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Lelièvre O, Benoist S, Brouquet A. Indications, modalities, and outcomes of surgery for ulcerative colitis in 2024. J Visc Surg 2024; 161:182-193. [PMID: 38897710 DOI: 10.1016/j.jviscsurg.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Treatment of ulcerative colitis (UC) has been revolutionized by the arrival of biotherapies and technical progress in interventional endoscopy and surgery. (Sub)total emergency colectomy is required in the event of complicated severe acute colitis: colectasis, perforation, hemorrhage, organ failure. Corticosteroid therapy is the reference treatment for uncomplicated severe acute colitis, while infliximab and ciclosporin are 2nd-line treatments. At each step, before and after each line of treatment failure, surgery should be considered as an option. In cases refractory to medical treatment, the choice between surgery and change in medication must weigh the chronic symptoms associated with the disease against the risks of postoperative complications and functional sequelae inherent to surgery. Detection of dysplastic lesions necessitates chromoendoscopic imaging with multiple biopsies and anatomopathological verification. Endoscopic treatment of these lesions remains reserved for selected patients. These different indications call for multidisciplinary medical-surgical discussion. Total coloproctectomy with ileo-anal anastomosis (TCP-IAA) is the standard surgery, and it holds out hope for healing. Modalities depend on patient characteristics, previous emergency colectomy, and presence of dysplasia. It may be carried out in one, in two modified, or in three phases. The main complications are anastomotic fistula, short-term pouch-related fistula, ileo-anal pouch syndrome, pouchitis and long-term digestive and sexual disorders. For selected cases, an alternative can consist in total colectomy with ileo-rectal anastomosis or permanent terminal ileostomy. The objective of this update is to clarify the indications, modalities, and results of surgical treatment of ulcerative colitis in accordance with the most recent data in the literature.
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Affiliation(s)
- Océane Lelièvre
- Department of oncologic and digestive surgery, Bicêtre Hospital, Assistance publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France; Paris-Saclay University, Paris, France
| | - Stéphane Benoist
- Department of oncologic and digestive surgery, Bicêtre Hospital, Assistance publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France; Paris-Saclay University, Paris, France
| | - Antoine Brouquet
- Department of oncologic and digestive surgery, Bicêtre Hospital, Assistance publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France; Paris-Saclay University, Paris, France.
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Ma L, Pang X, Ji G, Ma X, Li J, Chang Y, Ma C. Application of the neutrophil to lymphocyte ratio in the diagnosis and activity determination of ulcerative colitis: A meta-analysis and systematic review. Medicine (Baltimore) 2021; 100:e27551. [PMID: 34678891 PMCID: PMC8542122 DOI: 10.1097/md.0000000000027551] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 08/31/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The neutrophil to lymphocyte ratio (NLR) may be a potential biomarker to evaluate the condition of ulcerative colitis (UC), but whether it can determine the activity of UC is still controversial. So we conducted this meta-analysis to study the relationship between them. METHODS We searched the databases of Pubmed, Embase, Cochrane, Wanfang, and CNKI to collect qualified articles. Random effect or fixed effect model is used to calculate the standard mean difference (SMD) with 95% confidence interval (CI). RESULTS A total of 11 articles (including 1741 participants) were included in this meta-analysis. The results showed that the level of NLR in peripheral blood of patients with UC was significantly higher than that of control group (SMD = 1.04, 95% CI = 0.71-1.36). The NLR value of active patients was significantly higher than that of inactive patients (SMD = 1.35, 95% CI = 0.87-1.83). CONCLUSION NLR may be a useful index to determine the severity and activity of UC, and it is expected to be widely used in clinical practice in the future.
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Affiliation(s)
- Lushun Ma
- Department of Gastrointestinal and Colorectal Surgery, China-Japan Union Hospital of Jilin University, Changchun, Ji Lin, China
| | - Xinyuan Pang
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, Ji Lin, China
| | - Guofeng Ji
- Department of Gastrointestinal and Colorectal Surgery, China-Japan Union Hospital of Jilin University, Changchun, Ji Lin, China
| | - Xinrui Ma
- Department of Gastrointestinal and Colorectal Surgery, China-Japan Union Hospital of Jilin University, Changchun, Ji Lin, China
| | - Jie Li
- Department of Gastrointestinal and Colorectal Surgery, China-Japan Union Hospital of Jilin University, Changchun, Ji Lin, China
| | - Yuan Chang
- Department of Gastrointestinal and Colorectal Surgery, China-Japan Union Hospital of Jilin University, Changchun, Ji Lin, China
| | - Chong Ma
- Department of Gastrointestinal and Colorectal Surgery, China-Japan Union Hospital of Jilin University, Changchun, Ji Lin, China
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Ge X, Jiang L, Yu W, Wu Y, Liu W, Qi W, Cao Q, Bai R, Zhou W. The importance of sarcopenia as a prognostic predictor of the clinical course in acute severe ulcerative colitis patients. Dig Liver Dis 2021; 53:965-971. [PMID: 33934998 DOI: 10.1016/j.dld.2021.03.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/05/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Acute severe ulcerative colitis (ASUC) is a life-threatening condition that requires timely referral for therapy. Sarcopenia has been associated with clinical outcomes of inflammatory bowel disease (IBD). This study investigated the role of sarcopenia in predicting the clinical course of ASUC. METHODS This retrospective cohort study included ASUC patients with abdominal CT scans. Univariate and multivariable regression analyses were performed to identify a practical predictive index for the clinical course of ASUC. RESULTS Of 233 included patients, 151 had intravenous corticosteroid (IVS) failure, among whom 32 received surgery without medical rescue therapy. Fifty patients underwent colectomy after medical rescue therapy failure. Of these 82 surgical patients, 42 suffered postoperative complications. Multivariable regression analysis showed that sarcopenia remained an independent risk factor for IVS failure (OR=2.969; 95% CI, 1.547-5.701; p = 0.001), colectomy after medical rescue therapy failure (OR=3.411; 95% CI, 1.147-10.141; p = 0.027), and postoperative complications after colectomy (OR=4.157; 95% CI, 1.364-12.667; p = 0.012). During follow-up, patients with colectomy after first-line treatment had a lower comprehensive complication index and better health-related quality of life. CONCLUSION Sarcopenia is useful in predicting the clinical course and postoperative outcomes of ASUC.
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Affiliation(s)
- Xiaolong Ge
- Department of General Surgery, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang 310016, China
| | - Liping Jiang
- Department of Medicine, Guangxi Medical College, Nanning, GuangXi 530023, China
| | - Weihua Yu
- Department of General Surgery, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang 310016, China
| | - Yan Wu
- Department of Gastroenterology, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, China
| | - Wei Liu
- Department of General Surgery, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang 310016, China
| | - Weilin Qi
- Department of General Surgery, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang 310016, China
| | - Qian Cao
- Department of Gastroenterology, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, China
| | - Rongpan Bai
- Department of General Surgery, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang 310016, China.
| | - Wei Zhou
- Department of General Surgery, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang 310016, China.
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Sharma A, Tirpude NV, Kumari M, Padwad Y. Rutin prevents inflammation-associated colon damage via inhibiting the p38/MAPKAPK2 and PI3K/Akt/GSK3β/NF-κB signalling axes and enhancing splenic Tregs in DSS-induced murine chronic colitis. Food Funct 2021; 12:8492-8506. [PMID: 34302158 DOI: 10.1039/d1fo01557e] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A large body of emerging evidence has revealed the role of p38/MK2 and PI3K/Akt/GSK3β cascades in the orchestrating process of colitis. Rutin, a bioflavonoid present in many fruits and vegetables, has been recognized to offer therapeutic attributes in acute colitis. However, its role in chronic colitic condition has not yet been delineated in reference to p38/MK2 and PI3K/Akt/GSK3β signalling. The present investigation assessed the efficacy and underlying molecular mechanism of rutin in alleviating DSS-induced chronic colitis. The analysis of signalling pathways demonstrated the robust activation of PI3K/Akt/GSK3β/MAPKs/NF-κB and p38/MK2 in DSS-induced colitis in animals, which was efficiently alleviated following the rutin treatment. In silico studies indicated its target specificity with these pathways. Rutin administration markedly improved the disease activity score, colon length, goblet cell loss and compromised colon epithelial integrity in colitic mice. Decreased expression of oxi-inflammatory markers such as IgM, IgE, iNOS, ICAM-1, HO-1 and Th1/IL-10 cytokines ratios after treatment suggests its efficacy in regulating effector, regulatory and B cell homeostasis. Additionally, rutin demonstrated its role in restoring epithelial integrity by modulating the transcript levels of tight junction proteins, mucus-secreting proteins, epithelial cell proliferation and apoptosis. Treg expansion revealed that rutin supplementation also exhibits an immune regulatory potential and suppresses inflammatory aggravation mediated by adaptive immune responses. Overall, results indicate that the modulation of p38/MK2 and PI3K/Akt/GSK3β/NF-κB pathways by rutin represents a novel therapeutic approach in chronic colitis that help to curb dysregulated intestinal integrity, cytokine ratio and splenic Tregs.
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Affiliation(s)
- Anamika Sharma
- Pharmacology and Toxicology Lab, Dietetics and Nutrition technology, CSIR-Institute of Himalayan Bioresource Technology, Palampur, H.P., India. and Academy of Scientific and Innovative Research, (AcSIR), Ghaziabad, U.P. 201002, India
| | - Narendra Vijay Tirpude
- Pharmacology and Toxicology Lab, Dietetics and Nutrition technology, CSIR-Institute of Himalayan Bioresource Technology, Palampur, H.P., India. and Academy of Scientific and Innovative Research, (AcSIR), Ghaziabad, U.P. 201002, India
| | - Monika Kumari
- Pharmacology and Toxicology Lab, Dietetics and Nutrition technology, CSIR-Institute of Himalayan Bioresource Technology, Palampur, H.P., India.
| | - Yogendra Padwad
- Pharmacology and Toxicology Lab, Dietetics and Nutrition technology, CSIR-Institute of Himalayan Bioresource Technology, Palampur, H.P., India. and Academy of Scientific and Innovative Research, (AcSIR), Ghaziabad, U.P. 201002, India
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Ren Y, Liang S, Zheng Y, Deng X, Lei L, Ai J, Li Y, Zhang T, Chen L, Mei Z, Cheng YC, He C. Investigation on the function tropism of Tiaoqin and Kuqin (different specification of Scutellaria baicalensis) by comparing their curative effect on different febrile disease model. JOURNAL OF ETHNOPHARMACOLOGY 2021; 268:113596. [PMID: 33221498 DOI: 10.1016/j.jep.2020.113596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 11/13/2020] [Accepted: 11/14/2020] [Indexed: 06/11/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Scutellaria baicalensis (S. baicalensis) is the root of S. baicalensis Georgi. In traditional Chinese medicine it is divided into Tiaoqin (TQ, 1-3 years old) and Kuqin (KQ, more than 3 years old). However, the differences in TQ and KQ efficacy and their exact mechanisms are still unclear. AIM OF THE STUDY This study aimed to clarify the difference in the efficacy of TQ and KQ in relation to different fever types (damp heat and hyperpyrexia) by using rat models, as well as to determine the primary molecular mechanism. MATERIALS AND METHODS This study compared the compositional content of TQ and KQ by UPLC-MS/MS. Then, rat models of hyperpyrexia (HP, LPS) and damp heat (DH, high-fat and high-sugar diet feeding + fumigation in artificial climate chamber + E. coli injection) were established and their clinical symptoms, blood biochemistry, histopathological sections, cell cytokines and protein expression were compared following treatment with TQ or KQ. Finally, the mechanisms underpinning the differences observed for TQ and KQ were determined by measuring the components of these treatments in different target organs. RESULTS This study identified 31 compounds in the water extracts of both TQ and KQ, which differed significantly in their relative content. TQ and KQ showed different functional tropism in HP and DH model rats. Baicalin, wogonoside, oroxin A, baicalein, wogonin and oroxylin A appeared to be the basic functional components responsible for the functional tropism hypothesis, while the remaining compounds appeared to be the efficacy-oriented components. In addition, the difference in pharmacodynamics between TQ and KQ may be related to their absorption in vivo, which was consistent with the hypothesis of functional tropism proposed in this work. CONCLUSION In this study we adopted TQ and KQ-different specifications of Scutellaria baicalensis with similar chemical components-as a case study to systematically reveal the functional tropism of Chinese herbal medicine (CHM). The results showed that TQ and KQ contain the basic functional components to enable the basic function of 'clearing heat', while the variation in compositional content may result in their different therapeutic effects. A greater understanding and utilisation of the functional tropism of CHM would enormously improve the accuracy and scientific basis for the application of CHM medication, as well as in promoting the multi-function mechanism of CHM and guiding new drug development of CHM.
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Affiliation(s)
- Yongshen Ren
- School of Pharmaceutical Science, South-central University for Nationalities, Wuhan, 430074, China; School of Medicine, Yale University, New Haven, CT, 06511, USA.
| | - Shuai Liang
- School of Pharmaceutical Science, South-central University for Nationalities, Wuhan, 430074, China
| | - Yao Zheng
- School of Pharmaceutical Science, South-central University for Nationalities, Wuhan, 430074, China
| | - Xin Deng
- School of Pharmaceutical Science, South-central University for Nationalities, Wuhan, 430074, China
| | - Lei Lei
- School of Pharmaceutical Science, South-central University for Nationalities, Wuhan, 430074, China
| | - Jiao Ai
- School of Pharmaceutical Science, South-central University for Nationalities, Wuhan, 430074, China
| | - Yanqiu Li
- School of Pharmaceutical Science, South-central University for Nationalities, Wuhan, 430074, China
| | - Tianpei Zhang
- School of Pharmaceutical Science, South-central University for Nationalities, Wuhan, 430074, China
| | - Linlin Chen
- School of Pharmacy, Hubei University of Chinese Medicine, Wuhan, China
| | - Zhinan Mei
- School of Pharmaceutical Science, South-central University for Nationalities, Wuhan, 430074, China
| | - Yung-Chi Cheng
- School of Medicine, Yale University, New Haven, CT, 06511, USA.
| | - Caijing He
- School of Pharmaceutical Science, South-central University for Nationalities, Wuhan, 430074, China
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Tajti G, Wai DCC, Panyi G, Norton RS. The voltage-gated potassium channel K V1.3 as a therapeutic target for venom-derived peptides. Biochem Pharmacol 2020; 181:114146. [PMID: 32653588 DOI: 10.1016/j.bcp.2020.114146] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/05/2020] [Accepted: 07/07/2020] [Indexed: 02/07/2023]
Abstract
The voltage-gated potassium channel KV1.3 is a well-established therapeutic target for a range of autoimmune diseases, in addition to being the site of action of many venom-derived peptides. Numerous studies have documented the efficacy of venom peptides that target KV1.3, in particular from sea anemones and scorpions, in animal models of autoimmune diseases such as rheumatoid arthritis, psoriasis and multiple sclerosis. Moreover, an analogue of the sea anemone peptide ShK (known as dalazatide) has successfully completed Phase 1 clinical trials in mild-to-moderate plaque psoriasis. In this article we consider other potential therapeutic applications of inhibitors of KV1.3, including in inflammatory bowel disease and neuroinflammatory conditions such as Alzheimer's and Parkinson's diseases, as well as fibrotic diseases. We also summarise strategies for facilitating the entry of peptides to the central nervous system, given that this will be a pre-requisite for the treatment of most neuroinflammatory diseases. Venom-derived peptides that have been reported recently to target KV1.3 are also described. The increasing number of autoimmune and other conditions in which KV1.3 is upregulated and is therefore a potential therapeutic target, combined with the fact that many venom-derived peptides are potent inhibitors of KV1.3, suggests that venoms are likely to continue to serve as a rich source of new pharmacological tools and therapeutic leads targeting this channel.
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Affiliation(s)
- Gabor Tajti
- Department of Biophysics and Cell Biology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| | - Dorothy C C Wai
- Medicinal Chemistry, Monash Institute of Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, VIC 3052, Australia
| | - Gyorgy Panyi
- Department of Biophysics and Cell Biology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary.
| | - Raymond S Norton
- Medicinal Chemistry, Monash Institute of Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, VIC 3052, Australia; ARC Centre for Fragment-Based Design, Monash University, Parkville, VIC 3052, Australia.
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7
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Can red blood cell distribution width (RDW) predict clinical and endoscopic activity in ulcerative colitis patients? JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.712289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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8
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Liang S, Deng X, Lei L, Zheng Y, Ai J, Chen L, Xiong H, Mei Z, Cheng YC, Ren Y. The Comparative Study of the Therapeutic Effects and Mechanism of Baicalin, Baicalein, and Their Combination on Ulcerative Colitis Rat. Front Pharmacol 2019; 10:1466. [PMID: 31920656 PMCID: PMC6923254 DOI: 10.3389/fphar.2019.01466] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 11/13/2019] [Indexed: 12/13/2022] Open
Abstract
Introduction: Ulcerative colitis (UC) is an inflammatory bowel disease with a high incidence rate and a difficult treatment regimen. Recently, significant advances in the treatment of intestinal diseases, particularly UC, have been made with the use of the drugs baicalin and baicalein, separately or in combination. However, the therapeutic efficacy and mechanism of action of baicalin, baicalein, and their combination therapy, in the treatment of UC has not been fully elucidated. Materials and Methods: we constructed a UC rat model that encompassed a variety of complex factors, including a high-sugar and high-fat diet, a high temperature and humidity environment (HTHE), excess drinking, and infection of Escherichia coli. Model rats were then treated with baicalin, baicalein, or a combination of the two. Results: The results showed significant differences in the therapeutic effects of baicalin, baicalein, and the combination therapy, in the treatment of UC, as well as differences in the inhibition of inflammation via the nuclear factor-κB and MAPK pathways. The rat model of UC was established as described above. Then, the rats were treated for 7 days with baicalin (100 mg kg-1), baicalein (100 mg kg-1), or both (100 mg kg-1, baicalin: baicalein = 4:1/1:1). Clinical symptoms and signs, body temperature, organ indices, histopathology, blood biochemistry, and metabolites were examined to compare treatment effects and indicators of UC. Baicalin, YSR (Young Scutellaria baicalensis ratio of baicalin and baicalein), baicalein, and WSR (Withered Scutellaria baicalensis ratio of baicalin and baicalein) had significantly different effects in terms of clinical symptoms and signs, body temperature, organ indices, serum inflammatory cytokine levels, blood biochemistry, and histopathology changes in the main organs; YSR exhibited the best treatment effects. LC-MS/MS was used to detect the conversion of baicalin, baicalein, or both, into the six types of metabolites: baicalin, wogonoside, oroxin A, baicalein, wogonin, and oroxylin A. The levels of the six metabolites under the different treatment conditions were significantly different in the large intestine, small intestine, and lungs, but not in the blood. The levels of the six metabolites were significantly different in the large intestine, small intestine, and lung, but not in the serum. Conclusion: All these results indicate that baicalin and baicalein should be used more accurately in specific diseases, especially baicalin or high content of baicalin in Scutellaria baicalensis (Tiaoqin) should be preferred in treatment of UC.
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Affiliation(s)
- Shuai Liang
- School of Pharmaceutical Science, South-Central University for Nationalities, Wuhan, China
| | - Xin Deng
- School of Pharmaceutical Science, South-Central University for Nationalities, Wuhan, China
| | - Lei Lei
- School of Pharmaceutical Science, South-Central University for Nationalities, Wuhan, China
| | - Yao Zheng
- School of Pharmaceutical Science, South-Central University for Nationalities, Wuhan, China
| | - Jiao Ai
- School of Pharmaceutical Science, South-Central University for Nationalities, Wuhan, China
| | - Linlin Chen
- School of Pharmacy, Hubei University of Chinese Medicine, Wuhan, China
| | - Hui Xiong
- School of Pharmaceutical Science, South-Central University for Nationalities, Wuhan, China
| | - Zhinan Mei
- School of Pharmaceutical Science, South-Central University for Nationalities, Wuhan, China
| | - Yung-Chi Cheng
- School of Medicine, Yale University, New Haven, CT, United States
| | - Yongshen Ren
- School of Pharmaceutical Science, South-Central University for Nationalities, Wuhan, China.,School of Medicine, Yale University, New Haven, CT, United States
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Regulating effect of baicalin on IKK/IKB/NF-kB signaling pathway and apoptosis-related proteins in rats with ulcerative colitis. Int Immunopharmacol 2019; 73:193-200. [DOI: 10.1016/j.intimp.2019.04.052] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 04/15/2019] [Accepted: 04/25/2019] [Indexed: 12/19/2022]
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10
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Strowitzki MJ, Ritter AS, Kimmer G, Schneider M. Hypoxia-adaptive pathways: A pharmacological target in fibrotic disease? Pharmacol Res 2019; 147:104364. [PMID: 31376431 DOI: 10.1016/j.phrs.2019.104364] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/19/2019] [Accepted: 07/19/2019] [Indexed: 02/07/2023]
Abstract
Wound healing responses are physiological reactions to injuries and share common characteristics and phases independently of the injured organ or tissue. A major hallmark of wound healing responses is the formation of extra-cellular matrix (ECM), mainly consisting of collagen fibers, to restore the initial organ architecture and function. Overshooting wound healing responses result in unphysiological accumulation of ECM and collagen deposition, a process called fibrosis. Importantly, hypoxia (oxygen demand exceeds supply) plays a significant role during wound healing responses and fibrotic diseases. Under hypoxic conditions, cells activate a gene program, including the stabilization of hypoxia-inducible factors (HIFs), which induces the expression of HIF target genes counteracting hypoxia. In contrast, in normoxia, so-called HIF-prolyl hydroxylases (PHDs) oxygen-dependently hydroxylate HIF-α, which marks it for proteasomal degradation. Importantly, PHDs can be pharmacologically inhibited (PHI) by so-called PHD inhibitors. There is mounting evidence that the HIF-pathway is continuously up-regulated during the development of tissue fibrosis, and that pharmacological (HIFI) or genetic inhibition of HIF can prevent organ fibrosis. By contrast, initial (short-term) activation of the HIF pathway via PHI during wound healing seems to be beneficial in several models of inflammation or acute organ injury. Thus, timing and duration of PHI and HIFI treatment seem to be crucial. In this review, we will highlight the role of hypoxia-adaptive pathways during wound healing responses and development of fibrotic disease. Moreover, we will discuss whether PHI and HIFI might be a promising treatment option in fibrotic disease, and consider putative pitfalls that might result from this approach.
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Affiliation(s)
- Moritz J Strowitzki
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Alina S Ritter
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Gwendolyn Kimmer
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Martin Schneider
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
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11
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Viscido A, Papi C, Latella G, Frieri G. Has infliximab influenced the course and prognosis of acute severe ulcerative colitis? Biologics 2019; 13:23-31. [PMID: 31114154 PMCID: PMC6497489 DOI: 10.2147/btt.s179006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Ulcerative colitis (UC) still has no definitive cure since its etiology remains unclear. In recent years, considerable progress has been made with regard to our knowledge of the pathogenesis of UC. Advances in biotechnology have led to the development of biologic therapies which selectively target single key mediators or receptors involved in the pathogenesis of the disease - ie, tumor necrosis factor (TNF)-α, integrin, interleukins 12/23. Biologic therapies caused a revolution in the treatment of UC, providing specific options for patients refractory to conventional treatment. In recent years, antibodies anti-TNFα and anti-integrin have shown efficacy in improving the course and prognosis of ambulatory patients with moderate-to-severe UC. Nevertheless, whether biologics have brought so many benefits also for hospitalized patients with acute severe UC is still debated. Acute severe UC is a potentially life-threatening condition that affects up to 25% of patients during the course of their disease. It requires hospital admission due to the risk of complications and death, and it can necessitate urgent colectomy. Major adverse outcomes of acute severe UC are mortality and colectomy. The aim of this systematic review of the literature was to analyze the impact of biologics, in particular infliximab, on the course and prognosis of acute severe UC. Mortality and colectomy rates were considered as outcome measures.
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Affiliation(s)
- Angelo Viscido
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | | | - Giovanni Latella
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Giuseppe Frieri
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
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12
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Borren NZ, Khalili H, Luther J, Colizzo FP, Garber JJ, Ananthakrishnan AN. Second-Look Endoscopy in Hospitalized Severe Ulcerative Colitis: A Retrospective Cohort Study. Inflamm Bowel Dis 2019; 25:750-755. [PMID: 30204864 PMCID: PMC6765053 DOI: 10.1093/ibd/izy282] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Acute severe ulcerative colitis (ASUC) is a serious complication of ulcerative colitis (UC). Management of partial responders to steroids or rescue therapy remains challenging. Whether there is a role for re-look sigmoidoscopic evaluation in disease management is unknown. METHODS Our study cohort consisted of patients who underwent 2 sigmoidoscopic procedures during the same index hospitalization for ASUC at our center. Reasons for repeat endoscopic evaluation and endoscopic and histologic severity of inflammation during both procedures were noted. Multivariable regression models were performed to identify predictors of improvement at the second endoscopic assessment and to determine the independent effect of such an improvement on in-hospital colectomy and at 3, 6, and 12 months. RESULTS Our study included 49 patients (mean age, 42 years; 52% women). Just under one-third of patients (30%) were noted to have improved endoscopic appearance at the second sigmoidoscopy, at a median of 9 days after initial exam. None of the patients who had improvement on the second endoscopy underwent in-hospital colectomy, compared with 46% of those with worsening or persistent disease (P = 0.002). Similar differences in the improved group persisted at 3 months (P = 0.007) and 6 months (P = 0.027). Histologic severity at the first endoscopy was associated with increased risk of colectomy in-hospital (odds ratio, 3.8; 95% confidence interval, 1.02-14.21) and at 3 and 6 months. CONCLUSIONS After a median interval of 9 days, endoscopic improvement was noted in 30% of patients with ASUC undergoing a second sigmoidoscopy, which predicted lower rates of colectomy in-hospital and at 3 and 6 months.
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Affiliation(s)
- Nienke Z Borren
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Hamed Khalili
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jay Luther
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Francis P Colizzo
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - John J Garber
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ashwin N Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts,Address correspondence to: Ashwin N. Ananthakrishnan, MD, MPH, Division of Gastroenterology, Massachusetts General Hospital, 165 Cambridge Street, 9th Floor, Boston, MA 02114 ()
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Nalagatla N, Falloon K, Tran G, Borren NZ, Avalos D, Luther J, Colizzo F, Garber J, Khalili H, Melia J, Bohm M, Ananthakrishnan AN. Effect of Accelerated Infliximab Induction on Short- and Long-term Outcomes of Acute Severe Ulcerative Colitis: A Retrospective Multicenter Study and Meta-analysis. Clin Gastroenterol Hepatol 2019; 17:502-509.e1. [PMID: 29944926 PMCID: PMC6309670 DOI: 10.1016/j.cgh.2018.06.031] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/12/2018] [Accepted: 06/20/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS In patients with acute severe ulcerative colitis (ASUC), standard infliximab induction therapy has modest efficacy. There are limited data on the short-term or long-term efficacy of accelerated infliximab induction therapy for these patients. METHODS In a retrospective study, we collected data from 213 patients with steroid refractory ASUC who received infliximab rescue therapy at 3 centers, from 2005 through 2017. Patients were classified that received standard therapy (5mg/kg infliximab at weeks 0, 2, and 6) or accelerated therapy (>5mg/kg infliximab at shorter intervals). The primary outcome was colectomy in-hospital and at 3, 6, 12, and 24 months. Multivariable regression models were adjusted for relevant confounders. We also performed a meta-analysis of published effects of standard vs accelerated infliximab treatment of ASUC. RESULTS In the retrospective analysis, 81 patients received accelerated infliximab therapy and 132 received standard infliximab therapy. There were no differences in characteristics between the groups, including levels of C-reactive protein or albumin. Similar proportions of patients in each group underwent in-hospital colectomy (9% receiving accelerated therapy vs 8% receiving standard therapy; adjusted odds ratio, 1.35; 95% CI, 0.38-4.82). There was no significant difference between groups in proportions that underwent colectomy at 3, 6, 12, or 24 months (P > .20 for all comparisons). Among those in the accelerated group, an initial dose of 10 mg/kg was associated with a lower rate of colectomy compared to patients who initially received 5 mg/kg followed by subsequent doses of 5mg/kg or higher. Our systematic review identified 7 studies (181 patients receiving accelerated infliximab and 436 receiving standard infliximab) and found no significant differences in short- or long-term outcomes. CONCLUSION In a retrospective study and meta-analysis, we found no association between accelerated infliximab induction therapy and lower rates of colectomy in patients with ASUC, compared to standard induction therapy. However, confounding by disease severity cannot be excluded. Randomized trials are warranted to compare these treatment strategies.
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Affiliation(s)
- Niharika Nalagatla
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Katherine Falloon
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Gloria Tran
- Division of Gastroenterology and Hepatology, Indiana University Hospital, Indianapolis, Indiana
| | - Nienke Z Borren
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Danny Avalos
- Division of Gastroenterology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Jay Luther
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Francis Colizzo
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - John Garber
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Hamed Khalili
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Joanna Melia
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Matthew Bohm
- Division of Gastroenterology and Hepatology, Indiana University Hospital, Indianapolis, Indiana
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Yu Q, Mao R, Lian L, Ng SC, Zhang S, Chen Z, Zhang Y, Qiu Y, Chen B, He Y, Zeng Z, Ben-Horin S, Song X, Chen M. Surgical management of inflammatory bowel disease in China: a systematic review of two decades. Intest Res 2016; 14:322-332. [PMID: 27799883 PMCID: PMC5083261 DOI: 10.5217/ir.2016.14.4.322] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 07/11/2016] [Accepted: 07/14/2016] [Indexed: 12/12/2022] Open
Abstract
Background/Aims The past decades have seen increasing incidence and prevalence of inflammatory bowel disease (IBD) in China. This article aimed to summarize the current status and characteristics of surgical management for IBD in China. Methods We searched PubMed, Embase, and Chinese databases from January 1, 1990 to July 1, 2014 for all relevant studies on the surgical treatment IBD in China. Eligible studies with sufficient defined variables were further reviewed for primary and secondary outcome measures. Results A total of 74 studies comprising 2,007 subjects with Crohn's disease (CD) and 1,085 subjects with ulcerative colitis (UC) were included. The percentage of CD patients misdiagnosed before surgery, including misdiagnosis as appendicitis or UC, was 50.8%±30.9% (578/1,268). The overall postoperative complication rate was 22.3%±13.0% (267/1,501). For studies of UC, the overall postoperative complication rate was 22.2%±27.9% (176/725). In large research centers (n>50 surgical cases), the rates of emergency operations for CD (P=0.032) and in-hospital mortalities resulting from both CD and UC were much lower than those in smaller research centers (n≤50 surgical cases) (P=0.026 and P <0.001, respectively). Regarding the changes in CD and UC surgery over time, postoperative complications (P=0.045 for CD; P=0.020 for UC) and postoperative in-hospital mortality (P=0.0002 for CD; P=0.0160 for UC) both significantly improved after the year 2010. Conclusions The surgical management of IBD in China has improved over time. However, the rates of misdiagnosis and postoperative complications over the past two decades have remained high. Large research centers were found to have relatively better capacity for surgical management than the smaller ones. Higher quality prospective studies are needed in China.
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Affiliation(s)
- Qiao Yu
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ren Mao
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lei Lian
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Siew Chien Ng
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Chinese University of Hong Kong, Hong Kong, China
| | - Shenghong Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhihui Chen
- Department of General Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yanyan Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yun Qiu
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Baili Chen
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yao He
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhirong Zeng
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shomron Ben-Horin
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.; IBD Service, Department of Gastroenterology, Sheba Medical Center & Sackler School of Medicine, Tel-Aviv University, Tel Hashomer, Israel
| | - Xinming Song
- Department of General Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Minhu Chen
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Posul E, Yilmaz B, Aktas G, Kurt M. Does neutrophil-to-lymphocyte ratio predict active ulcerative colitis? Wien Klin Wochenschr 2015; 127:262-5. [PMID: 25576331 DOI: 10.1007/s00508-014-0683-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 11/24/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND Inflammatory markers have been studied in ulcerative colitis (UC) for diagnosis, disease activity, and prediction of relapse. Blood neutrophil-to-lymphocyte (N/L) ratio has been used to determine outcomes of some malignancies and coronary artery disease. Blood N/L ratio is a simple sign of clinical inflammation. In this study, we examined N/L ratio in recurrent patients suffering from UC. METHODS The aim of the present study was to analyze N/L ratios in serum samples of UC patients in remission and active phases. Patients' age, extend of the disease, disease duration, disease activity, drug, and other medical history were all noted for patients. C-reactive protein, erythrocyte sedimentation rate, and complete blood count were determined for patients. RESULTS Forty-nine UC patients were admitted into the present study. The blood N/L ratios were significantly increased in active phase compared with inactive UC patients (p < 0.05). The cut-off value for N/L ratio for the detection of active UC patients was calculated as ≥ 2.3 using receiver operating characteristic analysis [sensitivity: 61.2 %, specificity: 66.7 %, AUC: 0.650 (0.540-0.760), p = 0.01]. CONCLUSIONS Present study shows that in patients with UC, the blood N/L ratio is associated with active disease. N/L ratio may be used as an activity parameter in UC.
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Affiliation(s)
- Emrah Posul
- Faculty of Medicine, Department of Gastroenterology, Abant Izzet Baysal University, Golkoy, 14280, Bolu, Turkey
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Lim AH, Grafton R, Hetzel DJ, Andrews JM. Clinical audit: recent practice in caring for patients with acute severe colitis compared with published guidelines--is there a problem? Intern Med J 2014; 43:803-9. [PMID: 23176535 DOI: 10.1111/imj.12042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 10/28/2012] [Indexed: 12/27/2022]
Abstract
BACKGROUND Acute severe colitis (ASC) is a serious condition with possible outcomes of emergency colectomy and mortality. Validated guidelines exist to help avoid these. AIMS To examine local adherence to guidelines and identify (a) opportunities to improve care and (b) possible barriers to adherence. METHODS Retrospective, hospital-wide audit of all patients with ASC during a 2-year period (2009-2010) at a major metropolitan hospital. Cases were identified by an electronic search of all discharges with International Classification of Diseases-10 codes for colitis, colectomy, ulcerative colitis or Crohn disease. RESULTS Twenty-six patients had 30 ASC admissions (14 female). Most admissions were under gastroenterology (25), 4 (13%) were under general medicine and 1 was under general surgery. Only 8 patients' (26%) management (all under gastroenterology) included all major details: blood investigations, Clostridium difficile test, abdominal X-ray, colonic examination and venous thromboembolism prophylaxis. Only one patient had formal severity scoring on admission, and seven patients (24%) had descriptive severity recorded. On day 3, nine patients (30%) had some recorded severity assessment; however, no formal criteria were used. Four had colectomy, three during first admission and one on re-admission. Of these patients, three received cyclosporine prior to colectomy. The mean duration of admission was 10 days (standard deviation 10.54, range 1-61). CONCLUSION Opportunities to optimise care exist including formal severity assessments on days 1 and 3, better deep vein thrombosis/pulmonary embolism prophylaxis and prompt colonic examination. Admission under teams other than gastroenterology appeared to be a barrier to better care. Despite the low rate of ideal management, the colectomy rate was acceptably low at 20%.
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Affiliation(s)
- A H Lim
- University of Adelaide, Adelaide, South Australia, Australia.
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17
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Stewart MJ, Kutcher M, Storr M, Seow CH. Interventions for induction of mucosal healing in ulcerative colitis. Hippokratia 2014. [DOI: 10.1002/14651858.cd010997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Michael J Stewart
- Cedars-Sinai Medical Center; Inflammatory Bowel Disease Center; Los Angeles California USA
| | - Matthew Kutcher
- Dalhousie University; Faculty of Medicine; Halifax Nova Scotia Canada
| | - Martin Storr
- University of Munich; Department of Medicine; Marchioninistr 15 Munich Germany 81377
| | - Cynthia H Seow
- University of Calgary; Departments of Medicine & Community Health Sciences; TRW Building Rm 6D18 3280 Hospital Drive NW Calgary Alberta Canada T2N 4Z6
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18
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Interventions for maintenance of mucosal healing in ulcerative colitis. Hippokratia 2014. [DOI: 10.1002/14651858.cd010998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Senanayake SM, Fernandopulle ANR, Niriella MA, Wijesinghe NT, Ranaweera A, Mufeena MN, Pathmeswaran A, Nawarathne NM, de Silva AP, de Silva HJ. The long-term outcomes of a cohort of Sri Lankan patients with ulcerative colitis: a retrospective study at two national referral centers and review of literature. Clin Exp Gastroenterol 2013; 6:195-200. [PMID: 24068873 PMCID: PMC3782511 DOI: 10.2147/ceg.s49202] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Inflammatory bowel disease, especially ulcerative colitis, is increasing in many "non-Western" countries, including Sri Lanka. The aim was to evaluate long-term outcomes of ulcerative colitis in a Sri Lankan population. METHODS A retrospective cohort study was conducted at the gastroenterology clinics of the Colombo North Teaching Hospital, Ragama and the National Hospital of Sri Lanka, Colombo; the two major referral centers for ulcerative colitis. All cases had histological confirmation of ulcerative colitis. Three outcomes: colectomy, development of colorectal carcinoma, and death were assessed. Patients not attending the clinic during the previous 4 weeks, or their families, were contacted to obtain clinical details and survival status. In those who had died, the cause of death was confirmed from clinical records and death certificates. RESULTS Details of 348/425 (81.9%) patients with ulcerative colitis (mean age 45.6 [standard deviation {SD} 14.3] years, male/female ratio = 1.00:1.03) were available. The mean follow-up was 6.8 (SD 6.5) years. The cumulative colectomy rates at 1, 5, 10, and 15 years were 1.5%, 4.0%, 5.5%, and 9.3% respectively. The cumulative probability of colorectal cancer in this cohort after 10 and 15 years was 0.47% and 2.36% respectively. The cumulative survival rate after 1, 5, 10, and 15 years was 99.7%, 98.9%, 98.1%, and 94.5% respectively. Patients with pancolitis were more likely to have disease-related death (P = 0.05). Multivariate analysis (Cox proportional hazards model) showed that an older age at diagnosis was associated with long-term mortality (hazard ratio, 1.11; P = 0.001). CONCLUSION In this cohort, colectomy, colorectal carcinoma, and death rates were low, suggesting a relatively benign disease course for ulcerative colitis.
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Celikbilek M, Dogan S, Ozbakır O, Zararsız G, Kücük H, Gürsoy S, Yurci A, Güven K, Yücesoy M. Neutrophil-lymphocyte ratio as a predictor of disease severity in ulcerative colitis. J Clin Lab Anal 2013; 27:72-6. [PMID: 23292894 DOI: 10.1002/jcla.21564] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Accepted: 11/01/2012] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Blood neutrophil-to-lymphocyte (N/L) ratio is an indicator of the overall inflammatory status of the body, and an alteration in N/L ratio may be found in ulcerative colitis (UC) patients. The aims of this study were to investigate the utility of N/L ratio as a simple and readily available predictor for clinical disease activity in UC. METHODS Twenty-six patients and 28 healthy controls were enrolled in the study. The neutrophil and lymphocyte counts were recorded, and the N/L ratio was calculated from these parameters. The extent of disease classified according to the Montreal classification, clinical disease activity was evaluated using a modified Truelove-Witts severity index, and endoscopic disease activities were classified according to Schroder et al. RESULTS The serum N/L ratios of active patients were significantly higher than those of inactive UC and controls (P < 0.001). The optimum N/L ratio cut-off point for active UC was 2.47. There was no significant difference between inflammation parameters, disease extension, and disease activity. CONCLUSION Our results demonstrate that N/L ratio is higher in patients with active UC compared with controls and UC patients in remission and a cut-off value of 2.47 can be used to identify patients with active ulcerative colitis.
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Affiliation(s)
- Mehmet Celikbilek
- Department of Gastroenterology and Hepatology, Erciyes University, Medical School, Kayseri, Turkey.
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Uchida K, Araki T, Kusunoki M. History of and current issues affecting surgery for pediatric ulcerative colitis. Surg Today 2012. [PMID: 23203770 DOI: 10.1007/s00595-012-0434-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pediatric ulcerative colitis (UC) is reportedly more extensive and progressive in its clinical course than adult UC. Therefore, more aggressive initial therapies and more frequent colectomies are needed. When physicians treat pediatric UC, they must consider the therapeutic outcome as well as the child's physical and psychological development. Mucosal proctocolectomy with ileal J-pouch anal anastomosis is currently recommended as a standard curative surgical procedure for UC in both children and adults worldwide. This procedure was developed 100 years after the first surgical therapy, which treated UC by colon irrigation through a temporary inguinal colostomy. Predecessors in the colorectal and pediatric surgical fields have struggled against several postoperative complications and have long sought a surgical procedure that is optimal for children. We herein describe the history of the development of surgical procedures and the current issues regarding the surgical indications for pediatric UC. These issues differ from those in adults, including the definition of toxic megacolon on plain X-rays, the incidence of colon carcinoma, preoperative and postoperative steroid complications, and future growth. Surgeons treating children with UC should consider the historical experiences of pioneer surgeons to take the most appropriate next step to improve the surgical outcomes and patients' quality of life.
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Affiliation(s)
- Keiichi Uchida
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan,
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Yamamoto-Furusho JK, de León-Rendón JL, Rodas L. [Infection frequency in patients with chronic idiopathic ulcerative colitis]. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2012; 77:186-92. [PMID: 23159238 DOI: 10.1016/j.rgmx.2012.07.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 07/02/2012] [Accepted: 07/10/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND Ulcerative Colitis (UC) is a chronic inflammatory bowel disease characterized by diffuse inflammation of the mucosa of the colon. Up to now, diverse observational studies have implicated a wide variety of pathogenic microorganisms as causal and exacerbating factors in UC. Clostridium difficile (C. difficile) infection has been associated with recurrence and treatment failure and its incidence in patients with UC has been on the rise in the last few years. AIMS To determine the frequency of infection by different microorganisms in Mexican UC patients. PATIENTS AND METHODS A total of 150 patients with definitive UC diagnosis were studied. All the stool tests for parasites and ova, stool cultures, tests for the C. difficile toxins A and B, and immunohistochemistry for Cytomegalovirus in colon segment biopsies were analyzed. Other demographic and clinical variables of the disease were recorded for their correlation with infection frequency. RESULTS Infection frequency in UC patients was 28.00%. C. difficile infection was present in 0.013%. Other pathogens were found, such as Endolimax nana (9.00%), Entamoeba histolytica (3.00%), Cytomegalovirus (2.00%), Salmonella (2.00%), Shigella (0.70%), Toxoplasma gondii (0.70%) and Iodamoeba bütschlii (0.70%). CONCLUSIONS Infection frequency was 28.00% in our study and C. difficile infection represented only 0.013%.
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Affiliation(s)
- J K Yamamoto-Furusho
- Clínica de Enfermedad Inflamatoria Intestinal, Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México D.F., México.
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Serada S, Fujimoto M, Terabe F, Iijima H, Shinzaki S, Matsuzaki S, Ohkawara T, Nezu R, Nakajima S, Kobayashi T, Plevy SE, Takehara T, Naka T. Serum leucine-rich alpha-2 glycoprotein is a disease activity biomarker in ulcerative colitis. Inflamm Bowel Dis 2012; 18:2169-79. [PMID: 22374925 DOI: 10.1002/ibd.22936] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Accepted: 02/13/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Reliable biomarkers for monitoring disease activity have not been clinically established in ulcerative colitis (UC). This study aimed to investigate whether levels of serum leucine-rich alpha-2 glycoprotein (LRG), identified recently as a potential disease activity marker in Crohn's disease and rheumatoid arthritis, correlate with disease activity in UC. METHODS Serum LRG concentrations were determined by enzyme-linked immunosorbent assay (ELISA) in patients with UC and healthy controls (HC) and were evaluated for correlation with disease activity. Expression of LRG in inflamed colonic tissues from patients with UC was analyzed by western blotting and immunohistochemistry. Interleukin (IL)-6-independent induction of LRG was investigated using IL-6-deficient mice by lipopolysaccharide (LPS)-mediated acute inflammation and dextran sodium sulfate (DSS)-induced colitis. RESULTS Serum LRG concentrations were significantly elevated in active UC patients compared with patients in remission (P < 0.0001) and HC (P < 0.0001) and were correlated with disease activity in UC better than C-reactive protein (CRP). Expression of LRG was increased in inflamed colonic tissues in UC. Tumor necrosis factor alpha (TNF-α), IL-6, and IL-22, serum levels of which were elevated in patients with active UC, could induce LRG expression in COLO205 cells. Serum LRG levels were increased in IL-6-deficient mice with LPS-mediated acute inflammation and DSS-induced colitis. CONCLUSIONS Serum LRG concentrations correlate well with disease activity in UC. LRG induction is robust in inflamed colons and is likely to involve an IL-6-independent pathway. Serum LRG is thus a novel serum biomarker for monitoring disease activity in UC and is a promising surrogate for CRP.
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Affiliation(s)
- Satoshi Serada
- Laboratory for Immune Signal, National Institute of Biomedical Innovation, Osaka, Japan
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Hokama A, Ohira T, Kishimoto K, Kinjo F, Fujita J. Impending megacolon: small bowel distension as a predictor of toxic megacolon in ulcerative colitis. Intern Emerg Med 2012; 7:487-8. [PMID: 22843318 DOI: 10.1007/s11739-012-0834-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 07/14/2012] [Indexed: 12/17/2022]
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Jung SA. Differential diagnosis of inflammatory bowel disease: what is the role of colonoscopy? Clin Endosc 2012; 45:254-62. [PMID: 22977813 PMCID: PMC3429747 DOI: 10.5946/ce.2012.45.3.254] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 07/25/2012] [Accepted: 07/25/2012] [Indexed: 12/28/2022] Open
Abstract
Colonoscopy plays a crucial role in the diagnosis, treatment and follow-up monitoring of inflammatory bowel disease (IBD). Practitioners should be well informed of the colonoscopic findings of IBD to prevent the misdiagnosis, overtreatment or delayed treatment. Distinguishing between Crohn's disease and ulcerative colitis is essential in terms of pharmacological treatment, surgical decision-making, and prognosis. But there are still lesions with difficulty in differentiation that approximately 10% of the patients fall into the category of indeterminate colitis. Efforts are needed to carefully select treatment approach appropriate for each patient by providing a precise diagnosis on the extent and degree of lesions as well as to accurately delineate the lesions to assure that they are compared in subsequent rounds of follow-up monitoring in order to allow redetermination and adjustment of the treatment.
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Affiliation(s)
- Sung-Ae Jung
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
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Latella G, Papi C. Crucial steps in the natural history of inflammatory bowel disease. World J Gastroenterol 2012; 18:3790-9. [PMID: 22876029 PMCID: PMC3413049 DOI: 10.3748/wjg.v18.i29.3790] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 04/18/2012] [Accepted: 05/05/2012] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), are chronic, progressive and disabling disorders. Over the last few decades, new therapeutic approaches have been introduced which have led not only to a reduction in the mortality rate but also offered the possibility of a favorable modification in the natural history of IBD. The identification of clinical, genetic and serological prognostic factors has permitted a better stratification of the disease, thus allowing the opportunity to indicate the most appropriate therapy. Early treatment with immunosuppressive drugs and biologics has offered the opportunity to change, at least in the short term, the course of the disease by reducing, in a subset of patients with IBD, hospitalization and the need for surgery. In this review, the crucial steps in the natural history of both UC and CD will be discussed, as well as the factors that may change their clinical course. The methodological requirements for high quality studies on the course and prognosis of IBD, the true impact of environmental and dietary factors on the clinical course of IBD, the clinical, serological and genetic predictors of the IBD course (in particular, which of these are relevant and appropriate for use in clinical practice), the impact of the various forms of medical treatment on the IBD complication rate, the role of surgery for IBD in the biologic era, the true magnitude of risk of colorectal cancer associated with IBD, as well as the mortality rate related to IBD will be stressed; all topics that are extensively discussed in separate reviews included in this issue of World Journal of Gastroenterology.
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Treatment of hospitalized adult patients with severe ulcerative colitis: Toronto consensus statements. Am J Gastroenterol 2012; 107:179-94; author reply 195. [PMID: 22108451 DOI: 10.1038/ajg.2011.386] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The objective of this study was to provide updated explicit and relevant consensus statements for clinicians to refer to when managing hospitalized adult patients with acute severe ulcerative colitis (UC). METHODS The Canadian Association of Gastroenterology consensus group of 23 voting participants developed a series of recommendation statements that addressed pertinent clinical questions. An iterative voting and feedback process was used to do this in conjunction with systematic literature reviews. These statements were brought to a formal consensus meeting held in Toronto, Ontario (March 2010), when each statement was discussed, reformulated, voted upon, and subsequently revised until group consensus (at least 80% agreement) was obtained. The modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria were used to rate the strength of recommendations and the quality of evidence. RESULTS As a result of the iterative process, consensus was reached on 21 statements addressing four themes (General considerations and nutritional issues, Steroid use and predictors of steroid failure, Cyclosporine and infliximab, and Surgical issues). CONCLUSIONS Key recommendations for the treatment of hospitalized patients with severe UC include early escalation to second-line medical therapy with either infliximab or cyclosporine in individuals in whom parenteral steroids have failed after 72 h. These agents should be used in experienced centers where appropriate support is available. Sequential therapy with cyclosporine and infliximab is not recommended. Surgery is an option when first-line steroid therapy fails, and is indicated when second-line medical therapy fails and/or when complications arise during the hospitalization.
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Beyazit Y, Koklu S, Tas A, Purnak T, Sayilir A, Kurt M, Turhan T, Celik T, Suvak B, Torun S, Akbal E. Serum adenosine deaminase activity as a predictor of disease severity in ulcerative colitis. J Crohns Colitis 2012; 6:102-7. [PMID: 22261534 DOI: 10.1016/j.crohns.2011.07.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 07/01/2011] [Accepted: 07/15/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM Ulcerative colitis (UC) is a chronic inflammatory disease characterized by recurrent inflammation and ulcerations of colonic mucosa and an inappropriate and delayed healing. Adenosine deaminase (ADA) is a cytoplasmic enzyme involved in the catabolism of purine bases, capable of catalyzing the deamination of adenosine, forming inosine in the result process. Although ADA has been shown to increase in several inflammatory conditions, there are no literature data indicating an alteration in UC. METHODS This study evaluated the activity of total ADA in serum of 43 patients with UC and 18 healthy controls. Patients' age, disease duration, drug intake, and other medical history were all noted for each subject. Complete blood count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were determined for both patients and controls. Correlation analysis was also performed between ADA and other inflammation markers of UC. RESULTS Serum mean ADA levels were 11.12 ± 2.03 and 7.99 ± 2.04 U/l for patients with UC in active state and in remission and 8.55 ± 2.26 U/l in the healthy control group. Mean serum ADA levels were significantly elevated in active UC patients compared with patients with UC in remission and control groups. Overall accuracy of ADA in determination of active UC was 83.7 with sensitivity 83.3%, specificity 84.2%. CONCLUSIONS Serum ADA levels were found to be elevated in UC patients in active state suggesting a partial role of activated T-cell response in the disease pathophysiology. Further randomized controlled studies are warranted to demonstrate the role of ADA in UC patients, with a special interest in specifically targeted therapies against ADA for achieving disease remission.
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Affiliation(s)
- Yavuz Beyazit
- Department of Gastroenterology, Turkiye Yuksek İhtisas Training and Research Hospital, Ankara, Turkey.
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Abstract
Megacolon, defined as dilation of the abdominal colon, may occur acutely or in a chronic form. Acute megacolon that occurs in association with severe inflammation of the colon is known as toxic megacolon, whereas acute megacolon without obvious colonic disease is known as Ogilvie's syndrome. The pathophysiology and management of toxic megacolon, Ogilvie's syndrome, and chronic megacolon in adults differ significantly, and it is critically important to distinguish among these entities. Toxic megacolon is a medical emergency that requires coordinated intensive medical and surgical management. In addition to vigorous resuscitation with fluids, electrolytes, and blood products, medical treatment consists of parenteral corticosteroids, broad-spectrum antibiotics, and close monitoring of the patient. Surgical intervention is required if there is no improvement, or deterioration after 12 to 24 hours of intensive medical management, or if there is evidence of colon perforation. Ogilvie's syndrome usually occurs in hospitalized patients with serious underlying medical or surgical illnesses. Management is directed at preventing ischemia and perforation of the distended colon. Supportive therapy includes nasogastric suction, correction of fluid and electrolyte imbalances, stopping potentially aggravating medications, and decompressing the colon with a rectal tube and positional changes. Intravenous neostigmine is the only pharmacologic agent of proven efficacy; colonoscopic decompression is an alternative in patients who do not respond to neostigmine or who have conditions that contraindicate its use. Daily oral administration of polyethylene glycol electrolyte solutions appears to decrease the relapse rate after initial decompression is achieved. Chronic megacolon in adults represents advanced colon failure that does not respond to pharmacologic stimulation. Goals of therapy are to cleanse the colon, prevent impaction, and minimize stool volume and gas buildup. For patients with disabling symptoms, surgical exclusion of the colon, decompression and antegrade enemas via cecostomy, or subtotal or segmental resection may be palliative.
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Affiliation(s)
- Stephen B Hanauer
- Arnold Wald, MD Section of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, H6/516 CSC, Madison, WI 53792-5124, USA.
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Iacucci M, Ghosh S. Looking beyond symptom relief: evolution of mucosal healing in inflammatory bowel disease. Therap Adv Gastroenterol 2011; 4:129-43. [PMID: 21694814 PMCID: PMC3105624 DOI: 10.1177/1756283x11398930] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The focus of effective management of inflammatory bowel disease, especially Crohn's disease, has shifted from short-term symptom control to long-term modification of disease course and complications. Intestinal healing has achieved prominence as a goal of therapy that influences long-term disease course. We review the natural history of inflammatory bowel disease, the markers of disease control that may reflect outcomes and the specific role of mucosal healing. We may aim at better mucosal healing by appropriate choice of therapy, appropriate combinations of therapy and intervening early in the disease course.
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Affiliation(s)
- Marietta Iacucci
- Division of Gastroenterology, San Camillo/Forlanini Hospital, Rome, Italy
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Abstract
Pediatric ulcerative colitis (UC) has a more severe phenotype, reflected by more extensive disease and a higher rate of acute severe exacerbations. The pooled steroid-failure rate among 291 children from five studies is 34% (95% confidence interval [CI]: 27%-41%). It is suggested that corticosteroids should be dosed between 1-1.5 mg/kg up to 40-60 mg daily. Food restriction has a limited role in severe UC and should be generally discouraged in children who do not have a surgical abdomen. Appraisal of radiologic findings in children must recognize the variation in colonic width with age and size. Data suggest that the Pediatric UC Activity Index (PUCAI), determined at day 3, should be used to screen for patients likely to fail corticosteroids (>45 points), and at day 5 to dictate the introduction of second-line therapy (>65-70 points). Cyclosporine is successful in children with severe colitis but its use should be restricted to 3-4 months while bridging to thiopurine treatment (pooled short-term success rate 81% [95% CI: 76%-86%]; n = 94 from eight studies). Infliximab may be as effective as cyclosporine (75% pooled short-term response (95% CI: 67%-83%); n = 126, six studies) with a pooled 1-year response of 64% (95% CI: 56%-72%). In toxic megacolon, in patients refractory to one salvage medical therapy, and in chronic severe disease, colectomy may be preferred. Decision-making regarding colectomy in children must consider the toxicity of medication consumed over many future years, the quality of life and self-image associated with either choice, as well as both functional outcomes and, in females, fertility following pouch procedures.
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Affiliation(s)
- Dan Turner
- Pediatric Gastroenterology Unit, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.
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Holme O, Thiis-Evensen E, Vatn MH. Treatment of fulminant ulcerative colitis with cyclosporine A. Scand J Gastroenterol 2010; 44:1310-4. [PMID: 19891581 DOI: 10.3109/00365520903222673] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE. Fulminant ulcerative colitis not responding to high doses of corticosteroids remains a clinical challenge. Intravenous infusion of cyclosporine A (CyA) has shown an excellent short-term response, but its use has been restricted by potential serious adverse events and reports of high short- and long-term colectomy rates. The purpose of this study was to report on the Oslo experience with CyA in fulminant ulcerative colitis. MATERIAL AND METHODS. Between 1993 and 2006, intravenous CyA (5 mg/kg) was administered to 18 patients with fulminant ulcerative colitis. Responders were discharged under a 6 months' course of oral CyA. Patients were prospectively followed at 2, 6, 12 and 24 months after discharge. RESULTS. Fifteen patients (83%) responded to intravenous CyA treatment. On follow-up at 2, 6, 12 and 24 months, the colectomy-free rates were 72%, 67%, 61% and 56%, respectively. After a median follow-up of 60.3 months (range 1.7-146), 8 patients (44%) still had avoided having to undergo a colectomy. All patients had at least one relapse during follow-up. Only one patient had to discontinue CyA owing to adverse events. CONCLUSION. At our institution, CyA treatment of fulminant ulcerative colitis is an effective and safe treatment.
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Affiliation(s)
- Oyvind Holme
- Clinic of Gastroenterology, Oslo University Hospital, Norway.
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Yüksel O, Helvaci K, Başar O, Köklü S, Caner S, Helvaci N, Abayli E, Altiparmak E. An overlooked indicator of disease activity in ulcerative colitis: mean platelet volume. Platelets 2009; 20:277-81. [PMID: 19459134 DOI: 10.1080/09537100902856781] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Many non-invasive tests have been studied for diagnosis and determining the activation degree of inflammatory bowel disease (IBD). Nevertheless, an ideal test has not been found yet. Mean platelet volume (MPV) is influenced by the inflammation. In a few study, decreased platelet volume have been reported in IBD. The aim of this study is to determine whether platelet volume would be useful in ulcerative colitis (UC) activity. Additionally we have analyzed overall accuracy of MPV in disease activity and compared with other inflammatory markers. A total of 61 UC patients (male/female : 41/20), and 27 healthy subjects (male/female : 18/9) were enrolled into the study. For all subjects following tests were performed; ESR, CRP, white blood cell count and mean platelet volume. A statistically significant decrease in MPV was noted in patients with UC (8.29 +/- 1.02 fL) compared with healthy controls (8.65 +/- 0.79 fL). MPV of active UC (8.06 +/- 1.19 fL) patients were significantly lower than that of inactive UC (8.45 +/- 0.87 fL). Overall accuracy of MPV in determination of active UC was 71% (with sensitivity 67%, specificity 73%). A negative correlation was found between MPV and endoscopic activity index (r : -0.358 p : 0.005). In UC, MPV did not correlate with ESR, CRP and white blood cell. Our study showed that MPV reduced in UC, particularly in patients with active UC. Decreased MPV may be an indicator for increased disease activity in patients with UC.
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Affiliation(s)
- Osman Yüksel
- Department of Gastroenterology, Dişkapi Yildirim Beyazit Hospital, Ankara, Turkey.
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Ananthakrishnan AN, Issa M, Beaulieu DB, Skaros S, Knox JF, Lemke K, Emmons J, Lundeen SH, Otterson MF, Binion DG. History of medical hospitalization predicts future need for colectomy in patients with ulcerative colitis. Inflamm Bowel Dis 2009; 15:176-81. [PMID: 18680197 DOI: 10.1002/ibd.20639] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Patients who require hospitalization for the management of ulcerative colitis (UC) may represent a subset with severe disease. These patients may be more likely to require future colectomy. There are limited data examining whether medical hospitalization is predictive of subsequent colectomy. METHODS This was a retrospective case-control study utilizing the inflammatory bowel disease center database at our academic referral center. Cases comprised UC patients who underwent colectomy for disease refractory to medical management. The control population was comprised of all patients with UC who had not undergone colectomy. Multivariate logistic regression was used to identify independent predictors of requiring colectomy. RESULTS There were a total of 246 UC patients included in our study, with 103 being hospitalized sometime in their disease course (41.9%). A total of 27 patients underwent colectomy (11%). Colectomy patients were significantly more likely to have been on infliximab therapy (51.8% versus 22.4%, P = 0.001) but no more likely to have been on immunomodulator therapy (74.1% versus 59.4%, P = 0.14). Patients who required medical hospitalization for UC were more likely to require future colectomy (20.4% versus 4.2%, P < 0.001) than those who had not required hospitalization. On multivariate analysis, requiring medical hospitalization for management of UC (odds ratio [OR] 5.37, 95% confidence interval [CI] 2.00-14.46) and ever requiring infliximab therapy (OR 3.12, 95% CI 1.21-8.07) were independent predictors of colectomy. CONCLUSIONS Requiring medical hospitalization for the management of disease activity in UC is an independent predictor of the need for colectomy. Future studies will determine whether aggressive medical management may modify the need for colectomy in this cohort.
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Affiliation(s)
- Ashwin N Ananthakrishnan
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Becker JM, Stucchi AF. Treatment of choice for acute severe steroid-refractory ulcerative colitis is colectomy. Inflamm Bowel Dis 2009; 15:146-9. [PMID: 19009603 DOI: 10.1002/ibd.20780] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- James M Becker
- Department of Surgery, Boston University Medical Center, Boston, Massachusetts 02118, USA. interscience.wiley.com
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Caprilli R, Clemente V, Frieri G. Historical evolution of the management of severe ulcerative colitis. J Crohns Colitis 2008; 2:263-8. [PMID: 21172222 DOI: 10.1016/j.crohns.2008.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Accepted: 03/23/2008] [Indexed: 02/08/2023]
Abstract
Ulcerative colitis was first described in 1859, but it was not until the early 20th century that it became a well recognized clinical entity. The patients of the old series showed high mortality rate ranging from 30% in the severe forms to 60% in the fulminating forms. The introduction of corticosteroids in the 1950s dramatically improved the prognosis of patients with severe ulcerative colitis. The strategy based on intensive medical treatment, early detection of risk factors and early surgery progressively reduced the mortality rate to less than 1%. Tachycardia, fever, reduced number of intestinal sounds, hypoalbuminaemia, hypokalaemia metabolic alkalosis and elevated C-reactive protein were recognized to be the most useful risk factors. Plain abdominal X-ray remains the very reliable suitable tool to detect early complications of severe colitis. Once reduced the mortality near to zero, treatment has been addressed to avoid colectomy. Cyclosporine and Infliximab are currently used as rescue therapy, however, despite the high remission rates achieved with both drugs, about 50% of the treated patients ultimately will come to colectomy over the next few years.
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