Kuicolong-yu enema decoction retains traditional Chinese medicine enema attenuates inflammatory response ulcerative colitis through TLR4/NF-κB signaling pathway

BACKGROUND Ulcer colitis(UC)is a chronic,nonspecific,and noninfectious inflammatory bowel disease.Recently,Toll-like receptors(TLRs)have been found to be closely associated with clinical inflammatory diseases.Achieving complete remission in patients with intermittent periods of activity followed by dormancy is challenging.Moreover,no study has explored the mechanism by which Kuicolong-yu enema decoction retains traditional Chinese medicine enemas to attenuate the inflammatory response in UC.AIM To explore the mechanism by which Kuicolong-yu enema decoction retains traditional Chinese medicine enemas to attenuate the inflammatory response in UC.METHODS This prospective clinical study included patients who met the exclusion criteria in 2020 and 2021.The patients with UC were divided into two groups(control and experimental).The peripheral blood of the experimental and control groups were collected under aseptic conditions.The expression of TLR4 protein,NF-κB,IL-6,and IL-17 was detected in the peripheral blood of patients in the experimental group and control group before and 1 month after taking the drug.Linear co rrelation analysis was used to analyze the relationship between the expression level of TLR4 protein and the expression levels of downstream signal NF-κB and inflammatory factors IL-6 and IL-17,and P<0.05 was considered statistically significant.RESULTS There were no significant differences in the patient characteristics between the control and experimental groups.The results showed that the expression levels of TLR4 and NF-κB in the experimental group were significantly lower than those in the control group(P<0.05).The levels of IL-6 and IL-17 in the experimental group were significantly lower than those in the control group(P<0.05).The TLR4 protein expression in the experimental group was positively correlated with the expression level of downstream signal NF-κB and was positively correlated with the levels of downstream inflammatory cytokines IL-6 and IL-17(r=0.823,P<0.05).CONCLUSION Kuicolong-yu enema decoction retains traditional Chinese medicine enema attenuates the inflammatory response of UC through the TLR4/NF-κB signaling pathway.

A systematic review of the efficacy of traditional Chinese medicine retention enema in the treatment of ulcerative colitis

The objective of this study is to summarize the efficacy and safety of traditional Chinese medicine(TCM)enema in the treatment of ulcerative colitis(UC).The randomized controlled trials on TCM enema intervention in the treatment of UC were searched in seven databases:PubMed,Embase,Web of Science,CBM,CNKI,Wanfang Database,and VIP Database from January 1,2013 to June 6,2022,and the data were analyzed using RevMan 5.3 software.A total of 18 studies involving 1514 UC patients were included.Meta analysis results showed that compared with conventional Western medicine,Chinese medicine enema had a significant effect on UC,and the clinical effective rate of the experimental group using Chinese medicine enema was 4.45 times that of the control group using conventional Western medicine(odds ratio=4.45,95%confidence interval[3.27,6.06]).Therefore,Chinese medicine enema is effective in the treatment of UC,and can significantly reduce related symptoms.

Study of Quality Standards of Xiao’er Qingre Enema Preparation in Hospitals

Objective:To establish the quality standards for the preparation of Xiao’er Qingre enema in hospitals.Method:Thin-layer chromatography(TLC)was used to identify Radix Isatidis and Glycyrrhizae in the prescription.The content of(R,S)-Goitrin was determined by high-performance liquid chromatography(HPLC).Results:In TLC identification,there was no interference between the negative controls of Radix Isatidis and glycyrrhizae,and the spots were well-separated.The HPLC results of(R,S)-Goitrin showed a good linear relationship between the peak area and concentration within the range of 0.476-95.2μg·mL-1(r=0.9999).Conclusion:The TLC and HPLC methods established in this experiment are simple,reproducible,and specific,making them suitable for the quality control Xiao’er Qingre enema preparation in hospitals.

Pattern and distribution of colonic diverticulosis:Analysis of 2877 barium enemas in Thailand

AIM:To determine the pattern and distribution of colonic diverticulosis in Thai adults.METHODS:A review of the computerized radiology database for double contrast barium enema(DCBE)in Thai adults was performed at the Faculty of Medicine Siriraj Hospital,Mahidol University,Bangkok,Thailand.Incomplete studies and DCBE examinations performed in non-Thai individuals were excluded.The pattern and distribution of colonic diverticulosis detected during DCBE studies from June 2009 to October 2011 were determined.The occurrence of solitary cecal diverticulum,rectal diverticulum and giant diverticulum were reported.Factors influencing the presence of colonic diverticulosis were evaluated.RESULTS:A total of 2877 suitable DCBE examinations were retrospectively reviewed.The mean age of patients was 59.8±14.7 years.Of these patients,1778(61.8%)were female and 700(24.3%)were asymptomatic.Colonic diverticulosis was identified in 820patients(28.5%).Right-sided diverticulosis(641 cases;22.3%)was more frequently reported than left-sided diverticulosis(383 cases;13.3%).Pancolonic diverticulosis was found in 98 cases(3.4%).The occurrence of solitary cecal diverticulum,rectal diverticulum and giant diverticulum were 1.5%(42 cases),0.4%(12 cases),and 0.03%(1 case),respectively.There was no significant difference in the overall occurrence of colonic diverticulosis between male and female patients(28.3%vs 28.6%,P=0.85).DCBE examinations performed in patients with some gastrointestinal symptoms revealed the frequent occurrence of colonic diverticulosis compared with those performed in asymptomatic individuals(29.5%vs 25.3%,P=0.03).Change in bowel habit was strongly associated with the presence of diverticulosis(a relative risk of 1.39;P=0.005).The presence of diverticulosis was not correlated with age in symptomatic patients or asymptomatic individuals(P>0.05).CONCLUSION:Colonic diverticulosis was identified in28.5%of DCBE examinations in Thai adults.There was no association between the presence of diverticulosis and gender or age.

Effectiveness of therapeutic barium enema for diverticular hemorrhage

AIM:To evaluate the effectiveness of barium impaction therapy for patients with colonic diverticular bleeding.METHODS:We reviewed the clinical charts of patients in whom therapeutic barium enema was performed for the control of diverticular bleeding between August2010 and March 2012 at Yokohama Rosai Hospital.Twenty patients were included in the review,consisting of 14 men and 6 women.The median age of the patients was 73.5 years.The duration of the followup period ranged from 1 to 19 mo(median:9.8 mo).Among the 20 patients were 11 patients who required the procedure for re-bleeding during hospitalization,6patients who required it for re-bleeding that developed after the patient left the hospital,and 3 patients who required the procedure for the prevention of rebleeding.Barium(concentration:150 w%/v%)was administered per the rectum,and the leading edge of the contrast medium was followed up to the cecum by fluoroscopy.After confirmation that the ascending colon and cecum were filled with barium,the enema tube was withdrawn,and the patient’s position was changed every 20 min for 3 h.RESULTS:Twelve patients remained free of rebleeding during the follow-up period(range:1-19mo)after the therapeutic barium enema,including 9men and 3 women with a median age of 72.0 years.Re-bleeding occurred in 8 patients including 5 men and 3 women with a median age of 68.5 years:4developed early re-bleeding,defined as re-bleeding that occurs within one week after the procedure,and the remaining 4 developed late re-bleeding.The DFI(disease-free interval)decreased 0.4 for 12 mo.Only one patient developed a complication from therapeutic barium enema(colonic perforation).CONCLUSION:Therapeutic barium enema is effective for the control of diverticular hemorrhage in cases where the active bleeding site cannot be identified by colonoscopy.

Ischemic colitis after enema administration: Incidence, timing, and clinical features

BACKGROUND Enema administration is a common procedure in the emergency department(ED). However, several published case reports on enema-related ischemic colitis(IC) have raised the concerns regarding the safety of enema agents. Nevertheless, information on its true incidence and characteristics are still lacking.AIM To investigate the incidence, timing, and risk factors of IC in patients receiving enema.METHODS We consecutively collected the data of all adult patients receiving various enema administrations in the ED from January 2010 to December 2018 and identified patients confirmed with IC following enema. Of 8320 patients receiving glycerin enema, 19 diagnosed of IC were compared with an age-matched control group without IC.RESULTS The incidence of IC was 0.23% among 8320 patients receiving glycerin enema;however, there was no occurrence of IC among those who used other enema agents. The mean age ± standard deviation(SD) of patients with glycerin enemarelated IC was 70.2 ± 11.7. The mean time interval ± SD from glycerin enema administration to IC occurrence was 5.5 h ± 3.9 h(range 1-15 h). Of the 19 glycerin enema-related IC cases, 15(79.0%) were diagnosed within 8 h. The independent risk factors for glycerin-related IC were the constipation score [Odds ratio(OR), 2.0;95% confidence interval(CI): 1.1-3.5, P = 0.017] and leukocytosis(OR, 4.5;95%CI: 1.4-14.7, P = 0.012).CONCLUSION The incidence of glycerin enema-related IC was 0.23% and occurred mostly in the elderly in the early period following enema administration. Glycerin enemarelated IC was associated with the constipation score and leukocytosis.

Colonoscopy can miss diverticula of the left colon identified by barium enema

AIM: To identify the diagnostic value of colonoscopy for diverticulosis as determined by barium enema. METHODS: A total of 65 patients with hematochezia who underwent colonoscopy and barium enema were analyzed, and the diagnostic value of colonoscopy for diverticula was assessed. The receiver operating characteristic area under the curve was compared in relation to age (< 70 or ≥ 70 years), sex, and colon location. The number of diverticula was counted, and the detection ratio was calculated. RESULTS: Colonic diverticula were observed in 46 patients with barium enema. Colonoscopy had a sensitivity of 91% and specificity of 90%. No significant differences were found in the receiver operating characteristic area under the curve (ROC-AUC) for age group or sex. The ROC-AUC of the left colon was significantly lower than that of the right colon (0.81 vs 0.96, P=0.02). Colonoscopy identified 486 colonic diverticula, while barium enema identified 1186. The detection ratio for the entire colon was therefore 0.41 (486/1186). The detection ratio in the left colon (0.32, 189/588) was significantly lower than that of the right colon (0.50, 297/598) (P < 0.01). CONCLUSION: Compared with barium enema, only half the number of colonic diverticula can be detected by colonoscopy in the entire colon and even less in the left colon.

Research progress in the treatment of diabetic kidney disease with Chinese medicine enema

Chinese medicine enema is an effective guiding method to treat diabetic kidney disease,a common chronic complication of diabetes,by regulating the function of the intestines to increase clearing and lower turbidity.We reviewed the treatment of diabetic kidney disease(DKD)with traditional Chinese medicine enemas and found that commonly used traditional Chinese medicines included Rhei Radix Et Rhizoma(Rheum palmatum L.),Ostrea concha(Ostrea gigas Thunberg),Taraxaci Herba(Taraxacum mongolicum Hand.-Mazz.),Astmgali Radix(Astragalus membranaceus Bge.var.mongholicus(Bge.)Hsiao),Salviae Miltiorrhizae Radix Et Rhizoma(Salvia miltiorrhiza Bge.),and Aconiti Lateralis Radix Praeparata(Aconitum carmichaelii Debx).The mechanism of the adjuvant therapeutic effect on DKD may relate to regulating intestinal flora,inhibiting inflammation and oxidative stress and protecting against kidney injury.

Qingchang decoction retention enema may induce clinical and mucosal remission in left-sided ulcerative colitis: A case report

BACKGROUND Ulcerative colitis(UC)is a chronic autoimmune disease characterized by relapsing-remitting abdominal pain,diarrhea,mucopurulent discharge and rectal bleeding.To date,the etiology of the disease remains unknown;therefore,medical therapy is not yet available.Left-sided UC is mainly treated with oral and topical mesalazine.However,due to its modest clinical effect,endoscopic mucosal remission is not achieved in all patients.CASE SUMMARY A 44-year-old man presented to Longhua Hospital with a history of left-sided UC for more than 6 years and slight bloody diarrhea over time.Endoscopy suggested hyperemia,edema,and erosive mucosa involving the rectum and sigmoid colon.The Traditional Chinese medicine Qingchang decoction(QCD)enema treatment was initiated once a day combined with a previous standard dose of mesalazine for 8 wk,and rectal bleeding ceased after 4 wk of treatment.Another QCD enema treatment was provided after symptom relapse due to drug withdrawal for nearly 6 mo.At the 2-mo follow-up,the colonoscopy results indicated mucosal healing with no erosion or ulcers.CONCLUSION The Chinese formula QCD retention enema represents a potential treatment for left-sided UC with predominant rectal bleeding to achieve clinical and mucosal remission.

Two-day enema antibiotic therapy for parasite eradication and resolution of symptoms

BACKGROUND Blastocystis hominis(B.hominis)and Dientamoeba fragilis(D.fragilis)are two protozoan parasites of human bowel that are found throughout the world.There is still debate about the pathogenicity of these protozoans,despite them being commonly associated with gastrointestinal symptoms and can cause health issue in both children and adults.These parasites are usually transmitted through faecal-oral contact particularly under poor hygiene conditions or food/water contamination.Once a person is infected,the parasites live in the large intestine and are passed in the faeces.AIM To investigate the effect of triple antibiotic therapy using enema infusion in the treatment of B.hominis and D.fragilis infections.METHODS This retrospective longitudinal study was conducted in a single medical centre,which included fifty-four patients(≥18 years)who were positive for D.fragilis,B.hominis or both between 2017 and 2018.The treatment consisted of triple antibiotics that were infused over two consecutive days through rectal enema.Faecal samples were collected from participants pre-and post-treatment and were tested for parasites using microscopy and polymerase chain reaction.Patients’symptoms were recorded prior and after the treatment as well as patient demographic data.RESULTS Patients(n=54),were either positive for B.hominis(37%),D.fragilis(35%)or both(28%).All patients completed the two-day treatment and no serious adverse effect was reported.The most common side effect experienced by the patients during the treatment was urine discolouration which was cleared by six weeks of followup.Common symptoms reported prior to treatment were diarrhoea,abdominal pain,constipation and fatigue.Other symptoms included abdominal discomfort,dizziness and blood in the stool.Eighty-nine percent of patients completed a final stool test post-treatment.At six weeks post-treatment,79%of patients cleared the parasites from their faeces.Symptoms such as abdominal discomfort,dizziness and blood in the stool decreased significantly at both seven days and six weeks post-treatment(P<0.040).The enema retention time,bowel preparation,previous antibiotic treatment or previous gastrointestinal problems had no significant effect on parasite eradication.CONCLUSION Overall,eradication of parasites and improvement of clinical outcomes were observed in treated patients,showing the efficacy of this combination to eradicate the parasites and provide positive clinical outcome.

The effect of sodium phosphate enema in patients ingested foreign bodies: a prospective, randomized trial——Sodium phosphate enema in patients ingested foreign bodies

Background: Although foreign body ingestion is a common problem, poor knowledge for the treatment still remains a major obstacle, especially in preventing complications. Phosphate enemas were applied for chronic constipation for a long period of time. This study aims to evaluate the effect of a single dose of phosphate enema on bowel movements in patients who suffer from foreign body ingestion. Materials and Methods: Forty consecutive patients admitted to our emergency unit for foreign body ingestion were randomized into two groups. Patients in both groups were followed up with daily imaging and physical examinations. Cases in Group SP received daily doses of sodium phosphate enemas, while Group C did not. Demographics, number of X-rays, radiation dose, and period of the foreign body passage were recorded and compared between two groups. Also, data of patients who ingested pins (Group P) were compared with of those who ingested other materials (Group O). Results: There was no statistical difference between groups (Group SP vs. Group C and Group P vs. Group O) comparing demographics, number of X-rays, total amount of radiation doses (p > 0.05 for all comparisons). The period of foreign body passage was shorter in Group SP (3.4 ± 1.6 days vs. 6.2 ± 3.8 days;p = 0.005). Also, patients who ingested pins were compared to patients who ingested other materials. Pins were ingested by 23 (65%) patients. These were older (16.6 ± 9.4 years vs. 4.8 ± 3.5 years;p = 0.001) and generally females (78.3% vs. 29.4;p = 0.006). Contrary to the other cases, pins were less frequently confirmed in stool in patients who ingested pins (p = 0.02). Conclusion: A single dose of phosphate enema use may hasten the passage of the foreign bodies. Ingestion of pins is the more common especially in young females. The evacuation of pins is generally recognized with direct examination of the stool, so daily imaging may not be necessary for this group of patients.

Brief Introduction to the No.4 Gynecological Herbal Enema

In view of the characteristics of physiology,anatomyand absorbability of the rectum,rectal administration seems tobe a new approach and an effective method for application ofChinese herbal medicine.Based on the experiential formula ofDr.He Shaoshan(a famous and veteran TCM doctor),thepharmaceutical department of our hospital has developed aseries of medicinal herbal products for gynecological use,yielding satisfactory therapeutic results.The No.4Gynecological Herbal Enema is one of the series,and it isbriefly introduced as follows.

Clinical Study on the Retention Enema with Modified Dahuang Mudan Decoction in Treating Lower-Jiao Obstruction Syndrome Caused by Severe Pneumonia Complicated with Heart Failure

[Objectives]To treat patients with Lower-Jiao Obstruction Syndrome caused by severe pneumonia complicated with heart failure using the retention enema with Modified Dahuang Mudan Decoction,and to observe the effect and safety of this treatment on inflammatory indicators,cardiac function,gastrointestinal function and multiple organ failure in patients with Lower-Jiao(lower energizer)Obstruction Syndrome caused by severe pneumonia complicated with heart failure.[Methods]54 patients with Lower-Jiao Obstruction Syndrome caused by severe pneumonia complicated with heart failure diagnosed in Nanchong Chinese Medicine Hospital from January 2020 to December 2021 were randomly divided into experimental group(n=27)and control group(n=27).The control group was given conventional treatment combined with 0.9%sodium chloride injection(100 mL)+glycerine enema(40 mL).The treatment group was treated with Modified Dahuang Mudan Decoction on the basis of conventional treatment for 7 d.The efficacy indicators and adverse events such as white blood count(WBC),C-reactive protein(CRP),procalcitonin(PCT),N-terminal pro-brain natriuretic peptide(NT-proBNP),Lausanne Intestinal Failure Estimation(LIFE)and multiple organ dysfunction score(MODS)were observed.[Results](i)There was no significant difference in WBC,PCT,CRP and NT-proBNP between the two groups before treatment.All indicators after treatment were significantly lower than those before treatment in both groups(P<0.05).The levels of WBC,PCT and CRP in the treatment group were lower than those in the control group after treatment(P<0.05),and there was no significant difference in NT-proBNP between the two groups after treatment(P>0.05),but the difference in NT-proBNP before and after treatment in the treatment group was higher than that in the control group.(ii)The LIFE of the two groups decreased significantly after treatment,and the improvement of LIFE of the treatment group was better than that of the control group(P<0.05).(iii)The MODS of the two groups decreased significantly after treatment(P<0.05),and the degree of decrease after treatment in the treatment group was higher than that in the control group(P<0.05).(iv)There was no significant difference in all-cause mortality between the two groups(P>0.05).(v)No serious adverse events were found in both groups during the treatment period.[Conclusions]The conventional treatment,combined with the retention enema with Modified Dahuang Mudan Decoction could further reduce the inflammatory indicators,improve cardiac function,improve intestinal function and organ function,and the safety was good.

Effects of adjuvant raw rhubarb enema therapy on systemic inflammatory stress response and intestinal mucosal barrier function in patients with severe pancreatitis

Objective: To investigate the effects of adjuvant raw rhubarb enema therapy on systemic inflammatory stress response and intestinal mucosal barrier function in patients with severe pancreatitis. Methods: A total of 78 patients with severe pancreatitis treated in the Second People's Hospital of Neijiang, Sichuan, China between December 2016 and September 2018 were included in the study. The patients were divided into control group (n=39) and raw rhubarb group (n=39) by simple randomization. The control group of patients received conventional treatment of severe pancreatitis with western medicine, while the raw rhubarb group of patients received raw rhubarb enema on the basis of the treatment of control group, and the efficacy was evaluated after continuous treatment for 1 week. The differences in serum levels of inflammatory mediators (high mobility group protein B1, C-reactive protein, prostaglandin E2 and tumor necrosis factor α), stress hormones (cortisol and epinephrine) as well as intestinal mucosal barrier function indicators (D-lactate, endotoxin and diamine oxidase) were compared between the two groups of patients before and after treatment. Results: Before treatment, there was no statistically significant difference in serum levels of inflammatory mediators, stress hormones and intestinal mucosal barrier function indicators between the two groups (P>0.05). After treatment, serum high mobility group protein B1, C-reactive protein, prostaglandin E2 and tumor necrosis factor levels of the observation group were significantly lower than those of the control group;cortisol and epinephrine levels were significantly lower than those of the control group;D-lactate, endotoxin and diamine oxidase levels were significantly lower than those of the control group (P<0.05). Conclusions:Adjuvant raw rhubarb enema therapy on the basis of western medicine can help alleviate the inflammatory stress response and optimize the intestinal mucosal barrier function in patients with severe pancreatitis.

Effect of retention enema by caulis sargentodoxae enema combined with oral drugs on the immune inflammatory response and intestinal flora of UC patients

Objective:To study the effect of retention enema by caulis sargentodoxae enema combined with oral drugs on the immune inflammatory response and intestinal flora of UC patients. Methods: A total of 128 UC patients who received treatment in the hospital between January 2013 and April 2017 were collected and divided into control group and observation group by random number table. Control group received conventional oral drug therapy, and the observation group received retention enema by caulis sargentodoxae enema combined with oral drug therapy. Before treatment and after 4 weeks of treatment, the differences in the levels of immunoglobulin and inflammatory response indexes in serum as well as intestinal flora levels in mucosa lesion tissue were compared between the two groups.Results: The differences in levels of immunoglobulin and inflammatory response indexes in serum as well as intestinal flora levels in mucosa lesion tissue were not statistically significant between the two groups of patients before treatment. After 4 weeks of treatment, IgA, IgG, IgM and IL-4 contents in serum as well as bifidobacterium and lactobacillus levels in mucosa lesion tissue of observation group were higher than those of control group while ESR, CRP, IL-6 and TNF-αcontents as well as E. coli level in mucosa lesion tissue were lower than those of control group. Conclusion: Retention enema by caulis sargentodoxae enema combined with oral drugs can effectively optimize the immune inflammatory state and balance the intestinal flora distribution in patients with UC.

A Meta-Analysis of Treating Radiation Proctitis by Retention Enema with Integrated Traditional Chinese and Western Medicine

Objective:To systematically and objectively evaluate clinical efficacy of retention enema with integrated traditional Chinese and western medicine on radiation proctitis(RP).Methods:CNKI,WANFANG,VIP,CMB and foreign language databases like Embase,Central and Medline were searched.Search dates were from establishment of the databases until May 2020.Randomized controlled trials(RCTs)of retention enema with integrated traditional Chinese and western medicine for RP were retrieved.Two system reviewers selected literature materials,extracted literature data,and evaluated the quality of the literatures.RevMan 5.3 software was used for data analysis.Results:A total of 12 studies were included,including 941 patients.Meta-analysis results showed:Clinical efficacy in the retention enema group with integrated traditional Chinese and western medicine was better than that in the simple western medicine enema or blank enema group(OR=5.96,95%CI[5.50,14.29],P<0.00001).Improvement of abdominal pain in the retention enema group with integrated traditional Chinese and western medicine was better than that in the control group(MD=-0.57,95%CI[-0.72,-0.42],P<0.00001).Treatment for hematochezia in the retention enema group with integrated traditional Chinese and western medicine was better than that in the control group(MD=-0.55,95%CI[-0.69,-0.42],P<0.00001).Improvement of diarrhea in the retention enema group with integrated traditional Chinese and western medicine was better than that in the control group(MD=-0.69,95%CI[-0.91,-0.48],P<0.00001).KPS scores in the retention enema group with integrated traditional Chinese and western medicine were better than those in the control group(MD=11.91,95%CI[3.81,20.01],P<0.00001).Conclusion:Clinical efficacy of retention enema with integrated traditional Chinese and western medicine on RP is better than simple western medicine enema or blank enema.Due to the low quality of the included clinical literatures,it is necessary to carry out more deliberate,detailed,high-quality,randomized,double-blind,and multi-center RCTs in order to give more powerful demonstration on its clinical efficacy on RP.

Rectal perforations and fistulae secondary to a glycerin enema:Closure by over-the-scope-clip

Rectal perforations due to glycerin enemas(GE) typically occur when the patient is in a seated or lordotic standing position.Once the perforation occurs and peritonitis results,death is usually inevitable.We describe two cases of rectal perforation and fistula caused by a GE.An 88-year-old woman presented with a large rectal perforation and a fistula just after receiving a GE.Her case was further complicated by an abscess in the right rectal wall.The second patient was a 78-year-old woman who suffered from a rectovesical fistula after a GE.In both cases,we performed direct endoscopic abscess lavage with a saline solution and closed the fistula using an over-the-scope-clip(OTSC) procedure.These procedures resulted in dramatic improvement in both patients.Direct endoscopic lavage and OTSC closure are very useful for pararectal abscess lavage and fistula closure,respectively,in elderly patients who are in poor general condition.Our two cases are the first reports of the successful endoscopic closure of fistulae using double OTSCs after endoscopic lavage of the debris and an abscess of the rectum secondary to a GE.

Rebamipide enema therapy for left-sided ischemic colitis patients accompanied by ulcers:Open label study

AIM: To attempt rectal administration of rebamipide in the treatment of ischemic colitis patients with ulcers, and evaluate its effects. METHODS: We compared 9 ischemic colitis patients (2 men, 7 women) with ulcers treated by bowel rest only from 2000 to 2005 (conventional therapy group), with 6 patients (2 men, 4 women) treated by rebamipide enema therapy in 2006 (rebamipide enema therapy group) and analyzed the mean duration of fasting and hospitalization, degree of ulcer healing, and decrease in WBC count for the two groups. RESULTS: The mean duration of fasting and hos- pitalization were 2.7 ± 1.8 d and 9.2 ± 1.5 d in the rebamipide group and 7.9 ± 4.1 d and 17.9 ± 6.8 d in the control group, respectively, and signifi cantly re- duced in the rebamipide group (t = -2.915; P = 0.0121 and t = -3.054; P = 0.0092). As for the degree of ul- cer healing at 7 d after admission, the ulcer score was reduced by 3.5 ± 0.5 (points) in the rebamipide group and 2.8 ± 0.5 (points) in the control group (t = 1.975; P = 0.0797), while the decrease in WBC count was 120.0 ± 55.8 (× 102/μL) in the rebamipide group and 85.9 ± 56.8 (× 102/μL) in the control group (t = 1.006; P = 0.3360). CONCLUSION: In left-sided ischemic colitis patients with ulcers, rebamipide enema therapy significantly reduced the duration of fasting and hospitalization, recommending its use as a new and effective thera- peutic alternative.

Therapeutic barium enema for bleeding colonic diverticula:Four case series and review of the literature

The prevalence of diverticular diseases of the colon, including severe and persistent bleeding in Eastern countries, has increased in the last decades. The bleeding from colonic diverticula is the most common cause of acute lower gastrointestinal bleeding. Herein, we report four cases of severe and persistent bleeding of colonic diverticular disease that could be treated with a high concentration barium enema. These four cases showed a similar pattern of bleeding whose source could not be identified. Colonoscopy revealed fresh blood in the entire colon and many diverticula were noted throughout the colon. No active bleeding source was identified, but large adherent clots in some diverticula were noted. After endoscopic and angiographic therapies failed, therapeutic barium enema stopped the severe bleeding. These patients remained free of re-bleeding in the follow-up period (range 17-35 mo) after the therapy. We report the four case series of therapeutic barium enema and reviewed the literature pertinent to this procedure.

Kangfuxin Fluid on the Treatment of Ulcerative Colitis with Retention Enema： a Systematic Review

目的：系统评价康复新液在保留灌肠治疗溃疡性结肠炎中的作用.方法：计算机检索中国期刊全文数据库、维普期刊资源整合平台、万方数据库、PubMed、Medline、Cochranelibrary、Embase数据库;并手工检索纳入文献的参考文献.检索时间为建库至2017年.对检索到的随机对照试验进行了系统的回顾,用RevMan5.3软件进行meta分析.结果：共纳入18篇随机对照试验,1417例患者,其中试验组731例,对照组686例.Meta分析显示,康复新液联合保留灌肠治疗溃疡性结肠炎的疗效显著优于对照治疗（RR=1.2295%CI：[1.16,1.27],Z=8.14,p〈0.00001）,康复新液治疗后生活质量评分显著提高（MD=11.12,95%CI[7.00,15.23],Z=5.30,p〈0.00001）.结论：康复新液联合保留灌肠治疗溃疡性结肠炎能提高患者的生活质量,值得临床推广.同时,有必要对溃疡性结肠炎的治疗效果进行深入的研究并进行高质量的随机对照试验.