251
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Rahman FZ, Takhar GK, Roy O, Shepherd A, Bloom SL, McCartney SA. Henoch-Schönlein purpura complicating adalimumab therapy for Crohn’s disease. World J Gastrointest Pharmacol Ther 2010; 1:119-22. [PMID: 21577306 PMCID: PMC3091153 DOI: 10.4292/wjgpt.v1.i5.119] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Revised: 09/09/2010] [Accepted: 09/16/2010] [Indexed: 02/06/2023] Open
Abstract
Anti-tumour necrosis factor-α (TNF) therapy has revolutionised the management of chronic inflammatory conditions. With ever increasing numbers of patients being treated with these agents, uncommon adverse reactions will inevitably occur more frequently. Cutaneous manifestations are associated with many of these chronic conditions and can complicate anti-TNF therapy in about 20% of cases. Vasculitic complications are rarely associated with anti-TNF therapy. Henoch-Schönlein purpura (HSP), a small vessel vasculitis, has been described following infliximab and etanercept therapy but never with adalimumab, a fully humanized TNF antibody. The risk of such immune-mediated reactions is theoretically less with adalimumab compared to infliximab but can still occur. Here we report the first case in the literature of HSP that can be attributed to the use of adalimumab in a 19-year-old male with recalcitrant Crohn’s disease.
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Affiliation(s)
- Farooq Z Rahman
- Farooq Z Rahman, Gagandeep K Takhar, Ovishek Roy, Stuart L Bloom, Sara A McCartney, Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, United Kingdom
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252
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Dewan B, Chimata R. An open-label, randomized, cross-over bioequivalence study of lafutidine 10 mg under fasting condition. World J Gastrointest Pharmacol Ther 2010; 1:112-8. [PMID: 21577305 PMCID: PMC3091155 DOI: 10.4292/wjgpt.v1.i5.112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Revised: 09/21/2010] [Accepted: 09/28/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the relative bioavailability and pharmacokinetic properties of two formulations (test and reference) of Lafutidine 10 mg.
METHODS: The study was performed as an open label, randomized, two-way, two-period, two-treatment, single dose cross-over bioequivalence study, under non-fed condition to compare the pharmacokinetic profiles of the lafutidine formulation manufactured by Emcure Pharmaceuticals Ltd., India using an indigenously developed active pharmaceutical ingredient (API) and the commercially available Stogra® formulation, of UCB Japan Co., Ltd., Japan. The two treatments were separated by a wash-out period of 5 d. After an overnight fasting period of 10 h, the subjects were administered either the test or the reference medication as per the randomization schedule. Blood samples were collected at intervals up to 24 h, as per the approved protocol. Concentrations of lafutidine in plasma were analyzed by a validated liquid chromatography/tandem mass spectrometry (LC/MS/MS) method, and a non-compartmental model was used for pharmacokinetic analysis. The pharmacokinetic parameters were subjected to a 4-way ANOVA accounting for sequence, subjects, period and treatment. Statistical significance was evaluated at 95% confidence level (P ≥ 0.05).
RESULTS: The mean (± SD) values of the pharmacokinetic parameters (test vs reference) were Cmax (265.15 ± 49.84 ng/mL vs 246.79 ± 29.30 ng/mL, P < 0.05), Area under the curve (AUC)(0-t) (1033.13 ± 298.74 ng.h/mL vs 952.93 ± 244.07 ng.h/mL, P < 0.05), AUC(0-∞) (1047.61 ± 301.22 ng.h/mL vs 964.21 ± 246.45 ng.h/mL, P < 0.05), and t½(1.92 ± 0.94 h vs 2.05 ± 1.01 h, P < 0.05). The 90% confidence intervals (CI) for the test/reference ratio of mean Cmax, AUC(0-t), and AUC(0-∞) were within the acceptable range of 80.00 to 125.00. The mean times (± SD) to attain maximal plasma concentration (tmax) of lafutidine were 0.95 ± 0.24 h vs 1.01 ± 0.29 h (P < 0.05) for the test and the reference formulations respectively. Both the formulations were well tolerated.
CONCLUSION: In summary, this study has demonstrated the bioequivalence of the two formulations of lafutidine 10 mg. Hence it can be concluded that the two formulations can be used interchangeably in clinical settings.
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Affiliation(s)
- Bhupesh Dewan
- Bhupesh Dewan, Director Medical Services, Zuventus Healthcare Ltd., Mumbai 400072, India
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253
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Câmara PR, Moi GP, Ferraz JGP, Zeitune JMR. Effect of anesthetics on gastric damage using two models of portal hypertension. World J Gastrointest Pharmacol Ther 2010; 1:81-6. [PMID: 21577313 PMCID: PMC3091276 DOI: 10.4292/wjgpt.v1.i4.81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 02/16/2010] [Accepted: 02/23/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the effect of sodium pentobarbitone (SP) or ketamine/xylazine (KX) anesthetics on acute gastric injury.
METHODS: Portal hypertension was induced by bile duct ligation (BDL) or portal vein stenosis (PVS). Ethanol (EtOH)-induced gastric damage was assessed using ex vivo gastric chamber experiments. Gastric blood flow (GBF) was also measured by laser doppler flowmetry.
RESULTS: EtOH-induced gastric damage was reduced in BDL rats under KX anesthesia in comparison to those under SP anesthesia. GBF dysfunction in fasted BDL rats was partially restored under KX anesthesia. In contrast, in fasted PVS rats, EtOH-induced gastric damage was increased under KX anesthesia while GBF was reduced.
CONCLUSION: The use of KX anesthesia in experimental procedures involving cirrhotic rats (but not those with pure portal hypertension) is preferable to SP anesthesia.
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Affiliation(s)
- Paula Rs Câmara
- Paula RS Câmara, Gisele P Moi, UNIVAG, University Center of Várzea Grande, Mato Grosso, Brazil
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254
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Escobar J, Pereda J, Arduini A, Sandoval J, Sabater L, Aparisi L, López-Rodas G, Sastre J. Protein phosphatases and chromatin modifying complexes in the inflammatory cascade in acute pancreatitis. World J Gastrointest Pharmacol Ther 2010; 1:75-80. [PMID: 21577300 PMCID: PMC3091150 DOI: 10.4292/wjgpt.v1.i3.75] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Revised: 02/10/2010] [Accepted: 02/17/2010] [Indexed: 02/05/2023] Open
Abstract
Acute pancreatitis is an inflammation of the pancreas that may lead to systemic inflammatory response syndrome and death due to multiple organ failure. Acinar cells, together with leukocytes, trigger the inflammatory cascade in response to local damage of the pancreas. Amplification of the inflammatory cascade requires up-regulation of pro-inflammatory cytokines and this process is mediated not only by nuclear factor κB but also by chromatin modifying complexes and chromatin remodeling. Among the different families of histone acetyltransferases, the p300/CBP family seems to be particularly associated with the inflammatory process. cAMP activates gene expression via the cAMP-responsive element (CRE) and the transcription factor CRE-binding protein (CREB). CREB can be phosphorylated and activated by different kinases, such as protein kinase A and MAPK, and then it recruits the histone acetyltransferase co-activator CREB-binding protein (CBP) and its homologue p300. The recruitment of CBP/p300 and changes in the level of histone acetylation are required for transcription activation. Transcriptional repression is also a dynamic and essential mechanism of down-regulation of genes for resolution of inflammation, which seems to be mediated mainly by protein phosphatases (PP1, PP2A and MKP1) and histone deacetylases (HDACs). Class II HDACs are key transcriptional regulators whose activities are controlled via phosphorylation-dependent nucleo/cytoplasmic shuttling. PP2A is responsible for dephosphorylation of class II HDACs, triggering nuclear localization and repression of target genes, whereas phosphorylation triggers cytoplasmic localization leading to activation of target genes. The potential benefit from treatment with phosphodiesterase inhibitors and histone deacetylase inhibitors is discussed.
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Affiliation(s)
- Javier Escobar
- Javier Escobar, Javier Pereda, Alessandro Arduini, Juan Sastre, Department of Physiology, University of Valencia, 46100 Burjasot (Valencia), Spain
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255
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Mikocka-Walus AA. Treatment of psychological co-morbidities in common gastrointestinal and hepatologic disorders. World J Gastrointest Pharmacol Ther 2010; 1:64-71. [PMID: 21577298 PMCID: PMC3091146 DOI: 10.4292/wjgpt.v1.i2.64] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Revised: 01/20/2010] [Accepted: 01/27/2010] [Indexed: 02/06/2023] Open
Abstract
Anxiety and depressive disorders frequently coexist with gastrointestinal and hepatologic conditions. Despite their high prevalence, approach to treating these co-morbidities is not always straightforward. This paper aims to review the current literature into etiology of psychological co-morbidities and their treatment in three conditions commonly encountered at gastroenterology outpatient clinics, namely inflammatory bowel disease (IBD), irritable bowel syndrome (IBS) and chronic hepatitis C (HepC). The paper demonstrates that although psychotherapy (and cognitive-behavioural therapy in particular) has been established as an effective treatment in IBS, more studies are needed in HepC and IBD. Antidepressants have been recognized as an effective treatment for psychological and somatic symptoms in IBS and for depression in HepC, but good quality studies in IBD are lacking despite the promising preliminary findings from animal models and case studies. Further studies in this area are needed.
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Affiliation(s)
- Antonina A Mikocka-Walus
- Antonina A Mikocka-Walus, School of Nursing and Midwifery,University of South Australia, Adelaide 5001, SA, Australia; School of Psychology, University of Adelaide, Adelaide 5005, SA, Australia; Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide 5000, Australia
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256
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Koutroubakis IE. Recent advances in the management of distal ulcerative colitis. World J Gastrointest Pharmacol Ther 2010; 1:43-50. [PMID: 21577295 PMCID: PMC3091147 DOI: 10.4292/wjgpt.v1.i2.43] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Revised: 01/29/2010] [Accepted: 02/05/2010] [Indexed: 02/06/2023] Open
Abstract
The most frequent localization of ulcerative colitis (UC) is the distal colon. In treating patients with active distal UC, efficacy and targeting of the drug to the distal colon are key priorities. Oral and rectal 5-aminosalicylic acid (5-ASA) preparations represent the first line therapy of mild-to-moderate distal UC for both induction and maintenance treatment. It has been reported that many UC patients are not adherent to therapy and that non-compliant patients had a 5-fold risk of experiencing a relapse. These findings led to the introduction of once-daily oral regimens of 5-ASA as better therapeutic options in clinical practice due to improved adherence. New formulations of mesalazine, including the multi-matrix delivery system, and mesalazine granules, which allow once-daily administration, have been developed. They have been demonstrated to be efficacious in inducing and maintaining remission in mild-to-moderate distal UC in large clinical trials. However, existing data for distal UC are rather insufficient to make a comparison between new and classical 5-ASA formulations. It seems that the new formulations are at least as effective as classical oral 5-ASA formulations. Other treatment options, in the case that 5-ASA therapy is not effective, include systemic corticosteroids, thiopurines (azathioprine or 6-mercaptopurine), cyclosporine, infliximab and surgery. The combination of a prompt diagnostic work-up, a correct therapeutic approach and an appropriate follow-up schedule is important in the management of patients with distal UC. This approach can shorten the duration of symptoms, induce a prolonged remission, improve patient’s quality of life, and optimize the use of health resources.
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Affiliation(s)
- Ioannis E Koutroubakis
- Ioannis E Koutroubakis, Department of Gastroenterology, University Hospital Heraklion, PO BOX 1352, 71110 Heraklion, Crete, Greece
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257
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Foschi FG, Dall'aglio AC, Lanzi A, Marano G, Savini S, Andreone P, Bernardi M, Stefanini GF. Cryoglobulinemia in elderly patients with HCV-related chronic hepatitis. World J Gastrointest Pharmacol Ther 2010; 1:72-4. [PMID: 21577299 PMCID: PMC3091145 DOI: 10.4292/wjgpt.v1.i2.72] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2010] [Revised: 02/10/2010] [Accepted: 02/17/2010] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) infection affects about 3% of the world’s population and often leads to chronic liver disease. In some industrialized countries, HCV prevalence increases with age, but the optimal management of older patients has not been accurately defined. HCV infection can also lead to lymphoproliferative disorders, the most common being mixed cryoglobulinemia (MC), and also for this condition that frequently affects elderly patients, the optimal therapeutic strategy is still debated. We report the case of a 77-year-old Caucasian woman with HCV-related chronic hepatitis and cutaneous manifestations consisting of urticaria and pruritus related to MC resistant to antihistamines. The patient underwent a treatment with interferon and ribavirin. Such a treatment led to early biochemical and virological response associated with the resolution of cryoglobulinemia and cutaneous symptoms. After the end of treatment, HCV replication relapsed, but cryoglobulinemia and cutaneous symptoms did not recur. In the absence of definite treatment guidelines in this particular context, our experience suggests that the presence of symptoms related to HCV-infection that deeply affect patient quality of life warrants antiviral therapy even beyond the age limits that currently exclude patients from treatment.
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Affiliation(s)
- Francesco Giuseppe Foschi
- Francesco Giuseppe Foschi, Anna Chiara Dall'Aglio, Arianna Lanzi, Giorgio Marano, Sara Savini, Giuseppe Francesco Stefanini, Department of Internal Medicine, Faenza Hospital,Viale Stradone 9, 48018 Faenza (RA), Italy
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258
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Lin HJ. Role of proton pump inhibitors in the management of peptic ulcer bleeding. World J Gastrointest Pharmacol Ther 2010; 1:51-3. [PMID: 21577296 PMCID: PMC3091149 DOI: 10.4292/wjgpt.v1.i2.51] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 01/27/2010] [Accepted: 02/03/2010] [Indexed: 02/06/2023] Open
Abstract
Peptic ulcer bleeding is a serious medical problem with significant morbidity and mortality. Endoscopic therapy significantly reduces further bleeding, surgery and mortality in patients with bleeding peptic ulcers and is now recommended as the first hemostatic modality for these patients. The efficacy of large-dose proton pump inhibitor (PPI) therapy in reducing re-bleeding after endoscopic therapy has been supported by evidence derived from randomized controlled trials. It may be premature to recommend small-dose intravenous injection PPI after endoscopic hemostasis in patients with bleeding ulcers. An updated systematic review shows that PPI therapy before endoscopy significantly reduces the proportion with major stigmata and requirement for endoscopic therapy at index endoscopy. Some studies show that there is no significant difference between oral and intravenous PPIs in raising intragastric pH. However, clinical data is lacking in patients with peptic ulcer bleeding to date.
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Affiliation(s)
- Hwai-Jeng Lin
- Hwai-Jeng Lin, Department of Medicine, Division of Gastroenterology, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua 500, Taiwan, China
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259
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Riggio O, Ridola L, Pasquale C. Hepatic encephalopathy therapy: An overview. World J Gastrointest Pharmacol Ther 2010; 1:54-63. [PMID: 21577297 PMCID: PMC3091148 DOI: 10.4292/wjgpt.v1.i2.54] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 01/24/2010] [Accepted: 01/31/2010] [Indexed: 02/06/2023] Open
Abstract
Type-C hepatic encephalopathy (HE) is a severe complication of cirrhosis, which seriously affects quality of life and is strongly related to patient survival. Treatment based on a classical pharmacological approach that is aimed at reducing the production of gut-derived toxins, such as ammonia, is still under debate. Currently, results obtained from clinical trials do not support any specific treatment for HE and our competence in testing old and new treatment modalities by randomized controlled trials with appropriate clinically relevant end-points urgently needs to be improved. On the other hand, patients who are at risk for HE are now identifiable, based on studies on the natural history of the disease. Today, very few studies that are specifically aimed at establishing whether HE may be prevented are available or in progress. Recent studies have looked at non absorbable disaccharides or antibiotics and other treatment modalities, such as the modulation of intestinal flora. In the treatment of severe stage HE, artificial liver supports have been tested with initial positive results but more studies are needed.
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Affiliation(s)
- Oliviero Riggio
- Oliviero Riggio, Lorenzo Ridola, Chiara Pasquale, Department of Clinical Medicine, Centre for the Diagnosis and Treatment of Portal Hypertension, "Sapienza" University of Rome, Rome 00185, Italy
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260
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Ma LS. What is the purpose of launching World Journal of Gastrointestinal Pharmacology and Therapeutics? World J Gastrointest Pharmacol Ther 2010; 1:1-2. [PMID: 21577287 PMCID: PMC3091144 DOI: 10.4292/wjgpt.v1.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 08/13/2009] [Accepted: 08/20/2009] [Indexed: 02/06/2023] Open
Abstract
The first issue of World Journal of Gastrointestinal Pharmacology and Therapeutics (WJGPT), whose preparatory work was initiated on September 27, 2008, will be published on February 6, 2010. The WJGPT Editorial Board has now been established and consists of 188 distinguished experts from 36 countries. Our purpose of launching WJGPT is to publish peer-reviewed, high-quality articles via an open-access online publishing model, thereby acting as a platform for communication between peers and the wider public, and maximizing the benefits to editorial board members, authors and readers.
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Affiliation(s)
- Lian-Sheng Ma
- Lian-Sheng Ma, Beijing Baishideng BioMed Scientific Co., Ltd., Room 903, Building D, Ocean International Center, No. 62 Dongsihuan Zhonglu, Chaoyang District, Beijing 100025, China
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261
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Abstract
Pancreatic acinar cells are secretory cells whose main function is to synthesize, store and finally release digestive enzymes into the duodenum. However, in response to noxious stimuli, acinar cells behave like real inflammatory cells because of their ability to activate signalling transduction pathways involved in the expression of inflammatory mediators. Mediated by the kinase cascade, activation of Nuclear factor-κB, Activating factor-1 and Signal transducers and activators of transcription transcription factors has been demonstrated in acinar cells, resulting in overexpression of inflammatory genes. In turn, kinase activity is down-regulated by protein phosphatases and the final balance between kinase and phosphatase activity will determine the capability of the acinar cells to produce inflammatory factors. The kinase/phosphatase pair is a redox-sensitive system in which kinase activation overwhelms phosphatase activity under oxidant conditions. Thus, the oxidative stress developed within acinar cells at early stages of acute pancreatitis triggers the activation of signalling pathways involved in the up-regulation of cytokines, chemokines and adhesion molecules. In this way, acinar cells trigger the release of the first inflammatory signals which can mediate the activation and recruitment of circulating inflammatory cells into the injured pancreas. Accordingly, the role of acinar cells as promoters of the inflammatory response in acute pancreatitis may be considered. This concept leads to amplifying the focus from leukocyte to acinar cells themselves, to explain the local inflammation in early pancreatitis.
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Affiliation(s)
- Isabel De Dios
- Isabel De Dios, Department of Physiology and Pharmacology, University of Salamanca, Salamanca 37007, Spain
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262
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García M, Calvo JJ. Cardiocirculatory pathophysiological mechanisms in severe acute pancreatitis. World J Gastrointest Pharmacol Ther 2010; 1:9-14. [PMID: 21577289 PMCID: PMC3091142 DOI: 10.4292/wjgpt.v1.i1.9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 12/25/2009] [Accepted: 01/01/2010] [Indexed: 02/06/2023] Open
Abstract
Acute pancreatitis (AP) is a common and potentially lethal acute inflammatory process. Although the majority of patients have a mild episode of AP, 10%-20% develop a severe acute pancreatitis (SAP) and suffer systemic inflammatory response syndrome (SIRS) and/or pancreatic necrosis. The main aim of this article is to review the set of events, first localized in the pancreas, that lead to pancreatic inflammation and to the spread to other organs contributing to multiorganic shock. The early pathogenic mechanisms in SAP are not completely understood but both premature activation of enzymes inside the pancreas, related to an impaired cytosolic Ca2+ homeostasis, as well as release of pancreatic enzymes into the bloodstream are considered important events in the onset of pancreatitis disease. Moreover, afferent fibers within the pancreas release neurotransmitters in response to tissue damage. The vasodilator effects of these neurotransmitters and the activation of pro-inflammatory substances play a crucial role in amplifying the inflammatory response, which leads to systemic manifestation of AP. Damage extension to other organs leads to SIRS, which is usually associated with cardiocirculatory physiology impairment and a hypotensive state. Hypotension is a risk factor for death and is associated with a significant hyporesponsiveness to vasoconstrictors. This indicates that stabilization of the patient, once this pathological situation has been established, would be a very difficult task. Therefore, it seems particularly necessary to understand the pathological mechanisms involved in the first phases of AP to avoid damage beyond the pancreas. Moreover, efforts must also be directed to identify those patients who are at risk of developing SAP.
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Affiliation(s)
- Mónica García
- Mónica García, José Julián Calvo, Department of Physiology and Pharmacology, Campus Miguel de Unamuno, Universidad de Salamanca, 37007 Salamanca, Spain
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263
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Zingone F, Capone P, Ciacci C. Celiac disease: Alternatives to a gluten free diet. World J Gastrointest Pharmacol Ther 2010; 1:36-9. [PMID: 21577293 PMCID: PMC3091139 DOI: 10.4292/wjgpt.v1.i1.36] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 12/02/2009] [Accepted: 12/09/2009] [Indexed: 02/06/2023] Open
Abstract
Celiac disease is a chronic inflammatory disorder of the small intestine caused by the ingestion of gluten or related rye and barley proteins. At present, the only available treatment is a strict gluten-exclusion diet. However, recent understanding of the molecular basis for this disorder has improved and enabled the identification of targets for new therapies. This article aims to critically summarize these recent studies.
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Affiliation(s)
- Fabiana Zingone
- Fabiana Zingone, Pietro Capone, Carolina Ciacci, Department of Clinical and Experimental Medicine, Federico II University, 80131 Naples, Italy
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264
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Tapia JA, Salido GM, González A. Ethanol consumption as inductor of pancreatitis. World J Gastrointest Pharmacol Ther 2010; 1:3-8. [PMID: 21577288 PMCID: PMC3091140 DOI: 10.4292/wjgpt.v1.i1.3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Revised: 01/11/2010] [Accepted: 01/18/2010] [Indexed: 02/06/2023] Open
Abstract
Alcohol abuse is a major cause of pancreatitis, a condition that can manifest as both acute necroinflammation and chronic damage (acinar atrophy and fibrosis). Pancreatic acinar cells can metabolize ethanol via the oxidative pathway, which generates acetaldehyde and involves the enzymes alcohol dehydrogenase and possibly cytochrome P4502E1. Additionally, ethanol can be metabolized via a nonoxidative pathway involving fatty acid ethyl ester synthases. Metabolism of ethanol by acinar and other pancreatic cells and the consequent generation of toxic metabolites, are postulated to play an important role in the development of alcohol-related acute and chronic pancreatic injury. This current work will review some recent advances in the knowledge about ethanol actions on the exocrine pancreas and its relationship to inflammatory disease and cancer.
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Affiliation(s)
- José A Tapia
- José A Tapia, Ginés M Salido, Antonio González, PhD, Department of Physiology, Faculty of Veterinary Sciences, University of Extremadura, Avenida Universidad s/n, Cáceres E-10071, Spain
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265
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Abstract
Premature trypsinogen activation and production of oxygen free radicals (OFR) are early pathogenic events which occur within acinar cells and trigger acute pancreatitis (AP). OFR exert their harmful effects on various cell components causing lipid peroxidation, disturbances in calcium homeostasis and DNA damage, which lead to increased cell injury and eventually cell death. This review presents the most recent data concerning the effects of N-Acetylcysteine (NAC), in the treatment of AP. NAC is an antioxidant capable of restoring the levels of Glutathione, the most important cellular antioxidant. Studies show the beneficial effects of NAC treatment in preventing OFR production and therefore attenuating oxidative damage. Additionally, NAC treatment has been shown to prevent the increase in cytosolic Ca2+ concentration and reduce the accumulation of enzymes in acinar cells during AP. The prevention, by NAC, of these pathological events occurring within acinar would contribute to reducing the severity of AP. NAC is also capable of reducing the activation of transcription factors especially sensitive to the cellular redox state, such as Nuclear factor-κB, signal transducer and activator of transcription-3 and mitogen-activated protein kinase. This leads to a down-regulation of cytokines, adhesion molecules and chemokine expression in various cell types during AP. These findings point to NAC as a powerful therapeutic treatment, attenuating oxidative-stress-induced cell injury and other pathological events at early stages of AP, and potentially contributing to reducion in the severity of disease.
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Affiliation(s)
- Laura Ramudo
- Laura Ramudo, Manuel A Manso, Department of Physiology and Pharmacology, University of Salamanca, Salamanca 37007, Spain
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266
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Abstract
Formation of colonic diverticula, via herniation of the colonic wall, is responsible for the development of diverticulosis. When diverticulosis becomes symptomatic, it becomes diverticular disease. Diverticular disease is common in Western and industrialized countries, and it is associated with numerous abdominal symptoms (including pain, bloating, nausea, diarrhea, and constipation). Standard medical therapies with antibiotics are currently recommended for patients affected by diverticular disease. However, changing concepts on the pathophysiology of the disease suggest that diverticular disease may share many of the hallmarks of inflammatory bowel diseases. On this basis, the addition of therapies using mesalazine and probiotics may enhance treatment efficacy by shortening the course of the disease and preventing recurrences.
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Affiliation(s)
- Antonio Tursi
- Antonio Tursi, Servizio di Gastroenterologia Territoriale, ASL BAT, 70031 Andria, Italy
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Pendlimari R, Anaparthy R, Sugumar A. Drug interaction presenting as acute abdomen. World J Gastrointest Pharmacol Ther 2010; 1:40-2. [PMID: 21577294 PMCID: PMC3091138 DOI: 10.4292/wjgpt.v1.i1.40] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 01/20/2010] [Accepted: 01/27/2010] [Indexed: 02/06/2023] Open
Abstract
Warfarin is the most common oral anticoagulant prescribed around the world. Adverse drug interactions with warfarin are a huge problem especially in the elderly and in patients who take multiple medications. Most adverse drug interactions involve concomitantly prescribed oral or intravenous medications. Occasionally, topical or mucosally absorbed drugs can interact, leading to fluctuations in warfarin levels with adverse consequences. In this case report, we describe a case of intestinal intramural hematoma, a rare but known consequence of a supra therapeutic international normalized ratio (INR). The supra therapeutic INR was a consequence of mucosally absorbed miconazole, prescribed for vaginal candidiasis. We wish to highlight this rare and potentially fatal drug interaction, along with the need for frequent INR monitoring when new drugs are added or removed in patients taking warfarin.
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Affiliation(s)
- Rajesh Pendlimari
- Rajesh Pendlimari, Division of Colon & Rectal Surgery, Mayo Clinic, Rochester, MN 55905, United States
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