Errores frecuentes en el diagnóstico y tratamiento de los pacientes con enfermedad inflamatoria intestinal / Common errores in the diagnosis and treatment of patients with inflammatory bowel disease

El creciente aumento de pacientes con enfermedad inflamatoria intestinal (EII), sumado a la multiplicidad de alternativas terapéuticas y a la poca experiencia en general de los médicos para tratar estas patologías, ya que son enfermedades emergentes, ha facilitado que se cometan errores tanto en el diagnóstico como en el tratamiento de las EII. En este artículo, se presentarán los más frecuentes e importantes, según la experiencia del autor, con el objeto de corregir estas conductas y alertar a los equipos médicos sobre éstas. El listado incluye errores cometidos en la historia clínica, laboratorio general, endoscopia y tratamiento.

The increasing number of patients with inflammatory bowel disease (IBD), plus the multiplicity of therapeutic alternatives and the low experience of doctors to treat these conditions as they are emerging diseases, have facilitated errors in diagnosis and treatment of IBD. This article will show the most frequent and important ones according to the author's experience, in order to correct these behaviors and alert medical teams about them. The list includes errors in medical history, general laboratory, endoscopy and treatment.

STAT signaling pathway mediates high glucose induced cardiac fibroblasts proliferation and collagen deposition in vitro / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the signal transducers and activator of transcriptions (STATs) protein expression changes and investigate the functional role of STATs pathway in case of high glucose-induced cardiac fibroblasts (CFs) proliferation and collagen deposition in vitro.</p><p><b>METHODS</b>Rat cardiac fibroblasts were isolated from 1- to 3-day-old SD rats, cells from the second to fourth passages were used for the experiment. CFs were cultured in Dulbecco's modified Eagle's medium, supplemented with 5.5 mmol/L glucose (NG), 5.5 mmol/L glucose plus 19.4 mmol/L mannose (OC) or 25 mmol/L glucose (HG) in the presence of absence of STAT1 inhibitor (fludarabine, FLU) and STAT3 inhibitor (S3I-201). After 24 h and 48 h culture in vitro, the proliferation of CFs was measured by 3-(4,5-dimethyl-2 thiazoyl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay. After 12 h and 24 h culture in vitro, the production of type I and III collagen was evaluated using real-time quantitative PCR and ELISA. After 0, 30, 60 and 120 min culture in vitro, the phosphorylated expression of STAT1 and STAT3 was analyzed by Western blot.</p><p><b>RESULTS</b>CFs proliferation was significantly enhanced post 24 h and 48 h HG stimulation, and procollagen I and III mRNA expression was significantly upregulated post 12 h and 24 h HG stimulation. Deposition of collagen I and III was also significantly increased post 24 h and 72 h HG stimulation. STAT1 phosphorylation in CFs was increased after 120 min HG stimulation and STAT3 phosphorylation in CFs was increased post 60 min and 120 min HG stimulation. FLU and S3I-201 could inhibit HG-induced CFs proliferation and suppress of which was stimulated by FLU and S3I-201 could both suppress upregulated procollagen I and III mRNA expression and the deposition of collagen types I and III post HG stimulation. STAT1 phosphorylation inhibition resulted in less mRNA downregulation of procollagen type III than that of procollagen type I post 12 h HG stimulation. The STAT3 phosphorylation inhibition resulted in more significantly upregulated procollagen type III mRNA expression than procollagen type I mRNA expression at 12 h post HG stimulation.</p><p><b>CONCLUSION</b>HG could enhance the protein expression of phosphorylated STAT1 and STAT3 in CFs, which are responsible for HG-induced increased CFs proliferation and collagen deposition in vitro.</p>

Proctitis ulcerosa activa y refractaria: Una puesta al día: [revisión] / Active and refractory ulcerative proctitis: An update: [review]

Ulcerative colitis (UC) is a chronic inflammatory disease of unknown etiology that affects a variable length of the colon, starting from the rectum. When the disease is confined to the rectum is called ulcerative proctitis (UP). Several studies have unsuccessfully attempted to determine the factors that determine the extent of involvement. The goals of therapy in UP are to induce and maintain remission of symptoms and disease. Topical treatment with 5-aminosalicylates (5-ASA) is the treatment of choice to induce remission. In the maintenance phase, long-term follow up studies suggest that treatment with 5-ASA is better than placebo, to maintain the disease inactive. For those patients that do not respond to treatment with topical 5-ASA or have a moderate to severe disease, there are additional therapies such as oral 5-ASA, topical or systemic corticosteroids, immunomodulators, biological therapies (Infliximab) and cyclosporine. Surgery is seldom needed.

A Survey of Actual Clinical Practice Patterns in the Treatment of Inflammatory Bowel Disease in Korea

BACKGROUND/AIMS: The aim of this study was to determine the actual practice patterns of clinicians caring for Korean patients with inflammatory bowel diseases (IBDs). METHODS: Questionnaires, including te indications and doses of 5-aminosalicylic acid (5-ASA), corticosteroids, or azathioprine/6-mercaptopurine (AZA/6-MP), assessment of response, the surveillance method, and the interval for adverse effects, were distributed during the 2008 KASID annual lecture. Thirty questionnaires were collected. RESULTS: Most of the responders (93.3%) were board-certified with sub-specialty training in gastroenterology. For active diseases, 43.3% of the responders escalated the dose of 5-ASA from conventional to maximal doses. Of the patients in disease remission, 36.7% were maintained on the conventional or a reduced dose for a fixed period of time. Corticosteroids were prescribed by dose-base (20/30 [66.7%]). In most cases, the starting dose was 40 mg/d (15/19 [78.9%]), and tapered within a 1 (43.3%) or 2 week interval (40.0%). There were various definitions of corticosteroid-refractoriness and -dependency among the responders. Most of the responders initiated AZA at 50 mg/d; 68.4% of the patients increased the dose by 25 mg and 55.6% of the patients increased the dose within a 4-week interval. For monitoring adverse events, such as leukopenia, 63.3% of the patients checked a complete blood count for 2 weeks in the 1st month of therapy. CONCLUSIONS: There were various patterns of practice in the treatment of Korean IBD patients, especially in terms of the prescribing patterns of drugs and assessment of response, which suggests that standard therapeutic guidelines of IBD should be established in Korea.

A Case of Idiopathic Pancreatitis in a Patient with Crohn's Disease / 대한소화기학회지

Pancreatitis has been occasionally associated with Crohn's disease (CD). A definite etiology of pancreatitis can be identified in most patients, but a very small proportion remain idiopathic. We report a case of idiopathic pancreatitis resolved along with the clinical improvement of CD in a 25-year-old man. He presented with abdominal pain and diarrhea for 8 years. Ileocolonoscopy and enteroclysis showed multiple, longitudinal ulcers and strictures at the ileojejunum. The laboratory findings showed elevated serum amylase (951 IU/L) and lipase (326 IU/L) without positive autoantibodies. Esophagogastroduodenoscopy, enhanced pancreatic CT, and MRCP showed no abnormalities at ampulla of Vater, pancrease, and pancreaticobiliary duct. With the treatment with antibiotics, 5-aminosalicylic acid, steroid, and azathioprine, as a whole, decreasing pattern and intermittent fine coordinated fluctuation of the levels of amylase and lipase along with the decrease of Crohn's disease activity index (CDAI) and the CRP levels were observed. Then, three months after the start of the treatment, normalization of the pancreatic enzymes was observed, and there was recurrent elevation of pancreatic engyme during 12 months maintenance therapy. This report supports the concept of an association between idiopathic pancreatitis and CD, based on a significant and close relation between the levels of serum amylase and lipase, and CDAI.

Antioxidant effect of 5-amino salicylic acid on copper-mediated LDL oxidation

The antioxidant effect of 5-Aminosalicylic acid (5-ASA) on copper-mediated LDL oxidation was followed either by the emitted chemiluminiscence (CL) or by UV-vis spectroscopy. 5-ASA addition extends the lag phase in a concentration-dependent manner without changes in the rate of the process in the autoaccelerated phase. The antioxidant behavior of 5-ASA was very similar to that of Trolox, a very efficient water soluble antioxidant. The copper-binding capacity of 5-ASA was evaluated by UV-visible spectroscopy. The addition of copper to a 5-ASA solution increases the absorbance at 332 nm and generates a new band at 298 nm. These changes in the UV-vis spectra indicate formation of a complex between 5-ASA and copper. However, LDL protection by 5-ASA is unrelated to its copper chelating capacity.

Doença de Crohn: estado atual da abordagem terapêutica clínica / Crohn's disease: actual state of clinical therapeutic approach

A doença de Crohn (DC) é uma enteropatia recorrente, espontânea, debilitante e de etiologia desconhecida. Sua farmacoterapia permaneceu relativamente inalterada nos últimos 20 anos, firmando-se no uso de medicamentos à base de ácido 5-aminossalicílico (5-ASA), corticosteróides, antibióticos e imunossupressores. Investigações recentes sobre a sua fisiopatologia têm produzido novas drogas e tratamentos. Esta revisäo aborda os agentes atualmente em uso e oferece um panorama das terapias em surgimento

Acute pancreatitis in a child with idiopathic ulcerative colitis on long-term 5-aminosalicylic acid therapy.

Acute pancreatitis is a rare but known complication of inflammatory bowel disease in adults. In children, only a few cases with this complication have been reported. We describe a 10-year-old boy with ulcerative colitis who developed acute pancreatitis while on long-term treatment with 5-aminosalicylic acid.

Retocolite ulcerativa: diagnostico e tratamento clínico: parte II / Ulcerative cololitis: diagnosis and clinical treatment: part 2

A retocolite ulcerativa é, ainda, uma doença de etiologia desconhecida. Os conhecimentos acumulados com as observaçöes feitas na prática clínica ou com os resultados de investigaçöes bem controladas deixam-nos mais preocupaçäo do que certeza porque o curso evolutivo dessa moléstia continua sendo, às vezes, imprevisível e o tratamento frustrante, tanto para o médico como para o paciente. Por causa disso, essa "velha doença", motiva de aprofundadas e novas investigaçöes, vai deixando de ser capítulo de livros para se tornar livros de muitos capítulos - fruto do substancial progresso científico que acumulou saber sobre aspectos de ultra-estrutura da mucosa intestinal e sua reaçäo ao processo inflamatório; sobre a complexidade dos hormônios intestinais ou sobre o sistema imune da mucosa intestinal com características especiais de um órgäo linfóide. Enfim, tudo o que se sabe a respeito de reaçäo inflamatória envolvendo o intestino, de fatores, de agentes, de complexos, de citocinas pró-inflamatórias, de citocinas imuno-moduladoras, näo é suficiente para nos afastar de um padräo terapêutico vigente há 50 anos

Tratamiento actual de las enfermedades inflamatorias intestinales / Current treatment of inflammatory bowel diseases

En el curso de las últimas décadas y debido a los progresos terapéuticos logrados, las Enfermedades Inflamatorias Intestinales que antes eran afecciones crónicas, progresivas e irreversibles, de alta mortalidad y de tratamiento quirúrgico, se han transformado en cuadros susceptibles de alcanzar remisiones clínicas completas y mantenidas, compatibles con una calidad de vida prácticamente normal. Progresos y avances igualmente significativos se han alcanzado prácticamente en todos los campos de la Medicina Interna en la segunda mitad del presente siglo

Olsalazina / Olsalazine

En 1942 la reumatóloga sueca Dra. Nana Svartz comunicó los favorables resultados obtenidos con la administración de asulfidina a pacientes portadores de artritis y diarrea

Acute pancreatitis associated with the use of 5-aminosalicylic acid and sulfasalazine in a patient with ulcerative colitis

Several drugs including sulfonamides, azathioprine, thiazides, furosemide, estrogens and tetracyclines have been implicated in acute pancreatitis. Sulfsalazine is well established in the treatment of inflammatory bowel disease. However, adverse effects to this agent are common, the incidence of which varies from 5-55% in patients with inflammatory bowel disease. The most common adverse effects to sulfasalazine are gastrointestinal, hematological and generalized [headache, vertigo, rash, fever]. Pancreatitis and hepatitis are rare adverse effects of sulfasalazin therapy. Pancreatitis has been attributed to the sulfonamide moiety of this agent. Acute pancreatitis associated with the use of sulfasalzine is well known. Recently, acute pancreatitis associated with the use of 5 aminosaliclic acid has been reported. Presented is another case of acute pancreatitis induced by 5 aminosalicylic acid first and later by sulfasalazine in a patient with inflammatory bowel disease

Perforación intestinal múltiple en enfermedad de Crohn / Multiple perforation of the small bowel in crohn's disease

La perforación intestinal libre del intestino delgado en la Enfermedad de Crohn es un evento raro, la frecuencia reportada varía entre el 1 al 2 por ciento y solamente en el 25 por ciento de los casos aparece como manifestación de la enfermedad. Informamos un caso, al cual lo consideramos como único, debido al hecho de que dentro de un año hubo tres episodios independientes de perforación como manifestación única de la enfermedad