Endoscopic diagnosis of refractory ulcerative colitis

Background & AIM: To make the endoscopic characteristics and clinical appearance of refractory ulcerative colitis (UC) clear, we studied the frequency and location of refractory lesions of severe UC patients. Methods: The subjects were a total of 68 patients with severe UC. 41patients were identified with refractory UC, defined as poor response to high-dose systemic steroids (SH-resistant UC), and another group of 27 patients had non-refractory UC (SH-responsive UC). Two groups were compared by the following item; endoscopic findings, locations, effect of treatment, and relation to CMV infection. Results: In SH-resistant UC, longitudinal ulcer and extensive mucosal abrasion were found with high frequency, and there were refractory lesion significantly in proximal colon. In case of UC with refractory lesion, there is a high possibility that treatment is ineffective. Of 14 UC patients with refractory lesion treated with LCAP, 10 obtained remission, whereas only 12 of 30 those patients with treated by only steroids achieved remission. Of 11 steroid-refractory UC patients with CMV detected, were refractory to steroids and had undergone. Conclusions: The findings of this study suggest that it is very important to decide on a patient’s medication by relying on exact diagnosis concerning the condition of UC by endoscopy. Received 20 July 2006; accepted 22 August 2006     

Infliximab for refractory ulcerative colitis or indeterminate colitis: an open-label multicentre study

BACKGROUND: The efficacy of infliximab in ulcerative colitis (UC) and indeterminate colitis has been poorly assessed and preliminary results are conflicting. METHODS: The records of 30 patients treated with infliximab for ulcerative colitis (n=19) or indeterminate colitis (n=11) were reviewed. Infliximab was given because of steroid resistance (n=18), dependence (n=5) or intolerance (n=7); five patients had failed on cyclosporin; 19 patients had a severe flare-up. RESULTS: Median duration of follow-up was 10 months. In 28 patients with active disease, the response rate was 75% at day 7, with 43% having a complete remission, and 50% at month 1, with 32% having a complete remission. Among the 22 responders, the probability of relapse was 73% at month 6. The probability of complete remission without steroids, taking into account the re-treatment for relapse (n=11), was 57% (95% confidence interval (CI): 45% to 69%) at month 6. The probability of colectomy was 33% (95% CI: 23% to 43%) at month 12. In indeterminate colitis, response rate was only 50% at day 7 and 30% at month 1. Concomitant use of antimetabolite agents was associated with better results. CONCLUSIONS: Infliximab was able to induce a rapid response in some patients with UC or indeterminate colitis refractory to conventional treatment. Long-term results were less favourable, with frequent relapses, and about one-third of the patients required a colectomy.     

血小板激活与活动期发生溃疡性结肠炎的关系

目的探讨活动期溃疡性结肠炎和血小板激活状态的关系.方法对33例活动期溃疡性结肠炎、12例缓解期溃疡性结肠炎、30例肠易激综合征（IBS）患者和正常对照组28例用SH-93智能血液凝聚仪检测血小板聚集率,用酶联免疫法检测P选择素和血栓素B2（TXB2）.同时评价45例溃疡性结肠炎内镜下表现和结肠黏膜活检情况.结果33例活动期溃疡性结肠炎患者平均1 min血小板聚集率和最大血小板聚集率均明显高于IBS组和正常对照组（P＜0.01）,33例活动溃疡性结肠炎P选择素和TXB2明显高于IBS组和正常对照组,差异有显著意义（P＜0.01或P＜0.05）.缓解期溃疡性结肠炎的P选择素也高于正常对照组.结论活动期溃疡性结肠炎患者体内存在血小板激活,血小板可能直接参与结肠黏膜的急性炎症反应.其中P选择素是溃疡性结肠炎的特异性指标,而血小板聚集率和TXB2与疾病的活动度有关.抗血小板药物可能对溃疡性结肠炎有一定的治疗效果.     

复方甘草酸甘注射液治疗活动期溃疡性结肠炎的疗效观察

目的 :观察复方甘草酸甘注射液治疗活动期溃疡性结肠炎的疗效及安全性。方法 :48例活动期溃疡性结肠炎患者随机分为两组 ,治疗组给予复方甘草酸甘注射液60ml加入5 %葡萄糖500ml静脉滴注 ,1次/日 ,对照组给予美沙拉嗪1g口服 ,4次/日 ,疗程均为4周。比较两组的临床疗效及不良反应。结果 :两组患者治疗4周后症状明显改善 ,治疗组总有效率及临床治愈率分别为91.67 %和62.50 % ,对照组总有效率及临床治愈率分别为95.83 %和58.33 %。两组比较差异均无显著性(P>0.05) ,两组患者治疗后均未发现严重不良反应。结论 :复方甘草酸甘注射液和美沙拉嗪一样是治疗活动期溃疡性结肠炎安全、有效的药物     

Golimumab for moderately to severely active ulcerative colitis

Introduction: Anti-TNF agents are the mainstay of therapy in patients with moderate to severe ulcerative colitis (UC) not responding to 5-aminosalisylic acid, corticosteroids, immunmodulators and for patients dependent on corticosteroids. There is a therapeutic gap of 30%- 60% with infliximab and adalimumab, which is required to be bridged by newer agents. The present review summarizes the literature on the role of golimumab, a new anti TNF agent, in ulcerative colitis.

Areas covered: Literature search was done on PubMed using the search terms ‘golimumab’ AND ‘ulcerative colitis’ from inception till March 2016. Golimumab, a fully human monoclonal antibody against TNF-α, was approved by FDA for clinical use in UC in 2013. In vitro studies showed golimumab to be better than infliximab and adalimumab in terms of affinity and neutralization of TNF-α and its conformational stability. Golimumab was found to be effective and safe in inducing and maintaining clinical remission, clinical response and mucosal healing in patients with UC in the two registration trials.

Expert commentary: Although there is no difference in terms of efficacy between golimumab, infliximab and adalimumab, golimumab is better than infliximab in terms of route of administration (subcutaneous vs intravenous) and better than adalimumab in terms of frequency of dosing (4 weeks vs 2 weeks).     

大鼠溃疡性结肠炎模型的实验研究

目的对不同剂量的三硝基苯磺酸（ＴＮＢＳ）引起的大鼠溃疡性结肠炎（ＵＣ）模型进行观察和评价。方法采用一次性直肠注入大鼠ＴＮＢＳ（２５～１５０ｍｇ·ｋｇ－１）的３０％乙醇溶液，引起慢性炎症性肠疾病（ＩＢＤ），３ｗｋ后外死动物对各剂量下动物结肠的重量、髓过氧化物酶（ＭＰＯ）活性及组织形态学变化进行观察和评价。结果ＴＮＢＳ在１００～１５０ｍｇ·ｋｇ－１剂量下引起的ＵＣ肠壁明显增厚，炎症和溃疡至少维持７ｗｋ时间，ＭＰＯ活性值显著性升高，组织学检查发现粘膜及粘膜下层有大量中性粒细胞及淋巴细胞、巨噬细胞、纤维细胞浸润，肉芽组织及隐窝脓肿形成，５０ｍｇ·ｋｇ－１剂量时有一较轻度的损伤。２５ｍｇ·ｋｇ－１时对结肠的重量、ＭＰＯ活性及损伤指数都没有显著性改变（Ｐ＞０．０５）。结论用ＴＮＢＳ引起大鼠实验性ＵＣ，其溃疡和炎症维持一较长时间，这一病理特征为炎症性疾病防治药物的研究提供了条件；本模型的最佳剂量为１００ｍｇ·ｋｇ－１左右