Efficacy and safety of stellate ganglion block in chronic ulcerative colitis

AIM To investigate the efficacy and safety of stellate ganglion block for the treatment of patients with chronic ulcerative colitis.METHODS A total of 120 randomly selected patients with chronic ulcerative colitis treated in Cangzhou Central Hospital from January 2014 to January 2016 were included in this study. These patients were divided into two groups: control group(n = 30), patients received oral sulfasalazine treatment; experimental group(n = 90), patients received stellate ganglion block treatment. Clinical symptoms and disease activity in these two groups were compared before and after treatment using endoscopy. Blood was collected from patients on day 0, 10, 20 and 30 after treatment. Enzyme-linked immunosorbent assay was performed to determine interleukin-8(IL-8) level. The changes in IL-8 level post-treatment in the two groups were compared using repeated measures analysis of variance.RESULTS After treatment, clinical symptoms and disease activity were shown to be alleviated by endoscopy in both the control and experimental groups. However, patients in the control group did not have obvious abdominal pain relief. In addition, the degree of pain relief in the experimental group was statistically better than that in the control group(P < 0.05). Ten days after treatment, IL-8 level was found to be significantly lower in the experimental group than in the control group, and the difference was statistically significant(P < 0.05). In addition, adverse events were significantly higher in the control group than in the experimental group, and the difference was statistically significant(χ~2 = 33.215, P = 0.000).CONCLUSION The application of stellate ganglion block effectively improves treatment efficacy in chronic ulcerative colitis, relieves clinical symptoms in patients, and reduces the level of inflammatory factors. Furthermore, this approach also had a positive impact on the disease to a certain extent.

Efficacy and safety of stellate ganglion block in chronic ulcerative colitis

Sympathetic system modulation by stellate ganglion blockade may modulate immune dysfunction and significantly improve symptoms of chronic ulcerative colitis.

Differential diagnosis in ulcerative colitis in an adolescent: Chronic granulomatous disease needs extra attention

Chronic granulomatous disease(CGD) is a primary immune deficiency that is commonly diagnosed under the age of 5 years(95%) and is rarely seen in adulthood. CGD may manifest as inflammatory bowel disease(IBD) in childhood. Without proper diagnosis, these patients may be monitored for years as IBD; some may even be regarded as steroid-resistant ulcerative colitis(UC) and end up having a colectomy. In this case report, we described a patient who had been followedup for years as UC and subsequently underwent colectomy, but was finally diagnosed in adulthood as primary immune deficiency.

Risk of inflammatory bowel disease in patients with chronic obstructive pulmonary disease: A nationwide, population-based study

BACKGROUND There is a growing evidence regarding an increased risk of inflammatory bowel disease(IBD)among patients with airway diseases.AIM To investigate the influence of chronic obstructive pulmonary disease(COPD)on the risk of IBD.METHODS A nationwide,population-based study was conducted using data from the National Health Insurance Service database.A total of 1303021 patients with COPD and 6515105 non-COPD controls were identified.The COPD group was divided into the severe and the mild COPD group according to diagnostic criteria.The risk of IBD in patients with COPD compared to controls was analyzed by Cox proportional hazard regression models.The cumulative incidences of IBD were compared between the groups.RESULTS The COPD group had higher incidences of IBD compared to non-COPD controls(incidence rate,9.98 vs 7.18 per 100000 person-years,P<0.001).The risk of IBD in the COPD group was increased by 1.38(adjusted hazard ratio(HR);95%CI:1.25-1.52).The incidence rate of IBD was higher in the severe COPD group than in the mild COPD group(12.39 vs 9.77 per 100000 person-year,P<0.001).The severity of COPD was associated with an increased risk of IBD(adjusted HR 1.70 in severe COPD,95%CI:1.27-2.21 and adjusted HR 1.35 in mild COPD,95%CI:1.22-1.49)CONCLUSION The incidences of IBD were significantly increased in COPD patients in South Korea and the risk of developing IBD also increased as the severity of COPD increased.

In-vivo characterization of DALM in ulcerative colitis with high-resolution probe-based confocal laser endomicroscopy

Recently,the use of confocal laser endomicroscopy(CLE) in the diagnosis of chronic ulcerative colitis(CUC) was reported.In this brief report we aimed to assess the application of probe-based CLE to characterize colonic mucosa and dysplasia in CUC.The study involved a patient presenting long-standing CUC.Confocal imaging of both the inflamed mucosa,a circumscribed lesion(dysplasiaassociated lesional mass),and adjacent colonic mucosa are demonstrated and the correlation between the CLE and histological images.Inflamed mucosa and dysplasia showed specific alteration of crypt architecture,cellular infiltration,and vessel architecture with an excellent correlation between CLE and standard histological examination.

Systematic Evaluation and Meta-analysis of Modified Baitouweng Decoction in the Treatment of Ulcerative Colitis

[Objectives]To evaluate the clinical efficacy and safety of Modified Baitouweng Decoction in the treatment of ulcerative colitis(UC).[Methods]A randomized controlled trial of Modified Baitouweng Decoction in the treatment of ulcerative colitis was conducted,and the biased risk was evaluated in the included literature using a standardized method.A meta-analysis of the total effective rate and recurrence rate of the included literature was carried out.Sensitivity and safety analysis was carried out on the included literature.[Results]A total of 19 articles were included,involving a total of 1613 patients.The results of meta-analysis showed that the treatment of Modified Baitouweng Decoction alone or in combination with the western medicine is better than the treatment with the western medicine alone.[Conclusions]Modified Baitouweng Decoction is safe and effective in the treatment of ulcerative colitis.However,since the 19 articles included in this study are not high in quality,they have certain influence on the objectivity of the results.

Infliximab does not increase colonic cancer risk associated to murine chronic colitis

AIM To explore the influence of Infliximab(IFX) on cancer progression in a murine model of colonic cancer associated to chronic colitis.METHODS AOM/DSS model was induced in C57BL/6 mice. Mice were injected with IFX(5 mg/kg) during each DSS cycle while control mice received saline. Body weight, occult blood test and stool consistency were measured to calculate the disease activity index(DAI). Mice were sacrificed at week 10 and colons were analyzed macroscopically and microscopically for number of cancers and degree of inflammation. MTT assay was performed on CT26 to evaluate the potential IFX role on metabolic activity and proliferation. Cells were incubated with TNF-α or IFX or TNF-α plus IFX, and cell vitality was evaluated after 6, 24 and 48 h. The same setting was used after pre-incubation with TNF-α for 24 h.RESULTS IFX significantly reduced DAI and body weight loss in mice compared with controls, preserving also colon length at sacrifice. Histological score was also reduced in treated mice. At macroscopic analysis, IFX treated mice showed a lower number of tumor lesions compared to controls. This was confirmed at microscopic analysis, although differences were not statistically significant. In vitro, IFX treated CT26 maintained similar proliferation ability at MTT test, both when exposed to IFX alone and when associated to TNF-α.CONCLUSION IFX did not increase colonic cancer risk in AOM-DSS model of cancer on chronic colitis nor influence directly the proliferation of murine colon cancer epithelial cells.

Analyzing proteins in colonic tissues from mice with ulcerative colitis using the iTRAQ technology

Objective The aim of the study was to investigate the expression of proteins in colonic tissues of mice with ulcerative colitis(UC) by using isobaric tags for relative and absolute quantitation(iTRAQ), probe into the pathogenesis of UC, and find potential biomarkers of UC. Methods Forty C57 mice were randomly divided into the control and model groups(20 mice in each group). The mice in the model group were administered dextran sulphate sodium(DSS) for 7 consecutive days ad libitum to induce acute colitis, and the colon tissue was extracted on the 8 th day after the successful establishment of the UC model. Proteins were identified by the i TRAQ and tandem mass spectrometry techniques,and the identified proteins were analyzed by bioinformatics. Results A total of 4019 proteins were identified among the two groups. Among them, 317 significant differentially expressed proteins(DEPs) were detected according to the screening criteria for selecting DEPs, i.e. fold change ratios ≥ 1.5 or ≤ 0.67 and P-values < 0.05, of which 156 were upregulated and 161 were downregulated. In the Gene Ontology(GO) analysis, the DEPs were classified into 48 functional categories, which contained biological process, cellular component, and molecular function. Based on the 317 DEPs, the KEGG pathway analysis identified 160 vital pathways.Conclusion DEPs in colonic tissues of mice with UC were screened using the iTRAQ technique, which laid a foundation for further studies regarding the pathogenesis of UC.

Opioid use and misuse in ulcerative colitis

BACKGROUND Patients with ulcerative colitis(UC) may be exposed to opioids over their disease duration. The use of such medications carries significant risk, including intestinal dysmotility and potential for addiction. However, the rates of narcotic use and misuse in patients with UC have not been studied extensively. Functional gastrointestinal disorders(FGID) are prevalent in patients with UC, and have been shown to increase the risk of narcotic use and misuse in patients with Crohn's disease. We hypothesized that patients with UC and a concurrent diagnosis of FGID would have increased rates of both opioid use and misuse in our patient cohort.AIM To evaluate the prevalence of chronic opioid use and misuse in UC.METHODS A retrospective chart review of UC patients seen at the University of Virginia Digestive Health Center was performed on all patients evaluated between 2006 and 2011. Patient demographics, medical, surgical, and medication histories were obtained from the electronic medical record. Concomitant diagnosis of FGID was also noted at the time. The electronic prescription monitoring program was accessed to obtain prescription opioid filling histories. Prescription opioid misuse was defined as opioid prescriptions filled from four or more prescribers and four or more different pharmacies in a 12-mo period.RESULTS A total of 497 patients with UC were included. Patients with UC and FGID were more likely to be female, but no other demographic variables were associated with FGID. Of the UC patients who had FGID, a greater proportion were found to be using opioids chronically(36% with FGID vs 9% without FGID, P < 0.0001)and were misusing prescription opioids(12.8% vs 1.3%, P < 0.001). Multivariate logistic regression demonstrated a significant association with FGID and chronic opioid use(OR = 4.50; 95%CI: 1.91-10.59) and opioid misuse(OR = 5.19; 95%CI1.04-25.76). Tobacco use(OR 2.53; 95%CI: 1.06-6.08) and anxiety(OR 3.17; 95%CI:1.08-9.26) were other variables associated with an increased risk of chronic narcotic use.CONCLUSION FGID was associated with a 4.5-fold increase in chronic opioid use and a 5-fold increased risk of opioid misuse in this patient cohort with UC.

Diagnostic Value of Fecal Calprotectin and Serum MMP-9 in Diagnosing Disease Activity of Ulcerative Colitis

Background and Study Aim: Ulcerative colitis (UC) is a chronic, idiopathic inflammatory bowel disease characterized by remission of disease activity. Searching for laboratory markers which are simple, sensitive, specific and noninvasive is fundamental to assess the extent of inflammation, activity of the disease, evolution and prognosis which can be used to assess response to treatment and the possibility of relapse. Our aim of the work was to investigate the diagnostic role of fecal calprotectin and serum MMP-9 in determining the activity of ulcerative colitis. Patients and Methods: 71 patients were included in the study and fecal calprotectin, serum MMP-9, ESR and CRP were measured in these patients to determine the disease activity of ulcerative colitis. Results: Fecal calprotectin concentration in the patients with active UC was significantly higher than that in inactive disease and in controls (387.21 ± 44.07 μg/g vs 103.62 ± 119.67 μg/g, 12.44 ± 3.65 μg/g, p = 0.000). Serum MMP-9 was found to be higher in patients with active UC than in patients with inactive disease (11.02 ± 5.29 vs 4.01 ± 1.72 ng/ml, p = 0.000). A significant difference was also found in the patients with active UC of mild, moderate and severe degrees. Also, strong positive correlation was found between fecal calprotectin and serum MMP-9 and the severity of the disease. The area under the curve of the receiver operating characteristics (AUCROC) was 0.949 and 0.941 for fecal calprotectin and serum MMP-9 respectively. Conclusion: Fecal calprotectin and serum MMP-9 can be used to differentiate between active and inactive forms of UC.

Mechanism and Research Progress of Fuyang Huoxue Jiedu Formula against Recurrence of Ulcerative Colitis

By introducing the composition and modern pharmacology of Fuyang Huoxue Jiedu Formula,the paper further explored the mechanism and research progress of Fuyang Huoxue Jiedu Formula against recurrence of ulcerative colitis(UC).The formula can effectively improve the TCM syndromes of UC patients,reduce the recurrence rate,and improve clinical efficacy and patients’quality of life.

Fluoxetine Ameliorates the Aggravation of UC Symptoms in C57BL/6 Mice Induced by CUMS

Objective Patients with chronic ulcerative colitis(UC)often have mental symptoms such as depression and anxiety,and stress can lead to gastrointestinal diseases.However,the correlation between mental stress and UC is unclear.In this paper,chronic unpredictable mild stress(CUMS)was utilized to evaluate the involvement of mental factors in the pathogenesis of UC.Methods The CUMS model was used to evaluate the direct/indirect involvement of mental factors in the pathogenesis of UC.The behavior was evaluated by the open field,forced swimming,and tail suspension tests.Body weight,the disease activity index(DAI)score,colon length,and HE staining of colon tissue were used to evaluate the action of CUMS and fluoxetine.Results The results showed that weight loss and the DAI score increased in CUMS mice,but they had no meaningful effect on colon length and morphological structure of colon tissue.However,CUMS aggravated dextran sulfate sodium(DSS)-induced colon length shortening and colon morphological structure damage.Fluoxetine significantly improved the DAI score,shortened colon length,and damaged morphology and structure of the colons induced by CUMS combined with DSS in mice.Fluoxetine also decreased the level of IL-6 in the serum and the TNF-αand IFN-γlevels of colon tissue.Fluoxetine simultaneously improved behavioral abnormalities induced by CUMS combined with DSS in mice.Conclusion CUMS aggravated the UC symptoms induced by DSS,and fluoxetine could improve the UC symptoms due to its improvement in the inflammatory level and behavioral abnormalities.

以痈论治溃疡性结肠炎理论阐释及临床思路探析

于永铎认为,痈为火毒生,下利脓血为热毒本质,提出“病由毒起,热毒伤肠”为溃疡性结肠炎病机关键,“邪踞火毒”“湿热毒邪”“正虚伏毒”为溃疡性结肠炎的核心病机演变规律,体现热毒伤肠络,毒邪由实致虚,虚实夹杂的病邪转变过程。结合从肠黏膜屏障损伤、免疫功能紊乱、细胞自噬、凋亡、焦亡的病变特点及交叉转化的因果联系,提出以痈论治溃疡性结肠炎的核心治法,采用清热解毒、凉血消痈,清热利湿、解毒消痈,健脾益气、托毒消痈等辨治策略,并结合临床验案进行分析,以期为溃疡性结肠炎的治疗提供参考。

中医药调控PI3K/AKT信号通路干预溃疡性结肠炎研究进展

通过干预磷脂酰肌醇3-激酶(phosphatidylinositol 3-kinase,PI3K)/蛋白激酶B(protein kinase B,AKT)信号通路中的相关因子而发挥治疗作用的中医药疗法可分为清热解毒燥湿、活血化瘀止血、健脾温肾祛湿和攻补兼施等,能有效遏制UC的发生发展,其作用机制为:(1)通过抑制上游信号因子表皮生长因子受体,进而抑制PI3K/AKT通路,减少肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-1β(interleukin-1β,IL-1β)和白细胞介素-6(interleukin-6,IL-6)在内的促炎细胞因子的表达,降低结肠炎症反应,减轻炎症所引起的结肠组织损伤;(2)直接作用于PI3K-AKT通路,进而抑制核转录因子-κB(nuclear transcription factor-κB,NF-κB)的表达,减少细胞凋亡和促炎因子的表达,缓解肠黏膜组织损伤,修复肠黏膜屏障功能的完整性;(3)通过PI3K/AKT途径下调辅助性T细胞17(T helper cell 17,Th17)和辅助性T细胞3(T helper cell 3,Th3)的分化,调节免疫反应及细胞凋亡,改善肠黏膜屏障,缓解UC结肠炎症反应。中医药具有成分复杂,有效成分作用靶点多,治疗途径多样等特点,但其具体分子生物学作用机制尚未完全明确,今后,需对分子生物学作用机制进行深入研究,为临床治疗溃疡性结肠炎等易反复发作的消化性疾病和新药的开发提供新策略。

溃疡性结肠炎(UC)肠黏膜中IL-2、IL-4、IL-17和IL-10的表达特点及其与疾病活动度的关系

目的探讨溃疡性结肠炎(ulcerative colitis,UC)患者肠黏膜中的细胞因子IL-2、IL-4、IL-17和IL-10的表达特点,并分析其与疾病活动度的关系。方法收集UC患者36例,采用Sutherland疾病活动指数评估UC的炎症活动度。行结肠镜检查时对UC患者的病灶部位及病灶周围正常肠黏膜组织进行活检,以半定量PCR法检测肠黏膜组织中的细胞因子IL-2、IL-4、IL-17和IL-10的表达水平。从中选取10例以免疫组化法检测肠黏膜组织中上述各细胞因子的表达,同时检测该10例UC患者外周血的血沉(erythrocyte sedimentationrate,ESR)及C反应蛋白(c-reactive protein,CRP)值。结果 IL-2在UC患者肠黏膜病灶部位中的表达水平明显高于周围正常黏膜。在UC患者不同活动度组间,IL-2的蛋白表达水平无显著差异,但轻度组的IL-2mRNA表达水平高于中、重度组。IL-4在病灶部位中的表达水平明显高于正常黏膜,其中重度UC患者中的IL-4表达水平明显高于轻、中度UC患者。IL-17在病灶部位中的表达水平高于正常黏膜,其中重度UC患者中的IL-17表达水平明显高于轻、中度UC患者。IL-10在病灶部位中的蛋白及mRNA表达水平均高于正常黏膜,但前者差异无统计学意义,其中轻度UC患者中的IL-10表达水平明显高于中、重度UC患者。UC患者肠黏膜中上述细胞因子的表达水平与ESR、CRP值均无明显相关性。结论 IL-2、IL-4、IL-17及IL-10通过发挥不同的促炎或抑炎作用可能参与介导了UC发病,其mRNA表达水平与UC的炎症活动程度存在一定相关性,其中IL-4、IL-17及IL-10的蛋白表达水平亦与UC的炎症活动程度存在一定相关性,可用来评估UC的炎症程度。

基于肠道屏障探讨“脾主为卫”在溃疡性结肠炎发病与治疗中的作用机制

溃疡性结肠炎(UC)是一种以肠道屏障受损为特点,表现为直肠黏膜的持续性炎症反应、溃烂以及反复发作的炎症性肠病。脾与肠道屏障有密切联系,“脾主为卫”的功能失调是UC的重要病机,然而对UC中“脾主为卫”功能失调的微观机制尚不清楚。肠道屏障与“脾主为卫”的功能异曲同工,肠道屏障的破坏与UC互为因果,从肠道屏障的角度可以为中医“脾主为卫”理论做出新的科学阐释。现代医学尚缺乏对UC的有效治愈方法,药物治疗仍存在不良反应大、停药后加重、易复发等缺点。而中医基于“脾主为卫”理论的益气健脾治法可有效恢复肠道屏障功能,促进黏膜愈合,且无上述不良反应,对于促进UC的愈合以及防止其复发具有重要的临床价值。

从厥阴病机论乌梅丸现代临床证治思路

从厥阴病寒热错杂,阴阳失和的病机入手,探析乌梅丸收敛气血,调和阴阳的作用及其临床应用范围。结合现代药理学研究及古今医家经验,总结出乌梅丸在治疗糖尿病性胃轻瘫、胃食管反流病、慢性顽固性腹泻、慢性胆囊炎、顽固性失眠和溃疡性结肠炎上所取得的显著疗效,为经方临床应用提供思路。

术砂豆仁汤对UC模型大鼠血清IL-6、IL-10、TNF-α水平的影响

目的观察术砂豆仁汤对脾肾阳虚型溃疡性结肠炎大鼠的血清白细胞介素-6(IL-6)、白细胞介素-10(IL-10)及肿瘤坏死因子-α(TNF-α)水平的影响。方法健康SD雄性大鼠40只,随机分为4组,即正常组、模型组、SASP组、术砂豆仁汤组。采用5%的2、4、6-三硝基苯磺酸(TNBS)125 mg/kg乙醇灌肠法建立溃疡性结肠炎大鼠模型,光镜观察大鼠结肠组织病理形态并评分,用酶联免疫吸附法测定大鼠血清IL-6、IL-10、TNF-α水平。结果模型组大鼠血清IL-6、TNF-α含量均高于正常组(均P<0.01),而IL-10含量低于正常组(P<0.01);术砂豆仁汤组血清IL-6、TNF-α水平均较模型组降低(P<0.01),IL-6含量则显著升高(P<0.01)。结论术砂豆仁汤可降低血清IL-6、TNF-α含量,提高IL-10含量,这可能是其治疗UC作用机理之一。

妊娠合并活动期溃疡性结肠炎的诊疗过程

溃疡性结肠炎(UC)表现为反复发作的腹痛、腹泻及脓血便,妊娠期初次发生UC临床比较罕见,但若诊断和治疗不及时,将严重影响孕妇和胎儿健康,甚至危及母婴生命。本文详细介绍妊娠合并活动期UC患者的诊治经过,并结合文献,为提高临床医生对妊娠合并UC的诊疗技术提供经验参考。

敲低长链非编码RNA H19(lncRNA H19)促进人结肠细胞自噬抑制脂多糖诱导的凋亡

目的 探讨lncRNA H19在溃疡性结肠炎(UC)患者中的表达水平及其在UC中的作用。方法 收集西藏军区总医院25名UC患者和25名健康体检者的结肠黏膜标本及血清标本,采用荧光定量PCR检测lncRNA H19表达水平,并对血清标本进行受试者工作特征(ROC)曲线分析。采用脂多糖(LPS)处理建立体外HT29结肠细胞炎性模型,并采用荧光定量PCR检测lncRNA H19在结肠细胞的表达。通过慢病毒技术构建lncRNA H19低表达的HT29细胞株,噻唑蓝(MTT)法检测HT29细胞存活率,流式细胞术检测细胞凋亡率,Western blot法检测凋亡和自噬蛋白表达情况。采用自噬激动剂雷帕霉素处理后,MTT法观察对HT29细胞存活的影响。结果 lncRNA H19在UC患者结肠黏膜组织和血清中高表达,ROC曲线下面积为0.786。LPS刺激后,HT29细胞lncRNA H19表达显著升高,并与刺激时间正相关。敲低lncRNA H19可促进HT29细胞存活并抑制细胞凋亡,促进细胞自噬水平增加;雷帕霉素处理后,细胞存活率明显升高。结论 敲低lncRNA H19促进结肠细胞自噬抑制LPS诱导的结肠细胞凋亡并促进其存活。