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1.
Arq. gastroenterol ; 61: e23140, 2024. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1533819

ABSTRACT

ABSTRACT Background: Inflammatory bowel diseases (IBD) have rising incidence and prevalence rates globally. In IBD, there are scarce stu­dies comparing differences between patients according to socioeconomic status. Our aim was to comparatively evaluate hospitalizations, use of biologics and rates of surgery in patients with IBD between public and private healthcare systems. Methods: Single-center retrospective cohort study in patients with IBD from a tertiary referral unit from Latin America, between 2015 and 2021. CD and UC patients were classified into two subgroups: public and private systems. Demographic characteristics, hospitalizations, need for surgery and biologics were compared. Results: A total of 500 patients were included, 322 with CD and 178 with UC. CD-related hospitalizations were frequently observed in both healthcare systems (76.28% in private and 67.46% in public). More than half of the patients had been submitted to one or more CD-related abdominal surgery, with no significant difference between the subgroups. Although there was no difference in the rates of use of biological therapy in CD subgroups, infliximab was more used in the public setting (57.69% vs 43.97%). There was no difference in UC-related hospitalizations between the subgroups (public 30.69% and private 37.66%) as well as the rates of colectomy (public: 16.83%, private: 19.48%). Biologics were prescribed almost twice as often in private as compared to public (45.45 vs 22.77%). Conclusion: There were no differences in the rates of hospitalization and abdominal surgery between the systems. In patients with UC, there was greater use of biological therapy in the private healthcare setting.


RESUMO Contexto: As doenças inflamatórias intestinais (DII) têm taxas crescentes de incidência e prevalência em todo o mundo. Na DII, são escassos os estudos comparando as diferenças entre os pacientes de acordo com o nível socioeconômico. Objetivo: Nosso objetivo foi avaliar comparativamente as hospitalizações, o uso de biológicos e as taxas de cirurgia em pacientes com DII entre os sistemas público e privado de saúde. Métodos: Estudo de coorte retrospectivo unicêntrico em pacientes com DII de uma unidade terciária de referência da América Latina, entre 2015 e 2021. Os pacientes com DC (doença de Crohn) e retocolite ulcerativa foram classificados em dois subgrupos: sistema público e privado. Características demográficas, hospitalizações, necessidade de cirurgia e biológicos foram comparadas. Resultados: Foram inclusos 500 pacientes, sendo 322 com DC e 178 com retocolite ulcerativa. Internações por DC foram frequentes em ambos os sistemas de saúde (76,28% na rede privada e 67,46% na rede pública). Mais da metade dos pacientes havia sido submetida a uma ou mais cirurgias abdominais relacionadas à DC, sem diferença significativa entre os subgrupos. Embora não tenha havido diferença nas taxas de uso de terapia biológica nos subgrupos de DC, o infliximabe foi mais utilizado no ambiente público (57,69% vs 43,97%). Não houve diferença nas internações relacionadas a retocolite ulcerativa entre os subgrupos (público 30,69% e privado 37,66%) e nas taxas de colectomia (público: 16,83%, privado: 19,48%). Os biológicos foram prescritos quase duas vezes mais no privado do que no público (45,45 vs 22,77%). Conclusão: Não houve diferença nas taxas de internação hospitalar e de cirurgia abdominal entre os sistemas. Nos pacientes com retocolite ulcerativa, houve maior utilização da terapia biológica no setor privado de saúde.

2.
Chinese Journal of Experimental Traditional Medical Formulae ; (24): 281-289, 2024.
Article in Chinese | WPRIM | ID: wpr-1005278

ABSTRACT

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.

3.
China Pharmacy ; (12): 51-56, 2024.
Article in Chinese | WPRIM | ID: wpr-1005213

ABSTRACT

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.

4.
Chinese Journal of Experimental Traditional Medical Formulae ; (24): 45-53, 2024.
Article in Chinese | WPRIM | ID: wpr-1003765

ABSTRACT

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.

5.
Chinese Journal of Experimental Traditional Medical Formulae ; (24): 267-275, 2024.
Article in Chinese | WPRIM | ID: wpr-1003431

ABSTRACT

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.

6.
Chinese Journal of Experimental Traditional Medical Formulae ; (24): 244-254, 2024.
Article in Chinese | WPRIM | ID: wpr-999182

ABSTRACT

The clinical changes of ulcerative colitis (UC) with the main syndrome of large intestine dampness-heat and the alterations of intestinal flora in UC were summarized to reveal the underlying mechanism. After review of the treatment methods for UC with the syndrome of large intestine dampness-heat, we identified the representative traditional Chinese medicines and compound prescriptions and explored the treatment mechanisms. Furthermore, we probed into the associations of UC and the treatment methods with the intestinal flora. The related articles were retrieved from China National Knowledge Infrastructure (CNKI). The available studies have shown that Akkermansia muciniphila, Escherichia coli, Enterococcus, and probiotics such as Bifidobacterium and Lactobacillus are closely associated with Chinese medicines in UC patients with the syndrome of large intestine dampness-heat. However, due to the shortcomings in clinical research and the susceptibility of intestinal flora to diverse factors, it is still challenging to accurately characterize the intestinal flora changes associated with diseases. Additionally, the research on the mechanisms of Chinese medicines in regulating intestinal flora in UC patients with the syndrome of large intestine dampness-heat remains to be improved. The feasibility of using Chinese medicines and compound prescriptions for precise regulation of intestinal flora in these patients is still debatable. In this regard, scientific issues such as the biological connotation of UC with the syndrome of large intestine dampness-heat and the correlation between syndrome and intestinal flora have become primary research tasks. Additionally, attention should also be paid to the interactions between the intestinal lumen exposure profile of Chinese medicines and intestinal flora. Finally, the thinking of traditional Chinese medicine (TCM) and the concepts of modern medicine should be combined for the research on the formulation of TCM regimens for regulating intestinal flora in treating UC.

7.
J. coloproctol. (Rio J., Impr.) ; 43(4): 280-285, Oct.-Dec. 2023. tab
Article in English | LILACS | ID: biblio-1528947

ABSTRACT

Background and Aims: Some studies have reported the coexistence of inflammatory bowel disease (IBD) and celiac disease (CD). However, the prevalence of anti-tissue transglutaminase antibodies (IgA and IgG) and their screening value in patients with IBD is not yet clear. This study aimed to assess the prevalence of IgA anti-tTG and its potential correlation with disease status in patients with IBD. Materials and Methods: This cross-sectional study was conducted on 110 patients with confirmed IBD diagnosis at Ghaem Hospital, Mashhad, Iran. For each patient, all demographic and clinical data including age, extra intestinal manifestations, underlying diseases, types of diseases, and surgical history were collected. IgA anti-tissue transglutaminase titers were assessed by enzyme-linked immunosorbent assay. Results: None of the patients with IBD were positive for IgA anti-tTG antibodies, with a mean titer of 3.31 ± 1.3 AU/mL. Also, the mean titers were not associated with age, gender and various disease clinical features including the disease history, underlying disease, diagnosis type, extraintestinal manifestations, and surgery history. Conclusion: No significant prevalence pattern of IgA anti-tTG antibody was observed in patients with IBD. Accordingly, serological screening for CeD is not recommended in IBD patients, unless in a relevant clinical CeD suspicion. (AU)


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Immunoglobulin A , Inflammatory Bowel Diseases , Celiac Disease , Cohort Studies , Antibodies
8.
J. coloproctol. (Rio J., Impr.) ; 43(4): 286-291, Oct.-Dec. 2023. tab
Article in English | LILACS | ID: biblio-1528937

ABSTRACT

Objective: To evaluate the application of proactive pro-drug therapy (TDM) at week six in users of infliximab therapy in ulcerative colitis patients and to analyze the need for further disease optimization. Method: This is a retrospective analysis that will be carried out simultaneously at the Hospital de Clínicas de Passo Fundo and at the Endoclin Diagnostic Center in the city of Passo Fundo, with secondary data collection between January 2020 and May 2022. The sample included patients from both sexes, regardless of age, who are being followed up in the services mentioned above, by signing the informed Free and Clarified Consent Term. Results: 63.2% of patients required optimization of their treatment based on the serum level assessment at week six. Conclusion: Proactive TDM performed at week six benefits patients in order to complete indications for treatment to avoid lack of drug response and complications from the disease. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Colitis, Ulcerative/therapy , Drug Monitoring , Health Profile , Retrospective Studies , Infliximab/therapeutic use
9.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1535880

ABSTRACT

está disponible en el texto completo


Introduction: Pediatric ulcerative colitis (CUP), pediatric Crohn's disease (PCD), and pediatric inflammatory bowel disease not classifiable (PIDNCID) have clinical and psychosocial particularities that differentiate them from those of adults and may condition different therapeutic approaches due to possible nutritional, growth and developmental repercussions, representing a challenge for the pediatrician and gastroenterologist. Objective: Develop expert consensus evidence-based recommendations for the timely and safe diagnosis and treatment of Pediatric Inflammatory Bowel Disease (PID) in children under 18 years of age for professionals caring for these patients and healthcare payers. Methodology: Through a panel of experts from the Colombian College of Pediatric Gastroenterology, Hepatology and Nutrition (COLGAHNP) and a multidisciplinary group, 35 questions were asked regarding the clinical picture, diagnosis, and treatment of PID. Through a critical review and analysis of the literature with particular emphasis on the main clinical practice guidelines (CPGs), randomized clinical trials (RCTs), and meta-analyses of the last ten years, from which the experts made 77 recommendations that responded to each of the research questions with their respective practical points. Subsequently, each of the statements was voted on within the developer group, including the statements that achieved > 80%. Results: All statements scored > 80%. PID has greater extension, severity, and evolution towards stenosis, perianal disease, extraintestinal manifestations, and growth retardation compared to adult patients, so its management should be performed by multidisciplinary groups led by pediatric gastroenterologists and prepare them for a transition to adulthood. Porto's criteria allow a practical classification of PID. In CPE, we should use the Paris classification and perform ileocolonoscopy and esophagogastroduodenoscopy, since 50% have upper involvement, using the SES-CD (UCEIS/Mayo in CUP) and taking multiple biopsies. Initial labs should include inflammatory markers and fecal calprotectin and rule out intestinal infections. Treatment, induction, and maintenance of PID should be individualized and decided according to risk stratification. Follow-up should use PCDAI and PUCAI for the last 48 hours. Immunologists and geneticists should evaluate patients with early and infantile PID. Conclusion: A consensus guideline is provided with evidence-based recommendations on timely and safe diagnosis and treatments in patients with ILD.

10.
Arq. gastroenterol ; 60(3): 300-308, July-Sept. 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1513712

ABSTRACT

ABSTRACT Background: Nurses play a fundamental role within the inflammatory bowel disease (IBD) multidisciplinary team. Objective: To identify the profile of IBD nurses in Brazil and their work process organization and characterize the health services where they work. Methods: A questionnaire-based research was developed. The inclusion criteria were nurses with experience in IBD care, nurses with scientific research published in an indexed journal or in process, nurses with master's or doctorate degrees concluded or in progress, and educator nurses with expertise in IBD. Results: Seventy-four nurses were included, among whom 66 (89.19%) were women; their mean age was 40.63±9.98 years. Sixty-six percent work in the Southeast region, and more than half (54.05%) had a specialization course. Only four (5.41%) nurses worked exclusively with patients with IBD. The main areas of activity were outpatient clinics (39%) and ostomy care (35%). Nursing care was based on the nursing process (51.35%), and the main topics approached in nursing appointment were treatment adherence (72.97%), and ostomy (68.92%). Forty-seven (63.51%) nurses had knowledge on immunosuppressive medications and 52 (70.27%) on biological therapy. Most health services were integrated with a hospital that has clinical (72.97%) and surgical hospitalization units (67.57%), and 46 (62.16%) of them had an infusion center. Conclusion: Describing the work process of IBD nurses can supplement their organization of the IBD assistance process, as they do not follow any specific consensus. In addition, the characteristics necessary for IBD care are not found in all health services.


RESUMO Contexto: Enfermeiros desempenham um papel fundamental na equipe multidisciplinar das doenças inflamatórias intestinais. Objetivo: Identificar o perfil dos enfermeiros especialistas em doença inflamatória intestinal no Brasil e a organização do processo de trabalho e caracterizar os serviços de saúde onde atuam. Métodos: Estudo transversal, desenvolvido com aplicação de questionário. Os critérios de inclusão foram enfermeiros com experiência na assistência às doenças inflamatórias intestinais, enfermeiros com pesquisas científicas publicadas em periódico indexado ou em andamento, enfermeiros com mestrado ou doutorado concluídos ou em andamento e enfermeiros educadores com expertise em doenças inflamatórias intestinais. Resultados: Foram incluídos 74 enfermeiros, dos quais 66 (89,19%) eram mulheres; a média de idade foi de 40,63±9,98 anos. Sessenta e seis por cento trabalham na região Sudeste, e mais da metade (54,05%) possui curso de especialização. Apenas quatro (5,41%) enfermeiros trabalhavam exclusivamente com pacientes com doença inflamatória intestinal. As principais áreas de atuação foram: ambulatório (39%) e cuidados com ostomia (35%). A assistência de enfermagem foi pautada no processo de enfermagem (51,35%) e os principais temas abordados na consulta de enfermagem foram adesão ao tratamento (72,97%) e estomia (68,92%). Quarenta e sete (63,51%) enfermeiros tinham conhecimento sobre medicamentos imunossupressores e 52 (70,27%) sobre terapia biológica. A maioria dos serviços de saúde estava integrada a um hospital que possui unidades de internação clínica (72,97%) e cirúrgica (67,57%), sendo que 46 (62,16%) deles possuíam centro de infusão. Conclusão: Descrever o processo de trabalho do enfermeiro em doença inflamatória intestinal brasileira pode complementar a organização no processo de assistência à doença inflamatória intestinal, uma vez que não segue nenhum consenso específico. Além disso, as características necessárias para o cuidado das doenças inflamatórias intestinais não são encontradas em todos os serviços de saúde.

11.
Article | IMSEAR | ID: sea-226483

ABSTRACT

The symptomatology of Ulcerative Colitis (UC) presents from irregular, incomplete bowel evacuation to mucous and bloody defecation. Direct correlation of UC in Ayurvedic literature is not possible, may be correlated to Pittaja Atisara, Rakthaja Atisara, Kshataja Grahani, Samgrahini Grahani. This case report shows diagnosed case of Ulcerative Colitis with nidana (etiology), Samprapti (pathophysiology) and Rupa (clinical presentation) similar to Pittaja Atisara. Signs and symptoms observed were stools mixed with blood & mucous (Pita-Haridra-Saraktha-Sadavalaprabham), Udarashula (abdominal pain), Payusanthapa (burning sensation in anal region) and showed Rupa that of Pittaja Atisara. Treatment was given according treatment approach of Pittaja Atisara viz., Langhana, Pachana and Picha Vasthi. Initially patient general condition was worst, managed under the guidance of modern medicine consultation and gradually tapered to Ayurvedic medicines. Oral medicines chosen were based on Rakthasthambaka, Vranaropana, Agni deepana and Grahi action, the drugs used for Pichha vasti are Madhu, Charngeryadi ghritam, Murivenna, Yashtimadhu kalka, Shalmali kwatha. A 45-day course of treatment was given, during which 30 Picha Vasthi were administered, includes 14 days of solely Vasthi and the final 11 days of Samsarjana Kala. Treatment outcomes were evaluated using partial Mayo scores and through routine blood tests and colonoscopy. Partial Mayo score was evaluated at 0th, 15th, 30th, and 45th day of the treatment cycle. Total partial Mayo Index score went from Severe Disease (9) to Remission (1). Total Leucocyte Count (TLC) and indices for hemoglobin and RBC returned to normal range after treatment. The patient got improvement and Ayurveda treatment protocol was successful.

12.
Article in English | LILACS-Express | LILACS | ID: biblio-1535897

ABSTRACT

Interleukin 17 (IL-17) inhibitors are approved for treating psoriasis, psoriatic arthropathy, and ankylosing spondylitis. IL-17 is involved in the pathogenesis of inflammatory bowel disease (IBD); however, paradoxical events have been reported using selective IL-17 inhibitors such as secukinumab, whose pathophysiological mechanisms have not been fully clarified. Although the incidence of IBD in this group of patients is low, the risk could be reduced by carefully assessing risk factors such as family history, gastrointestinal symptoms, and fecal calprotectin before starting treatment.


Los inhibidores de interleucina 17 (IL-17) se encuentran aprobados para el tratamiento de psoriasis, artropatía psoriásica y espondilitis anquilosante. La IL-17 se encuentra involucrada en la patogenia de la enfermedad inflamatoria intestinal (EII); sin embargo, hasta la fecha se han reportado eventos paradójicos con el uso inhibidores selectivos de IL-17 como el secukinumab, cuyos mecanismos fisiopatológicos no han sido del todo aclarados. Aunque la incidencia de EII en este grupo de pacientes es baja, el riesgo podría disminuirse mediante una evaluación cuidadosa de factores de riesgo tales como historia familiar, síntomas gastrointestinales y la realización de calprotectina fecal previo al inicio del tratamiento.

13.
Arq. gastroenterol ; 60(1): 48-56, Jan.-Mar. 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1439388

ABSTRACT

ABSTRACT Background: Crohn's disease (CD) and ulcerative colitis (UC) are chronic diseases that result from the deregulation of the mucosal immune system of the gastrointestinal tract. The use of biological therapies, including infliximab (IFX), is one of the strategies to treat both CD and UC. The IFX treatment is monitored by complementary tests, namely: fecal calprotectin (FC); C-reactive protein (CRP); and endoscopic and cross-sectional imaging. Besides, serum IFX evaluation and antibody detection are also used. Objective: To evaluate trough levels (TL) and antibodies in a population with inflammatory bowel (IBD) disease undergoing treatment with IFX, and the factors that might impact the treatment effectiveness. Methods: Retrospective, cross-sectional study with patients with IBD that were assessed for TL and antibody (ATI) levels in a southern Brazilian hospital, from June 2014 to July 2016. Results: The study assessed 55 patients (52.7% female) submitted to serum IFX and antibody evaluations (95 blood samples, 55 first test; 30 second test, and 10 as third testing. Forty-five (47.3%) cases were diagnosed with CD (81.8%), and ten with UC (18.2%). Serum levels were adequate in 30 samples (31.57%), subtherapeutic in 41 (43.15%), and supratherapeutic in 24 (25.26%). IFX dosages were optimized for 40 patients (42.10%), maintained for 31 (32.63%), and discontinued for 7 (7.60%). The intervals between infusions were shortened in 17.85% of the cases. In 55 tests (55.79%), the therapeutic approach was exclusively defined according to IFX and/or serum antibody levels. The assessment of patients one year later indicated that: the approach was maintained with IFX for thirty-eight patients (69.09%); the class of biological agent was changed for eight (14.54%); changes using the same class of biological agent occurred for two patients (3.63%); the medication was discontinued and not replaced for three patients (5.45%), and four patients (7.27%) were lost to follow-up. Conclusion: There were no differences in TL between groups with or without immunosuppressants, serum albumin (ALB), erythrocyte sedimentation rate (ESR), FC, CRP, and endoscopic and imaging examinations. Current therapeutic approach could be maintained for almost 70% of patients. Thus, serum and antibody levels are a useful tool in the follow-up of patients undergoing maintenance therapy and after treatment induction in patients with inflammatory bowel disease.


RESUMO Contexto: A doença de Crohn e a colite ulcerativa são doenças crônicas nas quais existem desregulação do sistema imune da mucosa do trato gastrointestinal. Uma das terapias usadas no tratamento dessas doenças são as medicações biológicas, entre elas o Infliximabe. A monitorização do tratamento dos pacientes com Iinfliximabe é feita por exames complementares: calprotectina fecal, pesquisa de atividade inflamatória, exames endoscópicos e imagem. Utiliza-se, também a dosagem do nível sérico do Infliximabe e a pesquisa de anticorpos. Objetivo: Analisar uma população com doenças inflamatórias intestinais, em tratamento com Infliximabe, submetida a avaliação do nível sérico do Infliximabe e do anticorpo, além de possíveis fatores que possam alterar ou contribuir no tratamento. Métodos: Trata-se de estudo retrospectivo, transversal, realizado por meio da revisão dos prontuários dos pacientes com doença inflamatória intestinal, em um hospital sul-brasileiro, no período de junho de 2014 até julho de 2016, que foram submetidos a avaliação dos níveis séricos de Infliximabe e do anticorpo. Resultados: Foram incluídos 55 pacientes, submetidos a dosagem do Infliximabe e do anticorpo, totalizando 95 coletas sanguíneas. Destes, 55 realizaram uma primeira coleta, 30 tiveram uma segunda amostra coletada e 10 coletaram uma terceira vez. Vinte e nove pacientes eram do sexo feminino (52,7%) e vinte e seis do sexo masculino (43.2%). Quarenta e cinco (47,3%) casos tinham diagnóstico de doença de Crohn (81,8%) e 10 de colite ulcerativa (18,2%). Em relação ao nível sérico encontrou-se nível adequado em 30 coletas (31,57%), subterapêutico em 41 coletas (43,15%) e supraterapêutico em 24 coletas (25,26%). A prescrição foi otimizada em 40 (42,10%) casos, mantida em 31 (32,63%) pacientes, suspensa em 7 (7,60%) ou que o intervalo entre as infusões fosse aumentado (17,85%). Na análise geral, em 53 coletas (55,79%) a conduta foi definida em função exclusivamente da dosagem sérica do Infliximabe e/ou do anticorpo, já em relação, apenas a primeira coleta obteve-se 33 (60%) pacientes. Avaliando-se os pacientes um ano após, obteve-se: em 38 (69,09%) pacientes a conduta foi mantida com Infliximabe e, em 8 (14,54%) foi optado por troca de classe, em 2 (3,63%) foi optado por troca da medicação na mesma classe, em 3 (5,45%) pacientes a medicação foi suspensa e não foi substituída e, em 4 (7,27%), perdeu-se o seguimento. Conclusão: Não encontrou-se diferença entre os níveis de Infliximabe entre os grupos com ou sem imunossupressor, albumina sérica, velocidade de hemossedimentação, Calprotectina, Proteína C reativa, exames endoscópicos e exames de imagem. A conduta atual pode ser mantida em quase 70% dos pacientes. Concluindo, a dosagem do nível sérico e do anticorpo é ferramenta útil no acompanhamento dos pacientes em terapia de manutenção e após a indução de tratamento em pacientes com Doença Inflamatória Intestinal.

14.
International Journal of Pediatrics ; (6): 186-189, 2023.
Article in Chinese | WPRIM | ID: wpr-989063

ABSTRACT

The oral cavity is continuous with the gastrointestinal tract and oral health may be closely linked with the overall health of the gastrointestinal tract.Inflammatory bowel disease(IBD)is an intestinal disorder characterized by chronic inflammation of unknown etiology, affected by host genetics, immunoregulation, daily diet, and the gut microbiota.Recent studies of the microbiome in IBD suggest that translocation of oral microbes to the gut may be a common feature of the microbial dysbiosis which is a signature of both pediatric Crohn′s disease and ulcerative colitis.Murine studies suggest that translocation of oral bacteria and yeasts to the lower gastrointestinal tract may trigger inflammation in susceptible hosts, providing a mechanistic link to the development of IBD.Oral microbiota may play an important role in the development of IBD.This article reviews the relationship between oral microbiota and pediatric IBD.

15.
Chinese Journal of Experimental Traditional Medical Formulae ; (24): 239-246, 2023.
Article in Chinese | WPRIM | ID: wpr-988202

ABSTRACT

Gegen Qinliantang composed of Puerariae Lobatae Radix, Scutellariae Radix, Coptidis Rhizoma, and Glycyrrhizae Radix et Rhizoma exhibits exterior-releasing and interior-clearing effects and can treat diarrhea caused by fever invasion. Therefore, it is highly praised by physicians for treating damp-heat dysentery. This article systematically reviews the clinical applications and basic research advances of Gegen Qinliantang in treating ulcerative colitis. Modern clinical research has demonstrated that modified Gegen Qinliantang has also been used to treat ulcerative colitis, and it is often used in combination with Western drugs (mesalazine, olsalazine, sulfasalazine, etc.), other Chinese medicine prescriptions (Tongxie Yaofang, Baitouweng Tang, Shaoyaotang, Xianglianwan, etc.), and acupuncture. Such therapties can significantly alleviate symptoms, such as abdominal pain, diarrhea, and mucopurulent bloody stools, lower traditional Chinese medicine symptom scores and Baron score, improve the quality of life and sleep, reduce adverse reactions, and decrease the relapse rate within one year. Pharmacological studies have demonstrated that Gegen Qinliantang can inhibit the secretion of pro-inflammatory cytokines, such as tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6), and enhance the release of the anti-inflammatory cytokine interleukin-10 (IL-10) to alleviate intestinal inflammation. Additionally, it can modulate cellular signaling pathways and interfere with upstream and downstream connections in the pathways to inhibit oxidative stress response and prevent cell apoptosis. By regulating the balance of T-helper 17 (Th17) and regulatory T (Treg) cells and controlling the normal expression of immunoglobulins, Gegen Qinliantang can restore immune function. Moreover, this prescription can enrich the beneficial microorganisms in the intestine and stimulate intestinal epithelial cell regeneration to protect and repair the intestinal mucosal barrier. The active components in Gegen Qinliantang, such as puerarin, berberine, baicalin, and glycyrrhizin, can exert antibacterial, anti-inflammatory, and metabolic regulatory effects. This review provides a basis for treating ulcerative colitis with Gegen Qinliantang.

16.
China Pharmacy ; (12): 2167-2171, 2023.
Article in Chinese | WPRIM | ID: wpr-987150

ABSTRACT

Ulcerative colitis (UC) is a chronic non-specific inflammatory disease characterized by the damage of the epithelial barrier of the colon and the destruction of immune homeostasis. It has a long course, no recovery and high recurrence rate, and is recognized as a difficult digestive disease. MicroRNA (miRNA) has been confirmed to be specifically or differentially expressed in both UC patients and UC animal models, so miRNA can be used as markers for UC diagnosis or reference for treatment evaluation. TCM therapy has a definite therapeutic effect, a wide range of effects, and minimal side effects in the treatment of UC, so this article takes miRNA as the starting point and systematically elaborates on the mechanism of TCM regulating UC related signaling pathways by regulating the expression of miRNA. The results show that chlorogenic acid, Anchang decoction, and Fuyang huoxue jiedu formula can regulate the expressions of miR-155, miR-146a and miR-31-5p, etc., thereby inhibiting signal transducer and activator of transcription (STAT) signal pathway transduction to improve UC. Limonin, ginsenoside Rh2, artesunate, etc. can inhibit nuclear factor-κB (NF-κB) signaling pathway conduction to improve UC by regulating the expressions of miR-214, miR- 155 and miR-19a, etc. Nitidine chloride, berberine, resveratrol, etc. can regulate the expressions of miR-31, miR-146a, miR- 146b, etc., thereby inhibiting the Toll-like receptor 4 (TLR4) signaling pathway to improve UC. Mango polyphenolics, Compound qinbai granules, and Astragalus membranaceus polysaccharides can regulate the expressions of miR-126 and miR-193a-3p, thereby inhibiting the phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin (PI3K/AKT/mTOR) signaling pathway to improve UC.

17.
Journal of Southern Medical University ; (12): 1204-1213, 2023.
Article in Chinese | WPRIM | ID: wpr-987037

ABSTRACT

OBJECTIVE@#To assess the value of Improved Mayo Endoscopic Score (IMES) for evaluation of treatment efficacy for active ulcerative colitis (UC).@*METHODS@#We retrospectively analyzed the clinical and endoscopic data of 103 patients diagnosed with active UC in Beijing Tsinghua Changgung Hospital from January, 2015 to December, 2020. The severity of endoscopic lesions was determined by Mayo Endoscopic Score and the Ulcerative Colitis Endoscopic Index of Severity (UCEIS), and the area of the endoscopic lesions was evaluated based on the Montreal classification system. The IMES was established by combining the MES with the Montreal classification.@*RESULTS@#Univariate analysis suggested that young patients (<40 years old), patients with extensive disease type (E3), patients with high endoscopic scores (MES=3, UCEIS>4, and IMES>4), and patients receiving advanced drug therapy (with systemic hormones, immunosuppressants, immunomodulators, and biological agents, etc.) had lower clinical and endoscopic remission rates. COX survival analysis showed that IMES≤4 was an independent risk factor for clinical and endoscopic remission. ROC curve indicated that the predictive value of IMSE≤4 for clinical and endoscopic remission (AUC=0.7793 and 0.7095, respectively; P<0.01) was better than that of Montreal (AUC=0.7357 and 0.6847, respectively; P<0.01), MES=2 (AUC=0.6671 and 0.5929, respectively; P<0.01), and UCEIS≤4 (AUC=0.6823 and 0.6459, respectively; P<0.01); IMES=5 had a better predictive value for patients with active UC undergoing colectomy tham E3 and MES=3.@*CONCLUSION@#IMES has good value in evaluating treatment efficacy for active UC.


Subject(s)
Humans , Adult , Colitis, Ulcerative , Retrospective Studies , Endoscopy , Immunosuppressive Agents , Treatment Outcome
18.
Chinese Journal of Experimental Traditional Medical Formulae ; (24): 274-282, 2023.
Article in Chinese | WPRIM | ID: wpr-965673

ABSTRACT

Ulcerative colitis (UC) mainly occurs in the colon and rectum, with complex pathological mechanism. The occurrence of ulcerative colitis is associated with the uncontrollable inflammatory response of the intestine. The Western medicine therapy of UC mainly uses glucocorticoids and immunosuppressants to reduce intestinal inflammation. While blocking the progress of UC to a certain extent, it causes severe adverse reactions. More and more studies have confirmed that traditional Chinese medicine (TCM) has obvious advantages in the prevention and treatment of UC and can significantly reduce the recurrence of the disease. Pyroptosis, a novel form of cell death, can destroy cell structure, release intracellular pro-inflammatory substances, and mediate intestinal immune response in UC. TCM can promote pyroptosis (removing excess) or inhibit pyroptosis (replenishing deficiency), which is consistent with the regulation of Yin and Yang. TCM plays a role in the treatment of UC mainly by inhibiting pyroptosis (replenishing deficiency) and reducing intestinal immune response. In recent years, a large number of studies have been carried out to decipher the mechanism of TCM in the treatment of UC via NOD-like receptor protein domain 3 (NLRP3)-mediated pyroptosis pathway. The results have demonstrated that NLRP3 pathway is the key target of TCM in the treatment of UC. However, a comprehensive summary remains to be carried out on the inhibition of NLRP3-mediated pyroptosis pathway by TCM in the treatment of UC. Therefore, we retrieved the articles in this field in recent years with the keywords "pyroptosis", "NLRP3", "ulcerative colitis", and "Chinese medicine". The Chinese medicines regulating NLRP3 pathway mainly have the functions of clearing heat and drying dampness, harmonizing Qi and blood, moving Qi and dredging fu-organs, and invigorating spleen and removing dampness. The findings can help researchers to fully understand the mechanism of TCM in the treatment of UC via the NLRP3 pathway and provide a theoretical basis for the treatment of UC and further drug development.

19.
Chinese Journal of Experimental Traditional Medical Formulae ; (24): 61-70, 2023.
Article in Chinese | WPRIM | ID: wpr-965649

ABSTRACT

ObjectiveTo investigate the effect of Shaoyaotang on fecal metabolites in rats with ulcerative colitis (UC) induced by 2,4,6-trinitrobenzenesulfonic acid (TNBS) based on liquid chromatography-mass spectrometry (LC-MS). MethodMale SPF SD rats were randomly divided into normal group, model group and Shaoyaotang group (11.1 g·kg-1). Except for normal group, UC rat model was induced by TNBS, and each group was given normal saline except Shaoyaotang group. All groups were treated for 7 days, and the general condition and disease activity index (DAI) were observed. Hematoxylin-eosin (HE) staining was used to observe the histopathological changes of colon, and the protein expressions of interleukin-8 (IL-8) and interleukin-22 (IL-22) in colon tissue were detected by immunohistochemistry (IHC). Rat fecal samples were detected by LC-MS, and the data were analyzed by principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA). Human Metabolome Database (HMDB) and Kyoto Encyclopedia of Genes and Genomes (KEGG) were searched to screen differential metabolites in combination with literature reference. Then, pathway enrichment analysis was conducted using Metabo Analyst 5.0. ResultShaoyaotang (ig) decreased the DAI of UC rats. Compared with the normal group, the model group had damaged colonic mucosa structure, submucosal inflammatory cell infiltration, increased protein expressions of IL-8 (P<0.01) and IL-22 (P<0.05) in colon tissue. Compared with the conditions in the model group, the colonic damage was alleviated in the Shaoyaotang group, and the protein expressions of IL-8 and IL-22 in colon tissue were decreased (P<0.01). After screening, 15 differential metabolites were identified from the Shaoyaotang group, and the involved pathways mainly included biosynthesis of unsaturated fatty acids, linoleic acid metabolism, terpenoid backbone biosynthesis, porphyrin and chlorophyll metabolism, amino sugar and nucleotide sugar metabolism, pyrimidine metabolism and steroid hormone biosynthesis. ConclusionShaoyaotang has a therapeutic effect on UC, and its anti-inflammatory effect may be related to improving lipid metabolism and regulating the metabolism of cofactors and vitamins as well as the abnormal carbohydrate metabolism.

20.
Chinese Journal of Experimental Traditional Medical Formulae ; (24): 53-60, 2023.
Article in Chinese | WPRIM | ID: wpr-965648

ABSTRACT

ObjectiveTo investigate the role of cyclic adenosine monophosphate (cAMP)/protein kinase A (PKA)/cAMP-response element binding protein (CREB) signaling pathway in water metabolism and intestinal epithelial permeability in ulcerative colitis (UC) and the intervention mechanism of Shaoyaotang based on the theory of large intestine governing fluids. MethodSixty male SD rats were divided into blank group, model group, mesalazine group (0.42 g·kg-1), Shaoyaotang low-dose group (11.1 g·kg-1), Shaoyaotang medium-dose group (22.2 g·kg-1) and Shaoyaotang high-dose group (44.4 g·kg-1), with 10 in each group. The UC rat model of internal retention of dampness-heat was established by compound factors. The blank group and the model group were given normal saline (ig). The mesalazine group was given mesalazine (ig), and Shaoyaotang low-, medium- and high-dose groups were administrated with corresponding doses of Shaoyaotang (ig). The treatment lasted for 14 days. The diarrhea score and fecal moisture content of rats in each group were observed. The contents of diamine oxidase (DAO) and D-lactic acid in plasma were detected by enzyme-linked immunosorbent assay (ELISA). The protein expressions of aquaporin (AQP)8, AQP4, ZO-1 and Occludin in colon tissues were detected by immunohistochemistry, while those of cAMP, PKA and CREB in colon tissues were determined by Western blot. ResultCompared with the normal group, the model group had elevated diarrhea score and fecal moisten content (P<0.01), increased contents of DAO and D-lactic acid in plasma (P<0.01) and decreased protein expressions of ZO-1, Occludin, AQP8, AQP4, cAMP, PKA and CREB in colon (P<0.01). Compared with the conditions in the model group, the contents of DAO and D-lactic acid in plasma in each administration groups were lower (P<0.01), while the protein expressions of ZO-1, Occludin, AQP8, AQP4, cAMP, PKA and CREB in colon were higher (P<0.01). ConclusionShaoyaotang alleviates the diarrhea in UC, probably through activating cAMP/PKA/CREB signaling pathway, up-regulating expressions of AQPs, enhancing tight junctions in intestinal epithelium and thus improving the water metabolism in colon and the intestinal mucosal permeability.

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