 1. Differential scanning calorimetry (DSC) and powder X-ray diffraction were used to study the polymorphic changes if any in the formulations. An LC method was used for the assay of nicotine. The effect of bioadhesives (glyceryl monooleate (GMO), and Carbopol) on the nicotine flux was evaluated using Caco-2 cell permeability studies and Caco-2 cell viability was determined using the MTT toxicity assay. In vitro release studies indicated that the low melting AI base was superior to that of the AM base. Presence of GMO in the formulation enhanced the release of nicotine whereas Carbopol showed an opposite effect. The enhanced release of nicotine in the presence of GMO was found to be partly due to the melting point lowering effect of this compound. Caco-2 cell absorption studies showed that there was a decrease in the flux of nicotine in the presence of both the bioadhesives. The flux of the fluorescein marker which is used to study the integrity of the cell monolayers was found to be slightly higher only in the presence of 10% (w/w) Carbopol. Nicotine, Carbopol, and GMO do not have any cytotoxic effect on these cell monolayers within the concentration range used in the formulations. Rectal nicotine formulations containing bioadhesives were developed and characterized. Both in vitro release and cell culture studies have indicated that one can manipulate the nicotine release from these rectal delivery systems by incorporation of various bioadhesives or the use of different bases in the

  7. miRNA-26b Overexpression in Ulcerative Colitis-associated Carcinogenesis.

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    Benderska, Natalya; Dittrich, Anna-Lena; Knaup, Sabine; Rau, Tilman T; Neufert, Clemens; Wach, Sven; Fahlbusch, Fabian B; Rauh, Manfred; Wirtz, Ralph M; Agaimy, Abbas; Srinivasan, Swetha; Mahadevan, Vijayalakshmi; Rümmele, Petra; Rapti, Emmanouela; Gazouli, Maria; Hartmann, Arndt; Schneider-Stock, Regine

    2015-09-01

    Longstanding ulcerative colitis (UC) bears a high risk for development of UC-associated colorectal carcinoma (UCC). The inflammatory microenvironment influences microRNA expression, which in turn deregulates target gene expression. microRNA-26b (miR-26b) was shown to be instrumental in normal tissue growth and differentiation. Thus, we aimed to investigate the impact of miR-26b in inflammation-associated colorectal carcinogenesis. Two different cohorts of patients were investigated. In the retrospective group, a tissue microarray with 38 samples from 17 UC/UCC patients was used for miR-26b in situ hybridization and quantitative reverse transcription polymerase chain reaction analyses. In the prospective group, we investigated miR-26b expression in 25 fresh-frozen colon biopsies and corresponding serum samples of 6 UC and 15 non-UC patients, respectively. In silico analysis, Ago2-RNA immunoprecipitation, luciferase reporter assay, quantitative reverse transcription polymerase chain reaction examination, and miR-26b mimic overexpression were employed for target validation. miR-26b expression was shown to be upregulated with disease progression in tissues and serum of UC and UCC patients. Using miR-26b and Ki-67 expression levels, an UCC was predicted with high accuracy. We identified 4 novel miR-26b targets (DIP1, MDM2, CREBBP, BRCA1). Among them, the downregulation of the E3 ubiquitin ligase DIP1 was closely related to death-associated protein kinase stabilization along the normal mucosa-UC-UCC sequence. In silico functional pathway analysis revealed that the common cellular pathways affected by miR-26b are highly related to cancerogenesis and the development of gastrointestinal diseases. We suggest that miR-26b could serve as a biomarker for inflammation-associated processes in the gastrointestinal system. Because miR-26b expression is downregulated in sporadic