Long-term treatment with mesalazine and rifaximin versus rifaximin alone for patients with recurrent attacks of acute diverticulitis of colon

BACKGROUND/AIMS: To compare efficacy of combined therapy with rifaximin and mesalazine versus rifaximin alone in treatment of patients with recurrent diverticulitis in order to evaluate: 1) rapidity in improvement of symptoms, 2) regulation of bowel attacks, 3) prevention of recurrence of diverticulitis. METHODS: A total of 218 consecutive eligible patients (131 males, 87 females age 64.3 years, range 51-79), affected by diverticulitis were monitored. Of these, 109 patients were treated with rifaximin 400 mg bid plus mesalazine 800 mg tid for 7 days, followed by rifaximin 400 mg bid plus mesalazine 800 mg bid for 7 days/month (group A); 109 patients were treated with rifaximin 400 mg bid for 7 days, followed by rifaximin 400 mg bid for 7 days/month (group B). Colonoscopy was performed after 3, 6 and 12 months of therapy. RESULTS: At end of follow-up, 193 patients were fully compliant to therapy Two patients died during study (1 in group A, 1 in group B), while four patients were lost to follow-up [1 in group A (0.91%) and 3 in group B (2.75%)]. The only side-effects recorded were transient urticaria (1 in group B, 0.91%) and epigastric pain (9 in group A, 8.25%). Severity of symptoms improved significantly in group A vs group B within 3 months (p < 0.005, p < 0.001 and p < 0.0001 and p < 0.0005 at 3, 6, 9 and 12 months, respectively). Bowel habits inproved significantly in group A vs group B within 3 months (p < 0.005, p < 0.0005, p < 0.001 and p < 0.0001 at 3,6,9 and 12 months respectively). Symptomatic recurrence of diverticulitis occurred in 3 patients in group A, while 13 patients showed recurrence of diverticulitis in group B (p < 0.005) during follow-up. CONCLUSIONS: This study clearly shows that rifaximin plus mesalazine are more effective than rifaximin alone in resolution of symptoms and prevention of recurrence of diverticulitis.     

美沙拉嗪栓联合穴位贴治疗溃疡性结肠炎中期效果探讨

目的:探讨美沙拉嗪栓联合穴位贴治疗溃疡性结肠炎中期临床效果。方法:将溃疡性结肠炎中期患者86例随机分为2组,各43例,其中对照组在常规治疗的基础上使用美沙拉嗪栓每日1~2次治疗,1枚/次,观察组在对照组治疗的基础上使用穴位贴,以中脘、足三里、大肠俞及上巨虚四穴进行贴敷,1贴/d,连续治疗3个月为1个疗程,治疗1个疗程后比较2组患者临床症状积分,临床症状缓解时间及1年后随访患者临床症状复发情况。结果:治疗后1周开始观察组临床症状积分显著低于治疗前及同期对照组(P0.05),治疗后观察组腹泻、腹痛腹胀及黏液脓血便消失时间均短于对照组(P0.05),治疗后1年观察组中发生腹痛、腹泻及脓血便的比率低于对照组(P0.05)。结论:美沙拉嗪栓联合穴位贴治疗溃疡性结肠炎,能较快改善临床症状,且维持时间长。     

双歧杆菌三联活菌胶囊联合美沙拉嗪栓剂治疗UC的临床观察

目的：探讨双歧杆菌三联活菌胶囊联合美沙拉嗪栓剂治疗溃疡性结肠炎（UC）的临床疗效及安全性。方法将收治的60例UC患者按随机数字表分为观察组和对照组,每组30例。2组均予美沙拉嗪栓剂治疗,1 g/次,2次/d,塞肛,在此基础上,观察组加用双歧杆菌三联活菌胶囊,0.42g/次,3次/d,饭后半小时温水服用。2组疗程均为4周。观察治疗前后的临床疗效、改良Mayo评分及不良反应发生率,进行对比分析。结果观察组的总有效率为93.33%,与对照组比较,差异有统计学意义（P＜0.05）。2组治疗后的改良Mayo评分分别为（1.19±1.72）分、（3.21±1.36）分,组间比较,观察组的改善优于对照组（P＜0.05）,而2组不良反应发生率分别为6.67%。13.33%,组间比较无统计学意义。结论培菲康联合美沙拉嗪栓剂治疗溃疡性结肠炎疗效显著。     

Mesalazine in treating diverticular disease of the colon

Evaluation of: Kruis W, Meier E, Schumacher M, Mickisch O, Greinwald R, Mueller R; German SAG-20 Study Group. Randomised clinical trial: mesalazine (Salofalk granules) for uncomplicated diverticular disease of the colon – a placebo-controlled study. Aliment. Pharmacol. Ther. 37(7), 680–690 (2013).

Although diverticular disease (DD) is one of the commonest diseases in the western world, robust evidences about its treatment are lack so far. A recent, placebo-controlled study found mesalazine effective in obtaining pain relief in patients suffering from DD. A brief comment is provided herein in order to assess the rationale of this drug in treating DD.     

Maternal use of 5-aminosalicylates in early pregnancy and congenital malformation risk in the offspring

Abstract

Objective. Most previous studies have failed to demonstrate any effect of maternal use of 5-aminosalicylates (5-ASA) on malformation risk, but the number of infants studied have, in most cases, been low. The objective of the study was to get data from a large study with prospectively ascertained exposure information. Material and methods. The study was based on data in the Swedish Medical Birth Register (1996–2011) where identification of maternal drug use is made from midwife interviews in early pregnancy. The presence of congenital malformations was ascertained from three national registers. Adjusted odds ratios were calculated by the Mantel-Haenszel methodology. Results. Among 1,552,109 women, 3651 with 3721 infants had reported the use of 5-ASAs in early pregnancy. The risk of a major malformation was increased (1.37, 95% confidence interval = 1.17–1.62) and still more for a cardiovascular defect (1.74, 1.37–2.22). This effect seemed to be influenced by concomitant use of systemic glucocorticosteroids or immunosuppressants but some confounding by indication may also exist. There was no marked difference between the four 5-ASA drugs studied. Conclusions. Infants born of women who use 5-ASA drugs in early pregnancy have an increased risk of a congenital malformation, notably a cardiovascular defect. This could be a drug effect or an effect of an active inflammatory bowel disease.     

美沙拉嗪联合双歧三联活菌治疗溃疡性结肠炎效果

目的观察美沙拉嗪联合双歧三联活菌治疗溃疡性结肠炎（UC）的临床效果。方法将40例活动期UC病人,随机分为美沙拉嗪联合双歧三联活菌治疗组（20例）和美沙拉嗪对照组（20例）,治疗4周后观察两组临床疗效及结肠镜下改变。结果治疗组临床症状改善和总体疗效优于对照组（P=0.03～0.04;u=2.127,P〈0.05）,不良反应发生率明显低于对照组（χ2=4.514,P〈0.05）。结论美沙拉嗪联合双歧三联活菌治疗UC可显著提高疗效并减少不良反应。     

美沙拉嗪治疗溃疡性结肠炎68例临床研究

目的 研究美沙拉嗪栓剂治疗溃疡性结肠炎的临床疗效及安全性.方法 对2009年6月～2010年6月,门诊及入院治疗的68例溃疡性结肠炎患者随机进行分组,分别给予美沙拉嗪栓剂及口服柳氮磺吡啶片剂,8周为1个疗程.结果 美沙拉嗪栓剂治疗组显效率及总有效率均明显高于口服药柳氮磺吡啶组,两组差异有统计学意义(P＜0.05),且美沙拉嗪栓剂治疗组不良反应发生率低于口服药柳氮磺吡啶组,分别为29.6%和52.8%,差异有统计学意义(P＜0.05).结论 美沙拉嗪栓剂治疗溃疡性结肠炎疗效显著,安全性好,值得临床推广.     

破壁松花粉联合美沙拉嗪治疗溃疡性结肠炎的疗效及对免疫功能的影响

目的探讨破壁松花粉联合美沙拉嗪治疗溃疡性结肠炎(UC)患者的临床效果及对免疫功能的影响。方法回顾性分析55例溃疡性结肠炎患者的临床资料,将其分为美沙拉嗪组27例和破壁松花粉联合组28例,美沙拉嗪组给予美沙拉嗪口服,破壁松花粉联合组给予破壁松花粉联合美沙拉嗪口服。观察两组患者治疗前后疗效情况。结果与美沙拉嗪组比较,破壁松花粉联合组总有效率显著增高(P＜0.05);结肠黏膜病变、疾病活动度、免疫功能均明显改善(P＜0.05)。两组患者均未发生严重的不良反应。结论破壁松花粉联合美沙拉嗪能改善UC肠道黏膜炎症,有效控制疾病活动症状,促进机体免疫功能恢复。