Efficacy of Sishen pill compound combined with mesalazine in the treatment of mild to moderate ulcerative colitis and its effect on the circadian rhythm of symptoms / 中国基层医药

Objective:To investigate the efficacy of Sishen pill compound combined with mesalazine in the treatment of mild to moderate ulcerative colitis and its effect on the circadian rhythm of symptoms. Methods:A total of 136 patients with mild to moderate ulcerative colitis who received treatment in Hospital of Chengdu University of Traditional Chinese Medicine from January 2018 to December 2020 were included in this prospective randomized controlled trial. These patients were divided into a treatment group ( n = 68) and a control group ( n = 68). The treatment group was treated with Sishen pill compound combined with mesalazine. The control group was treated with mesalazine alone. All patients were treated for 12 weeks. Clinical efficacy, as well as morning abdominal pain grade, morning diarrhea score, fecal trait score, Mayo score, hemoglobin, and hypersensitive C-reactive protein pre- and post-treatment, were compared between the two groups. Results:Total response rate in the treatment group was significantly higher than that in the control group [91.18% (62/68) vs. 72.06% (49/68), χ2 = 8.28, P < 0.05]. After treatment, morning diarrhea score, morning abdominal pain score, fecal trait score, Mayo score, hemoglobin, and hypersensitive C-reactive protein in the treatment group were (0.47 ± 0.56) points, (0.53 ± 0.56) points, (3.01 ± 0.72) points, (7.13 ± 1.38) points, (108.04 ± 12.21) g/L, (4.00 ± 2.19) mg/L, respectively, and they were (0.84 ± 0.56) points, (1.12 ± 0.56) points, (4.40 ± 0.76) points, (3.25 ± 1.44) points, (102.15 ± 12.61) g/L, and (6.07 ± 3.66) mg/L respectively in the control group. There were significant differences in these indexes between the treatment and control groups ( t = 3.59, 5.95, 10.06, 9.62, 2.78, 3.99, all P < 0.05). Conclusion:Sishen pill compound combined with mesalazine can effectively reduce clinical symptoms of active ulcerative colitis, increase hemoglobin level, decrease C-reactive protein level, improve the efficiency of treatment, reduce symptoms and the number of diarrhea rhythms, and improve stool symptoms of mild to moderate ulcerative colitis patients.

Efficacy of probiotics, mesalazine and Kangfuxin liquid in combination in the treatment of 53 cases of ulcerative colitis / 中国基层医药

Objective:To investigate the efficacy of probiotics, mesalazine and Kangfuxin liquid in combination on ulcerative colitis and its effects on inflammatory factors. Methods:A total of 106 patients with ulcerative colitis admitted to Zhejiang Sian International Hospital from November 2021 to May 2022 were included in this study. They were randomly assigned to receive treatment with either probiotics, mesalazine and Kangfuxin liquid in combination (combined therapy group, n = 53) or mesalazine alone (monotherapy group, n = 53) for 30 days. Clinical efficacy, inflammatory factor level and Rachmilewitz endoscopic score pre- and post-treatment as well as the incidence of adverse reactions were compared between the two groups. Results:Total response rate in the combined therapy group was significantly higher than that in the monotherapy group [98.1% (52/53) vs. 79.3% (42/53), χ2 = 9.40, P < 0.05]. After treatment, tumor necrosis factor-a, interleukin-8, and interleukin-17 levels were significantly decreased, and interleukin-10 level was significantly increased (all P < 0.05). Tumor necrosis factor-a, interleukin-8, and interleukin-17 levels as well as Rachmilewitz endoscopic score in the combined therapy group were significantly lower than those in the monotherapy group ( t = -2.22, -5.85, -14.08, -2.62, all P < 0.05). The interleukin-10 level in the combined therapy group was significantly higher than that in the monotherapy group ( t = 3.91, P < 0.05). The incidence of clinical symptoms in the combined therapy group was significantly lower than that in the monotherapy group [11.3% (6/53) vs. 54.7% (29/53), χ2 = 22.57, P < 0.001]. There was no significant difference in the incidence of adverse reactions between the two groups ( P = 0.540). Conclusion:Probiotics, mesalazine and Kangfuxin liquid in combination for the treatment of ulcerative colitis can improve clinical efficacy, decrease inflammatory factor levels, reduce clinical symptoms, and have a few adverse reactions.

A preliminary study on the improved efficacy of mesalazine combined with vitamin D 3 in ulcerative colitis / 中华内科杂志

Objective:To analyze the influence of vitamin D 3 supplementation on the clinical efficacy of mesalazine in patients with ulcerative colitis (UC). Methods:From January 2015 to December 2020, patients with mild-to-moderate active UC were retrospectively and continuously enrolled, who accepted mesalazine treatment for at least 12 months at the Second Affiliated Hospital of Wenzhou Medical University. According to simultaneous supplement of vitamin D 3 (125 IU/d), the patients were divided into study group and control group. Demographic and disease characteristics, serum 25-hydroxyvitamin D[25(OH)D] levels and other information were collected through retrieving hospital database. Student′s t-test, Mann-Whitney U test and Chi-square test were applied for comparison of disease characteristics. The changes of modified Mayo scores[ΔMayo] and 25(OH)D[Δ25(OH)D] were compared before and after treatment by paired t-test, Wilcoxon signed rank test and Chi-square test. Multiple linear regression model was used to analyze the independent factors affecting ΔMayo and Δ25(OH)D, and variables with P-values less than 0.20 in the univariate analysis were allowed for further multivariate analysis. Results:A total of 74 UC patients (44 males, 30 females), with median age (range) 39.5 (20-76) years old, were analyzed and respectively assigned into study group ( n=36) and control group ( n=38). In study group, the average level of serum 25(OH)D was significantly increased at month 12 compared with that at baseline [(22.87±7.30) μg/L vs. (18.15±7.48) μg/L, P<0.001]. However, no significant elevation of serum 25(OH)D was found in control group [(19.17±8.49) μg/L vs. (19.82±9.47) μg/L, P=0.466]. Furthermore, there was a significant decrease of modified Mayo score [-3(-4.75, -1.25) vs.-2(-3.25, 0), P=0.034] and a higher clinical remission rate (55.6% vs. 28.9%, P=0.020) at month 12 in study group than those in control group. In addition, according to the baseline level of serum 25(OH)D before mesalazine treatment, 74 UC patients were divided into vitamin D deficiency group ( n=38, serum 25(OH)D<20 μg/L) and non-deficiency group ( n=36, serum 25(OH)D≥20 μg/L). At month 12 in vitamin D deficiency group, patients with vitamin D3 supplementation had a greater decline in modified Mayo score [-4(-5.75, -2) vs.-2(-4, 0), P=0.048] and a higher clinical remission rate (60.0% vs. 22.2%, P=0.019) compared with those without. Conclusions:In patients with mild-to-moderate active UC receiving mesalazine treatment, vitamin D3 supplementation may improve the clinical efficacy, especially in patients with vitamin D deficiency.

C-reactive protein levels and prevalence of leukopenia in patients with inflammatory bowel disease treated with azathioprine and/or mesalazine: a real-life study

ABSTRACT Objective To examine serum C-reactive protein levels and the prevalence of leukopenia in patients with Crohn's disease or ulcerative colitis undergoing treatment with azathioprine and/or mesalazine. Methods Retrospective observational study based on clinical and laboratory data collected from medical records of 76 adult patients with inflammatory bowel disease treated with azathioprine, mesalazine or both. Sex, age, diagnosis, number of blood samples and elevated serum C-reactive protein levels during the follow-up period were recorded. The following variables were analyzed in terms of C-reactive protein levels and leukopenia episodes: sex, age, diagnosis of inflammatory bowel disease and type of drug. Statistical analyses included multiple logistic regression and the Fisher's exact test for qualitative variables. Results Leukopenia was observed in 18.4% of patients and was associated with older age and higher doses of medication. In 44% of patients, C-reactive protein levels were high. However, symptoms were not associated with abnormal levels of this marker. Conclusion Regardless of symptoms, serum C-reactive protein levels were not a reliable indicator of controlled inflammatory bowel disease. Leukopenia was independently associated with older age and higher doses of medication and is a common side effect, which should be routinely monitored.

Evaluation of mesalazine polymeric conjugate in the treatment of actinic proctitis in rats

ABSTRACT Purpose: The present study aimed at testing a new formulation of mesalazine linked to chondroitin sulfate and its components alone in the treatment of actinic proctitis in rats. Methods: Forty-seven female Wistar rats were submitted to pelvic radiation and divided into eight groups: control A, mesalazine A, chondroitin A, and conjugate A, gavage of the according substance two weeks after irradiation and sacrifice three weeks after oral treatment; control C, mesalazine C, chondroitin C, and conjugate C, sacrifice six weeks after oral treatment. The rectum was submitted to histological characterization for each of the findings: inflammatory infiltrate, epithelial degeneration, mucosal necrosis, and fibrosis. Results: The inflammatory infiltrate was more intense in chondroitin A, mesalazine A, and conjugate C. The collagen deposition was less intense in chondroitin A, and mesalazine A, and more intense in control C. Conclusions: Mesalazine and chondroitin alone were efficacious in inducing a delayed inflammatory response, hence reducing the late fibrosis. The conjugate was able to induce an ever more delayed inflammatory response.

Epidemiological profile of inflammatory bowel disease in Caxias do Sul, Brazil: a cross-sectional study

ABSTRACT BACKGROUND: Inflammatory bowel diseases affect mostly young patients and have a huge impact on their quality of life and growing treatment costs. Currently, there are few Brazilian studies concerning their epidemiological profile. OBJECTIVE: The aim of this study was to describe the regional clinical and epidemiological profile of these pathological conditions in Caxias do Sul, Brazil. DESIGN AND SETTING: Cross-sectional study in Caxias do Sul (RS), Brazil. METHODS: A search for patients was conducted in the municipality's special medications pharmacy using the International Classification of Diseases, and medical records were manually reviewed for data collection. Sixty-seven patients were included. RESULTS: The patients' mean age was 46.5 years and females predominated (71.6%). Ulcerative colitis was the most prevalent disease (70%) and Montreal E3 was the most prevalent presentation. The mean age at diagnosis was 39 years. Most patients had recently undergone colonoscopy (67%). Only five patients (7.4%) had records of hospital admission due to the disease, while 12 (18%) underwent a surgical procedure during follow-up. Sixty patients (89.5%) were using aminosalicylates, while less than one fifth were using immunosuppressants or immunobiological drugs: 19.4% and 14.9%, respectively. CONCLUSION: The profile of inflammatory bowel disease patients in this region of Brazil is similar in some characteristics to other published Brazilian data, although it differs in others such as higher frequency of pancolitis. A prospective study on these patients is planned in this region, in order to improve the data quality.

Randomized, crossover questionnaire survey of acceptabilities of controlled-release mesalazine tablets and granules in ulcerative colitis patients

BACKGROUND/AIMS: Oral mesalazine is an important treatment for ulcerative colitis (UC), and non-adherence to mesalazine increases the risk of relapse. Controlled-release (CR) mesalazine has 2 formulations: tablets and granules. The relative acceptabilities of these formulations may influence patient adherence; however, they have not been compared to date. This study aimed to evaluate the acceptabilities of the 2 formulations of CR mesalazine in relation to patient adherence using a crossover questionnaire survey. METHODS: UC patients were randomly assigned to 2 groups in a 1:1 ratio. Patients in each group took either 4 g of CR mesalazine tablets or granules for 6 to 9 weeks, and then switched to 4 g of the other formulation for a further 6 to 9 weeks. The acceptability and efficacy were evaluated by questionnaires, and adherence was assessed using a visual analog scale. The difference in acceptabilities between the 2 formulations and its impact on adherence were assessed. RESULTS: A total of 49 patients were prospectively enrolled and 33 patients were included in the analysis. Significantly more patients found the tablets to be less acceptable than the granules (76% vs. 33%, P=0.0005). The granules were preferable to the tablets when the 2 formulations were compared directly (73% vs. 21%, P=0.004), for their portability, size, and numbers of pills. The adherence rate was slightly better among patients taking the granules (94% vs. 91%) during the observation period, but the difference was not significant (P=0.139). CONCLUSIONS: CR mesalazine granules are more acceptable than tablets, and may therefore be a better option for long-term medication.

Adherence to Asacol once daily versus divided regimen for maintenance therapy in ulcerative colitis: a prospective, multicenter, randomized study

BACKGROUND/AIMS: A once-daily (OD) regimen of 5-aminosalicylic acid (5-ASA) was easier to comply with than a divided daily (DD) regimen, and that treatment efficacy for ulcerative colitis (UC) was not affected by the dosing regimen. This study evaluated treatment adherence of OD and DD dosing in the Korean UC patients. METHODS: This study was a prospective, multicenter, randomized trial. UC patients were enrolled who have been in remission for more than 3 months. Patients were randomly assigned to the OD or DD group in a 1:1 ratio. The primary endpoint was adherence rate measured by tablet counts and self-reported adherence rate at 3, 6, 9, and 12 months. The relapse rate was measured at 1 year. RESULTS: Data from the 180 patients who were randomized were analyzed. Both self-reported adherence rate and adherence rate measured by tablet counts were not different at every points, including 1 year. The patients' satisfaction of the OD group was higher than that of the DD group (P<0.001). At 1 year, 91.2% and 95.5% of patients in the OD group and DD group had maintained clinical remission, respectively (P=0.37). CONCLUSIONS: The adherence rates were not different between the OD group and DD group. The patients' satisfaction was higher in the OD group than in the DD group. 5-ASA OD dosing might have the same effect as DD for the maintenance of UC remission.

Recurrent Eosinophilic Pneumonia Associated with Mesalazine Suppository in a Patient with Ulcerative Colitis / 대한소화기학회지

Mesalazine suppositories are widely used to treat ulcerative colitis and have a guaranteed safety profile, but although rare, they can cause pulmonary toxicity. A 35-year-old woman with ulcerative colitis was diagnosed to have acute eosinophilic pneumonia after 29 days of oral mesalazine use and improved after mesalazine and corticosteroid were withdrawn. Reintroduction of mesalazine suppositories resulted in acute eosinophilic pneumonia recurrence after 28 days. Mesalazine re-administration (even via a different route) in patients with a history of mesalazine-induced eosinophilic pneumonia should be undertaken cautiously, because eosinophilic pneumonia may recurrence.

Enemas with mesalazine increase the tissue contents of mucins in the colonic mucosa devoid of fecal stream

Abstract Purpose: To evaluate the inflammatory reaction and measure the content of mucins, in the colonic mucosa without fecal stream submit to intervention with mesalazine. Methods: Twenty-four rats were submitted to a left colostomy and a distal mucous fistula and divided into two groups according to euthanasia to be performed two or four weeks. Each group was divided into two subgroups according daily application of enemas containing saline or mesalazine at 1.0 g/kg/day. Colitis was diagnosed by histological analysis and the inflammatory reaction by validated score. Acidic mucins and neutral mucins were determined with the alcian-blue and periodic acid of Schiff techniques, respectively. Sulfomucin and sialomucin were identified by high iron diamine-alcian blue technique. The tissue contents of mucins were quantified by computer-assisted image analysis. Mann-Whitney test was used to analyze the results establishing the level of significance of 5%. Results: Enemas with mesalazine in colonic segments without fecal stream decreased the inflammation score and increased the tissue content of all subtypes of mucins. The increase of tissue content of neutral, acid and sulfomucin was related to the time of intervention. Conclusion: Mesalazine enemas reduce the inflammatory process and preserve the content of mucins in colonic mucosa devoid of fecal stream.

Curative effect of mesalamine combined with trimebutine maleate in the treatment of diarrhea predominant irritable bowel syndrome / 中国基层医药

Objective To investigate the curative effect of mesalamine combined with trimebutine maleate in the treatment of diarrhea predominant irritable bowel syndrome .Methods According to the digital table ,112 patients with diarrhea predominant irritable bowel syndrome were randomly divided into control group and observation group , 56 cases in each group .The two groups were given conventional symptomatic treatment ,on this basis ,the control group recieved mesalamine treatment ,the observation group recieved mesalamine combined with trimebutine maleate treat -ment.The two groups were treated for 4 consecutive weeks.The main indicators,clinical efficacy and adverse reaction of the two groups were compared .Results The total effective rate of the observation group was 94.6％,which was significatnly higher than 78.6％of the control group (χ2 =3.925,P<0.05).The antidiarrheal time,stool recovery time between the two groups had statistically significant differences (t=19.337,18.068,all P<0.05).The mental status,emotional status,diet and sleep status in the two groups were all improved ,the differences were statistically significant(all P<0.05),which in the observation group improved more significantly than that in the control group , the differences were statistically significant(all P<0.05).The two groups had no other serious adverse reactions . Conclusion On the basis of conventional treatment ,mesalamine combined with trimebutine maleate in the treatment of diarrhea predominant irritable bowel syndrome can significantly improve clinical symptoms ,improve clinical curative effect,and it has good safety and great clinical significance .

Evaluation of the drug-induced lymphocyte stimulation test for diagnosing mesalazine allergy

BACKGROUND/AIMS: Mesalazine is an effective drug for treating ulcerative colitis (UC), but causes allergic symptoms in a few cases. Therefore, the objective of this study was to evaluate the usefulness of the drug-induced lymphocyte stimulation test (DLST) for the diagnosis of mesalazine allergy. METHODS: Patients with UC treated with mesalazine with or without a history of associated adverse events (AEs) were enrolled at Kyorin University Hospital from July 2016 to April 2017. RESULTS: The DLST was performed in 104 patients with UC, of which 24 had a history of AEs due to mesalazine treatment. The control value of DLST was 337.4±296.3 counts per minute (cpm) in the AE+ group and 408.0±371.9 cpm in the AE− group. The measured value of DLST was 578.8±424.7 cpm in the AE+ group and 476.5±471.8 cpm in the AE− group. The stimulation index (SI) was 243.9%±291.1% in the AE+ group and 119.8%±53.0% in the AE− group. The SI value and DLST positivity were significantly higher in the AE+ group than in the AE− group (P=0.030 and P=0.029, respectively). The test sensitivity and specificity were 0.240 and 0.805, respectively, and the false-positive and false-negative rate was 0.195 and 0.760, respectively. CONCLUSIONS: The DLST for mesalazine showed low sensitivity and high specificity, suggesting that it may be useful for the definitive diagnosis of allergy to mesalazine.

Clinical efficacy of oral mesalazine combined with metronidazole enema in the treatment of patients with ulcerative colitis / 中国基层医药

Objective To evaluate the effect of oral mesalazine combined with metronidazole enema in the treatment of patients with ulcerative colitis and the impact on interferon-γ (IFN-γ),interleukin-4 (IL-4),interleukin-8 (IL-8).Methods A total of 80 patients with ulcerative colitis were selected and randomly divided into control group and observation group,40 cases in each group.The control group was treated with oral mesalazine.The observation group was treated with oral mesalazine and metronidazole retention enema.4 weeks as a course of treatment,the patients were treated for 2 courses.The clinical efficacy,disease activity index(DAI) score before and after treatment,as well as peripheral blood erythrocyte sedimentation rate (ESR),levels of IFN-γ,IL-4,IL-8 changes was compared between the two groups.Results The total effective rate was 90.00％ in the control group,which was significantly higher than 75.00％ in the control group,the difference was statistically significant (x2 =23.52,P ＜ 0.05).Before treatment,there were no significant changes in diarrhea,colonic mucosal inflammation,bloody stool and DAI scores (t =0.32,0.08,0.03,0.05,all P ＞ 0.05).After treatment,there were significant decline in each integral of the two groups,the integral of the observation group declined more than those in the control group,the differences were statistically significant(t =15.35,5.8,11.25,14.12,all P ＜0.05).Before treatment,there were no significant changes in ESR,IL-4,IL-8,IFN-γ of peripheral blood in the two groups (t =0.60,-0.95,0.03,-0.06,all P ＞ 0.05).After treatment,ESR,IL-8,IFN-γ of peripheral blood declined in the two groups,IL-4 was increased,and the changes were more significantly in the control group than those in the control group(t =10.02,4.70,10.23,22.82,all P ＜ 0.05).Conclusion Oral mesalazine enema combined with metronidazole enema has significant clinical effect in patients with ulcerative colitis,it is better than treating with oral mesalazine only,and can effectively improve the clinical symptoms and possibly plays a role by regulating IL-8,IFN-γ,IL-4,and it deserves further clinical application.

Clinical Study on Medicinal-cake-separated Moxibustion Treatment for Mild-to-moderate Ulcerative Colitis of Spleen Deficiency and Dampness Type / 中国中医药信息杂志

Objective To explore clinical efficacy and mechanisms of medicinal-cake-separated moxibustion treatment for mild-to-moderate ulcerative colitis (UC) of spleen deficiency and dampness type.Methods Totally 60 cases were randomly divided into observation group and control group according to a random digits table, with 30 cases in each group. The control group was inserted into the anus with mesalamine suppository 1 g once a day, while the observation group was given medicinal-cake-separated moxibustion treatment once a day based on the treatment for the control group. Medicinal cake (Aconiti Lateralis Radix Praeparata: Codonopsis Radix: Coptidix Rhizoma: Salviae Miltiorrhizae Radix et Rhizoma: Corydalis Rhizoma: Aucklandiae Radix=3:3:2:2:2:1) was put on the acupoints (Pishu, Zhongwan and Zusanli for the first group, Dachangshu, Tianshu and Shangjuxu for the second group, one group for each time, and 2 groups were used interchangeably). One wormwood cylinder was put on medicinal cake, 5 min each time, 3 doses each time, once a day. The treatment course for all was 8 weeks. The main symptom scores (diarrhea, bellyache, pus and blood stool) and total scores, colonoscopy Baron score and serum CC chemokine ligand 20 (CCL20) expression level were compared between before and after treatment in the two groups. The clinical efficacy was evaluated and the adverse reactions were observed.Results The total effective rate in observation group was 93.33% (28/30) and significantly higher than that of the control group of 76.67% (23/30). After the treatment, the main symptom scores and total scores, colonoscopy Baron score and serum CCL20 expression level were significantly lower than those of pre-treatment in the same one group (P0.05).Conclusion Medicinal-cake-separated moxibustion treatment is effective and safe in patients with mild-to-moderate UC of spleen deficiency and dampness type, which effects might be involved in regulating the expression of serum CCL20.

Effects of mesalamine on the expression of TNF-α, IL-6, IL-17 and intestinal barrier function with ulcerative colitis / 中国生化药物杂志

Objective To investigate the effect of mesalazine on the expression of TNF-α, IL-6, IL-17 and intestinal barrier function in patients with ulcerative colitis. Methods 76 patients with UC from January 2015 to April 2016 in The Fifth Central Hospital of Tianjin were collected and randomly divided into control group and observation group with 38 cases in each group. After admission were given maintenance of water and electrolyte, basic acid-base balance and nutritional support treatment, and the control group were treated with conventional drug sulfasalazine (SASP) treatment, two tablets each time, four times once day, four weeks for each course, the observation group was treated with mesalazine, four tablets each time, three times once day, four weeks each course of treatment. The levels of TNF-α, IL-6, IL-17, L/M and Baron endoscopic scores in the two groups were observed after two courses of treatment. The efficacy and side effects of the two groups were compared. Results No dropout or dropout cases in this study, two groups after the treatment of TNF-α, IL-6, IL-17, L/M, Baron scores were significantly decreased (P<0.05), but the observation group after treatment the above indexes were all significantly lower than the control group (P<0.05), the total effective rate of the observation group was 89.47%(34/38) higher than that of the control group 71.05%(21/38), the adverse reaction rate of 13.16% (5/38) was lower than that in the control group 34.21% (13/38), the differences were statistically significant(P<0.05). Conclusion Compared with conventional drug SASP, the effect of on the expression of TNF-α, IL-6 and IL-17 in serum of patients with UC and the improvement of intestinal barrier function can be effectively suppressed, which has the advantages of clinical efficacy and low adverse reaction rate.

Drug-induced eosinophilic pneumonia in a patient with Crohn's disease: diagnosis and treatment using fraction of exhaled nitric oxide

Oral 5-aminosalicylic acid agents (mesalazine and sulfasalazine) and azathioprine are the mainstays of treatment for inflammatory bowel disease. Reports of pulmonary toxicity induced by oral 5-aminosalicylic acid agents or azathioprine in patients with inflammatory bowel disease are very rare; to date, only 38 cases have been reported worldwide. We, herein, report a case involving a 26-year-old man who was diagnosed with eosinophilic pneumonia after using mesalazine and azathioprine for the treatment of Crohn's disease and recovered after treatment. We also found that the fraction of exhaled nitric oxide level was elevated in this patient. After treatment, the fraction of exhaled nitric oxide level decreased and the symptoms improved. The present case shows that fraction of exhaled nitric oxide is related to the disease activity and treatment effectiveness of druginduced eosinophilic pneumonia.

Síndrome cerebeloso por mesalamina: reporte de un caso / Cerebellar syndrome for mesalamine: a case report

El cerebelo proviene del latín "pequeño cerebro", es aproximadamente una décima parte del cerebro en tamaño y peso, se encuentra en la fosa craneal posterior. está conectado directamente o indirectamente a una variedad de estructuras, incluyendo el tronco cerebral, la columna vertebral, las regiones corticales y subcorticales. El cerebelo contiene casi el 80 % del total de las neuronas del cerebro y se compone de formas diferenciadas de unidades neuronales, cada una compartiendo microcircuitos cerebelosos básicos. El cerebelo está formado por dos hemisferios laterales y una porción media o vermis . El cerebelo tiene varias funciones: coordinar los movimientos voluntarios especializados al influir en la actividad muscular y controlar el equilibrio, el tono muscular a través de conexiones con el sistema vestibular, la médula espinal y sus neuronas motoras alfa. Dentro de la corteza del cerebelo existe una organización somatotópica de las partes del cuerpo. El cerebelo es una pieza clave para el procesamiento de la información y participa en numerosas actividades motoras y no motoras, gracias a las características anatómicas de sus circuitos, las enormes capacidades de análisis y la alta conectividad con otras áreas del cerebro, puede verse afectado por diferentes factores como: anormalidades en el desarrollo embrionario, tóxicos, enfermedades autoinmunes, inflamatorias, vasculares y metabólicas, infecciones, tumores primarios y secundarios, traumas, iatrogénicos, enfermedades genéticas, esporádicas, dando origen a signos y síntomas que causan un síndrome cerebeloso de acuerdo al área anatómica comprometida. En la literatura científica no hay reportes de casos de síndrome cerebeloso por mesalamina (mesalazina). A continuación presentamos el primer caso.

Cerebellum is Latin for "little brain" is about a tenth of the brain in size and weight, is in the posterior cranial fossa. It connects directly or indirectly to a variety of structures, including brainstem, spinal cord, cortical and subcortical regions. The cerebellum contains almost 80% of all neurons in the brain and consists of different forms of neuronal units, each sharing basic cerebellar microcircuits. The cerebellum is formed by two lateral hemispheres and vermis or a middle portion . The cerebellum has several functions: coordinate movements specialized volunteers to influence muscle activity and control the balance, muscle tone through connections with the vestibular system, the spinal cord and alpha motor neurons. Within the cerebellar cortex somatotopic organization exists a body part. The cerebellum is a key to information processing and participates in numerous motor and non-motor activities, thanks to the anatomical characteristics of its routes, huge analysis capabilities and high connectivity with other brain areas, can be affected by different factors such as abnormalities in embryonic development, toxic, autoimmune, inflammatory, vascular and metabolic, infections, primary and secondary tumors, trauma, iatrogenic, genetic diseases, sporadic, giving rise to signs and symptoms that cause cerebellar syndrome according to compromised anatomical area. In the scientific literature no reported cases of cerebellar syndrome mesalamina (mesalazina), we report the first case.

Relative effectiveness of aminosalicylates in the management of acute ulcerative colitis – Mesalamine vs Sulfasalazine

Introduction: Inflammatory bowel disease (IBD) is not a single condition. It is the term for a group of disorders that cause prolonged inflammation of the digestive tract. The most common types of inflammatory bowel disease (IBD) are ulcerative colitis and Crohn’s disease. Aim: The study was designed to compare the efficacy, safety, incidence of ADR’S in patients of inflammatory bowel disease with regard to the use of mesalamine, sulfasalazine and using combination of mesalamine and steroids. Materials and methods: This observational, non interventional study conducted in General Medicine Department and Gastroenterology department, Princess Esra hospital, shahali banda, within 6 months of duration. Patients selected randomly according to inclusion and exclusion criteria. A 110 patients aged 18 to 90 years, and presenting with complaints of abdomen pain, diarrhoea, bloody diarrhoea, painful defecation, altered appetite, bleeding per rectum were screened for the study after taking their informed consent. Patients were categorized into 4 groups; group I (control), group II (Mesalamine), group III (sulfasalazine), and group IV (Mesalamine + steroids) Results: Patients with age group from 18-80yrs were included in the study. The age group of 31- 50age was found more prone to disease. The total percentage of male and female in 110 patients was found to be 40% (male) and 60% (female). Patients with percentage of 60% male and 40% female underwent treatment with mesalamine (Group-I), 36.6%male and 63.3%female with mesalamine + steroids (Group-II), and 30% male and 70% female with sulfasalazine (Group-III) respectively. The Syed Ibrahim Hassan, Syed Mohd Akbar Hassan, Haleema Begum. Relative effectiveness of aminosalicylates in the management of acute ulcerative colitis - Mesalamine vs Sulfasalazine. IAIM, 2016; 3(12): 137-147. Page 138 most common symptom was abdomen pain present in 74% patients and rectal bleeding was the next common symptom (67.21%) and other symptoms include vomiting (55.2%), loose stools (52.3%), painful defecation (44%), and reduced appetite (43.3%). The adverse effects observed during sulfasalazine treatment was abdominal pain (50%), nausea (35%), dizziness (21.6%), anorexia (16.6%), rashes (10%), gastric distress (10%), sleeping disorders (3.30%), cyanosis (3.3), hemolytic anaemia (1.60%) and mesalamine treatment was abdominal pain 21.08%, nausea 3.50%, heartburn 22%, bloated stomach 7.7% and weakness 6.64% and with mesalamine + steroids was abdomen pain 48.3%, rectal bleeding 33.3%, painful defecation 18.3%, loose tools 45%, vomiting 50% and reduced appetite 28.3%. The percentage recovery of symptoms with sulfasalazine was 60% abdomen pain, 30% rectal bleeding, 15% painful defecation, 44% loose stools, 65% vomiting, and 0% reduced appetite, with mesalamine was 40% abdomen pain, 20% rectal bleeding, 0% painful defecation, 15% loose stools, 0% vomiting, 10% reduced appetite and mesalamine + steroids was 21.6% abdomen pain, 13.3 rectal bleeding, 8.3% painful defecation, 26.6% loose stools, 15% vomiting, 18.3% reduced appetite. Conclusion: Patients of acute IBD- acute ulcerative colitis of mild type respond faster to mesalamine with or without steroids compared to sulfasalazine alone although both drugs showed good response

Efficacy and safety of two pH-dependent-release mesalamine doses in moderately active ulcerative colitis: a multicenter, randomized, double-blind, parallel-group study

BACKGROUND/AIMS: The therapeutic effect of mesalamine is considered to be dose-dependent; however, no consensus has been reached regarding the optimal doses for individual patients. This study aimed to provide new insight for dose optimization using two doses of pH-dependent release mesalamine for induction of remission of moderately active ulcerative colitis (UC). METHODS: In a multicenter, double-blind, randomized study, 110 patients with moderately active UC were assigned to two groups after treatment with a constant dose of mesalamine. Fifty-five patients were treated with a pH-dependent release formulation of 3.6 or 4.8 g/day for 8 weeks. The primary endpoint was a decrease in the UC disease activity index (UCDAI) adjusted by covariates. RESULTS: In the full analysis set (n=110), the mean decrease in UCDAI was 3.1 in the 3.6 g/day group and 3.4 in the 4.8 g/day group (P>0.05). In a subgroup analysis, the effectiveness of the 4.8 g/day dose was greater in particular populations, such as those who had been previously treated with a lower dose of mesalamine and those with more severe disease. The safety was comparable between the two groups. CONCLUSIONS: The results suggest that treatment with pH-dependent release mesalamine at either 3.6 or 4.8 g/day was effective and safe for the induction of remission in patients with moderately active UC. However, the patients receiving mesalamine at 2.4 g/day but in whom the therapeutic effect is not sufficient and having more severe symptoms (UCDAI 9-10), benefit from higher doses of mesalamine compared to others.

Effect of 5-Aminosalicylic Acid on Cell Proliferation,Apoptosis and Cell Cycle in Human Colon Cancer Cell Line HT-29 / 胃肠病学

Background:Ulcerative colitis-associated colorectal cancer(UcCRC)is the most serious complication of ulcerative colitis(UC). 5-Aminosalicylic acid(5-ASA)could reduce the risk of UC progressing to UcCRC. Aims:To investigate the effect of 5-ASA on cell proliferation,apoptosis and cell cycle in human colon cancer cell line HT-29 for verifying the inhibitory effect of 5-ASA on UcCRC. Methods:HT-29 cells were treated with different concentrations(0,10,20,30, 40 mmol/ L)of 5-ASA. Cell proliferation was measured by CCK-8 assay. Cell apoptosis was determined by TUNEL method. Cell cycle was analyzed by flow cytometry. Expressions of cell mitotic regulators AuroraB and BubR1 were determined by immunohistochemistry. Results:Proliferation inhibition rates and apoptosis rates of HT-29 cells in 5-ASA 10,20,30,40 mmol/ L groups were increased with increase in concentration of 5-ASA(P ﹤ 0. 05). Proportions of cells in phase G0 / G1 in 5-ASA 30,40 mmol/ L groups were significantly lower than those in 5-ASA 0,10,20 mmol/ L groups (P ﹤ 0. 05);proportions of cells in phase S in 5-ASA 0,10,20,30 mmol/ L groups were significantly lower than that in 5-ASA 40 mmol/ L group(P ﹤ 0. 05);while proportions of cells in phase G2 / M in 5-ASA 30,40 mmol/ L groups were significantly higher than those in 5-ASA 0,10,20 mmol/ L groups(P ﹤ 0. 05). Mean optical density(MOD)values of AuroraB and BubR1 were decreased with increase in concentration of 5-ASA(P ﹤ 0. 05). Concentration of 5-ASA was positively correlated with proliferation inhibition rate and apoptosis rate of HT-29 cells(P ﹤ 0. 05),but was negatively correlated with MOD values of AuroraB and BubR1( P ﹤ 0. 05). MOD values of AuroraB and BubR1 were negatively correlated with proliferation inhibition rate and apoptosis rate of HT-29 cells as well as proportion of cells in phase G2/ M (P ﹤0. 05),but were positively correlated with proportion of cells in phase G0/ G1(P ﹤0. 05). MOD value of AuroraB was positively correlated with MOD value of BubR1(P ﹤ 0. 05). Conclusions:5-ASA can inhibit proliferation and induce apoptosis in HT-29 cells,the mechanism may be related to inhibiting expressions of AuroraB and BubR1 and the resulted effect on cell cycle.