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1.
J. coloproctol. (Rio J., Impr.) ; 43(4): 276-279, Oct.-Dec. 2023. tab
Article in English | LILACS | ID: biblio-1528941

ABSTRACT

Inflammatory bowel disease (IBD) is a problem that directly affects the quality of life of patients suffering from this condition. Monitoring the serum level of infliximab (IFX) (TDM) is an important tool for guiding therapeutic decisions in IBD patients. The purpose of this study was to determine the significance of quantitatively measuring the serum level of IFX (TDM) and antibody to IFX (ATI). Methods and materials: Prospective observational study involving 40 IBD patients on IFX therapy, including 14 Proactive (week 06 of the induction phase) and 26 Reactive (maintenance phase). Immediately prior to the infusion, blood samples were drawn and measured using a Bulhlmann rapid test instrument. Serum concentrations of IFX were categorized as supratherapeutic (>7.0 micrograms/ml), therapeutic (between 3.0 and 7.0 micrograms/ml), and subtherapeutic (3.0 micrograms/ml). When the serum concentration of IFX was 3 mcg/ml (subtherapeutic), the ATI was measured. 25 patients with CD and 15 patients with UC were evaluated. Only three of the twenty patients with subtherapeutic serum levels had a positive ATI, and both were reactive; two had CD and one had UC. There was a statistically significant difference between reactive and proactive patients with respect to levels of CRP (p = 0.042), with proactive DNS patients suffering greater alterations in CRP and albumin. (AU)


Subject(s)
Humans , Male , Female , Inflammatory Bowel Diseases/therapy , Drug Monitoring , C-Reactive Protein , Retrospective Studies , Albumins , Infliximab/therapeutic use
2.
J. coloproctol. (Rio J., Impr.) ; 43(4): 280-285, Oct.-Dec. 2023. tab
Article in English | LILACS | ID: biblio-1528947

ABSTRACT

Background and Aims: Some studies have reported the coexistence of inflammatory bowel disease (IBD) and celiac disease (CD). However, the prevalence of anti-tissue transglutaminase antibodies (IgA and IgG) and their screening value in patients with IBD is not yet clear. This study aimed to assess the prevalence of IgA anti-tTG and its potential correlation with disease status in patients with IBD. Materials and Methods: This cross-sectional study was conducted on 110 patients with confirmed IBD diagnosis at Ghaem Hospital, Mashhad, Iran. For each patient, all demographic and clinical data including age, extra intestinal manifestations, underlying diseases, types of diseases, and surgical history were collected. IgA anti-tissue transglutaminase titers were assessed by enzyme-linked immunosorbent assay. Results: None of the patients with IBD were positive for IgA anti-tTG antibodies, with a mean titer of 3.31 ± 1.3 AU/mL. Also, the mean titers were not associated with age, gender and various disease clinical features including the disease history, underlying disease, diagnosis type, extraintestinal manifestations, and surgery history. Conclusion: No significant prevalence pattern of IgA anti-tTG antibody was observed in patients with IBD. Accordingly, serological screening for CeD is not recommended in IBD patients, unless in a relevant clinical CeD suspicion. (AU)


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Immunoglobulin A , Inflammatory Bowel Diseases , Celiac Disease , Cohort Studies , Antibodies
3.
Rev. colomb. cir ; 38(4): 704-723, 20230906. fig, tab
Article in Spanish | LILACS | ID: biblio-1511124

ABSTRACT

Introducción. Los términos falla intestinal crónica, síndrome de intestino corto (SIC) y nutrición parenteral total son muy frecuentes en la práctica clínica cotidiana.El objetivo de esta guía fue establecer un marco de referencia de práctica clínica basado en el mejor de nivel de evidencia en pacientes con falla intestinal crónica secundaria a síndrome de intestino corto. Métodos. Se estableció un grupo de expertos interdisciplinarios en el manejo de la falla intestinal crónica quienes, previa revisión de la literatura escogida, se reunieron de manera virtual acogiendo el método Delphi para discutir una serie de preguntas seleccionadas, enfocadas en el contexto terapéutico de la falla intestinal crónica asociada al síndrome de intestino corto. Resultados. La recomendación del grupo de expertos colombianos es que se aconseje a los pacientes con SIC consumir dietas regulares de alimentos integrales que genere hiperfagia para compensar la malabsorción. Las necesidades proteicas y energéticas dependen de las características individuales de cada paciente; la adecuación del régimen debe ser evaluada a través de pruebas clínicas, antropométricas y parámetros bioquímicos. Se sugiere, especialmente a corto plazo después de la resección intestinal, el uso de análogos de somatostatina para pacientes con yeyunostomía de alto gasto en quienes el manejo de líquidos y electrolitos es problemático. En pacientes con SIC, que son candidatos a tratamiento con enterohormonas, Teduglutida es la primera opción. Conclusión. Existen recomendaciones en el manejo integral de la rehabilitación intestinal respaldadas ampliamente por este consenso y es importante el reconocimiento de alternativas terapéuticos enmarcadas en el principio de buenas prácticas clínicas.


Introduction. The terms chronic intestinal failure, short bowel syndrome (SBS), and total parenteral nutrition are very common in daily clinical practice. The objective of this guideline was to establish a reference framework for clinical practice based on the best level of evidence in patients with chronic intestinal failure secondary to short bowel syndrome. Methods. A group of interdisciplinary experts in the management of chronic intestinal failure was established who, after reviewing the selected literature, met virtually using the Delphi method to discuss a series of selected questions, focused on the therapeutic context of chronic intestinal failure associated with short bowel syndrome. Results. The recommendation of the Colombian expert group is that patients with SBS be advised to consume regular diets of whole foods that generate hyperphagia to compensate malabsorption. Protein and energy needs depend on the individual characteristics of each patient; the adequacy of the regimen must be evaluated through clinical, anthropometric tests and biochemical parameters. The use of somatostatin analogue is suggested, especially in the short term after bowel resection, for patients with high-output jejunostomy in whom fluid and electrolyte management is problematic. In SBS, who are candidates for enterohormonal therapy, Teduglutide is the first choice. Conclusion. There are recommendations on the comprehensive management of intestinal rehabilitation that are widely supported by this consensus and it is important to recognize therapeutic alternatives framed in the principle of good clinical practice.


Subject(s)
Humans , Short Bowel Syndrome , Inflammatory Bowel Diseases , Parenteral Nutrition, Total , Nutrition Programs and Policies , Gastrointestinal Hormones , Intestine, Small
4.
J. coloproctol. (Rio J., Impr.) ; 43(3): 227-234, July-sept. 2023. tab, ilus
Article in English | LILACS | ID: biblio-1521140

ABSTRACT

Inflammatory bowel disease (IBD) is a chronic condition that affects the digestive tract and can lead to inflammation and damage to the intestinal lining. IBD patients with cancer encounter difficulties since cancer treatment weakens their immune systems. A multidisciplinary strategy that strikes a balance between the requirement to manage IBD symptoms and the potential effects of treatment on cancer is necessary for effective care of IBD in cancer patients. To reduce inflammation and avoid problems, IBD in cancer patients is often managed by closely monitoring IBD symptoms in conjunction with the necessary medication and surgical intervention. Anti-inflammatory medications, immunomodulators, and biologic therapies may be used for medical care, and surgical options may include resection of the diseased intestine or removal of the entire colon. The current study provides a paradigm for shared decision-making involving the patient, gastroenterologist, and oncologist while considering recent findings on the safety of IBD medicines, cancer, and recurrent cancer risk in individuals with IBD. We hope to summarize the pertinent research in this review and offer useful advice. (AU)


Subject(s)
Humans , Inflammatory Bowel Diseases/complications , Inflammatory Bowel Diseases/therapy , Uterine Cervical Neoplasms , Urologic Neoplasms , Gastrointestinal Neoplasms , Methotrexate , Risk Factors , Tumor Necrosis Factor Inhibitors , Mercaptopurine
5.
Arch. argent. pediatr ; 121(3): e202202933, jun. 2023. tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1437257

ABSTRACT

Los avances tecnológicos y del conocimiento hicieron que un mayor número de pacientes con enfermedad crónica gastrointestinal pasen de ser atendidos por el pediatra al control por los médicos de adultos durante una de las etapas más vulnerables de la vida: la adolescencia. El Grupo de Trabajo de Transición del Comité de Gastroenterología de la Sociedad Argentina de Pediatría realizó una búsqueda de literatura exhaustiva y convocó a especialistas referentes del país, con el objeto de unificar los criterios basados en la evidencia y la experiencia. De esta manera, se proponen una serie de recomendaciones para todo el equipo de salud (pediatra, gastroenterólogo infantil, nutricionista, gastroenterólogo de adultos, psicólogo, enfermería), incluso para pacientes y familias, que faciliten el proceso de transición y optimicen el seguimiento, el control, la prevención de complicaciones y la calidad de vida de los pacientes con enfermedades crónicas gastrointestinales


Technological advances and the globalization of knowledge have led to a considerable increase in the number of patients with chronic gastrointestinal disease who transition from pediatric to adult care during one of the most vulnerable life stages: adolescence. The Transition Working Group of the Gastroenterology Committee of the Sociedad Argentina de Pediatría conducted an exhaustive literature search and summoned leading specialists in the most frequent chronic pathologies from all over the country to unify criteria based on evidence and experience. As a result, a series of recommendations are proposed for the whole health team (pediatrician, pediatric gastroenterologist, nutritionist, adult gastroenterologist, psychologist, and nurse) including patients and families, to facilitate the transition process, optimize follow-up, prevent complications, and improve the quality of life of patients with chronic gastrointestinal diseases.


Subject(s)
Humans , Adolescent , Adult , Inflammatory Bowel Diseases , Transition to Adult Care , Gastroenterology , Gastrointestinal Diseases/therapy , Quality of Life , Chronic Disease
7.
São Paulo; s.n; 2023. 191 p. tab, ilus.
Thesis in Portuguese | LILACS, Inca | ID: biblio-1451257

ABSTRACT

INTRODUÇÃO: As funções executivas (FE) constituem-se como importante mecanismo de controle cognitivo, responsável por direcionar e coordenar o comportamento de maneira adaptativa frente às novas exigências. Diante do diagnóstico da doença inflamatória intestinal (DII), ocorre sinalização excessiva de ameaças e sensibilidade à dor que afetam circuitos cerebrais relacionados às FE, o que culmina em maior vulnerabilidade ao estresse, e consequentemente à neuroinflamação. Diante de tais pressupostos, o posicionamento epistemológico deste estudo pauta-se na Psiconeuroimunologia. OBJETIVO: Investigar o impacto das FE sobre a percepção do estresse na atividade das doenças inflamatórias intestinais. METODOLOGIA: A pesquisa é de natureza quantitativa, de cunho descritivo e analítico, com corte transversal e correlacional. A amostra foi composta por 52 pacientes de um Ambulatório de Assistência Interdisciplinar às DII, integrado a uma universidade comunitária no sul do Brasil. Uma avaliação neuropsicológica realizada por meio de entrevista sociodemográfica e clínica, medidas de estresse, coping e FE possibilitou uma análise ecológica e sistêmica. O tratamento dos dados deu-se por meio da estatística descritiva e inferencial, correlacionando-se indicadores clínicos dos pacientes em fase remissiva e ativa da DII. RESULTADOS: A média de idade foi 43,6 anos, com predomínio de mulheres, cor branca, classe socioeconômica desfavorecida e atividade profissional autônoma. Evidenciou-se comprometimento leve nas FE, estabelecendo-se um perfil fenotípico com maiores prejuízos neurocognitivos na Doença de Crohn, em atividade, em uso de corticosteroides, com transtornos de humor e histórico de ideação suicida, maior idade e tempo de diagnóstico. Os prejuízos ocorreram tanto nos processos automáticos de velocidade de processamento, como nos processos controlados, atenção seletiva e alternada, memória de trabalho e flexibilidade cognitiva. A análise de regressão evidenciou que o comprometimento nas FE se constitui como preditor de estresse na DII, tendo como primeiro fator preditor o estresse financeiro; e o segundo, o estresse familiar. Na amostra total, o comprometimento nas FE explicou 18% da variância da percepção do impacto do estresse na saúde; já nos pacientes em atividade, explicou 24% da variância de estresse e 47% da variância do Coping Resolução de Problemas. Essa estratégia foi mais utilizada por pessoas com percepção de sucesso muito grande no alívio do estresse. Os níveis de estresse percebido foram moderados a elevados em mais de um quarto da amostra, sem diferenças significativas na emissão e atividade; e as estratégias de enfrentamento explicaram 62% da variância da percepção do impacto do suporte social recebido. CONCLUSÃO: Os resultados possibilitaram conhecer mecanismos associados às sobecargas inerentes ao processo adaptativo com a DII, sugerindo que os pacientes estão em risco elevado de disfunções executivas ao longo do tempo e suscetibilidade ao estresse. Por outro lado, o estresse interfere no desempenho das FE, retroalimentando esse circuito psiconeuroimunológico. Medidas interdisciplinares preventivas visando remissão duradoura, suporte social e aprendizagem de resolução de problemas poderão contribuir para a modulação dos estados cognitivos e emocionais. O estudo traz elementos relevantes para delineamento de alvos terapêuticos que guiem comportamentos autorregulatórios, prevenção da progressão de danos e incapacidades associadas aos comprometimentos como doenças neurodegenerativas, neuropsiquiátricas e risco de suicídio em pacientes com DII.


INTRODUCTION: Executive functions (EF) constitute an important mechanism of cognitive control, responsible for directing and coordinating behaviour in an adaptive manner, allowing for quick and flexible changes in response to new demands. In the context of inflammatory bowel disease (IBD) diagnosis, there is an excessive signalling of threats and sensitivity to pain that affect brain circuits involving the prefrontal cortex related to EF, resulting in increased vulnerability to stress and consequently to neuroinflammation. Based on these assumptions, the epistemological position of this study is grounded in Psychoneuroimmunology. OBJECTIVE: To investigate the impact of executive functions on stress perception in the activity of inflammatory bowel diseases. METHODOLOGY: This study is quantitative, descriptive, and analytical in nature, with a cross-sectional and correlational design. The sample consisted of 52 patients from an Interdisciplinary Outpatient Care Clinic for IBD, integrated into a community university in southern Brazil. A neuropsychological assessment, including sociodemographic and clinical interviews, stress measures, coping strategies, and executive functions, enabled an ecological and systemic analysis. Data analysis was conducted using descriptive and inferential statistics, correlating clinical indicators of patients in remission and active phases of IBD. RESULTS: The mean age was 43.6 years, with a predominance of women, white ethnicity, disadvantaged socioeconomic class and autonomous professional activity. Mild impairment in EF was evidenced, establishing a phenotypic profile with greater neurocognitive impairments in Crohn's Disease (CD), in activity, in use of corticosteroids, with mood disorders and history of suicidal ideation, older age and diagnosis time. Losses occurred both in automatic processes of processing speed and in controlled processes, selective and alternating attention, working memory and cognitive flexibility. The regression analysis showed that performance in EF is a predictor of stress in IBD, with financial stress as the first predictor; and the second, family stress. Performance in EF explained 18% of the variance in the perception of the impact of stress on health. In active patients, EF performance explained 24% of the stress variance and 47% of the Problem Solving variance. Moderate to high levels of perceived stress were evident in more than a quarter of the sample, with no significant differences in remission and activity. Coping strategies explained 62% of the variance in the perception of the impact of social support received. CONCLUSION: The results shed light on the mechanisms associated with the inherent burdens to the adaptive process with IBD, suggesting that patients are at high risk of executive dysfunction over time and susceptibility to stress. Conversely, stress also affects EF performance, thereby reinforcing this psychoneuroimmunological circuit. Preventive interdisciplinary measures aimed at last remission, social support and problem-solving learning may contribute to the modulation of cognitive and emotional states. The study provides relevant elements for the design of therapeutic targets that guide self-regulatory behaviors, prevention of the progression of damage and disabilities associated with impairments such as neurodegenerative and neuropsychiatric diseases and risk of suicide in patients with IBD.


Subject(s)
Inflammatory Bowel Diseases , Executive Function , Psychological Distress
8.
Acta cir. bras ; 38: e386723, 2023. tab, graf, ilus
Article in English | LILACS, VETINDEX | ID: biblio-1527586

ABSTRACT

Purpose: To evaluate the long-chain fatty acid and major compounds levels in the feces after prophylactic oral use of Lacticaseibacillus casei in an experimental model of intestinal mucositis. Methods: Fifteen Swiss mice were randomly divided into three groups (n=5/group): The negative or positive control groups (n = 5) received saline orally for 18 days and an the intraperitoneal (i.p.) of saline or 5 Fluorouracil (450 mg/kg) in 15th day, respectability. L. casei group received oral concentration of L. casei (1x109 CFU/mL) for 18 days, the i.p. injection of 5-fluorouracil (450 mg/kg) in 15th days. Tissue samples from colon and each small intestine segment were collected for histopathological analysis. Stool samples were collected. Fecal composition of long-chain fatty acids and sterols were analysed by gas chromatography-mass spectrometry on the 15th and the 18th day. Results: The mucosa layer of all small intestine segments of animals from L. casei showed well preserved epithelium and glands, without necrosis signs, but Goblet cells number decreased. Several long-chain fatty acids and sterols have been identified before and after in the groups. L. casei administration after 5-FU treatment reduced concentrations of linoleic acid (18:2) (p < 0.001) and oleic acid (18:1) (p < 0.001) in feces. Conclusions: L. casei prevented the mucosal damage associated with 5-FU-induced intestinal mucositis reduced long-chain fatty acid levels in the feces.


Subject(s)
Inflammatory Bowel Diseases , Mucositis , Fatty Acids , Lacticaseibacillus casei
9.
Chinese Journal of Contemporary Pediatrics ; (12): 745-750, 2023.
Article in Chinese | WPRIM | ID: wpr-982022

ABSTRACT

OBJECTIVES@#To investigate the nutritional status and its influencing factors in children with newly diagnosed inflammatory bowel disease (IBD).@*METHODS@#A retrospective analysis was conducted on the clinical data of children who were diagnosed with IBD for the first time in Hunan Children's Hospital from January 2015 to December 2021. Diagnostic delay was defined as the time from the symptom onset to IBD diagnosis being in the upper quartile (P76-P100) of all IBD children in the study. Multivariate logistic regression analysis was used to explore the risk factors for emaciation and growth retardation.@*RESULTS@#A total of 125 children with newly diagnosed IBD were included, with Crohn's disease being the main type (91.2%). The rates of emaciation and growth retardation were 42.4% (53 cases) and 7.2% (9 cases), respectively, and the rate of anemia was 77.6% (97 cases). Diagnostic delay was noted in 31 children (24.8%), with the time from the symptom onset to IBD diagnosis of 366 to 7 211 days. Multivariate logistic regression analysis showed that diagnostic delay was a risk factor for emaciation and growth retardation (OR=2.73 and OR=4.42, respectively; P<0.05) and that age was positively associated with emaciation (OR=1.30, P<0.05).@*CONCLUSIONS@#Children with newly diagnosed IBD have poor nutritional status, and the rates of anemia, emaciation, and growth retardation are high. Diagnostic delay is associated with malnutrition in children with IBD.


Subject(s)
Humans , Child , Colitis, Ulcerative/diagnosis , Nutritional Status , Retrospective Studies , Emaciation/complications , Delayed Diagnosis , Inflammatory Bowel Diseases/complications , Malnutrition/complications , Growth Disorders/complications
10.
Chinese Journal of Internal Medicine ; (12): 532-538, 2023.
Article in Chinese | WPRIM | ID: wpr-985957

ABSTRACT

Objective: To explore disease characteristics of primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD) and compare the differences between PSC with and without IBD. Methods: Study design was cross sectional. Forty-two patients with PSC who were admitted from January 2000 to January 2021 were included. We analyzed their demographic characteristics, clinical manifestations, concomitant diseases, auxiliary examination, and treatment. Results: The 42 patients were 11-74(43±18) years of age at diagnosis. The concordance rate of PSC with IBD was 33.3%, and the age at PSC with IBD diagnosis was 12-63(42±17) years. PSC patients with IBD had higher incidences of diarrhea and lower incidences of jaundice and fatigue than in those without IBD (all P<0.05). Alanine aminotransferase, total bilirubin, direct bilirubin, total bile acid and carbohydrate antigen 19-9 levels were higher in PSC patients without IBD than in those with IBD (all P<0.05). The positive rates for antinuclear antibodies and fecal occult blood were higher in PSC patients with IBD than in those without IBD (all P<0.05). Patients with PSC complicated with ulcerative colitis mainly experienced extensive colonic involvement. The proportion of 5-aminosalicylic acid and glucocorticoid application in PSC patients with IBD was significantly increased compared with that of PSC patients without IBD (P=0.025). Conclusions: The concordance rate of PSC with IBD is lower at Peking Union Medical College Hospital than in Western countries. Colonoscopy screening may benefit PSC patients with diarrhea or fecal occult blood-positive for early detection and diagnosis of IBD.


Subject(s)
Humans , Child , Adolescent , Young Adult , Adult , Middle Aged , Cholangitis, Sclerosing/therapy , Cross-Sectional Studies , Inflammatory Bowel Diseases/diagnosis , Colitis, Ulcerative/complications , Diarrhea
11.
Chinese Journal of Pediatrics ; (12): 606-613, 2023.
Article in Chinese | WPRIM | ID: wpr-985917

ABSTRACT

Objective: To explore the mechanism of intestinal tissue damage induced by macrophages activated by WNT2B high-expressed fibroblasts. Methods: This study involved biological information analysis, pathological tissue research and cell experimental research. The biological information of the colon tissue from the children with inflammatory bowel disease in previous study was analyzed again with single-cell sequencing. The pathological tissues were collected by colonoscopy from 10 children with Crohn's disease treated in the Department of Gastroenterology of Guangzhou Women and Children's Medical Center from July 2022 to September 2022. According to the findings of colonoscopy, tissues with obvious inflammation or ulceration were classified as the inflammatory group, while tissues with slight inflammation and no ulceration were classified as the non-inflammatory group. HE staining was performed to observe the pathological changes of the colon tissues. Macrophage infiltration and CXCL12 expression were detected by immunofluorescence. In terms of cell experiments, fibroblasts transfected with WNT2B plasmid or empty plasmid were co-cultured with salinomycin treated or non-treated macrophages, respectively; the expression of proteins through Wnt classical pathway were detected by western blotting. Macrophages treated with SKL2001 were used as the experimental group, and those with phosphate buffer as the control group. The expression and secretion of CXCL12 in macrophages were detected by quantitative Real-time PCR and enzyme-linked immunosorbent assay (ELISA). T-test or rank sum test were used for the comparison between groups. Results: Single-cell sequencing analysis suggested that macrophages were the main cells in inflammatory bowel disease colon tissue, and there was interaction between WNT2B high-expressed fibroblasts and macrophages. HE staining of the 10 patients ((9.3±3.8) years old, 7 males and 3 females) showed that the pathological score of colon tissue in the inflammatory group was higher than that in the non-inflammatory group (4 (3, 4) vs. 2 (1, 2) points, Z=3.05, P=0.002). Tissue immunofluorescence indicated that the number of infiltrating macrophages in the inflammatory group was significantly higher than that in the non-inflammatory group under high power field of view (72.8±10.4 vs.8.4±3.5, t=25.10, P<0.001), as well as the number of cells expressing CXCL12 (14.0±3.5 vs. 4.7±1.9, t=14.68, P<0.001). In cell experiments, western blotting suggested an elevated level of glycogen synthase kinase-3β phosphorylation in macrophages co-cultured with fibroblast transfected with WNT2B plasmid, and salinmycin could reverse this change. Real-time PCR suggested that the transcription level of CXCL12 in the experimental group was higher than that in the control group (6.42±0.04 vs. 1.00±0.03, t=183.00, P<0.001), as well as the expression and secretion of CXCL12 by ELISA ((465±34) vs. (77±9) ng/L, t=13.21, P=0.006). Conclusion: WNT2B high-expressed fibroblasts can secrete WNT2B protein and activate the Wnt classical signaling pathway thus enhancing the expression and secretion of CXCL12 in macrophages, inducing the development of intestinal inflammation of Crohn's disease.


Subject(s)
Child , Male , Humans , Female , Child, Preschool , Adolescent , Crohn Disease , Inflammatory Bowel Diseases , Colon , Inflammation , Colonoscopy , Glycoproteins , Wnt Proteins
12.
Journal of Southern Medical University ; (12): 206-212, 2023.
Article in Chinese | WPRIM | ID: wpr-971516

ABSTRACT

OBJECTIVE@#To investigate the mechanism by which fibroblasts with high WNT2b expression causes intestinal mucosa barrier disruption and promote the progression of inflammatory bowel disease (IBD).@*METHODS@#Caco-2 cells were treated with 20% fibroblast conditioned medium or co-cultured with fibroblasts highly expressing WNT2b, with the cells without treatment with the conditioned medium and cells co-cultured with wild-type fibroblasts as the control groups. The changes in barrier permeability of Caco-2 cells were assessed by measuring transmembrane resistance and Lucifer Yellow permeability. In Caco-2 cells co-cultured with WNT2b-overexpressing or control intestinal fibroblasts, nuclear entry of β-catenin was detected with immunofluorescence assay, and the expressions of tight junction proteins ZO-1 and E-cadherin were detected with Western blotting. In a C57 mouse model of dextran sulfate sodium (DSS)-induced IBD-like enteritis, the therapeutic effect of intraperitoneal injection of salinomycin (5 mg/kg, an inhibitor of WNT/β-catenin signaling pathway) was evaluated by observing the changes in intestinal inflammation and detecting the expressions of tight junction proteins.@*RESULTS@#In the coculture system, WNT2b overexpression in the fibroblasts significantly promoted nuclear entry of β-catenin (P < 0.01) and decreased the expressions of tight junction proteins in Caco-2 cells; knockdown of FZD4 expression in Caco-2 cells obviously reversed this effect. In DSS-treated mice, salinomycin treatment significantly reduced intestinal inflammation and increased the expressions of tight junction proteins in the intestinal mucosa.@*CONCLUSION@#Intestinal fibroblasts overexpressing WNT2b causes impairment of intestinal mucosal barrier function and can be a potential target for treatment of IBD.


Subject(s)
Humans , Mice , Animals , Caco-2 Cells , beta Catenin/metabolism , Culture Media, Conditioned/pharmacology , Tight Junctions/metabolism , Intestinal Mucosa , Inflammatory Bowel Diseases , Tight Junction Proteins/metabolism , Inflammation/metabolism , Fibroblasts/metabolism , Mice, Inbred C57BL , Glycoproteins/metabolism , Wnt Proteins/pharmacology , Frizzled Receptors/metabolism
13.
Chinese Journal of Hepatology ; (12): 35-41, 2023.
Article in Chinese | WPRIM | ID: wpr-970949

ABSTRACT

What are the new contents of the guideline since 2010?A.Patients with primary and non-primary sclerosing cholangitis (PSC) are included in these guidelines for the diagnosis and management of cholangiocarcinoma.B.Define "related stricture" as any biliary or hepatic duct stricture accompanied by the signs or symptoms of obstructive cholestasis and/or bacterial cholangitis.C.Patients who have had an inconclusive report from MRI and cholangiopancreatography should be reexamined by high-quality MRI/cholangiopancreatography for diagnostic purposes. Endoscopic retrograde cholangiopancreatography should be avoided for the diagnosis of PSC.D. Patients with PSC and unknown inflammatory bowel disease (IBD) should undergo diagnostic colonoscopic histological sampling, with follow-up examination every five years until IBD is detected.E. PSC patients with IBD should begin colon cancer monitoring at 15 years of age.F. Individual incidence rates should be interpreted with caution when using the new clinical risk tool for PSC for risk stratification.G. All patients with PSC should be considered for clinical trials; however, if ursodeoxycholic acid (13-23 mg/kg/day) is well tolerated and after 12 months of treatment, alkaline phosphatase (γ- Glutamyltransferase in children) and/or symptoms are significantly improved, it can be considered to continue to be used.H. Endoscopic retrograde cholangiopancreatography with cholangiocytology brushing and fluorescence in situ hybridization analysis should be performed on all patients suspected of having hilar or distal cholangiocarcinoma.I.Patients with PSC and recurrent cholangitis are now included in the new unified network organ sharing policy for the end-stage liver disease model standard.J. Liver transplantation is recommended after neoadjuvant therapy for patients with unresectable hilar cholangiocarcinoma with diameter < 3 cm or combined with PSC and no intrahepatic (extrahepatic) metastases.


Subject(s)
Child , Humans , Cholangitis, Sclerosing/diagnosis , Constriction, Pathologic/complications , In Situ Hybridization, Fluorescence , Cholangiocarcinoma/therapy , Liver Diseases/complications , Cholestasis , Inflammatory Bowel Diseases/therapy , Bile Ducts, Intrahepatic/pathology , Bile Duct Neoplasms/therapy
14.
Rev. bras. ginecol. obstet ; 44(10): 915-924, Oct. 2022. tab
Article in English | LILACS | ID: biblio-1423256

ABSTRACT

Abstract Objective To assess obstetric/puerperal/neonatal outcomes in an inflammatory bowel disease (IBD) population and to analyze disease characteristics that may be associated to adverse outcomes. Methods Retrospective descriptive analysis including 47 pregnant women with IBD (28 with Crohn's disease - CD and 19 with ulcerative colitis - UC) who delivered between March 2012 and July 2018 in a tertiary hospital. We reviewed clinical records to extract demographic information, previous medical history, disease subtype, activity, severity, treatment, and obstetric, puerperal, and neonatal outcome measures. Results Obstetric and neonatal complications (composite outcomes) occurred in 55.3% and 14.6% of the IBD population, respectively, and were more frequent in UC patients. Preterm birth (PTB), preeclampsia, anemia, low birth weight (LBW), and neonatal death were also more frequent in UC patients. The rate of postpartum hemorrhage (PPH) was 14.9%, and it was higher in CD patients. Women with active IBD had more obstetric/neonatal adverse outcomes (fetal growth restriction and LBW in particular) and cesarean sections. Patients with medicated IBD had less obstetric/neonatal complications (PTB and LBW in specific) and cesarean sections but more PPH. Conclusion Women with IBD may have an increased risk of obstetric/puerperal/neonatal adverse outcomes. Ulcerative colitis patients had more obstetric and neonatal complications, whereas PPH was more frequent if CD patients. Other disease characteristics were considered, which allowed a better understanding of their possible influence. Although more research is needed, this work reinforces the importance of adequate surveillance to allow prompt recognition and treatment of complications.


Resumo Objetivo Avaliar os desfechos obstétricos/puerperais/neonatais em uma população com doença inflamatória intestinal (DII) e analisar as características da doença, que podem estar associadas a desfechos adversos. Métodos Análise descritiva retrospectiva incluindo 47 gestantes com DII (28 com doença de Crohn - DC e 19 com retocolite ulcerativa - RCU) que deram à luz entre março de 2012 e julho de 2018 em um hospital terciário. Revisamos os registros clínicos para extrair informações demográficas, histórico médico prévio, subtipo da doença, atividade, gravidade, tratamento e medidas de resultados obstétricos, puerperais e neonatais. Resultados As complicações obstétricas e neonatais (desfechos compostos) ocorreram em 55,3% e 14,6% da população com DII, respectivamente; e foram mais frequentes em pacientes com RCU. Nascimento prematuro (PTB), pré-eclâmpsia, anemia, baixo peso ao nascer (BPN) e óbito neonatal também foram mais frequentes em pacientes com RCU. A taxa de hemorragia pós-parto (HPP) foi de 14,9% e foi maior em pacientes com DC. Mulheres com DII ativa tiveram mais desfechos obstétricos/neonatais adversos (restrição de crescimento fetal e BPN em particular) e cesarianas. Pacientes com DII medicada tiveram menos complicações obstétricas/neonatais (PTB e BPN em específico) e cesarianas, mas mais HPP. Conclusão Mulheres com DII podem ter um risco aumentado de desfechos adversos obstétricos/puerperais/neonatais. As pacientes com RCU apresentaram mais complicações obstétricas e neonatais, enquanto a HPP foi mais frequente em pacientes com DC. Outras características da doença foram consideradas, o que permitiu uma melhor compreensão de sua possível influência. Embora mais pesquisas sejam necessárias, este trabalho reforça a importância de uma vigilância adequada para permitir o reconhecimento e o tratamento imediatos das complicações.


Subject(s)
Humans , Female , Pregnancy , Inflammatory Bowel Diseases , Retrospective Studies
15.
Cambios rev. méd ; 21(1): 710, 30 Junio 2022. ilus, tabs, grafs.
Article in Spanish | LILACS | ID: biblio-1400338

ABSTRACT

INTRODUCCIÓN: La colitis eosinofílica y la colitis de la enfermedad inflamatoria intestinal, son dos entidades que pueden compartir similares características clínicas, endoscópicas y terapéuticas pero diferentes criterios diagnósticos. OBJETIVOS: Describir el caso clínico de un niño preescolar con antecedente de alergia alimentaria, de hospitalizaciones y uso de antibióticos por varias ocasiones, que evoluciona con diarrea crónica intermitente. CASO CLÍNICO: Se trata de un paciente masculino, de 3 años 5 meses, con antecedente de alergia alimentaria con cuadro crónico de dolor abdominal, diarrea y retraso en el crecimiento. Se realiza abordaje de diarrea crónica. RESULTADOS: Con hallazgos clínicos de enfermedad inflamatoria intestinal y descripción histopatológica de colitis eosinofílica, se considera la asociación entre estas dos patologías sin dejar la posibilidad de que esta última se trate de una fase inicial de enfermedad inflamatoria intestinal. CONCLUSIONES: El tratamiento de pacientes con colitis eosinofílica complicada es similar a la enfermedad inflamatoria intestinal, se requiere seguimiento clínico, endoscópico e histopatológico de pacientes con colitis eosinofílica a largo plazo.


INTRODUCTION: Eosinophilic colitis and inflammatory bowel disease colitis are two entities that may share similar clinical, endoscopic and therapeutic features but different diagnostic criteria. OBJECTIVES: To describe the clinical case of a preschool child with a history of food allergy, hospitalizations and use of antibiotics for several occasions, who evolves with chronic intermittent diarrhea. CLINICAL CASE: This is a male patient, 3 years 5 months old, with a history of food allergy with chronic abdominal pain, diarrhea and growth retardation. Chronic diarrhea was approached. RESULTS: With clinical findings of inflammatory bowel disease and histopathological description of eosinophilic colitis, the association between these two pathologies is considered without leaving the possibility that the latter is an initial phase of inflammatory bowel disease. CONCLUSIONS: The treatment of patients with complicated eosinophilic colitis is similar to inflammatory bowel disease, clinical, endoscopic and histopathological follow-up of patients with eosinophilic colitis is required in the long term.


Subject(s)
Humans , Male , Child, Preschool , Inflammatory Bowel Diseases , Colitis , Diarrhea/diagnosis , Enterocolitis , Eosinophils , Food Hypersensitivity , Pediatrics , Colitis, Ulcerative , Abdominal Pain , Colon , Enteric Nervous System , Diarrhea, Infantile , Eosinophilia , Prescription Drug Overuse , Gastrointestinal Diseases , Hospitalization
16.
J. coloproctol. (Rio J., Impr.) ; 42(1): 1-6, Jan.-Mar. 2022. tab, graf
Article in English | LILACS | ID: biblio-1375758

ABSTRACT

Background: Organic colonic manifestation may be difficult to be differentiated from functional one. Inflammatory bowel disease (IBD) is a common chronic inflammatory and destructive disease of the bowel wall. Chronic inflammation is associated with ulcerations, strictures, perforations, and it is a risk factor for dysplasia and cancer. To reduce these long-standing complications, IBD patients are in a continuous need for early diagnosis1. Markers, such as erythrocyte sedimentation rate (ESR), and c-reactive protein (CRP), fecal calprotectin (FC) have been widely used as noninvasive parameters for IBD monitoring. We aimed, in this current study, to evaluate the value of fecal calprotectin and other noninvasive biomarkers in predicting abnormal histologic findings in patients undergoing colonoscopy.in addition to determine the cutoff value which predict IBD2. Methods: The present prospective study included 160 patients with complaint of colicky abdominal pain with frequent diarrhea associated with mucous and infrequent bleeding per rectum for more than 6 months. They presented partial improvement with medication and recurrence once stopping the treatment These patients had been recently diagnosed with IBD at many primary healthcare centers covering the areas of the Kafrelsheikh and Zagazik governorate in the North of Egyptian Nile delta. After complete history, clinical examination, and laboratory investigation, they were referred to the IBD clinic at Kafrelsheikh University Hospital for assessment and ileocolonoscopy with biopsies. Results: There was a wide spectrum of age of the studied patients, with mean age 40.12±7.88 (minimum 18 and maximum 56 years). Regarding gender, males represented 87.5% of the studied patients. Forty percent of the patients with colonic manifestation were smokers, 57% preferred a spicy diet, and the majority had low educational level (77.5%). Forty percent had obvious blood in stool, 55% had occult blood, and raised ESR CRP occurred in 32.5% and 50%, respectively. Fecal calprotectin cutoff was>159, with sensitivity 92.8% and specificity 97.5%. Conclusions: Biomarkers (FC, ESR, CRP) can be used as noninvasive parameters for the early diagnosis and prediction of organic colonic disease. Fecal calprotectin in the IBD group revealed significant area under the curve (AUC) values and cutoff> 159, with sensitivity 92.8% and specificity 97.5%. (AU)


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Biomarkers/blood , Inflammatory Bowel Diseases/diagnosis , Leukocyte L1 Antigen Complex/blood , Health Profile , Blood Sedimentation , C-Reactive Protein , Abdominal Pain
18.
Rev. colomb. gastroenterol ; 37(1): 48-56, Jan.-Mar. 2022. tab
Article in English | LILACS | ID: biblio-1376905

ABSTRACT

Abstract Introduction: Inflammatory bowel disease (IBD) is an immune-mediated disease whose incidence in Latin America has increased in recent years. Aim: To analyze the demographic and clinical characteristics of patients with IBD treated in a university hospital and present the epidemiological data compared to other centers in Colombia. Patients and methods: Descriptive study of patients with IBD (1996-2019) at the Hospital Universitario Fundación Santa Fe de Bogotá. Analysis of data from centers in Medellín, Cali, Bogotá, and Cartagena. Results: Of 386 patients, 277 presented with ulcerative colitis (UC), 102 with Crohn's disease (CD), and seven with unclassifiable colitis. IBD was more frequent in women (53 %). Mortality was less than 1 %. The involvement of UC was mainly pancolitis (42.6 %). The greater the extent of the disease, the higher the hospitalization and surgery rates (OR 3.70, P < 0.01). Thirteen percent of patients with UC received biologics. Compromise due to CD was mainly ileocolonic (43.6 %) and ileal (43.6 %). The predominant clinical pattern of CD was structuring (50%). Forty-five percent received biologicals and 56 % surgery. Primary sclerosing cholangitis (PSC) was found in 4 % of patients (n = 15). Two patients with PSC developed colorectal cancer (OR 4.18; p 0.008), while 13 patients with UC developed colon cancer and seven dysplastic changes. Three patients with CD developed colon cancer. Conclusions: The results were compared to other reference centers. We found similar trends in the clinical behavior and treatment of IBD, with higher hospitalization and surgery rates in our cases.


Resumen Introducción: la enfermedad inflamatoria intestinal (EII) es una enfermedad inmunomediada, cuya incidencia en Latinoamérica ha aumentado en los últimos años. Objetivo: analizar las características demográficas y clínicas de los pacientes con EII tratados en un hospital universitario y presentar los datos epidemiológicos con respecto a otros centros en Colombia. Pacientes y métodos: estudio descriptivo de pacientes con EII (1996-2019) en el Hospital Universitario Fundación Santa Fe de Bogotá. Análisis de datos de centros de Medellín, Cali, Bogotá y Cartagena. Resultados: de 386 pacientes, 277 presentaron colitis ulcerativa (CU), 102 enfermedad de Crohn (EC) y 7 colitis no clasificable. La EII fue más frecuente en mujeres (53 %). La mortalidad fue menor de 1 %. El compromiso de la CU fue principalmente la pancolitis (42,6 %). Entre mayor la extensión de la enfermedad, más alta fue la tasa de hospitalización y cirugías (OR 3,70; p < 0,01). El 13 % de los pacientes con CU recibió biológicos. El compromiso por la EC fue principalmente ileocolónico (43,6 %) e ileal (43,6 %). El patrón clínico predominante de la EC fue estenosante (50%). El 45 % recibió biológicos y 56% cirugía. La colangitis esclerosante primaria (CEP) se encontró en 4 % de los pacientes (n = 15). Dos pacientes con CEP desarrollaron cáncer colorrectal (OR 4,18; p 0,008), mientras que 13 pacientes con CU desarrollaron cáncer de colon y 7 cambios displásicos. 3 pacientes con EC desarrollaron cáncer de colon. Conclusiones: se compararon los resultados en relación con otros centros de referencia. Encontramos tendencias similares en el comportamiento clínico y en el tratamiento de la EII, con mayores tazas de hospitalizaciones y cirugías en nuestros casos.


Subject(s)
Humans , Male , Female , Inflammatory Bowel Diseases , Colitis, Ulcerative , Colitis , Data Analysis , Patients , Behavior , Colorectal Neoplasms , Crohn Disease , Incidence , Hospitals
19.
Arch. latinoam. nutr ; 72(1): 50-59, mar. 2022. ilus, tab
Article in English | LILACS, LIVECS | ID: biblio-1368371

ABSTRACT

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)


Subject(s)
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
20.
DST j. bras. doenças sex. transm ; 34: 1-4, fev. 02, 2022.
Article in English | LILACS | ID: biblio-1399699

ABSTRACT

Introduction: The diagnosis of ulcerative colitis is relatively complex because the symptoms are similar to those seen in several other diseases. Objective: To report a case of rectal chlamydial infection whose initial symptoms resembled ulcerative colitis. Case report: A 50-year-old male patient presented with diarrhea, blood and mucus in the stools, and an ulcer in the rectum. The histopathological exam pointed to chronic, unspecified inflammation. After a broad serological screening, with Immunoglobulin M positive for Chlamydia and a high titer of immunoglobulin G, the patient was treated with antibiotics and is clinically cured. Later, he remained Immunoglobulin M positive, but the titers of immunoglobulin G lowered considerably. Chlamydia has been shown to live in the gut microbiota, which could explain the case. Conclusion: It is important to search for chlamydial infection as a differential diagnosis of ulcerative colitis.


Introdução: A retocolite ulcerativa é uma condição clínica de diagnóstico relativamente complexo, uma vez que apresenta sinais e sintomas comuns a muitas outras doenças. Objetivo: Relatar um caso de infecção anorretal por clamídia, cujos sintomas iniciais se pareciam com os de retocolite ulcerativa. Relato de caso: Paciente de 50 anos, do sexo masculino, apresentou-se com diarreia, muco e sangue nas fezes, e úlcera no canal anorretal. O exame histopatológico mostrou um processo inflamatório crônico e inespecífico, então procedeu-se a amplo rastreamento sorológico, que revelou Imunoglobulina M positivo para clamídia e altos títulos de Imunoglobulina G. O paciente foi tratado com antibióticos e encontra-se clinicamente curado. No seguimento, permanece com Imunoglobulina M positivo, mas os títulos de Imunoglobulina G decresceram consideravelmente. Bactérias do gênero Chlamydia têm sido reportadas como parte da microbiota intestinal, o que poderia explicar tal comportamento sorológico. Conclusão: É importante rastrear por clamídia como diagnóstico diferencial das suspeitas de retocolite ulcerativa


Subject(s)
Humans , Ulcer , Inflammatory Bowel Diseases , Chlamydia , Proctocolitis , Sexually Transmitted Diseases , Colonoscopy
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