ABSTRACT
In recent years the clinical course of celiac disease (CD; gluten enteropathy) has changed. It has been diagnosed more and more frequently in adults. Celiac disease in adults may manifest itself as active, silent, latent and late onset. To confirm the diagnosis of CD the most important is the result of jejunal mucosa biopsy and the presence of anti-endomysium, anti-reticuline and/or anti-tissue transglutaminase IgA antibodies in serum. All the patients with CD should be recommended a gluten free diet. In some cases, resistant to gluten free diet, the immunosuppressive therapy may be taken into consideration.
Subject(s)
Celiac Disease/diagnosis , Intestinal Mucosa/pathology , Adult , Autoantibodies/analysis , Biomarkers/analysis , Celiac Disease/epidemiology , Celiac Disease/pathology , Celiac Disease/therapy , Glutens/administration & dosage , Glutens/immunology , Humans , Jejunum/pathologyABSTRACT
We present a 45-year-old woman with atypical celiac sprue who was unresponsive to gluten-free diet. Cyclosporine therapy was applied (5 mg/kg body weight daily for 2 months). The patient demonstrated a remarkable clinical and histological response to this drug.
Subject(s)
Celiac Disease/drug therapy , Cyclosporine/therapeutic use , Enzyme Inhibitors/therapeutic use , Biopsy , Cyclosporine/pharmacology , Duodenum/drug effects , Duodenum/pathology , Duodenum/physiology , Enzyme Inhibitors/pharmacology , Female , Humans , Middle Aged , Regeneration/drug effects , Regeneration/physiologyABSTRACT
BACKGROUND: Botulinum toxin A (BT-A) is a powerful biological toxin. Nevertheless, it has proved to be a remarkable therapeutic agent for the treatment of benign anal disorders. Higher doses of BT-A could change the outcome of treatment. It is not known whether doses of BT-A higher than 20 units of Botox (or corresponding doses of Dysport) are as safe for patients as lower doses of BT-A. METHODS: The side effects of BT-A injections in the treatment of chronic anal fissure (105 patients) and functional outlet obstruction (34 patients) were analysed prospectively. The patients received at least 25 units of Botox or 150 units of Dysport. RESULTS: The patients with chronic anal fissure complained of incontinence of flatus (one severe case and eight mild cases), incontinence of faeces (five mild cases), anal haematoma (five cases), flu-like syndrome (three cases), an acute inflammation of external anal varices (two cases), epididymitis (one case) and haemorrhoid prolapse (one case). Patients with anismus suffered from intertrigo (one case); the pain after injection lasted for 2-4 days (four cases). No life-threatening side effects after 181 injections of BT-A were observed. Most of the side effects were only transient symptoms. No significant interdependence between injection methods (injection into one or two sites) and the risk of side effects was found. CONCLUSION: Treatment with BT-A is safe. Despite the application of higher doses of BT-A in the treatment of benign anal disorders so far, no severe side effects were observed.
Subject(s)
Anus Diseases/drug therapy , Anus Diseases/pathology , Botulinum Toxins/administration & dosage , Botulinum Toxins/adverse effects , Adult , Aged , Aged, 80 and over , Cohort Studies , Dose-Response Relationship, Drug , Female , Fissure in Ano/drug therapy , Fissure in Ano/pathology , Follow-Up Studies , Humans , Injections, Intralesional , Intestinal Obstruction/drug therapy , Intestinal Obstruction/pathology , Male , Manometry , Middle Aged , Prospective Studies , Risk Assessment , Sensitivity and Specificity , Treatment OutcomeABSTRACT
Pharmacological sphincterotomy with the use of botulinum toxin (BT) that inhibits acetylcholine secretion from neural endings in the motor plate or of nitric oxide (NO) donors should be a method applied earlier than surgical treatment due to its safety. BT mechanism of action on internal anal sphincter is not yet fully understood similarly to the effect of loosening of this sphincter under influence of NO donors applied after BT. Likewise paradoxical vasoconstrictive reaction on acetylcholine in the muscular layer of coronary arteries and decrease of tonic, vasodilative action of NO on the vessels may be observed in the patients with arterial hypertension. However, the muscle tissue of coronary arteries maintains the right dilative reaction on the endothelium independent NO donors. Local application of nitroglycerin is very safe and can be used by physicians in general practice for chronic anal fissure.
