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Arch. latinoam. nutr ; 72(1): 50-59, mar. 2022. ilus, tab
Article in English | LILACS, LIVECS | ID: biblio-1368371


Crohn's disease (CD) is an inflammatory condition that can affect the entire gastrointestinal tract due to an exacerbated and inadequate immune system response. Objective. This study aimed to conduct a systematic review, through clinical trials, about the use of probiotics in humans with CD. Materials and methods. Research was carried out in the PubMed, Scopus and Science Direct databases using the keywords "Crohn's disease" and "probiotics". We conducted the review by searching clinical trials published from 2000 to December 2019. Results. Of 2,164 articles found, only nine were considered eligible for this review. The studies investigated patients with CD at different stages of the pathology, and in three studies the potential effect of probiotics in the active phase was observed; in two, in the remission phase; and in four, after intestinal surgery. The sample size of the studies ranged from 11 to 165 individuals and the age of the participants between 5 and 71 years. Gram-positive bacteria were used in six clinical interventions and in two studies yeasts were used. As for the significant results obtained with the treatment with probiotics, in one study there was beneficial clinical effects in patients and, in another, there was an improvement in intestinal permeability. Conclusion. Currently, it is not possible to establish a recommendation for probiotic therapy to control CD due to the few clinical trials with significant results. There is a need for more research on clinical intervention with probiotics in CD to clarify the action, define doses and time of use(AU)

La enfermedad de Crohn (EC) es una afección inflamatoria que puede afectar todo el tracto gastrointestinal debido a una respuesta del sistema inmunitario exacerbada e inadecuada. Objetivo. Realizar una revisión sistemática, a través de ensayos clínicos, sobre el uso de probióticos en humanos con EC. Materiales y métodos. La investigación se realizó en las bases de datos PubMed, Scopus y Science Direct utilizando las palabras clave "enfermedad de Crohn" y "probióticos". La revisión se hizo en ensayos clínicos publicados desde 2000 hasta diciembre 2019. Resultados. De 2164 artículos encontrados, solo nueve fueron considerados elegibles. Los estudios investigaron pacientes con EC en diferentes etapas de la patología, y en tres estudios se observó el efecto potencial de los probióticos en la fase activa; en dos, en remisión; y en cuatro, tras cirugía intestinal. El tamaño de la muestra fue entre 11 y 165 individuos y la edad entre 5 y 71 años. Se utilizaron bacterias grampositivas en seis intervenciones clínicas y en dos estudios se utilizaron levaduras. En cuanto a los resultados significativos obtenidos con el tratamiento con probióticos, en un estudio hubo efectos clínicos beneficiosos en los pacientes y, en otro, hubo una mejora en la permeabilidad intestinal. Conclusión. Actualmente, no es posible establecer una recomendación de terapia con probióticos para el control de la EC debido a los pocos ensayos clínicos con resultados significativos. Existe la necesidad de más investigación sobre la intervención clínica con probióticos en EC para aclarar la acción, definir dosis y tiempo de uso(AU)

Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Crohn Disease , Probiotics , Gastrointestinal Tract , Gram-Positive Bacteria , Permeability , Yeasts , Inflammatory Bowel Diseases , PubMed , Immune System
Article in English | WPRIM | ID: wpr-922575


OBJECTIVE@#To investigate the protective effect of Chinese herbal formula Huangqin Decoction (HQD) on ulcerative colitis mouse model induced by dextran sulphate sodium (DSS) and human intestinal epithelial cell injury induced by tumour necrosis factor-α (TNF-α).@*METHODS@#In vivo, 30 male C57BL/6 mice were divided into 5 groups using a random number table (n=6 per group), including control, DSS, 5-aminosalicylic acid (5-ASA), HQD low- (HQD-L) and high-dose (HQD-H) groups. The colitis mouse model was established by 3% (w/v) DSS water for 5 days. Meanwhile, mice in the HQD-L, HQD-H and 5-ASA groups were administrated with 100, 200 mg/kg HQD or 100 mg/kg 5-ASA, respectively, once daily by gavage. After 9 days of administration, the body weight, disease activity index (DAI) score and colon length of mice were measured, the pathological changes of colons were analyzed by hematoxylin-eosin staining (HE) staining, and the levels of serum interleukin (IL)-6, IL-1β and TNF-α were measured by enzyme linked immunosorbent assay. In vitro, the human colon epithelial normal cells (FHC cells) were exposed to HQD (0.6 mg/mL) for 12 h and then treated with TNF-α (10 ng/mL) for 24 h. The tight junction (TJ) protein expression levels of Claudin-4 and Occludin, and the protein phosphorylation levels of p65 and inhibitor of nuclear factor kappaB (NF-κB)-α (IκBα) were measured by Western blot.@*RESULTS@#In vivo, compared with the DSS group, HQD-H treatment attenuated the weight loss and reduced DAI score of mice on the 8th day (P<0.05). Moreover, HQD-H treatment ameliorated the colon shortening in the DSS-induced colitis mice (P<0.05). HE staining showed HQD attenuated the pathological changes of colitis mice, and the histological scores of HQD-H and 5-ASA groups were significantly decreased compared with the DSS group (P<0.05). Meanwhile, HQD-H and 5-ASA significantly decreased the serum IL-1β, IL-6 and TNF-α levels of mice (P<0.05). In vitro experiments showed that HQD up-regulated Occludin and Claudin-4 protein expressions and inhibited p-p65 and p-IκBα levels in FHC cells compared with the TNF-α group (P<0.05).@*CONCLUSION@#HQD significantly relieved the symptoms in DSS-induced colitis mice by inhibiting pro-inflammatory cytokines expression and maintained the homeostasis of TJ protein in FHC cells by suppressing TNF-α-induced NF-κB activation.

Animals , Colitis, Ulcerative/drug therapy , Dextran Sulfate , Disease Models, Animal , Male , Mice , Mice, Inbred C57BL , NF-kappa B , Scutellaria baicalensis , Tumor Necrosis Factor-alpha
Rev. Ciênc. Méd. Biol. (Impr.) ; 20(3): 394-399, dez 20, 2021. tab
Article in Portuguese | LILACS | ID: biblio-1354226


Introdução: a Doença Inflamatória Intestinal (DII) é decorrente de vários fatores que provocam alteração na homeostase do microbioma na resposta imune e no aumento da permeabilidade intestinal. O estado nutricional inadequado, principalmente em pacientes pediátricos com DII, representa prognóstico ruim e pode influenciar na resposta ao tratamento, à morbidade e à mortalidade. Objetivo: esse estudo teve objetivo de caracterizar o estado antropométrico de pacientes pediátricos atendidos em um ambulatório referência para DII. Metodologia: a amostra foi constituída por pacientes atendidos em primeira consulta no ambulatório, de junho de 2020 até fevereiro de 2021. Foram incluídos pacientes com diagnóstico clínico de Doença de Cronh e Colite Ulcerativa, de ambos sexos, com idade entre 2 a 19 anos. Resultados: dos pacientes com CU, 54,7% apresentaram adequado estado nutricional e 45,3% dos pacientes com DC. O percentual de déficit de massa muscular foi de 47,6% dos pacientes com CU e 52,4% dos pacientes com DC. A baixa estatura foi de 37,5% nos pacientes com CU e 62,5% com DC. Conclusão: a avaliação nutricional de crianças e adolescentes portadores de doenças inflamatórias intestinais deve fazer parte da rotina de atendimento, para que sejam promovidas práticas alimentares saudáveis que favoreçam o crescimento, recuperação ponderal e manutenção de massa muscular.

Background: Inflammatory Bowel Disease (IBD) is due to several factors that cause changes in microbiome homeostasis, immune response and increased intestinal permeability. Inadequate nutritional status, especially in pediatric patients with IBD, represents a poor prognosis and can influence treatment response, morbidity and mortality. Objective: the aim of this study was to characterize the anthropometric status of pediatric patients seen at the reference outpatient clinic for IBD. Methods: the sample consisted of patients seen in the first consultation at the clinic, from June 2020 to February 2021. Patients with a clinical diagnosis of Cronh's Disease and Ulcerative Colitis, of both genders, aged between 2 and 19 years were included. Results: of patients with UC 54.7% had an adequate nutritional status and 45.3% of patients with CD. The percentage of muscle mass deficit was 47.6% of patients with UC and 52.4% of patients with CD. Short stature was 37.5% in patients with UC and 62.5% with CD. Conclusion: nutritional assessment of children and adolescents with inflammatory bowel diseases should be part of the routine of care, so that healthy eating practices that favor growth, weight recovery and maintenance of muscle mass are promoted.

Humans , Male , Female , Child , Adolescent , Pediatrics , Colitis, Ulcerative , Crohn Disease , Anthropometry
Rev. colomb. gastroenterol ; 36(4): 501-507, oct.-dic. 2021. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1360975


Resumen Los tumores neuroendocrinos del colon son relativamente raros en comparación con el carcinoma colorrectal esporádico; su incidencia es muy baja y la localización más frecuente es en el ciego, colon sigmoideo y recto. Se describe con poca frecuencia la asociación de tumor neuroendocrino con la colitis ulcerativa debido a la inflamación crónica que conduce a la diferenciación de células neuroendocrinas a partir de células multipotenciales en el epitelio displásico, que puede ser responsable del desarrollo de carcinomas neuroendocrinos colorrectales. La presentación del caso se trata de un paciente de 57 años de edad con colitis ulcerativa con cuadro de dolor abdominal, pérdida de peso y diarreas líquidas con moco. En el examen físico presentó una lesión endurecida en el marco colónico derecho con tomografía de lesión neoplásica en el colon ascendente y en su hospitalización presentó un cuadro de oclusión intestinal, por lo que se le realizó una hemicolectomía más ileostomía, cuyo resultado en la biopsia fue un tumor neuroendocrino G3 de células grandes en el colon ascendente. En este artículo se revisan de forma práctica los aspectos relacionados con la fisiopatología, diagnóstico y tratamiento de la asociación de estas dos patologías.

Abstract Neuroendocrine colon tumors are relatively unknown compared with sporadic colorectal cancer; its incidence is low, and it is generally located in the cecum, sigmoid colon, and rectum. The existing relation between neuroendocrine tumors and ulcerative colitis is not frequently described due to the chronic inflammation that leads to neuroendocrine cell differentiation from multipotential cells in the dysplastic epithelium, which can be responsible for colorectal neuroendocrine carcinomas development. The study refers to the case of a patient of 57 years old with ulcerative colitis, abdominal pain, weight loss, and liquid diarrhea with mucus. Physical examination revealed a hardened lesion in the right colonic framework with the tomography of a neoplastic lesion in the ascending colon. When the patient was hospitalized, he developed an intestinal obstruction. A hemicolectomy plus ileostomy procedure was performed resulting in a large cell G3 neuroendocrine tumor in the ascending colon revealed in the biopsy. In this article, the aspects related to the pathophysiology, diagnosis, and treatment of the association of these two pathologies are reviewed in a practical way.

Arq. gastroenterol ; 58(3): 377-383, July-Sept. 2021. tab, graf
Article in English | LILACS | ID: biblio-1345300


ABSTRACT BACKGROUND: Crohn's disease (CD) and ulcerative colitis (UC), two of the main inflammatory bowel diseases (IBD), have been increasingly diagnosed in South America. Although IBD have been intensively studied in the last years, epidemiologic data in Brazil are scarce. OBJECTIVE: To study the clinical and epidemiologic profile of IBD patients treated in the Clinical Hospital of the Federal University of Uberlândia from 1999 to 2014. METHODS: We performed a retrospective study of the medical records of patients diagnosed with IBD, according to the international classification of diseases (ICD) - ICD K50 for CD and ICD K51 for UC - confirmed by endoscopic examination in the case of both diseases. We analyzed the following variables: age; sex; ethnicity; smoking habit; primary diagnosis; site of disease manifestation; main clinical manifestations; IBD-related complications; extraintestinal manifestations; and established drug and/or surgical treatment. RESULTS: We evaluated 183 IBD cases (91 UC and 92 CD cases). The estimated prevalence rate of UC was 15.06/100.000 inhabitants and of CD was 15.23/100.000. The CU and CD female to male incidence ratios were 1.7 and 1.8, respectively. The average age of patients diagnosed with UC was 39.4 years and of those diagnosed with CD was 31.1 years. White-skinned people were the most affected by UC (66.0%) and CD (69.0%). Few patients were submitted to surgical procedures as treatment alternative. CONCLUSION: The estimated prevalence of IBD in this population was low compared to that of populations of North America, but high compared to that of other regions considered to present low incidence, such as some Asian and Latin American countries.

RESUMO CONTEXTO: A doença de Crohn (DC) e a retocolite ulcerativa (RCU), duas das principais doenças inflamatórias intestinais (DIIs), têm sido cada vez mais diagnosticadas na América do Sul. Embora a DII tenha sido intensamente estudada nos últimos anos, os dados epidemiológicos no Brasil são escassos. OBJETIVO: Estudar o perfil clínico e epidemiológico dos pacientes com DII atendidos no Hospital das Clínicas da Universidade Federal de Uberlândia de 1999 a 2014. MÉTODOS: Foi realizado um estudo retrospectivo dos prontuários de pacientes com diagnóstico de DII, de acordo com a classificação internacional de doenças (CID) - CID K50 para DC e CID K51 para RCU - confirmado por exame endoscópico para ambas as doenças. Analisamos as seguintes variáveis: idade; sexo; etnia; hábito tabágico; diagnóstico primário; local de manifestação da doença; principais manifestações clínicas; complicações relacionadas a DII; manifestações extraintestinais; tratamentos medicamentoso e/ou cirúrgico instituídos. RESULTADOS: Foram avaliados 183 casos de DII (91 casos de RCU e 92 casos de DC). A prevalência estimada de RCU foi de 15,06/100.000 habitantes e de DC foi de 15,23/100.000. As taxas de incidência entre pacientes do sexo feminino e masculino foram de 1,7 para RCU e 1,8 para DC. A idade média dos pacientes com diagnóstico de RCU foi de 39,4 anos e daqueles com DC foi de 31,1 anos. A raça branca foi o grupo étnico mais afetado por RCU (66,0%) e DC (69,0%). Poucos pacientes foram submetidos a procedimentos cirúrgicos como alternativas de tratamento. CONCLUSÃO: A prevalência estimada de DII nesta população foi baixa em comparação com populações da América do Norte, mas elevada em comparação com outras regiões consideradas de baixa incidência, como alguns países da Ásia e da América Latina.

Humans , Male , Female , Adult , Inflammatory Bowel Diseases/epidemiology , Colitis, Ulcerative/epidemiology , Crohn Disease/epidemiology , Brazil/epidemiology , Incidence , Retrospective Studies
J. coloproctol. (Rio J., Impr.) ; 41(3): 222-227, July-Sept. 2021. tab
Article in English | LILACS | ID: biblio-1346422


Introduction: Anal intraepithelial neoplasia (AIN) is a premalignant lesion of the anal canal associated with HPV, with a higher prevalence in immunosuppressed individuals. Patients with inflammatory bowel disease (IBD) are at potential risk for their development, due to the use of immunosuppressants and certain characteristics of the disease. Method: This is a prospective, cross-sectional, and interventional study that included 53 patients with IBD treated at a tertiary outpatient clinic, who underwent anal smear for cytology in order to assess the prevalence of AIN and associated risk factors. Results: Forty-eight samples were negative for dysplasia and 2 were positive (4%). Both positive samples occurred in women, with Crohn's disease (CD), who were immunosuppressed and had a history of receptive anal intercourse. Discussion: The prevalence of anal dysplasia in IBD patients in this study is similar to that described in low-risk populations. Literature data are scarce and conflicting and there is no evidence to recommend screening with routine anal cytology in patients with IBD. Female gender, history of receptive anal intercourse, immunosuppression and CD seem to be risk factors. (AU)

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Anal Canal/injuries , Anus Neoplasms/epidemiology , Inflammatory Bowel Diseases , Anal Canal/cytology , Crohn Disease
Rev. inf. cient ; 100(3): e3517, 2021. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1289646


RESUMEN Se presentó el caso de un paciente masculino de 8 años de edad con antecedentes de salud anterior, referido a la consulta externa de Gastroenterología del Hospital Nacional Guido Valadares, de Timor Oriental, por episodios recurrentes de diarreas mucosanguinolentas acompañadas de dolor abdominal en hipogastrio de cuatro meses de evolución. Se realizaron exámenes de laboratorio, ultrasonido abdominal y videocolonoscopia con citología y biopsia de la mucosa del colon. El estudio endoscópico informó una colitis ulcerativa extensa y la histología arrojó el diagnóstico de una enfermedad inflamatoria crónica intestinal del tipo colitis ulcerosa. La colitis ulcerosa es un proceso inflamatorio intestinal de origen desconocido que causa inflamación crónica, difusa y continua, en la mucosa y submucosa. Su incidencia en los niños está aumentando y afecta, incluso, a los lactantes. Se indicó tratamiento dietético y medicamentoso. Actualmente se encuentra asintomático y lleva seguimiento mensual en la consulta de Digestivo.

ABSTRACT The case of an 8-year-old male patient with a previous health history was presented, referred to the Gastroenterology outpatient clinic of the Guido Valadares National Hospital, East Timor, for recurrent episodes of mucosanguineous diarrhea accompanied by abdominal pain in the hypogastrium with four months of evolution. Laboratory tests, abdominal ultrasound and video colonoscopy with cytology and biopsy of the colon mucosa were performed. The endoscopic study reported extensive ulcerative colitis and the histology gave the diagnosis of a chronic inflammatory bowel disease of the ulcerative colitis type. Ulcerative colitis is an inflammatory intestinal process of unknown origin that causes chronic, diffuse and continuous inflammation in the mucosa and submucosa. Its incidence in children is increasing and affects even infants. Dietary and drug treatment was indicated. He is currently asymptomatic and undergoes monthly follow-up in the Digestive Clinic.

RESUMO Foi apresentado o caso de um paciente do sexo masculino, 8 anos, com antecedentes de saúde, encaminhado ao ambulatório de Gastroenterologia do Hospital Nacional Guido Valadares, Timor Leste, por episódios recorrentes de diarreia mucosanguínea acompanhada de dor abdominal em hipogástrio de quatro meses de evolução. Foram realizados exames laboratoriais, ultrassonografia abdominal e videocolonoscopia com citologia e biópsia da mucosa do cólon. O estudo endoscópico relatou colite ulcerativa extensa e a histologia deu o diagnóstico de doença inflamatória intestinal crônica do tipo colite ulcerativa. A colite ulcerosa é um processo inflamatório intestinal de origem desconhecida que causa inflamação crônica, difusa e contínua na mucosa e na submucosa. Sua incidência em crianças está aumentando e afeta até mesmo bebês. Foi indicado tratamento dietético e medicamentoso. Ele atualmente é assintomático e tem acompanhamento mensal na consulta Digestiva.

Humans , Male , Child , Colitis, Ulcerative/diagnosis , Colitis, Ulcerative/therapy
Rev. medica electron ; 43(3): 855-867, 2021. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1289823


RESUMEN Clostridium difficile es una bacteria relacionada con la colitis, asociada a antibióticos y a la diarrea adquirida en pacientes hospitalizados. Sin embargo, su comportamiento ha cambiado en los últimos años, hasta el punto de ser considerada un problema de salud mundial. Su curso clínico varía desde casos asintomáticos, colitis, hasta complicaciones que ponen en peligro la vida del paciente. Dentro de los factores de riesgo descritos se encuentra la enfermedad inflamatoria intestinal, especialmente la colitis ulcerativa idiopática. El caso reportado versa sobre la presentación de esta infección asociada a un brote de colitis ulcerativa en un paciente joven, sin antecedentes de enfermedad inflamatoria intestinal, consumo de antibióticos ni hospitalización (AU).

ABSTRACT Clostridium difficile is a bacterium related to antibiotic-associated colitis and to diarrhea acquired in hospitalized patients. However, its behavior has changed in recent years to the point of being considered as a global health problem. Its clinical course ranges from asymptomatic cases, colitis, to complications with risk for the patient's life. The inflammatory bowel disease, especially idiopathic ulcerative colitis is found among the described risk factors. The case reported deals with the presentation of this infection associated to an outbreak of ulcerative colitis in a young patient, with no previous history of inflammatory bowel disease, consumption of antibiotics or hospitalization (AU).

Humans , Male , Colitis, Ulcerative/diagnosis , Clostridioides difficile/virology , Diarrhea/complications , Infections/complications , Infections/transmission , Inpatients , Anti-Bacterial Agents/adverse effects
Dermatol. argent ; 27(2): 78-80, abr-jun 2021. il, graf
Article in Spanish | LILACS, BINACIS | ID: biblio-1367373


Los anticuerpos anti-TNF-a (tumor necrosis factor alpha) se utilizan para tratar tanto la psoriasis como la enfermedad inflamatoria intestinal (EII). Sin embargo, estos fármacos han sido implicados en la ocurrencia de la psoriasis paradójica en los pacientes sin antecedentes de psoriasis que reciben tratamiento por una colitis ulcerosa (CU) y otras enfermedades autoinmunes. Se presenta el caso de un paciente de 29 años, sin antecedentes de dermatosis, que desarrolló una psoriasis palmoplantar paradójica por el uso del adalimumab que recibía por un diagnóstico de CU. El cuadro remitió al suspender el medicamento y recurrió al reiniciarlo, motivo por el cual se rotó al ustekinumab. La CU respondió satisfactoriamente, sin nuevas lesiones dermatológicas.

Anti TNF-a (tumor necrosis factor alpha) antibodies are used to treat both psoriasis and inflammatory bowel disease (IBD). However, these drugs have been implicated in the occurrence of the so-called paradoxical psoriasis in patients with no previous history of psoriasis, who receive treatment for ulcerative colitis and other autoimmune diseases. We present a 29-year-old male patient, with no previous history of dermatosis, who developed paradoxical palmar-plantar psoriasis due to the use of adalimumab that he was receiving for a diagnosis of ulcerative colitis. The condition remitted when the drug was suspended and recurred when it was restarted, and for that reason, treatment was rotated to ustekinumab. Ulcerative colitis responded satisfactorily, with no new dermatological lesions.

Humans , Male , Adult , Psoriasis/diagnosis , Adalimumab/adverse effects , Psoriasis/pathology , Skin Diseases , Colitis, Ulcerative/drug therapy , Ustekinumab
Rev. colomb. gastroenterol ; 36(supl.1): 12-18, abr. 2021. graf
Article in Spanish | LILACS | ID: biblio-1251540


Resumen Las vasculitis leucocitoclásticas se definen como el daño e inflamación de las paredes vasculares, son aquellas vasculitis de pequeños vasos que anatomopatológicamente presentan leucocitoclasia y puede observarse como una manifestación extraintestinal de la enfermedad inflamatoria intestinal. En la colitis ulcerativa se presentan en menor frecuencia, por inmunocomplejos generados en la mucosa intestinal debido a la exposición del tejido linfoide submucoso a antígenos fecales; podrían precipitarse en las paredes de los pequeños vasos. Se pueden asociar con Clostridium difficile, que es un bacilo grampositivo esporulado, anaerobio estricto, que se encuentra normalmente en el medio ambiente y produce colitis, que se manifiesta como un cuadro diarreico presentado después de la ingesta de antibióticos y altera la flora bacteriana común de este órgano. El caso se trata de un paciente 36 años de edad con cuadro de diarreas líquidas con moco y escaso sangrado; se realizó un estudio endoscópico y anatomopatológico en el que se observó colitis ulcerativa con coproparasitario positivo para antígeno de C. difficile, y en su hospitalización presentó lesiones dérmicas petequiales y necróticas en el cuarto dedo de la mano izquierda, que en la biopsia dio como resultado vasculitis de pequeños vasos. En este artículo se revisan de forma práctica los aspectos relacionados con la fisiopatología, histología, tratamiento y diagnósticos de la manifestación extraintestinal dermatológica rara, como la vasculitis leucocitoclástica en pacientes con colitis ulcerativas asociadas con Clostridium.

Abstract Leukocytoclastic vasculitis is defined as the damage and inflammation of the vascular walls. The term refers to vasculitis of the small vessels that anatomopathologically present leukocytoclasia and it can be seen as an extra-intestinal manifestation of inflammatory bowel disease. In ulcerative colitis, it occurs less frequently due to immune complexes produced in the intestinal mucosa by exposure of the submucosal lymphoid tissue to fecal antigens, which could precipitate in the walls of the small vessels. This condition can be associated with Clostridium difficile, which is a gram-positive, sporulated, strict anaerobic bacillus, normally found in the environment. It causes colitis that manifests as a diarrheal disease following the ingestion of antibiotics that alter the common bacterial flora of this organ. This is the case report of a 36-year-old patient with liquid diarrhea with mucus and scarce bleeding. Endoscopic and anatomopathological studies were performed, finding ulcerative colitis with positive coproparasite for Clostridium difficile antigen. The patient was hospitalized, and during his stay, he presented with petechiae and necrotic skin lesions on the fourth finger of the left hand. Skin biopsy showed small vessel vasculitis. This article is a practical review of the pathophysiology, histology, treatment, and diagnosis of a rare dermatologic extraintestinal manifestation, namely, leukocytoclastic vasculitis, in patients with C. difficile-associated ulcerative colitis.

Humans , Male , Adult , Vasculitis , Inflammatory Bowel Diseases , Colitis, Ulcerative , Clostridioides difficile , Skin , Therapeutics , Diarrhea , Fingers , Histology
Gac. méd. Méx ; 157(2): 154-159, mar.-abr. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1279095


Resumen Antecedentes: La colitis ulcerosa crónica idiopática (CUCI) es una enfermedad con inflamación crónica de la mucosa del colon de origen multifactorial. El objetivo de este trabajo es identificar posibles cambios en el comportamiento de la CUCI en un hospital de referencia. Métodos: Se incluyeron nuevos casos de CUCI confirmados por histopatología de enero del 2007 a diciembre del 2014. Resultados: Se incluyeron un total de 189 pacientes. La media de nuevos casos anuales de CUCI fue de 23.6. Este estudio incorpora 95 pacientes de sexo masculino (50 %) y 94 de sexo femenino (50 %), con una edad promedio al diagnóstico de 44.6 años. La frecuencia de pancolitis fue del 77 %, en comparación con el 59 % en el periodo anterior. Las manifestaciones extraintestinales (MEI) estuvieron presentes en el 55.8 % y las colectomías en el 5.2 %. Conclusión: Algunas características de la enfermedad han cambiado con el tiempo: aumento de la frecuencia de pancolitis y MEI, así como disminución de la tasa de colectomías.

Abstract Background: Chronic idiopathic ulcerative colitis (CIUC) is a disease with multifactorial chronic inflammation of the colonic mucosa. In Mexico, there are studies that show an increase in the frequency of new cases. The purpose of this work was to identify possible changes in CIUC behavior in a referral hospital. Methods: New ulcerative colitis (UC) cases confirmed by histopathology from January 2007 to December 2014 were included. Results: A total of 189 patients were included. Mean number of UC annual new cases was 23.6. The study included 95 male patients (50 %) and 94 female patients (50 %), with an average age of 44.6 years at diagnosis. The frequency of pancolitis was 77 %, in comparison with 59 % in the previous period. Extra-intestinal manifestations (EIM) were present in 55.8 % and colectomies in 5.2 %. Conclusion: Some characteristics of the disease have changed over time: there is an increased frequency of pancolitis and EIM, as well as a decrease in the rate of colectomies.

Humans , Male , Female , Adult , Middle Aged , Young Adult , Colitis, Ulcerative/epidemiology , Colitis, Ulcerative/surgery , Colitis, Ulcerative/complications , Comorbidity , Incidence , Retrospective Studies , Sex Distribution , Colectomy/statistics & numerical data , Age Distribution , Tertiary Care Centers/statistics & numerical data , Mexico/epidemiology
J. pediatr. (Rio J.) ; 97(2): 242-247, Mar.-Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1287023


Abstract Objective: Metabolic bone disease concerns a broad spectrum of conditions related to reduced bone density. Metabolic bone disease has been linked to chronic inflammatory diseases, such as ulcerative colitis. This study examines the prevalence of metabolic bone disease in ulcerative colitis patients and explores possible clinical predictors. Method: The authors performed a retrospective study involving children and adolescents with confirmed ulcerative colitis between January 2013 and December 2018. Bone density was evaluated through a dual-energy X-ray absorptiometry scan of the spine and total body. Osteoporosis was defined as a bone mineral density Z-score of <−2 and osteopenia as a Z-score of between −1.0 and −2. Results: A total of 37 patients were included in this analysis, with a mean age of 13.4 ± 3.9 years and a mean duration of illness of 2.1 ± 2.4 years. Using lumbar spine Z-scores and total body Z-scores, osteoporosis and osteopenia were identified by dual-energy X-ray absorptiometry scan measurements in 11 patients (29.7%) and 15 patients (40.5%), and in ten patients (27%) and 13 patients (35%), respectively. Lumbar spine Z-scores were significantly positively associated with male gender (B = 2.02; p = 0.0001), and negatively associated with the presence of extraintestinal manifestations (B = −1.51, p = 0.009) and the use of biologics (B = −1.33, p = 0.004). However, total body Z-scores were positively associated with body mass index Z-scores (B = 0.26, p = 0.004) and duration of illness in years (B = 0.35, p = 0.003). Conclusions: Metabolic bone disease is very common in this cohort of Saudi Arabian children and adolescents with ulcerative colitis and its occurrence appears to increase in female patients who suffer from extraintestinal manifestations.

Humans , Male , Female , Child , Adolescent , Bone Diseases, Metabolic/etiology , Bone Diseases, Metabolic/epidemiology , Colitis, Ulcerative/complications , Saudi Arabia , Absorptiometry, Photon , Bone Density , Retrospective Studies
Rev. colomb. gastroenterol ; 36(1): 65-72, ene.-mar. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1251523


Resumen Del 20% al 30% de los pacientes con colitis ulcerativa (CU) son sometidos a cirugía, ya sea por intratabilidad, curso fulminante, aparición de displasia o cáncer de colon. La cirugía de elección es la proctocolectomía con reservorio ileoanal. Sin embargo, el 20%-50% de los pacientes presentan reservoritis a 10 años. El diagnóstico se realiza con base en las manifestaciones clínicas, las alteraciones endoscópicas y la histología. Los medicamentos utilizados en el tratamiento de la CU no son tan eficaces en la reservoritis y el tratamiento de primera línea es los antibióticos. Dependiendo de la respuesta inicial y el curso clínico de la entidad, se elegirá el tratamiento posterior. En esta revisión se discuten los aspectos más importantes con respecto a la epidemiología, diagnóstico, patogénesis y tratamiento de la reservoritis.

Abstract Between 20% and 30% of patients with ulcerative colitis (UC) undergo surgery because it is not treatable or because it is associated with a fulminant course, dysplasia, or colon cancer. The surgery of choice is proctocolectomy with ileal-anal pouch. However, 20%-50% of patients present with pouchitis 10 years after surgery. The diagnosis is made based on clinical manifestations, endoscopic alterations, and histology. The drugs used in the treatment of UC are not as effective in pouchitis and the first-line treatment is antibiotics administration. Depending on the initial response and clinical course of the condition, subsequent treatment will be chosen. This review discusses the most important aspects of the epidemiology, diagnosis, pathogenesis, and treatment of pouchitis.

Humans , Male , Female , Therapeutics , Colitis, Ulcerative , Pouchitis , Diagnosis , Signs and Symptoms , Proctocolectomy, Restorative , Anti-Bacterial Agents
Rev. colomb. gastroenterol ; 36(1): 98-102, ene.-mar. 2021. tab
Article in Spanish | LILACS | ID: biblio-1251528


Resumen La enfermedad de Behçet es una enfermedad poco frecuente con un compromiso sistémico cuyas principales manifestaciones abarcan el sistema gastrointestinal, neurológico, vascular y articular, además de la piel y los ojos. Por su compromiso multisistémico, es frecuente confundirlo con otras entidades como la enfermedad inflamatoria intestinal, con la cual comparte gran parte de su presentación clínica, por lo que se describe un caso clínico y se aborda una revision narrativa desde el punto de vista epidemiológico de las manifestaciones clínicas con el fin de tener un mayor conocimiento para identificarla a tiempo.

Abstract Behçet's disease is a rare disease with systemic involvement whose main manifestations include the gastrointestinal, neurological, vascular, and articular systems, as well as the skin and eyes. Due to its multisystemic nature, it is often mistaken for other entities such as inflammatory bowel disease since they share multiple characteristics in their clinical presentation. A clinical case is described, and an epidemiological review of clinical manifestations is discussed to have better knowledge that allow identifying it on time.

Humans , Male , Middle Aged , Signs and Symptoms , Inflammatory Bowel Diseases , Behcet Syndrome , Rare Diseases
Int. j. med. surg. sci. (Print) ; 8(1): 1-9, mar. 2021. ilus
Article in Spanish | LILACS | ID: biblio-1151628


La terapia con fármacos antagonistas del factor de necrosis tumoral alfa ha sido beneficiosa en el tratamiento de varias enfermedades como las del tejido conectivo e inflamatorias del intestino, pero no está exenta de riesgos. Las principales complicaciones de estas drogas inmunosupresoras son las infecciones, y la tuberculosis pulmonar es una de las principales afecciones, que se pueden observar en los pacientes con este tipo de tratamiento.Se presentó una mujer de 31 años, atendida en el Hospital Clínico Quirúrgico Hermanos Ameijeiras, La Habana, Cuba, con antecedentes de colitis ulcerativa, que hace 3 meses recibe terapia con Infliximab. Acude al hospital por referir 4 días previos al ingreso, fiebre de 390 C dos veces al día, acompañándose de cefalea, pérdida del apetito y dolor en la región perineal. Se le realizó radiografía de tórax, donde se describe radiopacidad heterogénea que va desde el cuerno superior del hilio derecho hasta planos axilares, en la tomografía axial de tórax reportan consolidación en segmento anterior del lóbulo superior derecho con presencia de broncograma aéreo y en el lavado bronquial microbiológico para bacilos ácido-alcohol resistentes se informó codificación 8, positivo a Mycobacterium tuberculosis. El diagnóstico preciso de tuberculosis relacionada con el uso de fármacos antagonistas del factor de necrosis tumoral alfa requiere un alto índice de sospecha y una investigación detallada. Existe un alto grado de complejidad diagnóstica, por la existencia de un amplio espectro clínico y la necesidad de excluir otras enfermedades.

Tumor necrosis factor alpha antagonist drug therapy has been beneficial in the treatment of several diseases such as connective tissue and inflammatory bowel diseases, but it is not without risks. The main complications of these immunosuppressive drugs are infections, and pulmonary tuberculosis is one of the main conditions, which can be observed in patients with this type of treatment. A 31-year-old woman, treated at the Hermanos Ameijeiras Clinical Surgical Hospital, Havana, Cuba, with a history of ulcerative colitis, who has been receiving Infliximab therapy for 3 months, presented. He went to the hospital for referring 4 days prior to admission, a fever of 390 C twice a day, accompanied by headache, loss of appetite and pain in the perineal region. A chest X-ray was performed, which described heterogeneous radiopacity that goes from the upper horn of the right hilum to axillary planes, in the chest axial tomography they report consolidation in the anterior segment of the right upper lobe with the presence of air bronchogram and in the bronchial lavage microbiological for acid-fast bacilli coding 8, positive for mycobacterium tuberculosis was reported. Accurate diagnosis of tuberculosis related to the use of tumor necrosis factor alpha antagonist drugs requires a high index of suspicion and detailed investigation. There is a high degree of diagnostic complexity, due to the existence of a wide clinical spectrum and the need to exclude other diseases.

Humans , Female , Adult , Tuberculosis, Pulmonary/diagnostic imaging , Infliximab/adverse effects , Immunosuppressive Agents/adverse effects , Tuberculosis, Pulmonary/etiology , Tomography, X-Ray Computed , Infections/etiology
An. Fac. Cienc. Méd. (Asunción) ; 54(2): 151-156, 2021.
Article in Spanish | LILACS | ID: biblio-1281113


La Colitis Ulcerativa (CU) es una enfermedad crónica multifactorial de etiología desconocida caracterizada por la presencia de inflamación difusa en la mucosa colónica en presencia de diarrea sanguinolenta asociada con urgencia y tenesmo rectal. Una mujer de 51 años, acudió al Servicio de Urgencias por rectorragia con molestias en hipogastrio y tenesmo, además un mes y medio de deposiciones liquidas, sensación febril intermitente, anorexia, nauseas sin vómitos y pérdida de peso de aprox. 10 kilos en 1 mes, con un abdomen distendido, levemente depresible, doloroso en hipogastrio. La colonoscopía y anatomía patológica informan una Rectocolitis Ulcerativa Pancolónica. La paciente continua con mala evolución a pesar de tratamiento médico, por lo que se decide el manejo quirúrgico con una colectomía subtotal con confección de ileostomía y fístula mucosa de sigmoides por colitis aguda grave refractaria al tratamiento. El manejo médico previo al manejo quirúrgico en este caso se vio limitado por la disponibilidad de fármacos. Esto resalta la necesidad del conocimiento del manejo multidisciplinario de las patologías colorectales.

Ulcerative Colitis (UC) is a multifactorial chronic disease of unknown etiology characterized by the presence of diffuse inflammation in the colonic mucosa and often the presence of bloody diarrhea associated with rectal urgency. A 51-year-old woman came to the emergency room due to rectal bleeding with hypogastric pain and tenesmus, in addition to a month and a half of diarrhea, intermittent fever, anorexia, nausea without vomiting and weight loss of approx. 10 kilos in 1 month, with a distended abdomen, slightly depressible, painful in the hypogastrium. Colonoscopy and pathological anatomy report a Pancolonic Ulcerative Rectocolitis. The patient continues with poor evolution despite medical treatment, so a surgical approach is decided with a subtotal colectomy, terminal ileostomy and sigmoid fistula due to severe acute colitis refractory to treatment. Medical treatment prior to a surgical approach in this case was limited by the availability of drugs. This highlights the need for a multidisciplinary management of colorectal pathologies.

Anorexia , Colitis, Ulcerative , Chronic Disease , Colectomy , Diarrhea , Colon, Sigmoid , Abdomen
Article in Chinese | WPRIM | ID: wpr-921798


Huangqin Decoction(HQD) is a classic prescription for treating dysentery in the Treatise on Cold Damage and now is mainly used for the treatment of ulcerative colitis(UC). Since there are no requirements on specific Paeonia species, both Paeoniae Radix Alba(white peony root, WPR) and Paeoniae Radix Rubra(red peony root, RPR) are clinically used in HQD now. Although the two types of peony roots are close in origin and similar in primary components, the medicinal properties and efficacies are different. Furthermore, the systematic comparative analysis on the efficacy differences in treating UC of HQD with the roots of multi-originated peony has been seldom reported. This study compared and evaluated the pharmacological effects of HQD prepared from the roots of multi-originated peony, including WPR, RPR-l(derived from P. lactiflora), and RPR-v(derived from P. veitchii) based on the mouse model of UC induced by dextran sodium sulfate(DSS) by animal behaviors, pathological section(colon), and cytokine expression(IL-1β and IL-6), aiming to provide evidence for the identification of the original resource of peony root in HQD. The results indicated that all HQD samples prepared from WPR, RPR-l, and RPR-v could improve the symptoms of UC. Compared with the HQD-WPR, HQD-RPR-l and HQD-RPR-v were significantly different in weight loss, colon length, and disease activity index(DAI) score, but there was no significant difference between HQD-RPR-l and HQD-RPR-v. Moreover, HQD-RPR-v exhibited the most significant improvement in the pathological morphology of colonic tissue and mucosal defects. According to the previous comparative analysis of chemical profiling and content distribution of HQD prepared from the roots of multi-originated peony, RPR-v in HQD was potent in protecting against UC, which was presumedly attributed to a large number of monoterpene glycosides and galloyl glucoses. This study provided a scientific basis for the determination of peony root in HQD and its clinical medication.

Animals , Colitis, Ulcerative/drug therapy , Dextran Sulfate , Disease Models, Animal , Drugs, Chinese Herbal/therapeutic use , Mice , Monoterpenes , Paeonia/chemistry , Plant Roots/chemistry
Article in Chinese | WPRIM | ID: wpr-921757


The aim of this paper was to explore the effect and mechanism of Jiawei Baitouweng Decoction(JWBTW) against ulcerative colitis(UC) from the perspective of intestinal mucosal tight junction proteins. From 60 SPF-grade male SD rats, 10 were randomly selected as the blank control, and the remaining 50 were treated with 3% dextran sodium sulfate(DSS) solution to induce UC and then randomized into the model group, mesalazine group, and low-, medium-, and high-dose JWBTW( L-JWBTW, M-JWBTW and H-JWBTW) groups, with 10 rats in each group. After successive medication for 14 days, the rat general conditions like body weight and stool were observed and the disease activity index(DAI) was calculated. The pathological changes in colon tissue was observed under a microscope for injury severity scoring and histopathological scoring. The serum endotoxin content was determined by limulus assay, followed by the measurement of protein expression levels of ZO-1, occludin, claudin-1, p38 MAPK, MLCK, MLC2 and p-MLC in colon tissue by Western blot. The results showed that compared with the blank group, the model group exhibited significantly reduced body weight, elevated DAI, injury severity and histopathological scores and serum endotoxin content, up-regulated protein expression levels of p38 MAPK, MLCK, MLC2 and p-MLC, and down-regulated ZO-1, occludin and claudin-1. Compared with the model group,mesalazine and JWBTW at each dose obviously increased the body weight, lowered the DAI, injury severity and histopathological scores and serum endotoxin content, down-regulated the protein expression levels of p38 MAPK, MLCK, MLC2 and p-MLC, and up-regulated the ZO-1, occludin and claudin-1, with the most obvious changes noticed in the H-JWBTW group. All these have indicated that JWBTW exerts the therapeutic effect against UC by inhibiting the activation of p38 MAPK/MLCK pathway, reversing the protein expression levels of occludin, claudin-1 and ZO-1, decreasing the serum endotoxin content, promoting the repair of intestinal mucosal mechanical barrier, maintaining the integrity of tight junctions, and reducing the permeability of intestinal mucosa.

Animals , Colitis, Ulcerative/genetics , Disease Models, Animal , Intestinal Mucosa , Male , Rats , Rats, Sprague-Dawley , Signal Transduction , Tight Junction Proteins/genetics , p38 Mitogen-Activated Protein Kinases/genetics
Chinese Acupuncture & Moxibustion ; (12): 1127-1134, 2021.
Article in Chinese | WPRIM | ID: wpr-921021


OBJECTIVE@#To observe the effect of moxibustion at "Zusanli" (ST 36) on distal, middle and proximal colonic mucosal injury and expression of calcitonin gene-related peptide (CGRP) positive nerve fibers of distal colonic mucosa in ulcerative colitis (UC) mice at different time points.@*METHODS@#A total of 51 C57BL/6N mice were randomized into a 7-day control group (@*RESULTS@#Mucosal injury can be observed in mice after modeling, displaying epithelial layer disappearance, abnormal crypt structure or crypt disappearance. Compared with the 7-day control group, colon length was shortened (@*CONCLUSION@#Moxibustion at "Zusanli" (ST 36) can reduce the expressions of positive nerve fibers of colonic mucosa and CGRP positive nerve fibers of distal colonic mucosa, thus, improve the colonic mucosal injury.

Animals , Calcitonin , Calcitonin Gene-Related Peptide/genetics , Colitis, Ulcerative/therapy , Intestinal Mucosa , Mice , Mice, Inbred C57BL , Moxibustion , Nerve Fibers