Relationship Between Cytomegalovirus Infection and Steroid Resistance in Inflammatory Bowel Disease: A Meta-Analysis.

BACKGROUND AND AIMS: Steroid resistance presents an administration difficulty in inflammatory bowel disease (IBD). The reason of steroid resistance is still unclear, but cytomegalovirus (CMV) infection may be a potential cause in some IBD patients. We carried out a meta-analysis to investigate the relationship between CMV infection and steroid-resistant IBD. METHODS: The PubMed, EMBASE, and Cochrane Library databases were searched up to June 2014, with no language restrictions, for observational studies. Additional references were obtained from reviewed articles. RESULTS: Eleven studies involving 867 IBD patients were included in the meta-analysis. Steroid resistance rate was 70.0% in CMV-positive IBD patients, which was significantly higher than that in CMV-negative IBD patients (RR = 2.12, 95% CI = 1.72-2.61). There was significant heterogeneity in the included eleven studies (I (2) = 57.6%). When the only one study with a few patients was excluded, sensitivity analysis suggested a similar outcome (RR = 2.07, 95% CI = 1.80-2.39, 10 studies). Based on the funnel plot and Egger's test, we considered that there was a probable publication bias. CONCLUSION: Our meta-analysis suggests that CMV-positive IBD patients have a nearly double risk of steroid resistance compared with CMV-negative IBD patients, indicating that CMV infection is a probable cause of steroid-resistant IBD.

[Treating irritable bowel syndrome by wuling capsule combined pinaverium bromide: a clinical research].

OBJECTIVE: To evaluate the efficacy and safety of wuling Capsule combined with Pinaverium Bromide in treatment of irritable bowel syndrome (IBS). METHODS: Sixty-four IBS patients were randomized into two groups, the treatment group and the control group, 32 in each group. Patients in the treatment group took wuling Capsule (0. 33 g/capsule, 3 times per day) and Pinaverium Bromide (50 mg/tablet, one tablet each time, 3 times per day) , while those in the control group only took Pinaverium Bromide (50 mg/tablet, one tablet each time, 3 times per day). The therapeutic course for all was 6 weeks. IBS symptom score questionnaire, IBS-Quality of Life (IBS-QOL) , Self-Rating Depression Scale (SDS) , and Self-Rating Anxiety Scale (SAS) were assessed before and after treatment. Adverse reactions were also observed. RESULTS: The improvement of abdominal pain, stool frequency, and stool properties, as well as changing rates of integrals were significantly higher in the treatment group than in the control group (P <0. 05). The improvement of dysphoria, body image, concerns for health, and dietary restriction of IBS-QOL, as well as changing rates of integrals were significantly higher in the treatment group than in the control group (P <0. 05). The improvement of SDS and SAS, as well as changing rates of integrals were significantly higher in the treatment group than in the control group (P <0. 05). No severe adverse reaction occurred in either group. CONCLUSION: Combination therapy of wuling Capsule and Pinaverium Bromide could improve abdominal pain and defecation, attenuate depression and anxiety of IBS patients with higher safety.

Helicobacter pylori infection and inflammatory bowel disease in Asians: a meta-analysis.

AIM: To investigate the relationship between Helicobacter pylori infection and inflammatory bowel disease (IBD) in an Asian population. METHODS: The PubMed, EMBASE, and Cochrane Library databases were searched for observational studies published up until June 2014, without language restrictions. Additional references were obtained from reviewed articles. RESULTS: Ten studies involving 1299 IBD patients and 1817 controls were included in the meta-analysis (24.9% of IBD patients had H. pylori infection vs 48.3% of the controls). The pooled risk ratio for H. pylori infection in IBD patients compared with controls was 0.48 (95%CI: 0.43-0.54; P < 0.001). There was no significant heterogeneity in the included studies (I (2) = 21%). Egger's linear regression indicated that there was no significant publication bias (P = 0.203). CONCLUSION: The H. pylori infection rate in Asian IBD patients is significantly lower than in non-IBD patients, indicating that infection protects against the development of IBD.

Meta-analysis of ciprofloxacin in treatment of Crohn's disease.

The aim of the present study was to evaluate the efficacy of ciprofloxacin (cipro) for the treatment of Crohn's disease (CD) through a meta-analysis of randomized controlled trials. The PubMed, Embase and Cochrane Library databases were searched up to May 2014, with no language restrictions, for randomized placebo-controlled trials. Additional references were obtained from the reviewed studies. Five studies were in accordance with the criteria and were included in the meta-analysis. The pooled risk ratio (RR) of all the studies was 1.35 [95% confidence interval (CI), 1.03-1.76; P=0.03]. In three studies, cipro was used for the treatment of CD with perianal fistula and the pooled RR was 1.66 (95% CI, 1.16-2.39; P=0.006). In two studies, cipro was used to treat active CD and the pooled RR was 1.13 (95% CI, 0.77-1.66; P=0.54). Thus in conclusion, cipro exhibits a significant efficacy for the treatment of CD, in particular with perianal fistula.

Increased expression of chymase in inflammatory polyps in elderly patients with functional bowel disorder.

Chymase, a chymotrypsin-like protease, is a non-angiotensin-converting enzyme (ACE) angiotensin II (Ang II)-generating enzyme. The aim of the present study was to investigate whether chymase activity was increased in inflammatory polyps of elderly patients with functional bowel disorder (FBD). This study enrolled 45 elderly patients with FBD and 44 healthy control individuals. Expression of chymase in intestinal mucosa was assessed using fluorescence quantitative polymerase chain reaction and immunohistochemistry (IHC). IHC showed an increased number of chymase-positive mast cells in inflammatory polyps than in healthy intestinal mucosa (P<0.05). Compared with healthy mucosa, expression of chymase at the mRNA and protein level was significantly higher in inflammatory polyps. The frequencies of the chymase GG genotype and the G allele type were higher in the intestinal mucosa of patients with FBD compared with healthy controls (66.67 versus 40.91%, 81.11 versus 63.63%, both P<0.05). The frequency of the G allele type in the intestinal mucosa of the C4 subgroup of FBD was higher than that in the control group. However, in other FBD subgroups, there was no difference between patients and controls. Based on the fact that enhanced chymase expression was observed in inflammatory polyps of elderly patients with FBD relative to those in healthy controls, it was concluded that chymase has a significant role in the pathogenesis of inflammatory polyps in elderly patients with FBD.

Detection of RASSF1A promoter hypermethylation in serum from gastric and colorectal adenocarcinoma patients.

AIM: To evaluate the diagnostic role of serum RASSF1A promoter hypermethylation in gastric and colorectal adenocarcinoma. METHODS: Methylation-specific polymerase chain reaction (MSPCR) was used to examine the promoter methylation status of the serum RASSF1A gene in 47 gastric adenocarcinoma patients, 45 colorectal adenocarcinoma patients, 60 patients with benign gastrointestinal disease (30 with benign gastric disease and 30 with benign colorectal disease), and 30 healthy donor controls. A paired study of RASSF1A promoter methylation status in primary tumor, adjacent normal tissue, and postoperative serum were conducted in 25 gastric and colorectal adenocarcinoma patients who later were underwent surgical therapy. RESULTS: The frequencies of detection of serum RASSF1A promoter hypermethylation in gastric (34.0%) and colorectal (28.9%) adenocarcinoma patients were significantly higher than those in patients with benign gastric (3.3%) or colorectal (6.7%) disease or in healthy donors (0%) (P < 0.01). The methylation status of RASSF1A promoter in serum samples was consistent with that in paired primary tumors, and the MSPCR results for RASSF1A promoter methylation status in paired preoperative samples were consistent with those in postoperative serum samples. The serum RASSF1A promoter hypermethylation did not correlate with patient sex, age, tumor differentiation grade, surgical therapy, or serum carcinoembryonic antigen level. Although the serum RASSF1A promoter hypermethylation frequency tended to be higher in patients with distant metastases, there was no correlation between methylation status and metastasis. CONCLUSION: Aberrant CpG island methylation within the promoter region of RASSF1A is a promising biomarker for gastric and colorectal cancer.