الملخص
Introduction : Lymphocytic colitis is an important cause of chronic diarrhoea which is amenable to appropriate treatment which helps to reduce the morbidity and mortality associated with chronic diarrhoea.In Africa unfortunately, there is poor awareness of this treatable cause of chronic diarrhoea on account of a paucity of skilled experts necessary to make a diagnosis and implement effective therapy.Aim :We present the clinical aspects, endoscopic findings and Introduction :Lymphocytic colitis is an important cause of chronic diarrhoea which is amenable to appropriate treatment which helps to reduce the morbidity and mortalit y associated with chronic diarrhoea. In Africa unfortunately, there is poor awareness of this treatable cause o chronic diarrhoea on account of a paucity of skilled experts necessary to make a diagnosis and implement effective therapy. Aim : We present the clinical aspects, endoscopic findings and pathological features of twenty-one Nigerian patients with lymphocytic colitis. A short literature review of the epidemiological, clinical, endoscopic, and pathological features of this important condition is also presented. Materials and Methods : This was a retrospective analysis of the clinical, endoscopic and pathological findings of twenty-one patients who were diagnosed with lymphocytic colitis following colonoscopy in an open-access endoscopy setting in Akure, Ondo State, Nigeria over eighteen months. Results : Twenty-one diagnoses of lymphocytic colitis were made from a pool of one hundred and twenty-two colonosco pies done between December 2021 and May 2023.There were slightly more females diagnosed with an M: F ratio of 3:4 with a mean (SD) age of 52.2 (± 14.3) years. All of the patients had a history of passage of watery diarrhoea while normal colonoscopy findings were present in 87.5%. The mean (SD) time to diagnosis in five of these study subjects was 18.4 ± 9.1 months.These patients had standard medical treatment with good outcomes. Conclusion : In sub-Saharan Africa, lymphocytic diarrhoea is a treatable cause of chronic diarrhoea. It is important to refer patients with chronic diarrhoea to facilities where they can benefit from the expertise of endoscopists and pathologists. pathological features of twenty-one Nigerian patients with lymphocytic colitis.A short literature review of the epidemiological, clinical, endoscopic, and pathological features of this important condition is also presented. Materials and Methods :This was a retrospective analysis of the clinical, endoscopic and pathological findings of tIntroduction : Lymphocytic colitis is an important cause of chronic diarrhoea which is amenable to appropriate treatment which helps to reduce the morbidity and mortality associated with chronic diarrhoea. In Africa unfortunately , there is poor awareness of this treatable cause of chronic diarrhoea on account of a paucity of skilled experts necessary to make a diagnosis and implement effective therapy. Aim : We present the clinical aspects, endoscopic findings and pathological features of twenty-one Nigerian patients with lymphocytic colitis. A short literature review of the epidemiological, clinical, endoscopic, and pathological features of this important condition is also presented. Materials and Methods :This was a retrospective analysis of the clinical, endoscopic and pathological findings of twenty-one patients who were diagnosed with lymphocytic colitis following colonoscopy in an open-access endoscopy setting in Akure, Ondo State, Nigeria over eighteen months. Results :Twenty-one diagnoses of lymphocytic colitis were made from a pool of one hundred and twenty-two colonoscopies done between December 2021 and May 2023.There were slightly more females diagnosed with an M: F ratio of 3:4 with a mean (SD) age of 52.2 (± 14.3) years. All of the patients had a history of passage of watery diarrhoea while normal colonoscopy findings were present in 87.5%. The mean (SD) time to diagnosis in five of these study subjects was 18.4 ± 9.1 months. These patients had standard medical treatment with good outcomes. Conclusion : In sub-Saharan Africa, lymphocytic diarrhoea is a treatable cause of chronic diarrhoea. It is important to refer patients with chronic diarrhoea to facilities where they can benefit from the expertise of endoscopists and pathologists.wenty-one patients who were diagnosed with lymphocytic colitis following colonoscopy in an open-access endoscopy setting in Akure, Ondo State, Nigeria over eighteen months. Results :Twenty-one diagnoses of lymphocytic colitis were made from a pool of one hundred and twenty-two colonoscopies done between December 2021 and May 2023. There were slightly more females diagnosed withIntroduction : Lymphocytic colitis is an important cause of chronic diarrhoea which is amenable to appropriate treatment which helps to reduce the morbidity and mortality associated with chronic diarrhoea.In Africa unfortunately , there is poor awareness of this treatable cause of chronic diarrhoea on account of a paucity of skilled experts necessary to make a diagnosis and implement effective therapy. Aim :We present the clinical aspects, endoscopic findings and pathological features of twenty-one Nigerian patients with lymphocytic colitis. A short literature review of the epidemiological, clinical, endoscopic, and pathological features of this important condition is also presented. Materials and Methods :This was a retrospective analysis of the clinical, endoscopic and pathological findings of twenty-one patients who were diagnosed with lymphocytic colitis following colonoscopy in an open-access endoscopy setting in Akure, Ondo State, Nigeria over eighteen months. Results :Twenty-one diagnoses of lymphocytic colitis were made from a pool of one hundred and twenty-two colonosco pies done between December 2021 and May 2023. There were slightly more females diagnosed with an M: F ratio of 3:4 with a mean (SD) age of 52.2 (± 14.3) years. All of the patients had a history of passage of watery diarrhoea while normal colonoscopy findings were present in 87.5%. The mean (SD) time to diagnosis in five of these study subjects was 18.4 ± 9.1 months.These patients had standard medical treatment with good outcomes. Conclusion : In sub-Saharan Africa, lymphocytic diarrhoea is a treatable cause of chronic diarrhoea. It is important to refer patients with chronic diarrhoea to facilities where they can benefit from the expertise of endoscopists and pathologists. an M: F ratio of 3:4 with a mean (SD) age of 52.2 (± 14.3) years. All of the patients had a history of passage of watery diarrhoea while normal colonoscopy findings were present in 87.5%. The mean (SD) time to diagnosis in five of these study subjects was 18.4 ± 9.1 months.These patients had standard medical treatment with good outcomes. Conclusion :In sub-Saharan Africa, lymphocytic diarrhoea is a treatable cause of chronic diarrhoea. It is important to refer patients with chronic diarrhoea to facilities where they can benefit from the expertise of endoscopists and pathologists.
الملخص
Introducción: La colitis ulcerosa (CU) es una enfermedad inflamatoria intestinal que afecta el colon y el recto de etiología desconocida. Se ha planteado la apendicectomía electiva en pacientes con colitis ulcerosa refractaria como una alternativa de tratamiento. Objetivo: Comunicar el caso clínico de una paciente con CU refractaria a quien la apendicectomía electiva permitió una mejoría de su sintomatología y calidad de vida. Resultados: Se presenta el caso de una paciente de 46 años con antecedentes de hipotiroidismo y colitis ulcerosa de 2 años de evolución, con rectorragia, dolor abdominal y diarrea importante pese a la terapia biológica. Se decide apendicectomía laparoscópica electiva, logrando una mejoría sintomática de la paciente objetivada mediante la aplicación de la encuesta "Inflammatory Bowel Disease Questionnaire". El puntaje preoperatorio de la paciente fue de 60 puntos, y el postoperatorio de 176. Discusión: Se hace evidente que la colitis ulcerosa y el apéndice cecal están íntimamente relacionados. Los desafíos futuros deberían apuntarse a identificar las características clínicas que precisen qué pacientes se benefician de esta intervención.
Introduction: Ulcerative colitis (UC) is an inflammatory bowel disease that affects the colon and rectum of unknown etiology. Elective appendectomy has been proposed as a possible treatment for patients with refractory ulcerative colitis. Objective: To report the clinical case of a patient with refractory UC who showed improvement in symptomatology and quality of life after undergoing elective appendectomy. Results: We present the case of a 46-year-old patient with a 2-year history of hypothyroidism and ulcerative colitis, with rectal bleeding, abdominal pain, and significant diarrhea despite biological therapy. Elective laparoscopic appendectomy was performed, resulting in symptomatic improvement of the patient as measured by the Inflammatory Bowel Disease Questionnaire. The patient's preoperative score was 60 points, and the postoperative score was 176. Discussion: It seems evident that ulcerative colitis and the cecal appendix are intimately related. Future challenges should aim to identify clinical characteristics that determine which patients benefit from this intervention.
الملخص
El 25% de los pacientes con Enfermedades Inflamatorias Intestinales (EII) se diagnostican antes de los 20 años. En la mayor parte de los centros del país se lleva a cabo la "transferencia" del paciente desde un centro de atención pediátrico a uno de adultos. La "transición" es un criterio de calidad con beneficios en el control de la EII reduciendo el número de recaídas, de hospitalizaciones y de cirugías. Por tal motivo hemos desarrollado un Programa Interdisciplinario de Transición entre dos hospitales de referencia nacional e internacional en EII. Materiales y métodos: Entre 1/2021 y 12/ 2022 se incorporaron 24 pacientes que ingresaron en 3 fases: Fase 1 Pacientes entre 14 y 16 años asistidos en el Hospital Garrahan (HG) con un abordaje interdisciplinario. Fase 2. A partir de los 17 años se realizaron 2 (dos) encuentros en el HG en conjunto con gastroenterólogos de adultos evaluando adherencia y autonomía y la Fase 3 llevada a cabo en el Hospital B. Udaondo (HBU) sólo con el equipo de adultos luego de 6 meses de realizada la transferencia evaluando adherencia al tratamiento, consultas a emergencias, internación y/o cirugías Resultados: Al inicio del Programa el 66% de los pacientes presentaban una actividad moderada a severa vs el 8% al finalizar la fase 3. Luego de la transferencia el 12,5% necesito ingreso a guardia e internación y un 8% tratamiento quirúrgico. El 83% de los pacientes continúan en seguimiento luego de 6 meses de haber sido transferidos (AU)
Twenty-five percent of patients with inflammatory bowel diseases (IBD) are diagnosed before the age of 20 years. In most centers in the country, the "transfer" of the patient from a pediatric to an adult care center is done. However, "transition" is a quality criterion with benefits in the control of IBD by reducing the number of relapses, hospitalizations, and surgeries. For this reason, we developed an Interdisciplinary Transition Program between two national and international reference hospitals in IBD. Materials and Methods: Between January 2021 and December 2022, we incorporated 24 patients into a three-phase program. Phase 1 involved patients between 14 and 16 years of age seen at Garrahan Hospital (HG) with an interdisciplinary approach. Phase 2 began from 17 years of age, with two meetings held at HG involving adult gastroenterologists to evaluate adherence and autonomy. Phase 3 was conducted at Hospital B. Udaondo (HBU) only with the adult team, six months after the transfer, evaluating adherence to treatment, emergency consultations, hospitalizations, and/or surgeries. Results: At the beginning of the program, 66% of the patients presented with moderate to severe disease activity, compared to 8% at the end of Phase 3. After the transfer, 12.5% of the patients required emergency department visits and hospitalization, and 8% required surgical treatment. Eighty-three percent of the patients continue in the program and are still being followed up six months after the transfer (AU)
الموضوعات
Humans , Adolescent , Inflammatory Bowel Diseases/therapy , Adolescent , Transition to Adult Care/organization & administration , Treatment Adherence and Compliance , Patient Care Team , Chronic Disease , Surveys and Questionnairesالملخص
This report presents the case of a 13-year-old female with a history of ulcerative colitis who underwent ileostomy closure after total colectomy. Postoperatively, she developed right leg paresis and extensive swelling of the lower extremities. Imaging investigations revealed myositis with avascular necrosis in the distal femoral condyles. These findings were consistent with myositis as an extraintestinal complication of ulcerative colitis.
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ABSTRACT Introduction: Endoscopy plays a fundamental role in inflammatory bowel disease (IBD), and becomes essential in diagnosis, treatment monitoring, and detection and management of complications. Materials and methods: The Pan American Crohn's and Colitis Organization (PANCCO) and the Inter-American Society of Endoscopy (SIED) appointed 22 Latin American experts in IBD to develop a consensus study using the modified Delphi method, based on the best available evidence. A working group of 22 members from 9 countries identified 15 topics and formulated 98 statements, who participated in 2 rounds of voting. It was defined as agreement of ≥80% of experts for each statement. Results: After the voting of all the statements, 8 statements were obtained that did not reach 80% consensus among the participants, so the questions were reconsidered in the Coordinating Committee of the consensus with the participation of the expert reviewers of these questions and 7 final statements were voted again by all the experts in a second round and 1 was eliminated with consensus. After two rounds of voting, the experts reached consensus with literature review with the best available evidence, the most important issues were developed with scientific evidence supporting each of the statements around the topic of endoscopy in IBD. Conclusions: Consensus statements were developed and based on the best available evidence about endoscopy in inflammatory bowel disease.
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Background: The initiation and progression of enteral nutrition in premature infants remains a challenge. The aim of this study was to evaluate enteral nutritional management in premature infants in the neonatology department at the mother and child complex Androva Mahajanga.Methods: This was a retrospective descriptive study over a 7-month period, from January to July 2018. All neonates under 37SA who received enteral feeding were included.Results: During the study period, 74 newborns were able to receive enteral feeding. The mean age of onset of enteral feeding was 10.6 hours. In 89.2% of cases, enteral feeding was started within the first 24 hours of life. On average, the initial quantity administered was 28.4ml/kg/d. Human milk was used most frequently (54.8%). The presence of residue was the most frequently encountered incident (31.5%). Ulcero-necrotizing enterocolitis occurred in 7 newborns (9.5%). Forty-five newborns had a good outcome, with an average weight gain of 9.28 g/kg/d.Conclusions: The implementation of a nutritional management protocol for newborns, especially premature babies, in the neonatology department would be beneficial for a better outcome and growth of the baby.
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Chronic conditions known as Inflammatory Bowel Diseases (IBD), including Crohn's Disease (CD) and Ulcerative Colitis (UC), have a significant impact on the quality of life experienced by patients. Innovative research is revealing complex molecular interactions between medicinal plants and diseases, advancing plant-based therapies. Typically, the primary methods for managing the condition involve using medications and making lifestyle adjustments. However, recent research indicates that medicinal plants could serve as additional, supportive options for managing the condition. This review article examines around 99 articles from sources such as Scopus, Web of Science, Google Scholar, PubMed, ResearchGate, DOAJ, SCIELO, and NOPR. The review methodically investigates the therapeutic potential of different medicinal plants in the management of Inflammatory Bowel Disease (IBD), including Crohn's Disease and ulcerative Colitis. The review provides insights into the underlying mechanisms, pharmacological properties, and effectiveness of these plants. The findings present a promising opportunity for further research and development of plant-based therapies to improve IBD management and improve patient outcomes.
الملخص
Ulcerative colitis (UC) is a difficult intestinal disease characterized by inflammation, and its mechanism is complex and diverse. Angiopoietin-like protein 2 (ANGPT2) plays an important regulatory role in inflammatory diseases. However, the role of ANGPT2 in UC has not been reported so far. After exploring the expression level of ANGPT2 in serum of UC patients, the reaction mechanism of ANGPT2 was investigated in dextran sodium sulfate (DSS)-induced UC mice. After ANGPT2 expression was suppressed, the clinical symptoms and pathological changes of UC mice were detected. Colonic infiltration, oxidative stress, and colonic mucosal barrier in UC mice were evaluated utilizing immunohistochemistry, immunofluorescence, and related kits. Finally, western blot was applied for the estimation of mTOR signaling pathway and NLRP3 inflammasome-related proteins. ANGPT2 silencing improved clinical symptoms and pathological changes, alleviated colonic inflammatory infiltration and oxidative stress, and maintained the colonic mucosal barrier in DSS-induced UC mice. The regulatory effect of ANGPT2 on UC disease might occur by regulating the mTOR signaling pathway and thus affecting autophagy-mediated NLRP3 inflammasome inactivation. ANGPT2 silencing alleviated UC by regulating autophagy-mediated NLRP3 inflammasome inactivation via the mTOR signaling pathway.
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RESUMEN Introducción: Se ha tratado de identificar los factores genéticos relacionados con susceptibilidad para enfermedad inflamatoria intestinal (EII), y los hallazgos actuales se inclinan por un modelo de patología complejo, sin un patrón hereditario claro. Objetivo: Realizar caracterización fenotípica y genotípica de pacientes con EII en población colombiana y describir su posible asociación con predisposición. Materiales y métodos: Serie de casos, 16 pacientes con EII por criterios clínicos y anatomopatológicos, inicio de síntomas gastrointestinales después de los 18 años. Todos tuvieron asesoramiento genético pre-test y se realizaron árboles genealógicos de mínimo tres generaciones. También, genotipificación, por medio de un panel de genes múltiples que incluía genes relacionados con EII y algunos trastornos autoinmunitarios. Finalmente, se realizó análisis genómico de variantes. Resultados: 9 mujeres y 7 hombres, con edad media de diagnóstico de EII 35 años, y 32 años para aparición de síntomas gastrointestinales. 11/16(68,75%) requirieron terapia biológica. 10/16 (62,5%) presentaron refractariedad a terapia estándar. 3/16 (18,75%) tenían antecedentes familiares positivos de EII. 100% casos presentaron al menos un single nucleotide polymorphism relacionado con riesgo de EII en más de un gen. Los genes más relacionados con colitis ulcerosa (CU), fueron CD48, CD6, y TYK2 para CU, y CD6 e ITGAM para la enfermedad de Crohn. El gen más frecuente fue CD6. Se observó en 3/16 (18,75%) presencia de hasta 5 genes, 4 en 3/16 (18,75%), y tres en 5/16 (31,25%). Conclusión: En EII hay presencia de variantes genéticas con predisposición asociada, pero sin patogenicidad confirmada, y cuya sumatoria parece contribuir en su fisiopatología.
ABSTRACT Introduction: Attempts have been made to identify the genetic factors related to susceptibility to inflammatory bowel disease (IBD), and the current conclusions are in favor of a complex pathology model, without a clear hereditary pattern. Objective: To perform phenotypic and genotypic characterization of patients with IBD in Colombian population and to describe its possible association with predisposition. Materials and methods: case series, 16 patients with IBD according to clinical and pathological criteria, onset of gastrointestinal symptoms after 18 years of age. All had pre-test genetic counseling and family trees of at least three generations were made. Also, genotyping, using a multigene panel that included genes related to IBD and some autoimmune disorders. Finally, a genomic analysis of variants was performed. Results: 9 women and 7 men, with mean age of diagnosis of IBD of 35 years, and gastrointestinal symptoms appearance of 32 years. 11/16 (68.75%) required biological therapy. 10/16 (62.5%) were refractory to standard therapy. 3/16 (18.75%) had positive family history of IBD. 100% cases presented at least one single nucleotide polymorphism related to IBD risk in more than one gene. The genes most related to ulcerative colitis (UC) were CD48, CD6, and TYK2 for UC, and CD6 and ITGAM for Crohn's disease. The most frequent gene was CD6. It was found presence of up to 5 genes in 3/16 (18.75%), 4 in 3/16 (18.75%), and three in 5/16 (31.25%). Conclusion: In IBD there is the presence of genetic variants with associated predisposition, but without confirmed pathogenicity, and whose sum seems to contribute to its pathophysiology.
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RESUMEN El megacolon tóxico es una enfermedad mortal, que se presenta, con mayor frecuencia, como una complicación de la inflamación intestinal, infecciones e isquemia intestinal. Se caracteriza por la presencia de diarrea sanguinolenta, distensión abdominal, signos de toxicidad sistémica y, en estudios de imagen, se observa dilatación colónica segmentaria. Para el diagnóstico, según los criterios de Jalan, se tiene en cuenta la dilatación colónica más de 6 cm, tres de los siguientes: fiebre, taquicardia, leucocitosis o anemia, y cualquiera de los siguientes criterios: hipotensión, hipovolemia, trastorno electrolítico y estado mental alterado. En este artículo, se presenta el caso de una paciente mujer que ingresa por cuadro de dolor abdominal y diarrea crónica con estudio de imagen, en la que se visualiza dilatación de todo el marco colónico. Se realizan los estudios correspondientes y se diagnostica megacolon tóxico por colitis ulcerativa, por lo que recibe tratamiento médico con evolución favorable. Es dado de alta y reingresa por shock séptico, se realizan estudios y se identifica infección por Clostridium difficile. Se inicia tratamiento antibiótico, pero presenta evolución desfavorable, lo que ocasionó el fallecimiento de la paciente. El presente caso representa la alta mortalidad de esta enfermedad.
ABSTRACT Toxic megacolon is a fatal disease, most commonly occurring as a complication of inflammatory bowel disease, infections, and intestinal ischemia. It is characterized by the presence of bloody diarrhea, abdominal distension, signs of systemic toxicity, and segmental colonic dilation is observed in imaging studies. For the diagnosis, according to the Jalan criteria, colonic dilation of more than 6 cm is taken into account, three of the following: fever, tachycardia, leukocytosis or anemia, and any of the following criteria: hypotension, hypovolemia, electrolyte disorder and altered mental status. This article presents the case of a female patient who was admitted with abdominal pain and chronic diarrhea with an imaging study showing dilation of the entire colonic framework. The corresponding studies were carried out which indicated that she had a toxic megacolon due to colitis. ulcerative, receives medical treatment with favorable evolution, is discharged and readmitted for septic shock, studies are performed and Clostridium difficile infection is identified, antibiotic treatment is started but the evolution is unfavorable, which caused the death of the patient. The present case represents the high mortality of this disease.
الملخص
Ulcerative colitis （UC） is a chronic， non-specific inflammatory bowel disease. The pathogenesis of this disease is complex and is attributed to multiple factors. Intestinal mucosal barrier damage is the basic pathological change of UC， and intestinal flora disorder is one of the important characteristics of UC. Intestinal flora plays a key role in the pathological process of UC by regulating intestinal mucosal immunity and inflammatory response to repair the damaged intestinal mucosal barrier. At present， western medicine has the advantages of rapid action onset and significant short-term efficacy， but the curative effect of long-term use is not good， accompanied by many adverse reactions， causing great physical and mental pain to patients. Therefore， it is urgent to explore new treatment methods with definite long-term efficacy and mild adverse reactions. A large number of studies have shown that Chinese medicine can regulate intestinal flora through multiple targets in an all-around way， restore the homeostasis of the flora， and repair the damaged intestinal mucosal barrier， thereby inhibiting the progression of UC. Numerous studies have shown that the active components， monomers， and compounds of Chinese medicine can effectively antagonize UC by regulating the intestinal flora to improve the intestinal mucosal immunity， reduce the inflammatory response of the intestinal mucosa， and restore the normal physiological function of the intestinal mucosal barrier， providing a new strategy for UC prevention and treatment. Although there are some studies of the regulation of intestinal flora by Chinese medicine to prevent and treat UC， those studies have the shortcomings of systematic and comprehensive inadequacy. Therefore， based on the research status of UC， intestinal flora， and Chinese medicine treatment， this study reviewed the relationship between intestinal flora and UC and clarified the key role of intestinal flora in the occurrence and development of UC. At the same time， this paper comprehensively summarized the Chinese medicine that targeted the regulation of intestinal flora for the treatment of UC in the past five years to provide new strategies and ideas for UC treatment.
الملخص
ObjectiveTo explore the protective mechanism of paeoniflorin on mice with ulcerative colitis （UC） through the adenosine monophosphate-activated protein kinase （AMPK）/mammalian target of rapamycin （mTOR） autophagy pathway. MethodUC mouse model was established by allowing mice freely drink 4% DSS， and 56 BALB/c male mice were randomly divided into model group， AMPK inhibitor group （20 mg·kg-1）， paeoniflorin （50 mg·kg-1） + inhibitor （20 mg·kg-1） group， and high dose （50 mg·kg-1）， medium dose （25 mg·kg-1）， and low dose （12.5 mg·kg-1） paeoniflorin groups. After seven days of drug intervention， the protective effect of paeoniflorin on mice with UC was determined by comparing the body weight， disease activity index （DAI） changes， and Hematoxylin-eosin （HE） staining results. Enzyme linked immunosorbent assay （ELISA） was used to detect the levels of tumor necrosis factor-α （TNF-α） and interleukin-6 （IL-6） in the serum of mice in each group， and immunofluorescence was utilized to detect microtubule-associated protein 1 light chain 3 （LC3） content in the colon， AMPK， mTOR proteins， and their phosphorylated proteins including p-AMPK and p-mTOR in the colon tissue were detected by Western blot， and the mRNA expression levels of AMPK， mTOR， Beclin1， LC3， and p62 were detected by Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR）. ResultCompared with the blank group， the model group showed a decrease in body mass， an increase in DAI score， and severe pathological damage to the colon. The levels of inflammatory factors including TNF-α and IL-6 increased in serum （P<0.01）， while the protein levels of LC3 and p-AMPK/AMPK were down-regulated in colon tissue， and those of p-mTOR/mTOR were up-regulated （P<0.01）. The mRNA expression levels of AMPK and LC3 were down-regulated， while the mRNA expression levels of mTOR and p62 were up-regulated （P<0.01）. Compared with the model group and the paeoniflorin + inhibitor group， the mice treated with paeoniflorin showed an increase in body mass， a decrease in DAI score， a reduction in pathological damage to colon tissue， and a reduction in the levels of inflammatory factors of TNF-α and IL-6 in serum （P<0.05）. The protein levels of LC3 and p-AMPK/AMPK in colon tissue were up-regulated， while the protein levels of p-mTOR/mTOR were down-regulated （P<0.01）. The mRNA expression levels of AMPK， Beclin1， and LC3 were up-regulated， while the mRNA expression of mTOR and p62 were down-regulated （P<0.01）. The colon tissue of the inhibitor group was severely damaged， and the trend of various indicators was completely opposite to that of the high dose paeoniflorin group. ConclusionPaeoniflorin can enhance autophagy and reduce inflammatory damage in mice with UC by activating the AMPK/mTOR signaling pathway and thus play a protective role.
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OBJECTIVE To investigate the improvement effects of limonin on intestinal injury and intestinal flora disturbance in rats with ulcerative colitis （UC） and its mechanism. METHODS UC rat models were established， and 70 rats with successful modeling were randomly divided into model group， limonin low-， medium-， and high-dose groups （12.5， 25， 50 mg/kg）， and sulfasalazine group （positive control group，500 mg/kg）， with 14 rats in each group. Another 14 rats were selected as the control group. After modeling， each group was given the corresponding drug or equal amount of normal saline， once a day， for 2 weeks. Twenty-four hours after the last administration， the general condition of rats was observed and the body weight was measured， and colon tissue was collected for colonic mucosal damage index （CMDI） scoring； the levels of interleukin-1β （IL-1β）， IL-6 and tumor necrosis factor-α （TNF-α） in colon tissue were detected； the pathological changes of colon tissue were observed； the protein expressions of Claudin-1， Occludin， ZO-1， high mobility group protein B1 （HMGB1） and receptor for advanced glycation end products （RAGE） in colon tissue were detected； fecal 16S rRNA sequencing was used to detect the relative abundance of zhangxiaxia5287@163.com intestinal microbiota in rats. RESULTS Compared with the control group， the rats in the model group were in poor mental state， with darker fur， irritable mood， disordered arrangement of colon glands， inflammatory cell infiltration， cell necrosis and edema； CMDI score， the levels of IL-1β， IL-6 and TNF-α， protein expressions of HMGB1 and RAGE in colon tissue， the relative abundance of Proteobacteria and Bacteroidetes were significantly increased （P＜0.05）； body weight， the protein expressions of Claudin-1， Occludin and ZO-1 in colon tissue， the relative abundance of Firmicutes in the intestine were significantly decreased （P＜0.05）. Compared with the model group， general situation and pathological damage of colonic tissue in limonin groups were improved， the levels of the above indicators were significantly reversed （P＜0.05）， and in a dose-dependent manner （P＜0.05）； there was no significant difference in various indexes between sulfasalazine group and limonin high-dose group （P＞0.05）. CONCLUSIONS Limonin can improve intestinal injury and intestinal flora disturbance in UC model rats， the mechanism of which may be associated with the down-regulation of HMGB1/RAGE signaling pathway.
الملخص
Ulcerative colitis （UC） is a chronic inflammatory bowel disease with complex etiology. The pathogenesis of this disease， due to a combination of factors， is complex and has not yet been elucidated. Among them， intestinal mucosal barrier damage is the basic pathological change of UC. As a non-destructive response of cells， autophagy regulates intestinal mucosal immunity， inflammation， oxidative stress， and bacterial homeostasis through degradation and reabsorption to actively repair damaged intestinal mucosal barrier， exerting a key role in the occurrence and development of UC. The disease is mainly treated clinically with aminosalicylic acid preparations， glucocorticoids， and immunosuppressants. Western medicine treatment of the disease has a fast onset of effect， and the short-term efficacy is definite， but the long-term application is easy to be accompanied by more adverse reactions. Moreover， some drugs are expensive， bringing great physical and mental pain and economic burden to patients. Therefore， it is urgent to explore new therapies with stable efficacy and mild adverse effects. In recent years， a large number of studies have shown that Chinese medicine can regulate autophagy of the intestinal mucosa with multiple targets and effects and repair the intestinal mucosal barrier function， thereby inhibiting the development of UC. Many experiments have shown that the active ingredient or monomers and compound formulas of Chinese medicine can improve the immunity of the intestinal mucosa， inflammation， oxidative stress， and flora by regulating the level of autophagy to maintain the normal function of the intestinal mucosal barrier to effectively intervene in UC， providing a new measure for the prevention and treatment of UC. However， there is a lack of systematic review of Chinese medicine in regulating the level of autophagy in the intestinal mucosa for the prevention and treatment of UC. Therefore， based on the current research on UC， autophagy process， and Chinese medicine treatment， this article reviewed the relationship of autophagy and its key target proteins with UC to clarify the key role of autophagy in UC production and systematically summarized Chinese medicines targeting the regulation of autophagy to treat UC in recent years to provide new ideas for the treatment and drug development of UC.
الملخص
ObjectiveThe bioinformatics method was used to screen ferroptosis differential genes （FRGs） closely related to ulcerative colitis （UC）， and animal experiments were conducted to verify whether the mechanism of Xiezhuo Jiedu recipe in treating UC is related to the regulation of ferroptosis. MethodThe differentially expressed genes （DEGs） of colonic mucosa tissue of UC patients were obtained from the GEO database， and the intersection of the genes with ferroptosis genes was used to obtain FRGs. The core FRGs were obtained by cluster analysis， minimum absolute contraction and selection operator （LASSO） regression， and receiver operating characteristic curve （ROC） curve analysis. In animal experiments， the UC mouse model was prepared by making the mouse freely drink 2.5% dextran sodium sulfate （DSS）. Xiezhuo Jiedu recipe and mesalazine were given by gavage for seven days， and the inflammatory infiltration of colonic mucosa was observed by hematoxylin-eosin （HE） staining. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） was used to detect the mRNA expression levels of E3 ubiquitin ligase （FBXW7）， zinc finger protein （ZFP36）， solute carrier family 7 member 11 （SLC7A11）， and Toll-like receptor 4 （TLR4） in colon tissue. The protein expression levels of FBXW7， ZFP36， SLC7A11， and TLR4 in colon tissue were detected by Western blot. ResultDataset GSE87466 was screened from the GEO database， and its intersections with the ferroptosis gene were analyzed to obtain 21 FRGs. After cluster analysis， LASSO regression， and ROC analysis， core FRGs （FBXW7， ZFP36， SLC7A11， and TLR4） were obtained. Immunoinfiltration analysis showed significant differences in the expression of initial B cells， M1 macrophages， plasma cells， and M2 macrophages in the colonic mucosa tissue of UC mice， and there was a significant correlation between core FRGs and these immune cells. Further animal experiments showed that the colonic mucosa tissue of mice in the model group was disorganized and infiltrated by a large number of inflammatory cells. The inflammation of the colonic mucosa tissue of mice in each group was relieved to varying degrees after treatment with Xiezhuo Jiedu recipe and mesalazine， while the colonic mucosa tissue of mice in the high-dose group of Xiezhuo Jiedu recipe showed almost no inflammatory changes. Compared with the normal group， the protein and mRNA expressions of FBXW7， ZFP36， SLC7A11， and TLR4 in the model group were significantly increased， and the expression of core FRGs in colonic mucosa tissue of mice in all groups was significantly down-regulated after treatment with Xiezhuo Jiedu recipe and mesalazine. ConclusionFBXW7， ZFP36， SLC7A11， and TLR4 are ferroptosis genes closely related to the pathogenesis of UC， and Xiezhuo Jiedu recipe can significantly alleviate colonic mucosa inflammation in mice by down-regulating core ferroptosis genes.
الملخص
ObjectiveThe differential expression of microRNAs （miRNAs） between the active stage and the remission stage of ulcerative colitis （UC） was analyzed by bioinformatics method， and the regulatory relationship was constructed by screening the differentially expressed genes （DEGs）. The mechanism of Xizhuo Jiedu recipe in the treatment of UC was speculated and verified by animal experiments. MethodThe miRNAs data set of colonic mucosa tissue of UC patients was obtained from the gene expression database （GEO）， and the most differentially expressed miRNAs were screened by GEO2R， Excel， and other tools as research objects. TargetScan， miRTarbase， miRDB， STRING， TRRUST， and Matescape databases were used to screen key DEGs， predict downstream transcription factors （TFs）， gene ontology （GO）， and conduct Kyoto Encyclopedia of Genes and Genomes （KEGG） enrichment analysis. The key signaling pathways were selected for animal experiments. In animal experiments， the UC mouse model was prepared by making the mouse freely drink 2.5% dextran sodium sulfate （DSS）. Xiezhu Jiedu recipe and mesalazine were given by gavage for seven days， and the inflammatory infiltration of colonic mucosa was observed by hematoxylin-eosin （HE） staining. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） was used to detect the mRNA expression of miR-155-5p in colon tissue. Immunohistochemistry and Western blot were used to detect the protein expression levels of cytokine signal transduction inhibitor （SOCS1）， phosphorylated transcriptional signal transductor and activator 3 （p-STAT3）， phosphorylated Janus kinase 2 （p-JAK2）， and retinoic acid-associated orphan receptor-γt （ROR-γt）. The expression levels of transforming growth factor-β （TGF-β）， interleukin-17 （IL-17）， interleukin-6 （IL-6）， and interleukin-10 （IL-10） in serum were detected by enzyme linked immunosorbent assay （ELISA）. ResultThe GSE48957 dataset was screened from the GEO database， and miR-155-5p was selected as the research object from the samples in the active and remission stages. 131 DEGs were screened. The GO/KEGG enrichment analysis was closely related to biological processes such as positive regulation of miRNA transcription and protein phosphorylation， as well as signaling pathways such as stem cell signaling pathway， IL-17 signaling pathway， and helper T cell 17 （Th17） cell differentiation. The Matescape database was used to screen out 10 key DEGs， among which SOCS1 was one of the key DEGs of miR-155-5p. Further screening of the TFS of key DEGs revealed that STAT3 was one of the main TFs of SOCS1. The results of animal experiments showed that Xiezhu Jiedu Recipe could effectively down-regulate the mRNA expression of miR-155-5p and protein expression of p-STAT3， p-JAK2， and ROR-γt in colon tissue of UC mice and the expression of IL-17 and IL-6 in serum of UC mice， up-regulate the protein expression of SOCS1 and the expression of TGF-β and IL-10， increase the level of anti-inflammatory factors， and reduce inflammatory cell infiltration. ConclusionIt is speculated that Xizhuo Jiedu recipe may interfere with SOCS1 by regulating the expression of miR-155-5p in UC mice， inhibit the phosphorylation of STAT3， inhibit the differentiation of CD4+ T cells into Th17 cells， reduce the levels of pro-inflammatory factors （IL-17 and IL-6）， and increase the levels of anti-inflammatory factors （TGF-β and IL-10）. As a result， the inflammation of colon mucosa in UC mice was alleviated.
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Inflammatory bowel disease （IBD）， mainly including ulcerative colitis （UC） and Crohn's disease （CD）， is a common chronic inflammatory disease of the gastrointestinal tract， with its incidence increasing year by year. Due to its long treatment duration， difficulty in treatment， prolonged remission， and high costs， it has attracted global attention. Exploring safe， effective， and sustainable treatment regimens has become an urgent global issue. The pathogenesis of IBD is complex， involving intestinal mucosal injury，disturbances in the internal environment， and inflammatory responses. In recent years， research has found that ferroptosis is also one of the important pathogenic factors of IBD. Ferroptosis， as a new form of non-apoptotic cell death， is characterized by iron dependence， lipid peroxidation， and imbalance in the redox system. Studies have shown that inhibiting ferroptosis in intestinal epithelial cells can protect the intestinal mucosa. Targeted intervention in ferroptosis may be a new direction for the treatment of IBD. IBD is mainly treated with drugs， including corticosteroids， aminosalicylates， biologics， and immunomodulators， but drug resistance and adverse reactions are common. Traditional Chinese medicine （TCM） has unique advantages such as low cost， low drug resistance， and fewer side effects， and has accumulated rich experience in the treatment of IBD. Scholars have confirmed that TCM can inhibit ferroptosis， and recent studies have shown that TCM can not only inhibit iron-dependent lipid peroxidation in intestinal cells but also enhance the antioxidant and anti-inflammatory abilities of intestinal mucosa， thus playing a role in the treatment of IBD. Increasing evidence suggests that TCM may treat IBD by interfering with ferroptosis. This article explores the relevance of TCM intervention in ferroptosis and the treatment of IBD， discusses the possible mechanisms of ferroptosis in IBD， and aims to provide a basis for the diagnosis and treatment of IBD.
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@#Abstract: To explore the mechanism of the intestinal microecology regulation by polysaccharide prebiotics, ELISA, histopathologic analysis, immunohistochemical analysis, 16S rRNA high-throughput sequencing, and gas chromatography-mass spectrometry were applied to investigate the effects of fermented polysaccharides on changes in the intestinal microbiota and short-chain fatty acids (SCFAs) in mice with dextran sulfate sodium (DSS)-induced colitis model and their relationship with the level of intestinal inflammation and barrier protein expression. It was found that fermented Lycium barbarum polysaccharides (FLBP) significantly reduced intestinal inflammation level, improved colonic tissue structure, up-regulated the expression of tight junction proteins Claudin-1 and ZO-1, and significantly increased the content of intestinal SCFAs in mice. Gut bacteria analyses showed that FLBP enriched intestinal Dubosiella and Akkermansia in mice and decreased the abundance of Turicibacter, Faecalibaculum, and Escherichia-Shigella. Results showed that remodeled Dubosiella activated by FLBP played a dominant role in ameliorating colitis by significantly increasing SCFAs content, improving intestinal barrier and reducing intestinal inflammation. The study aimed to provide a safer and better option for the amelioration of colitis and to provide a theoretical basis for the development of functional foods with FLBP.
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@#Abstract: Ulcerative colitis (UC) is a chronic intestinal disease caused by a variety of factors. Severe intestinal inflammation can also cause liver injury. Based on the previous research, microbial dysbiosis in the inflammatory state leads to the conversion of excess choline into trimethylamine (TMA) by the intestinal flora, which competes with the host for the use of the nutrient choline, and induces liver injury. 3, 3-dimethyl-1-butanol (DMB), a structural analogue of choline, can reduce TMA levels from choline conversion. The aim of this study was to investigate the protective effect and possible mechanism of DMB on UC and secondary liver injury. Dextran sulfate sodium-induced acute colitis model in mice was established. The weight of mice, and collected serum, liver and intestinal contents after mice sacrifice were measured. The morphological changes of colon and liver were observed; liver function was detected with the kit of biochemical indexes; UHPLC-MS/MS was applied to detect changes in choline metabolism in vivo. The experimental results showed that DMB could attenuate body weight loss index, improve colonic inflammation, and reduce liver injury in UC mice. The detection of choline-related metabolites in serum, intestinal contents and liver showed that DMB could effectively inhibit the production of trimethylamine in the intestine, improve the availability of host choline, effectively alleviate colitis deterioration, and reduce liver damage caused by severe intestinal lesions.
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Ischemic colitis is a disease in which local tissue in the intestinal wall dies to varying de-grees due to insufficient blood supply to the colon.Risk factors include cardiovascular disease,diabetes,chronic kidney disease,chronic obstructive pulmonary disease,etc.Typical clinical manifestations of the disease are abdominal pain and hematochezia.The most common locations are the watershed areas of splenic flexure and rectosigmoid junction.The lesions are segmental and clearly demarcated from normal mucosa under endoscopy.The digestive tract is a common extra-pulmonary organ affected by the novel coronavirus,which can be directly damaged by the virus or indirectly caused by virus-mediated inflamma-tion and hypercoagulability.The corona virus disease 2019(COVID-19)associated intestinal injury can be characterized by malabsorption,malnutrition,intestinal flora shift,etc.CT can show intestinal ische-mia,intestinal wall thickening,intestinal wall cystoid gas,intestinal obstruction,ascites,intussusception and other signs.In this study,we reported a case of ischemic colitis in a moderate COVID-19 patient.The affected area was atypical and the endoscope showed diffuse lesions from the cecum to the rectosig-moid junction.No signs of intestinal ischemia were found on imaging and clear thrombosis in small inter-stitial vessels was found in pathological tissue.Combined with the fact that the patient had no special risk factors in his past history,the laboratory tests indicated elevated ferritin and D-dimer,while the autoanti-bodies and fecal etiology results were negative,we speculated that the hypercoagulability caused by novel coronavirus infection was involved in the occurrence and development of the disease in this patient.After prolonged infusion support and prophylactic anti-infection therapy,the patient slowly resumed diet and eventually went into remission.Finally,we hoped to attract clinical attention with the help of this case of moderate COVID-19 complicated with ischemic colitis which had a wide range of lesions and a slow reco-very.For patients with abdominal pain and blood in the stool after being diagnosed as COVID-19,even if they are not severe COVID-19,they should be alert to the possibility of ischemic colitis,so as not to be mistaken for gastrointestinal reactions related to COVID-19.