RESUMO
OBJECTIVE: To evaluate the efficacy and safety of Qingchang suppository (, QCS), a preparation of Chinese herbal medicine, in the induction of remission in patients with mild-to-moderate ulcerative proctitis (UP). METHODS: We performed a multicenter, prospective, randomized, parallel-controlled trial to evaluate the efficacy of QCS induction therapy in 140 adult patients with mild-to-moderate UP and TCM syndrome of dampness-heat in large intestine. The patients were randomized to receive QCS (study group) or Salicylazosulfapyridine (SASP) suppository (control group) one piece each time, twice a day, per anum for 12 weeks. Mayo score and main symptoms score were evaluated at weeks 0, 2, 4, 8 and 12, rectosigmoidscopy was taken at weeks 0, 4, 8 and 12, Geboes score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and safety indexes were assessed at weeks 0 and 12. The primary efficacy endpoint is clinical remission rate, the secondary efficacy endpoints are clinical response rate, mucosa healing rate, Geboes score, the remission rates of the main symptoms, the median day to the remission of the symptom, etc. RESULTS: There were no statistical difference in the clinical remission rates, the clinical response rates, the mucosa healing rates, Geboes score, ESR and CRP between the two groups. The remission rates of tenesmus and anal burning sensation of the study group were significantly higher than those of the control group (76.5% vs 25.0%, P = 0.009; 74.51% vs 29.63%, P = 0.003). The median day to the remission of purulent bloody stool of the study group was significantly less than that of control group [11 (1, 64) vs 19 (2, 67), P = 0.007]. The patients receiving QCS had a significantly higher mucosa healing rate at week 4 than the patients receiving SASP suppository (71.42% vs 52.85%, P = 0.023). No adverse event occurred in the study group while the adverse events incidence of the control group was 5.7% (P = 0.049). CONCLUSIONS: QCS could induce the remission of UP as effectively and safely as SASP suppository, and was superior to SASP suppository in relieving the symptoms of tenesmus, anal burning sensation and purulent bloody stool and the time to reach mucosa healing.
Assuntos
Colite Ulcerativa , Proctite , Adulto , Humanos , Proteína C-Reativa , Colite Ulcerativa/tratamento farmacológico , Colite Ulcerativa/induzido quimicamente , Dor/induzido quimicamente , Proctite/tratamento farmacológico , Proctite/induzido quimicamente , Estudos Prospectivos , Indução de Remissão , Sulfassalazina/efeitos adversos , Resultado do TratamentoAssuntos
Canal Anal/efeitos dos fármacos , Meios de Contraste/efeitos adversos , Endossonografia/métodos , Peróxido de Hidrogênio/efeitos adversos , Proctite/induzido quimicamente , Fístula Retal/diagnóstico por imagem , Adulto , Canal Anal/diagnóstico por imagem , Meios de Contraste/administração & dosagem , Humanos , Peróxido de Hidrogênio/administração & dosagem , Masculino , Proctite/diagnósticoRESUMO
BACKGROUND: Fistulizing anoperineal lesions (FAPLs) are common and severe complications of Crohn's disease (CD), exposing patients to the risk of anal sphincter alteration and permanent stoma. Due to the limited efficacy of current treatments, identifying new local therapies is mandatory. However, testing new treatments is currently limited because no relevant preclinical model of Crohn's-like FAPL is available. Thus, a reliable and reproducible experimental model of FAPLs is needed to assess new therapeutic strategies. METHODS: Twenty-one rats received a rectal enema of 2,4,6-trinitrobenzensulfonic acid (TNBS) to induce proctitis. Seven days later, a transsphincteric fistula tract was created with a surgical thread, instilled with TNBS twice a week until its removal at day 7 (group 1), day 14 (group 2), or day 28 (group 3). In each rat, pelvic MRI was performed just before and 7 days after thread removal. Rats were sacrificed 7 days after thread removal for pathological assessment of the fistula tract. RESULTS: The optimal preclinical model was obtained in group 3. In this group, 7 days after thread removal, all animals (9 of 9) had a persistent fistula tract visible on MRI with T2-hypersignal (normalized T2 signal intensity: 2.36 ± 0.39 arbitrary units [a.u.] [2.08-2.81]) and elevation of the apparent diffusion coefficient (1.33 ± 0.16 10-3 millimeter squared per seconds [1.18-1.49]). The pathological examination of the fistula tract revealed acute and chronic inflammation, granulations, fibrosis, epithelialization, and proctitis in the adjacent rectum. CONCLUSIONS: This reproducible preclinical model could be used to assess the effectiveness of innovative treatments in perianal fistulizing CD.
Assuntos
Doença de Crohn/complicações , Modelos Animais de Doenças , Proctite/induzido quimicamente , Fístula Retal/etiologia , Canal Anal , Animais , Ratos , Reprodutibilidade dos Testes , Ácido TrinitrobenzenossulfônicoAssuntos
Enema/efeitos adversos , Peróxido de Hidrogênio/efeitos adversos , Dor/induzido quimicamente , Proctite/induzido quimicamente , Administração Retal , Adulto , Feminino , Humanos , Peróxido de Hidrogênio/administração & dosagem , Dor/diagnóstico , Proctite/diagnóstico , Reto , Sigmoidoscopia , Tomografia Computadorizada por Raios XRESUMO
No disponible
Assuntos
Idoso , Humanos , Masculino , Proctite/induzido quimicamente , Ergotamina/efeitos adversos , Colite Ulcerativa/diagnóstico , Diagnóstico DiferencialAssuntos
Ergotamina/efeitos adversos , Proctite/induzido quimicamente , Acetaminofen/administração & dosagem , Idoso , Anti-Inflamatórios não Esteroides/uso terapêutico , Colite Ulcerativa/diagnóstico , Diagnóstico Diferencial , Ergotamina/administração & dosagem , Hemorragia Gastrointestinal/etiologia , Humanos , Isquemia/induzido quimicamente , Masculino , Mesalamina/uso terapêutico , Transtornos de Enxaqueca/tratamento farmacológico , Proctite/complicações , Proctite/diagnóstico , Proctite/tratamento farmacológico , Reto/irrigação sanguínea , Supositórios , VasoconstriçãoRESUMO
Golimumab is a human IgG monoclonal antibody specific for human tumor necrosis factor alpha. Golimumab has been approved for use in rheumatological conditions; however, its use in inflammatory bowel disease is still being evaluated in clinical trials. We report a case of an exacerbation of ulcerative proctitis after starting on golimumab for ankylosing spondylitis.
Assuntos
Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais/uso terapêutico , Doenças Inflamatórias Intestinais/induzido quimicamente , Espondilite Anquilosante/tratamento farmacológico , Adalimumab , Adulto , Anticorpos Monoclonais Humanizados/uso terapêutico , Diarreia/induzido quimicamente , Humanos , Doenças Inflamatórias Intestinais/patologia , Masculino , Proctite/induzido quimicamente , Proctite/patologia , Espondilite Anquilosante/complicações , Fator de Necrose Tumoral alfa/antagonistas & inibidoresRESUMO
BACKGROUND: Claudins have been demonstrated to be associated with inflammatory bowel disease (IBD), but the specific role of claudin-2 in colorectal inflammation remains undefined. AIMS: We aimed to determine the role of claudin-2 in TNFα-induced colorectal inflammation. METHODS: We used claudin-2 (-/-) mice to assess the role of claudin-2 in colon. The mice were intraperitoneally injected with 3 µg of recombinant murine TNFα, and the NF-κB signaling and mRNA expression levels of proinflammatory cytokines and myosin light chain kinase (MLCK) were evaluated. Moreover, in claudin-2 (-/-) mice, colitis was induced by the administration of dextran sodium sulfate (DSS). The involvement of claudin-2 in colorectal inflammation was also investigated using the Caco-2 human colon adenocarcinoma cell line, and the expression of claudin-2 was downregulated using claudin-2 siRNA. RESULTS: TNFα-induced colorectal inflammation via NF-κB signaling activation was enhanced in claudin-2 (-/-) mice compared with that in claudin-2 (+/+) mice. MLCK expression level in the colon tissue of claudin-2 (-/-) mice treated with TNFα was enhanced in comparison to that of the claudin-2 (+/+) mice. DSS-induced colitis was more severe in the claudin-2 (-/-) mice than in the claudin-2 (+/-) mice. In in vitro experiments, the decreased expression of claudin-2 enhanced the expressions of IL-6, IL-1ß and MLCK. CONCLUSIONS: Our findings concerning the role of claudin-2 in epithelial inflammatory responses enrich our collective understanding of mucosal homeostasis and intestinal diseases such as IBD. Furthermore, the results of this study indicate that claudin-2 and MLCK are potential therapeutic targets for treatments against intestinal disease.
Assuntos
Claudina-2/metabolismo , Colite/metabolismo , Quinase de Cadeia Leve de Miosina/metabolismo , Proctite/metabolismo , Animais , Biomarcadores/metabolismo , Western Blotting , Células CACO-2 , Colite/induzido quimicamente , Citocinas/metabolismo , Sulfato de Dextrana , Feminino , Humanos , Imuno-Histoquímica , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , NF-kappa B/metabolismo , Proctite/induzido quimicamente , Reação em Cadeia da Polimerase em Tempo Real , Fator de Necrose Tumoral alfaAssuntos
Transtornos de Enxaqueca/tratamento farmacológico , Proctite/induzido quimicamente , Proctite/patologia , Supositórios/efeitos adversos , Acetaminofen/administração & dosagem , Acetaminofen/efeitos adversos , Adulto , Analgésicos não Narcóticos/administração & dosagem , Analgésicos não Narcóticos/efeitos adversos , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Cafeína/administração & dosagem , Cafeína/efeitos adversos , Estimulantes do Sistema Nervoso Central/administração & dosagem , Estimulantes do Sistema Nervoso Central/efeitos adversos , Doença Crônica , Endoscopia do Sistema Digestório , Feminino , Humanos , Ópio/administração & dosagem , Ópio/efeitos adversos , Úlcera/induzido quimicamente , Úlcera/patologiaRESUMO
Neutropenic enterocolitis is a common gastrointestinal complication in children undergoing chemotherapy for a variety of malignancies. It usually involves ileum and caecum, and involvement of rectum has rarely been reported. The authors report neutropenic enterocolitis in a child undergoing chemotherapy for acute lymphoblastic lymphoma which presented with ileus along with a mass like lesion in the rectum.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Países em Desenvolvimento , Enterocolite Neutropênica/induzido quimicamente , Enterocolite Neutropênica/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Proctite/induzido quimicamente , Proctite/diagnóstico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biópsia , Criança , Enterocolite Neutropênica/patologia , Humanos , Índia , Mucosa Intestinal/efeitos dos fármacos , Mucosa Intestinal/patologia , Obstrução Intestinal/induzido quimicamente , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/patologia , Masculino , Proctite/patologia , Reto/efeitos dos fármacos , Reto/patologiaAssuntos
Budesonida/uso terapêutico , Peróxido de Hidrogênio/efeitos adversos , Proctite/induzido quimicamente , Reto/patologia , Dor Abdominal/induzido quimicamente , Adulto , Diagnóstico Diferencial , Diarreia/induzido quimicamente , Enema/efeitos adversos , Feminino , Hemorragia Gastrointestinal/induzido quimicamente , Humanos , Proctite/diagnósticoRESUMO
A 73-year-old female patient presented with acute very painful perianal ulcerations. She reported using various ointments and later potassium permanganate baths because of maceration of the rima ani as a manifestation of her psoriasis vulgaris. Suddenly after starting the potassium permanganate baths, necrotic areas developed with then became ulcerated. After excluding the relevant differential diagnostic considerations, we diagnosed ulcerations caused by a caustic burn from potassium permanganate. After stooping potassium permanganate baths and employing modern moist wound therapy, we attained complete healing after 8 months of treatment.
Assuntos
Banhos , Permanganato de Potássio/toxicidade , Proctite/induzido quimicamente , Úlcera Cutânea/induzido quimicamente , Doença Aguda , Idoso , Diagnóstico Diferencial , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Humanos , Proctite/diagnóstico , Proctite/terapia , Úlcera Cutânea/diagnóstico , Úlcera Cutânea/terapiaRESUMO
Paracetamol is a readily available non-prescription analgesic. Fixed drug eruption (FDE) is a well-reported side effect of paracetamol, usually the classic, pigmenting type. In women, it may present as a chronic, erosive vulvitis. We describe a case of FDE due to paracetamol presenting as a chronic erosive vulvitis in an older woman taking multiple medications. Diagnosis was delayed because paracetamol is available without prescription, taken intermittently and may be omitted from the clinical history. Cessation of paracetamol led to prompt resolution of symptoms. Consideration should be given to paracetamol as a cause of FDE presenting as a chronic erosive vulvitis.
Assuntos
Acetaminofen/efeitos adversos , Analgésicos não Narcóticos/efeitos adversos , Toxidermias/diagnóstico , Proctite/induzido quimicamente , Vulvite/induzido quimicamente , Toxidermias/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Proctite/diagnóstico , Prurido/induzido quimicamente , Prurido/diagnóstico , Automedicação , Vulvite/diagnósticoRESUMO
We report a 38-year-old immunocompetent patient who presented with a neutropenic rectitis after a treatment by amoxicillin for nasopharyngitis. Neutropenic colitis is a digestive wall inflammation, preferentially localized in the ileo-caecal area and the right colon, which leads to necrosis and sepsis, and usually occurs in neutropenic patients treated by chemotherapy with an incidence of 6%. It is a serious and often lethal disease. The treatment is supportive, and surgery is limited to the occurrence of complications (perforation, bleeding). Neutropenic colitis occurring in a rectal location after antibiotic therapy in an immunocompetent patient has been rarely described.
Assuntos
Amoxicilina/efeitos adversos , Antibacterianos/efeitos adversos , Imunocompetência , Neutropenia/induzido quimicamente , Proctite/induzido quimicamente , Adulto , Amoxicilina/administração & dosagem , Antibacterianos/administração & dosagem , Humanos , Transfusão de Leucócitos , Masculino , Nasofaringite/tratamento farmacológico , Neutropenia/patologia , Neutropenia/terapia , Proctite/patologia , Proctite/terapia , Proctoscopia , Resultado do TratamentoAssuntos
Enema/efeitos adversos , Hemorragia Gastrointestinal/etiologia , Peróxido de Hidrogênio/efeitos adversos , Proctite/induzido quimicamente , Úlcera/induzido quimicamente , Administração Retal , Constipação Intestinal/complicações , Constipação Intestinal/terapia , Feminino , Humanos , Peróxido de Hidrogênio/administração & dosagem , Pessoa de Meia-Idade , Proctite/complicações , Úlcera/complicaçõesAssuntos
Fármacos Dermatológicos/efeitos adversos , Fissura Anal/induzido quimicamente , Hemorragia Gastrointestinal/induzido quimicamente , Isotretinoína/efeitos adversos , Proctite/induzido quimicamente , Rosácea/tratamento farmacológico , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , RetoRESUMO
Introducción: La incidencia de complicaciones de la colonoscopía es del 0,1 al 3 por ciento y las más frecuentes son la perforación y la hemorragia. Las lesiones producidas por glutaraldehído al 2 por ciento son menos frecuentes y se deben a un efecto tóxico por acción directa sobre la mucosa del colon. Objetivo: analizar la proctitis por este desinfectante y analizar su presentación clínica. Diseño: Análisis retrospectivo. Revisión de la literatura. Pacientes: se registraron todas las colonoscopías (diagnósticas y terapéuticas), realizadas entre enero de 1996 y julio 2004. Métodos: se analizaron las complicaciones. Se realizó una actualización bibliográfica en bases nacionales e informáticas internacionales. Se evaluaron sexo y edad, tipo de endoscopía, sitio afectado, lesiones únicas o múltiples, presentación clínica y metodología diagnóstica, tiempo del diagnóstico, tipo de tratamiento y morbilidad asociada. El proceso de desinfección del instrumental se realizó según las normas establecidas por el servicio de infectología. Resultados: en un total de 4790 colonoscopías, se registraron 5 lesiones (0,1 por ciento) atribuidas al glutaraldehído. Fueron 2 pacientes del sexo masculino y 2 del sexo femenino. Una paciente tuvo dos episodios en dos colonoscopías. La edad promedio fue de 66 años. Todos fueron diagnosticados por la clínica. La presentación consistió en mucorrea, proctorragia leve, pujo y tenesmo. Ningún caso se presentó después de las 48 horas. El diagnóstico presuntivo fue confirmado por rectosigmoideoscopia con biopsia. Histología: rectitis inespecífica. El tratamiento fue sintomático y realizado en forma ambulatoria excepto un caso que requirió de internación por 24 horas. La resolución completa de los síntomas ocurrió antes de la primera semana. Discusión y conclusiones: la presentación de una colitis aguda, auto limitada luego de un procedimiento endoscópico normal con tenesmo y diarrea sanguinolenta en las 48 horas debe suponer este diagnóstico...
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Humanos , Glutaral/efeitos adversos , Glutaral/toxicidade , Proctite/epidemiologia , Proctite/induzido quimicamente , Proctite/terapia , Colonoscópios , Colonografia Tomográfica Computadorizada/efeitos adversos , Colonoscopia/efeitos adversos , Colonoscopia/métodos , Desinfetantes/efeitos adversos , Peróxido de Hidrogênio/efeitos adversos , Estudos RetrospectivosAssuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Diclofenaco/efeitos adversos , Isquemia/induzido quimicamente , Proctite/induzido quimicamente , Supositórios/efeitos adversos , Hérnia Inguinal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/prevenção & controleRESUMO
Some chemotherapeutic agents can "recall" the irradiated volumes by skin or pulmonary reactions in cancer patients who previously received radiation therapy. We report a recall colitis following the administration of paclitaxel-containing regimen in a patient who had been irradiated for a carcinoma of the uterine cervix. A 63-year-old woman underwent a Wertheim operation because of uterine cervix carcinoma. After 8 years of follow-up, a local recurrence was observed and she received curative external radiotherapy (45 Gy) to the pelvis. No significant adverse events were observed during the radiotherapy. Approximately one year later, she was hospitalized because of metastatic disease with multiple pulmonary nodules, and a chemotherapy regimen consisting of paclitaxel and carboplatin was administered. The day after the administration of chemotherapy the patient had diarrhea and rectal bleeding. Histological examination of the biopsy taken from rectal hyperemic lesions showed a radiation colitis. The symptoms reappeared after the administration of each course of chemotherapy and continued until the death of the patient despite the interruption of the chemotherapy. In conclusion, the probability of recall phenomena should be kept in mind in patients who received previously with pelvic radiotherapy and treated later with cytotoxic chemotherapy.