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Alhalabi M, Alziadan SM. A diagnostic dilemma: cytomegalovirus colitis as an uncommon comorbidity in inflammatory bowel disease: a case report. Virol J 2024; 21:188. [PMID: 39152468 PMCID: PMC11330031 DOI: 10.1186/s12985-024-02467-y] [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] [Received: 06/08/2024] [Accepted: 08/13/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND The role of cytomegalovirus infection as an opportunistic pathogen in exacerbating ulcerative colitis and its response to treatment remain a topic of ongoing debate. Clinicians encounter numerous challenges, including the criteria for differentiating between an acute ulcerative colitis flare and true cytomegalovirus colitis, the diagnostic tests for identifying cytomegalovirus colitis, and determining the appropriate timing for initiating antiviral therapy. CASE PRESENTATION A 28-year-old Syrian female with a seven-year history of pancolitis presented with worsening bloody diarrhea, abdominal pain, and tenesmus despite ongoing treatment with azathioprine, mesalazine, and prednisolone. She experienced a new flare of acute severe ulcerative colitis despite recently completing two induction doses of infliximab (5 mg/kg) initiated four weeks prior for moderate-to-severe ulcerative colitis. She had no prior surgical history. Her symptoms included watery, bloody diarrhea occurring nine to ten times per day, abdominal pain, and tenesmus. Initial laboratory tests indicated anemia, leukocytosis, elevated C-reactive protein (CRP) and fecal calprotectin levels, and positive CMV IgG. Stool cultures, Clostridium difficile toxin, testing for Escherichia coli and Cryptosporidium, and microscopy for ova and parasites were all negative. Sigmoidoscopy revealed numerous prominent erythematous area with spontaneous bleeding. Biopsies demonstrated CMV inclusions confirmed by immunohistochemistry, although prior biopsies were negative. We tapered prednisolone and azathioprine and initiated ganciclovir at 5 mg/kg for ten days, followed by valganciclovir at 450 mg twice daily for three weeks. After one month, she showed marked improvement, with CRP and fecal calprotectin levels returning to normal. She scored one point on the partial Mayo score. The third induction dose of infliximab was administered on schedule, and azathioprine was resumed. CONCLUSION Concurrent cytomegalovirus infection in patients with inflammatory bowel disease presents a significant clinical challenge due to its associated morbidity and mortality. Diagnosing and managing this condition is particularly difficult, especially regarding the initiation or continuation of immunosuppressive therapies.
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Affiliation(s)
- Marouf Alhalabi
- Gastroenterology Department, Damascus Hospital, Almujtahed Street, Damascus, Syria.
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Martins ASDP, de Araújo ORP, Gomes ADS, Araujo FLC, Oliveira Junior J, de Vasconcelos JKG, Rodrigues Junior JI, Cerqueira IT, Lins Neto MÁDF, Bueno NB, Goulart MOF, Moura FA. Effect of Curcumin Plus Piperine on Redox Imbalance, Fecal Calprotectin and Cytokine Levels in Inflammatory Bowel Disease Patients: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Pharmaceuticals (Basel) 2024; 17:849. [PMID: 39065700 PMCID: PMC11279814 DOI: 10.3390/ph17070849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/11/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024] Open
Abstract
The development and course of inflammatory bowel disease (IBD) are significantly influenced by inflammation and oxidative stress. Antioxidant therapy is a promising therapeutic option to enhance the clinical results of these individuals in this particular scenario. The purpose of this study is to assess the impact of curcumin, with or without piperine, on cytokines, fecal calprotectin (CalF), and oxidative stress enzymatic and non-enzymatic indicators in patients with IBD. METHODS Patients with Crohn's disease (CD) or ulcerative colitis (UC) who were at least 18 years old and had intact liver and kidney function participated in this randomized, double-blind trial (trial registration: ensaiosclinicos.gov.br as RBR-89q4ydz). For 12 weeks, participants were randomly assigned to one of three groups: placebo, curcumin (1000 mg/day), or curcumin plus piperine (1000 mg + 10 mg/day). In order to examine oxidative stress indicators, CalF, and pro-inflammatory cytokines, blood and fecal samples were obtained, both prior to and following the intervention time. RESULTS After adjusting for age, sex, and type of IBD, the curcumin plus piperine group had substantially higher serum levels of superoxide dismutase (SOD) than the placebo group (4346.9 ± 879.0 vs. 3614.5 ± 731.5; p = 0.041). There were no discernible variations between the groups in CalF, inflammatory markers, or other indicators of oxidative stress. CONCLUSIONS In patients with inflammatory bowel disease (IBD), our study indicates that a 12-week curcumin plus piperine treatment effectively increases enzymatic antioxidant defense, especially SOD. These results demonstrate the potential therapeutic benefits of managing redox imbalance in individuals with IBD.
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Affiliation(s)
- Amylly Sanuelly da Paz Martins
- Pós-Graduação da Rede Nordeste de Biotecnologia (RENORBIO), Universidade Federal de Alagoas (UFAL), Maceió 57072-970, AL, Brazil;
| | - Orlando Roberto Pimentel de Araújo
- Instituto de Química e Biotecnologia (IQB/UFAL), Universidade Federal de Alagoas (UFAL), Maceió 57072-970, AL, Brazil; (O.R.P.d.A.); (I.T.C.)
| | - Amanda da Silva Gomes
- Pós-Graduação em Nutrição (PPGNUT), Universidade Federal de Alagoas (UFAL), Maceió 57072-970, AL, Brazil; (A.d.S.G.); (J.I.R.J.); (N.B.B.)
| | - Fernanda Lívia Cavalcante Araujo
- Faculdade de Nutrição (FANUT), Universidade Federal de Alagoas (UFAL), Maceió 57072-970, AL, Brazil; (F.L.C.A.); (J.O.J.); (J.K.G.d.V.)
| | - José Oliveira Junior
- Faculdade de Nutrição (FANUT), Universidade Federal de Alagoas (UFAL), Maceió 57072-970, AL, Brazil; (F.L.C.A.); (J.O.J.); (J.K.G.d.V.)
| | - Joice Kelly Gomes de Vasconcelos
- Faculdade de Nutrição (FANUT), Universidade Federal de Alagoas (UFAL), Maceió 57072-970, AL, Brazil; (F.L.C.A.); (J.O.J.); (J.K.G.d.V.)
| | - José Israel Rodrigues Junior
- Pós-Graduação em Nutrição (PPGNUT), Universidade Federal de Alagoas (UFAL), Maceió 57072-970, AL, Brazil; (A.d.S.G.); (J.I.R.J.); (N.B.B.)
| | - Islany Thaissa Cerqueira
- Instituto de Química e Biotecnologia (IQB/UFAL), Universidade Federal de Alagoas (UFAL), Maceió 57072-970, AL, Brazil; (O.R.P.d.A.); (I.T.C.)
| | | | - Nassib Bezerra Bueno
- Pós-Graduação em Nutrição (PPGNUT), Universidade Federal de Alagoas (UFAL), Maceió 57072-970, AL, Brazil; (A.d.S.G.); (J.I.R.J.); (N.B.B.)
| | - Marília Oliveira Fonseca Goulart
- Pós-Graduação da Rede Nordeste de Biotecnologia (RENORBIO), Universidade Federal de Alagoas (UFAL), Maceió 57072-970, AL, Brazil;
- Instituto de Química e Biotecnologia (IQB/UFAL), Universidade Federal de Alagoas (UFAL), Maceió 57072-970, AL, Brazil; (O.R.P.d.A.); (I.T.C.)
- Programa de Pós-Graduação em Química e Biotecnologia (PPGQB), Universidade Federal de Alagoas (UFAL), Maceió 57072-970, AL, Brazil
- Pós-Graduação em Ciências da Saúde (PPGCS), Universidade Federal de Alagoas (UFAL), Maceió 57072-970, AL, Brazil
| | - Fabiana Andréa Moura
- Pós-Graduação em Nutrição (PPGNUT), Universidade Federal de Alagoas (UFAL), Maceió 57072-970, AL, Brazil; (A.d.S.G.); (J.I.R.J.); (N.B.B.)
- Faculdade de Nutrição (FANUT), Universidade Federal de Alagoas (UFAL), Maceió 57072-970, AL, Brazil; (F.L.C.A.); (J.O.J.); (J.K.G.d.V.)
- Pós-Graduação em Ciências Médicas (PPGCM), Universidade Federal de Alagoas (UFAL), Maceió 57072-970, AL, Brazil;
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Bajaj A, Markandey M, Singh M, Sahu P, Vuyyuru SK, Kante B, Kumar P, Verma M, Makharia G, Kedia S, Travis SPL, Ahuja V. Exclusive Enteral Nutrition Mediates Beneficial Gut Microbiome Enrichment in Acute Severe Colitis. Inflamm Bowel Dis 2024; 30:641-650. [PMID: 37950921 DOI: 10.1093/ibd/izad232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND Exclusive enteral nutrition (EEN) supplementation of the standard of care (SOC) augments steroid responsiveness in patients with acute severe ulcerative colitis (ASUC). EEN is known to alter gut microbial composition. The present study investigates EEN-driven gut microbial alterations in patients with ASUC and examines their correlations with clinical parameters. METHODS Stool samples from patients with ASUC (n = 44) who received either EEN-supplemented SOC (EEN group; n = 20) or SOC alone (SOC group; n = 24) for 7 days were collected at baseline (day 0) and postintervention (day 7). Microbiome analysis was carried out using 16S ribosomal RNA gene sequencing followed by data processing using QIIME2 and R packages. RESULTS Seven-day EEN-conjugated corticosteroid therapy in patients with ASUC enhanced the abundances of beneficial bacterial genera Faecalibacterium and Veillonella and reduced the abundance of Sphingomonas (generalized linear model fitted with Lasso regularization with robustness of 100%), while no such improvements in gut microbiota were observed in the SOC group. The EEN-associated taxa correlated with the patient's clinical parameters (serum albumin and C-reactive protein levels). Unlike the SOC group, which retained its preintervention core microbiota, EEN contributed Faecalibacterium prausnitzii, a beneficial gut bacterial taxon, to the gut microbial core. EEN responders showed enhancement of Ligilactobacillus and Veillonella and reduction in Prevotella and Granulicatella. Analysis of baseline gut microbiota showed relative enhancement of certain microbial genera being associated with corticosteroid response and baseline clinical parameters and that this signature could conceivably be used as a predictive tool. CONCLUSIONS Augmentation of clinical response by EEN-conjugated corticosteroid therapy is accompanied by beneficial gut microbial changes in patients with ASUC.
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Affiliation(s)
- Aditya Bajaj
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Manasvini Markandey
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Mukesh Singh
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Pabitra Sahu
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Sudheer K Vuyyuru
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Bhaskar Kante
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Peeyush Kumar
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Mahak Verma
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Govind Makharia
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Kedia
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Simon P L Travis
- Translational Gastroenterology Unit, University of Oxford and Oxford Biomedical Research Centre, Oxford, United Kingdom
- Kennedy Institute of Rheumatology, University of Oxford and Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Vineet Ahuja
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
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Mpakogiannis K, Fousekis FS, Christodoulou DK, Katsanos KH, Narula N. The current role of Tofacitinib in acute severe ulcerative colitis in adult patients: A systematic review. Dig Liver Dis 2023; 55:1311-1317. [PMID: 37316363 DOI: 10.1016/j.dld.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Despite rescue therapy, acute severe ulcerative colitis (ASUC) is associated with a high risk of colectomy, while treatment options remain limited. Tofacitinib, a rapidly acting Janus Kinase (JAK) inhibitor, is gaining ground as an effective alternative treatment option for the management of acute severe ulcerative colitis, which may prevent emergency colectomy. METHODS A systematic literature search of PubMed and Embase was undertaken for studies of adult patients with ASUC treated with tofacitinib. RESULTS In total, two observational studies, seven case series and five case reports incorporating 134 patients who received tofacitinib in ASUC were identified with a follow-up period ranging from 30 days to 14 months. Overall, the pooled colectomy rate was 23.9% (95% CI 16.6-31.2). The pooled 90-day and 6-month colectomy free rate were 79.9% (95% CI 73.1-86.7) and 71.6% (95% CI 64-79.2) respectively. The most frequent adverse event was C. Difficile infection. CONCLUSIONS Tofacitinib appears to be a promising option for the treatment of ASUC. Randomized clinical trials are required to further access the efficacy, safety and optimal dose of tofacitinib in cases of ASUC.
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Affiliation(s)
- Konstantinos Mpakogiannis
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Fotios S Fousekis
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Dimitrios K Christodoulou
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Konstantinos H Katsanos
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.
| | - Neeraj Narula
- Division of Gastroenterology, Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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Rodrigues Junior JI, de Vasconcelos JKG, Xavier LEMDS, Gomes ADS, Santos JCDF, Campos SBG, Martins ASDP, Goulart MOF, Moura FA. Antioxidant Therapy in Inflammatory Bowel Disease: A Systematic Review and a Meta-Analysis of Randomized Clinical Trials. Pharmaceuticals (Basel) 2023; 16:1374. [PMID: 37895845 PMCID: PMC10610019 DOI: 10.3390/ph16101374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/08/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023] Open
Abstract
The objective of this study is to assess the effectiveness of treatment for inflammatory bowel diseases in modulating oxidative stress biomarkers and cytokine levels. A systematic review of clinical trials was conducted, searching electronic databases including PubMed, Science Direct, and Scopus. After excluding articles that did not meet the inclusion criteria, 19 studies were included in the systematic review and 8 in the meta-analysis (6 for antioxidant capacity, 6 for superoxide dismutase (SOD), and 5 for lipid peroxidation analyzed through malondialdehyde (MDA) levels). SOD was significantly modulated (RR = 0.3764, 95% CI [0.0262 to 0.7267], p = 0.035) but not antioxidant capacity (RR = 0.3424, 95% CI [0.0334 to 0.7183], p = 0.0742) or MDA (RR = -0.8534, 95% CI [-1.9333 to 0.2265], p = 0.1214). Nonetheless, studies investigating oxidative stress biomarkers and cytokines in the context of alternative therapies for IBD treatment are still scarce. This review highlights the potential of antioxidant supplementation in IBD management and underscores the need for further investigations into its effects on oxidative stress biomarkers and cytokines to improve therapeutic approaches for IBD patients.
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Affiliation(s)
- José Israel Rodrigues Junior
- Faculdade de Nutrição (FANUT), Universidade Federal de Alagoas (UFAL), Maceió 57072-970, Brazil; (J.I.R.J.); (J.K.G.d.V.); (S.B.G.C.)
| | - Joice Kelly Gomes de Vasconcelos
- Faculdade de Nutrição (FANUT), Universidade Federal de Alagoas (UFAL), Maceió 57072-970, Brazil; (J.I.R.J.); (J.K.G.d.V.); (S.B.G.C.)
| | | | - Amanda da Silva Gomes
- Pós-Graduação em Nutrição (PPGNUT), Universidade Federal de Alagoas (UFAL), Maceió 57072-970, Brazil; (L.E.M.d.S.X.); (A.d.S.G.)
| | | | - Samara Bomfim Gomes Campos
- Faculdade de Nutrição (FANUT), Universidade Federal de Alagoas (UFAL), Maceió 57072-970, Brazil; (J.I.R.J.); (J.K.G.d.V.); (S.B.G.C.)
| | - Amylly Sanuelly da Paz Martins
- Pós-Graduação da Rede Nordeste de Biotecnologia (RENORBIO), Universidade Federal de Alagoas (UFAL), Maceió 57072-970, Brazil; (A.S.d.P.M.); (M.O.F.G.)
| | - Marília Oliveira Fonseca Goulart
- Pós-Graduação da Rede Nordeste de Biotecnologia (RENORBIO), Universidade Federal de Alagoas (UFAL), Maceió 57072-970, Brazil; (A.S.d.P.M.); (M.O.F.G.)
- Instituto de Química e Biotecnologia (IQB/UFAL), Universidade Federal de Alagoas (UFAL), Maceió 57072-970, Brazil
- Pós-Graduação em Ciências da Saúde (PPGCS), Universidade Federal de Alagoas (UFAL), Maceió 57072-970, Brazil
| | - Fabiana Andréa Moura
- Pós-Graduação em Nutrição (PPGNUT), Universidade Federal de Alagoas (UFAL), Maceió 57072-970, Brazil; (L.E.M.d.S.X.); (A.d.S.G.)
- Pós-Graduação em Ciências Médicas (PPGCM/UFAL), Universidade Federal de Alagoas (UFAL), Maceió 57072-970, Brazil;
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Huang S, Zhai B, Fan Y, Sun J, Cheng J, Zou J, Zhang X, Shi Y, Guo D. Development of Paeonol Liposomes: Design, Optimization, in vitro and in vivo Evaluation. Int J Nanomedicine 2022; 17:5027-5046. [PMID: 36303804 PMCID: PMC9594912 DOI: 10.2147/ijn.s363135] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 09/07/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Ulcerative colitis (UC) is one of the intractable diseases recognized by the World Health Organization, and paeonol has been proven to have therapeutic effects. However, the low solubility of paeonol limits its clinical application. To prepare and optimize paeonol liposome, study its absorption mechanism and the anti-inflammatory activity in vitro and in vivo, in order to provide experimental basis for the further development of paeonol into an anti-inflammatory drug in the future. METHODS Paeonol loaded liposomes were prepared and optimized by thin film dispersion-ultrasonic method. The absorption mechanism of paeonol-loaded liposomes was studied by pharmacokinetics, in situ single-pass intestinal perfusion and Caco-2 cell monolayer model, the anti-inflammatory activity was studied in a mouse ulcerative model. RESULTS Box-Behnken response surface methodology permits to screen the best formulations. The structural and morphological characterization showed that paeonol was entrapped inside the bilayer in liposomes. Pharmacokinetic studies found that the AUC0-t of Pae-Lips was 2.78 times than that of paeonol suspension, indicating that Pae-Lips significantly improved the absorption of paeonol. In situ single intestinal perfusion and Caco-2 monolayer cell model results showed that paeonol was passively transported and absorbed, and was the substrate of P-gp, MRP2 and BCRP, and the Papp value of Pae-Lips was significantly higher than that of paeonol. In vitro and in vivo anti-inflammatory experiments showed that compared with paeonol, Pae-Lips exhibited excellent anti-inflammatory activity. CONCLUSION In this study, Pae-Lips were successfully prepared to improve the oral absorption of paeonol. Absorption may involve passive diffusion and efflux transporters. Moreover, Pae-Lips have excellent anti-inflammatory activity in vitro and in vivo, which preliminarily clarifies the feasibility of further development of Pae-Lips into oral anti-inflammatory drugs.
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Affiliation(s)
- Shan Huang
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, 712046, People’s Republic of China
| | - Bingtao Zhai
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, 712046, People’s Republic of China
| | - Yu Fan
- School of Basic Medicine, Shaanxi University of Chinese Medicine, Xianyang, 712046, People’s Republic of China
| | - Jing Sun
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, 712046, People’s Republic of China
| | - Jiangxue Cheng
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, 712046, People’s Republic of China
| | - Junbo Zou
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, 712046, People’s Republic of China
| | - Xiaofei Zhang
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, 712046, People’s Republic of China
| | - Yajun Shi
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, 712046, People’s Republic of China
| | - Dongyan Guo
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, 712046, People’s Republic of China,Correspondence: Dongyan Guo, Tel +86-029-38185180, Email
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Limdi JK. Editorial commentary on the Indian Journal of Gastroenterology-May-June 2022. Indian J Gastroenterol 2022; 41:213-217. [PMID: 35704177 PMCID: PMC9198610 DOI: 10.1007/s12664-022-01266-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Jimmy K Limdi
- grid.451052.70000 0004 0581 2008Section of Inflammatory Bowel Diseases, Division of Gastroenterology, Northern Care Alliance NHS Foundation Trust, Manchester, UK ,grid.5379.80000000121662407University of Manchester, Manchester, UK ,grid.25627.340000 0001 0790 5329Manchester Metropolitan University, Manchester, UK
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Alhalabi M, Eddin KA, Cheha K, Abbas A. Subcutaneous golimumab induced and maintained clinical response in a child with a biological-experienced steroid-refractory flare of ulcerative colitis: A case report. Medicine (Baltimore) 2021; 100:e27283. [PMID: 34559136 PMCID: PMC8462589 DOI: 10.1097/md.0000000000027283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/20/2021] [Accepted: 09/02/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Golimumab is a fully human antitumor necrosis monoclonal antibody that can be administered by either subcutaneous injection or intravenous infusion. Golimumab is approved for the treatment of the adults with rheumatic diseases, and ulcerative colitis, Whereas in children, golimumab is indicated only for the treatment of active polyarticular juvenile idiopathic arthritis. We have written on the off-label use of subcutaneous golimumab, which helped to induce and maintain remission on a low-weight biologically experienced child with steroid-refractory ulcerative colitis flare. PATIENT CONCERNS A 13-year-old pancolitis Syrian boy presented with abdominal pain and six to seven times bloody diarrhea. The child had treated with mesalamine 80 mg/kg/day, azathioprine 2.5 mg/kg/day, infliximab with an induction dose of 5 mg/kg at weeks 0, 2, and 6 followed by 5 mg/kg every 8 weeks. Infliximab did not maintain remission as the patient suffered from two flares that required hospital admission, intravenous corticosteroids, and infliximab escalation. Initial tests disclosed leukocytosis, anemia, hypoalbuminemia, an elevation in C-reactive protein and fecal calprotectin. All Stool studies were negative including routine stool cultures, Clostridium difficile toxin, Escherichia coli O157:H7, Cryptosporidium, and microscopy for ova and parasites. A sigmoidoscopy revealed multiple large ulcerations and spontaneous bleeding, colon biopsies were negative for Clostridium difficile and Cytomegalovirus. Cyclosporine, tacrolimus, and adalimumab were unavailable in Syria. Child's parents opposed colectomy as a treatment option. DIAGNOSIS Ulcerative colitis flare. INTERVENTIONS A subcutaneous golimumab with a loading dose of 200 mg at week 0, followed by 100 mg at week 2, then 50 mg every 4 weeks. OUTCOMES The patient achieved clinical remission by week sixth and maintained the remission for the next 90 weeks. At the time of last evaluation, tests, including C-reactive protein and fecal calprotectin, were within normal limits, complete colonoscopy revealed erythema, edema, mucosal friability, loss of vascular patterns, and pseudo-polyps. The Pediatric Ulcerative Colitis Activity Index and Mayo scores were 5 and 2 points, respectively. No adverse events were documented. CONCLUSION Golimumab has shown potential efficacy and safety in the treatment of ulcerative colitis in children which may indicate a significant future role for subcutaneous golimumab in pediatrics ulcerative colitis.
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Rosiou K, Selinger CP. Acute severe ulcerative colitis: management advice for internal medicine and emergency physicians. Intern Emerg Med 2021; 16:1433-1442. [PMID: 33754227 PMCID: PMC8354863 DOI: 10.1007/s11739-021-02704-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/08/2021] [Indexed: 02/06/2023]
Abstract
Acute severe ulcerative colitis is a medical emergency that warrants in-patient management. This is best served within a multidisciplinary team setting in specialised centres or with expert consultation. Intravenous corticosteroids remain the cornerstone in the management of ASUC and should be initiated promptly, along with general management measures and close monitoring of patients. Unfortunately, one-third of patients will fail to respond to steroids. Response to intravenous corticosteroid therapy needs to be assessed on the third day and rescue therapies, including cyclosporine and infliximab, should be offered to patients not responding. Choice of rescue therapy depends on experience, drug availability and factors associated with each individual patient, such as comorbidities, previous medications or contra-indications to therapy. Patients who have not responded within 7 days to rescue therapy must be considered for surgery. Surgery is a treatment option in ASUC and should not be delayed in cases of failure of medical therapy, because such delays increase surgical morbidity and mortality. This review summarises the current management of acute severe ulcerative colitis and discusses potential future developments.
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Affiliation(s)
- Konstantina Rosiou
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, St James University Hospital, Bexley Wing, Leeds, LS9 7TF, UK
| | - Christian Philipp Selinger
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, St James University Hospital, Bexley Wing, Leeds, LS9 7TF, UK.
- University of Leeds, Leeds, UK.
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Taman H, Fenton CG, Anderssen E, Florholmen J, Paulssen RH. DNA hypo-methylation facilitates anti-inflammatory responses in severe ulcerative colitis. PLoS One 2021; 16:e0248905. [PMID: 33793617 PMCID: PMC8016308 DOI: 10.1371/journal.pone.0248905] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/06/2021] [Indexed: 12/16/2022] Open
Abstract
Severe ulcerative colitis (UC) is a potentially life-threatening disease with a potential colorectal cancer (CRC) risk. The aim of this study was to explore the relationship between transcriptomic and genome-wide DNA methylation profiles in a well-stratified, treatment-naïve severe UC patient population in order to define specific epigenetic changes that could be responsible for the grade of disease severity. Mucosal biopsies from treatment-naïve severe UC patients (n = 8), treatment-naïve mild UC (n = 8), and healthy controls (n = 8) underwent both whole transcriptome RNA-Seq and genome-wide DNA bisulfite- sequencing, and principal component analysis (PCA), cell deconvolutions and diverse statistical methods were applied to obtain a dataset of significantly differentially expressed genes (DEGs) with correlation to DNA methylation for severe UC. DNA hypo-methylation correlated with approximately 80% of all DEGs in severe UC when compared to mild UC. Enriched pathways of annotated hypo-methylated genes revealed neutrophil degranulation, and immuno-regulatory interactions of the lymphoid system. Specifically, hypo-methylated anti-inflammatory genes found for severe UC were IL10, SIGLEC5, CD86, CLMP and members of inflammasomes NLRP3 and NLRC4. Hypo-methylation of anti-inflammatory genes during severe UC implies an interplay between the epithelium and lamina propria in order to mitigate inflammation in the gut. The specifically DNA hypo-methylated genes found for severe UC can potentially be useful biomarkers for determining disease severity and in the development of new targeted treatment strategies for severe UC patients.
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Affiliation(s)
- Hagar Taman
- Clinical Bioinformatics Research Group, Department of Clinical Medicine, UiT- The Arctic University of Norway, Tromsø, Norway
- Genomics Support Centre Tromsø (GSCT), Department of Clinical Medicine, UiT- The Arctic University of Norway, Tromsø, Norway
| | - Christopher G. Fenton
- Genomics Support Centre Tromsø (GSCT), Department of Clinical Medicine, UiT- The Arctic University of Norway, Tromsø, Norway
| | - Endre Anderssen
- Genomics Support Centre Tromsø (GSCT), Department of Clinical Medicine, UiT- The Arctic University of Norway, Tromsø, Norway
| | - Jon Florholmen
- Gastroenterology and Nutrition Research Group, Department of Clinical Medicine, UiT- The Arctic University of Norway, Tromsø, Norway
| | - Ruth H. Paulssen
- Clinical Bioinformatics Research Group, Department of Clinical Medicine, UiT- The Arctic University of Norway, Tromsø, Norway
- Genomics Support Centre Tromsø (GSCT), Department of Clinical Medicine, UiT- The Arctic University of Norway, Tromsø, Norway
- * E-mail:
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11
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Goulart RDA, Barbalho SM, Rubira CJ, Araújo AC, Lima VM, Rogerio Leoni B, Guiguer EL. Curcumin therapy for ulcerative colitis remission: systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol 2020; 14:1171-1179. [PMID: 32772752 DOI: 10.1080/17474124.2020.1808460] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Despite significant advances in the study of Ulcerative colitis (UC) management, up to a third of patients may be refractory to conventional therapy, and specialists have considered natural compounds such as curcumin. AREA COVERED The meta-analyzes found in the literature compare the effects of curcumin used in different administration routes or compare patients in remission with patients with active disease. Due to the biases in these studies, we performed a systematic review and meta-analysis of randomized clinical trials (RCTs) that investigated the efficacy of orally administrated curcumin in mild-to-moderate active UC. EXPERT OPINION Curcumin produces relevant anti-inflammatory and antioxidant effects that are crucial in inducing remission in UC patients. Unfortunately, in the treatment of UC, we have not observed studies with standardization of dose and routes of administration. Existing meta-analyses are biased because they compare studies using different administration routes and patients in different stages of the disease. Our meta-analysis is the only one that tried to make a comparison with a few of biases as possible and show that curcumin can help in the induction of remission in UC subjects.
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Affiliation(s)
- Ricardo de Alvares Goulart
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marilia (UNIMAR) , Marília, São Paulo, Brazil
| | - Sandra M Barbalho
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marilia (UNIMAR) , Marília, São Paulo, Brazil.,School of Medicine, University of Marília (UNIMAR) , Marília, São Paulo, Brazil.,Department of Biochemistry and Nutrition, Faculty of Food Technology of Marília , Marília, São Paulo, Brazil
| | - Cláudio José Rubira
- School of Medicine, University of Marília (UNIMAR) , Marília, São Paulo, Brazil
| | - Adriano Cressoni Araújo
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marilia (UNIMAR) , Marília, São Paulo, Brazil.,School of Medicine, University of Marília (UNIMAR) , Marília, São Paulo, Brazil
| | | | - Buchaim Rogerio Leoni
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marilia (UNIMAR) , Marília, São Paulo, Brazil.,Department of Biological Sciences, University of São Paulo (FOB - USP) , Bauru, São Paulo, Brazil
| | - Elen Landgraf Guiguer
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marilia (UNIMAR) , Marília, São Paulo, Brazil.,School of Medicine, University of Marília (UNIMAR) , Marília, São Paulo, Brazil.,Department of Biochemistry and Nutrition, Faculty of Food Technology of Marília , Marília, São Paulo, Brazil
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12
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Alkhatry M, Al-Rifai A, Annese V, Georgopoulos F, Jazzar AN, Khassouan AM, Koutoubi Z, Nathwani R, Taha MS, Limdi JK. First United Arab Emirates consensus on diagnosis and management of inflammatory bowel diseases: A 2020 Delphi consensus. World J Gastroenterol 2020; 26:6710-6769. [PMID: 33268959 PMCID: PMC7684461 DOI: 10.3748/wjg.v26.i43.6710] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/15/2020] [Accepted: 10/12/2020] [Indexed: 02/06/2023] Open
Abstract
Ulcerative colitis and Crohn's disease are the main entities of inflammatory bowel disease characterized by chronic remittent inflammation of the gastrointestinal tract. The incidence and prevalence are on the rise worldwide, and the heterogeneity between patients and within individuals over time is striking. The progressive advance in our understanding of the etiopathogenesis coupled with an unprecedented increase in therapeutic options have changed the management towards evidence-based interventions by clinicians with patients. This guideline was stimulated and supported by the Emirates Gastroenterology and Hepatology Society following a systematic review and a Delphi consensus process that provided evidence- and expert opinion-based recommendations. Comprehensive up-to-date guidance is provided regarding diagnosis, evaluation of disease severity, appropriate and timely use of different investigations, choice of appropriate therapy for induction and remission phase according to disease severity, and management of main complications.
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Affiliation(s)
- Maryam Alkhatry
- Gastroenterology and Endoscopy Department, Ibrahim Bin Hamad Obaid Allah Hospital, Ministry of Health and Prevention, Ras Al Khaiman, United Arab Emirates
| | - Ahmad Al-Rifai
- Department of Gastroenterology, Sheikh Shakbout Medical City, Abu Dhabi, United Arab Emirates
| | - Vito Annese
- Department of Gastroenterology, Valiant Clinic, Dubai, United Arab Emirates
- Department of Gastroenterology and Endoscopy, American Hospital, Dubai, United Arab Emirates
| | | | - Ahmad N Jazzar
- Gastroenterology Division, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Ahmed M Khassouan
- Digestive Disease Unit, Rashid Hospital, Dubai, United Arab Emirates
| | - Zaher Koutoubi
- Digestive Disease Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Rahul Nathwani
- Department of Gastroenterology, Mediclinic City Hospital, Dubai, United Arab Emirates
- Department of Gastroenterology, Mohammed Bin Rashid University, Dubai, United Arab Emirates
| | - Mazen S Taha
- Gastroenterology and Hepatology, Tawam Hospital, Al Ain, United Arab Emirates
| | - Jimmy K Limdi
- Department of Gastroenterology, The Pennine Acute Hospitals NHS Trust, Manchester Academic Health Sciences, University of Manchester, Manchester M8 5RB, United Kingdom
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13
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Goulart RDA, Barbalho SM, Lima VM, Souza GAD, Matias JN, Araújo AC, Rubira CJ, Buchaim RL, Buchaim DV, Carvalho ACAD, Guiguer ÉL. Effects of the Use of Curcumin on Ulcerative Colitis and Crohn's Disease: A Systematic Review. J Med Food 2020; 24:675-685. [PMID: 33155879 DOI: 10.1089/jmf.2020.0129] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Inflammatory bowel disease (IBD) is an umbrella term used to describe chronic inflammatory disorders related to a substantial reduction in the quality of life of patients. Some patients with Crohn's disease (CD) and ulcerative colitis (UC) are refractory to conventional therapies, and Curcuma longa derivatives have been considered as adjuvants. Owing to the anti-inflammatory and antioxidant effects, some clinical trials used this plant in the therapeutic approach of IBD, and some meta-analyses evaluated the outcomes found in these studies. Owing to controversial findings, our systematic review aimed to evaluate these studies to show whether C. longa compounds can still be considered in the therapeutic approach of patients with CD and UC. MEDLINE-PubMed, EMBASE, and Cochrane were searched, and Preferred Reporting Items for a Systematic Review and Meta-Analysis guidelines were followed. The results of the randomized clinical trials (RCTs) showed promising results with the use of curcumin in the therapeutic approach of both UC and CD patients. Some meta-analyses show controversial results, possibly due to the presence of bias in the included studies. The actions of curcumin are achieved by several mechanisms, such as reducing the expression of interleukin (IL)-1, IL-6, IL-12, and tumor necrosis factor-α. Moreover, it reduces the levels of reactive oxygen species, such as superoxide anions and malondialdehyde. The results of using curcumin in CD and UC patients are challenging to be evaluated because RCTs are variable in the dose and the formulations of curcumin, in the time of treatment, and the route of administration. The number of patients in the samples is also usually small.
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Affiliation(s)
- Ricardo de Alvares Goulart
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília (UNIMAR), Marília, Brazil
| | - Sandra M Barbalho
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília (UNIMAR), Marília, Brazil.,Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Marília, Brazil.,Department of Biochemistry and Nutrition, Faculty of Food Technology of Marília, Marília, Brazil
| | - Vinícius Marinho Lima
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Marília, Brazil
| | - Gabriela Achete de Souza
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Marília, Brazil
| | - Julia Novaes Matias
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Marília, Brazil
| | - Adriano Cressoni Araújo
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília (UNIMAR), Marília, Brazil.,Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Marília, Brazil
| | - Cláudio José Rubira
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Marília, Brazil
| | - Rogério Leone Buchaim
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília (UNIMAR), Marília, Brazil.,University of São Paulo (FOB-USP), Alameda Doutor Octávio Pinheiro Brisolla, Bauru, Brazil
| | - Daniela Vieira Buchaim
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília (UNIMAR), Marília, Brazil.,Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Marília, Brazil.,Medical School, University Center of Adamantina (UniFAI), Adamantina, Brazil
| | | | - Élen Landgraf Guiguer
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marília (UNIMAR), Marília, Brazil.,Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Marília, Brazil.,Department of Biochemistry and Nutrition, Faculty of Food Technology of Marília, Marília, Brazil
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14
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Zhang Z, Dong L, Jia A, Chen X, Yang Q, Wang Y, Wang Y, Liu R, Cao Y, He Y, Bi Y, Liu G. Glucocorticoids Promote the Onset of Acute Experimental Colitis and Cancer by Upregulating mTOR Signaling in Intestinal Epithelial Cells. Cancers (Basel) 2020; 12:cancers12040945. [PMID: 32290362 PMCID: PMC7254274 DOI: 10.3390/cancers12040945] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/08/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023] Open
Abstract
The therapeutic effects of glucocorticoids on colitis and colitis-associated cancer are unclear. In this study, we investigated the therapeutic roles of glucocorticoids in acute experimental ulcerative colitis and colitis-associated cancer in mice and their immunoregulatory mechanisms. Murine acute ulcerative colitis was induced by dextran sulfate sodium (DSS) and treated with dexamethasone (Dex) at different doses. Dex significantly exacerbated the onset and severity of DSS-induced colitis and potentiated mucosal inflammatory macrophage and neutrophil infiltration, as well as cytokine production. Furthermore, under inflammatory conditions, the expression of the glucocorticoid receptor (GR) did not change significantly, while mammalian target of rapamycin (mTOR) signaling was higher in colonic epithelial cells than in colonic immune cells. The deletion of mTOR in intestinal epithelial cells, but not that in myeloid immune cells, in mice significantly ameliorated the severe course of colitis caused by Dex, including weight loss, clinical score, colon length, pathological damage, inflammatory cell infiltration and pro-inflammatory cytokine production. These data suggest that mTOR signaling in intestinal epithelial cells, mainly mTORC1, plays a critical role in the Dex-induced exacerbation of acute colitis and colitis-associated cancer. Thus, these pieces of evidence indicate that glucocorticoid-induced mTOR signaling in epithelial cells is required in the early stages of acute ulcerative colitis by modulating the dynamics of innate immune cell recruitment and activation.
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Affiliation(s)
- Zhengguo Zhang
- Key Laboratory of Cell Proliferation and Regulation Biology, Ministry of Education, Institute of Cell Biology, College of Life Sciences, Beijing Normal University, Beijing 100875, China; (Z.Z.); (L.D.); (A.J.); (X.C.); (Q.Y.); (Y.W.); (Y.W.); (R.L.); (Y.C.); (Y.H.)
- Department of Immunology, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Lin Dong
- Key Laboratory of Cell Proliferation and Regulation Biology, Ministry of Education, Institute of Cell Biology, College of Life Sciences, Beijing Normal University, Beijing 100875, China; (Z.Z.); (L.D.); (A.J.); (X.C.); (Q.Y.); (Y.W.); (Y.W.); (R.L.); (Y.C.); (Y.H.)
| | - Anna Jia
- Key Laboratory of Cell Proliferation and Regulation Biology, Ministry of Education, Institute of Cell Biology, College of Life Sciences, Beijing Normal University, Beijing 100875, China; (Z.Z.); (L.D.); (A.J.); (X.C.); (Q.Y.); (Y.W.); (Y.W.); (R.L.); (Y.C.); (Y.H.)
| | - Xi Chen
- Key Laboratory of Cell Proliferation and Regulation Biology, Ministry of Education, Institute of Cell Biology, College of Life Sciences, Beijing Normal University, Beijing 100875, China; (Z.Z.); (L.D.); (A.J.); (X.C.); (Q.Y.); (Y.W.); (Y.W.); (R.L.); (Y.C.); (Y.H.)
- Department of Immunology, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Qiuli Yang
- Key Laboratory of Cell Proliferation and Regulation Biology, Ministry of Education, Institute of Cell Biology, College of Life Sciences, Beijing Normal University, Beijing 100875, China; (Z.Z.); (L.D.); (A.J.); (X.C.); (Q.Y.); (Y.W.); (Y.W.); (R.L.); (Y.C.); (Y.H.)
| | - Yufei Wang
- Key Laboratory of Cell Proliferation and Regulation Biology, Ministry of Education, Institute of Cell Biology, College of Life Sciences, Beijing Normal University, Beijing 100875, China; (Z.Z.); (L.D.); (A.J.); (X.C.); (Q.Y.); (Y.W.); (Y.W.); (R.L.); (Y.C.); (Y.H.)
| | - Yuexin Wang
- Key Laboratory of Cell Proliferation and Regulation Biology, Ministry of Education, Institute of Cell Biology, College of Life Sciences, Beijing Normal University, Beijing 100875, China; (Z.Z.); (L.D.); (A.J.); (X.C.); (Q.Y.); (Y.W.); (Y.W.); (R.L.); (Y.C.); (Y.H.)
| | - Ruichen Liu
- Key Laboratory of Cell Proliferation and Regulation Biology, Ministry of Education, Institute of Cell Biology, College of Life Sciences, Beijing Normal University, Beijing 100875, China; (Z.Z.); (L.D.); (A.J.); (X.C.); (Q.Y.); (Y.W.); (Y.W.); (R.L.); (Y.C.); (Y.H.)
| | - Yejin Cao
- Key Laboratory of Cell Proliferation and Regulation Biology, Ministry of Education, Institute of Cell Biology, College of Life Sciences, Beijing Normal University, Beijing 100875, China; (Z.Z.); (L.D.); (A.J.); (X.C.); (Q.Y.); (Y.W.); (Y.W.); (R.L.); (Y.C.); (Y.H.)
| | - Ying He
- Key Laboratory of Cell Proliferation and Regulation Biology, Ministry of Education, Institute of Cell Biology, College of Life Sciences, Beijing Normal University, Beijing 100875, China; (Z.Z.); (L.D.); (A.J.); (X.C.); (Q.Y.); (Y.W.); (Y.W.); (R.L.); (Y.C.); (Y.H.)
| | - Yujing Bi
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China
- Correspondence: (Y.B.); (G.L.); Tel.: +86-10-6694-8562 (Y.B.); +86-10-5880-0026 (G.L.); Fax: +86-10-6694-8562 (Y.B.); +86-10-5880-0026 (G.L.)
| | - Guangwei Liu
- Key Laboratory of Cell Proliferation and Regulation Biology, Ministry of Education, Institute of Cell Biology, College of Life Sciences, Beijing Normal University, Beijing 100875, China; (Z.Z.); (L.D.); (A.J.); (X.C.); (Q.Y.); (Y.W.); (Y.W.); (R.L.); (Y.C.); (Y.H.)
- Department of Immunology, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
- Correspondence: (Y.B.); (G.L.); Tel.: +86-10-6694-8562 (Y.B.); +86-10-5880-0026 (G.L.); Fax: +86-10-6694-8562 (Y.B.); +86-10-5880-0026 (G.L.)
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15
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Kongon P, Tangsirapat V, Ohmpornuwat V, Sumtong K, Chakrapan Na Ayudhya V, Chakrapan Na Ayudhya K, Sookpotarom P, Vejchapipat P. A challenge in diagnosis and management of ulcerative colitis in elderly patient with atypical presentation: A reported case. Int J Surg Case Rep 2019; 61:234-237. [PMID: 31377552 PMCID: PMC6698301 DOI: 10.1016/j.ijscr.2019.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 07/06/2019] [Indexed: 12/01/2022] Open
Abstract
Diagnosis of severe UC constitutes a difficult task in elderly patient. CT imaging can help physicians exclude non-surgical condition. Severe UC should be kept in mind in elderly patients with new onset abdominal pain.
Introduction Recognition of elderly-onset ulcerative colitis (UC) remains poor as the differential diagnosis in older patients with acute abdominal pain and bloody diarrhea is extensive and UC is generally not the obvious cause. A typical presentation in an elderly patient with acute severe UC can mimic surgical abdomen. Presentation of case An 80-year-old female had been presented with high grade fever, abdominal pain and diarrhoea. Physical examination showed sign of peritonitis and severe hypotension. A provisional diagnosis of perforated sigmoid diverticulitis was made. However, at the theater, there was only turbid yellowish ascites at cal-de-sac. Consequently, colonoscopy was performed and revealed continuous and circumferential erythematous with friable mucosa and multiple shallow ulcer along upper left side colon. Histologic examination of the colonic tissue was consistent with UC. Discussion As UC is uncommon in Thailand and clinical features of elderly-onset UC are much more non-specific; as a result, misdiagnosis at initial presentation is more common in elderly patients (60%) than that in younger population (15%). These might result in an unnecessary exploratory laparotomy; however, computed tomography scan can reduce the risk of that event. Conclusion The diagnosis of severe acute UC in elderly patients with acute abdomen had been complicated by the distinctive physiology of this aged group with atypical presentation and markedly unreliable physical examination. Eventually, severe UC should always be kept in mind with a circumstance of abdominal pain in geriatric population.
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Affiliation(s)
- Panutchaya Kongon
- Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, 11120, Thailand.
| | - Vorapatu Tangsirapat
- Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, 11120, Thailand.
| | - Vittawat Ohmpornuwat
- Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, 11120, Thailand.
| | - Kannakrit Sumtong
- Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, 11120, Thailand.
| | - Vichack Chakrapan Na Ayudhya
- Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, 11120, Thailand.
| | - Kobkool Chakrapan Na Ayudhya
- Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, 11120, Thailand.
| | - Paiboon Sookpotarom
- Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, 11120, Thailand.
| | - Paisarn Vejchapipat
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
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