Lack of effect of 5-aminosalicylic acid on platelet aggregation and fibrinolytic activity in vivo and in vitro

Summary We have studied platelet aggregation and fibrinolytic activity in six patients with chronic inflammatory bowel disease treated with 5-aminosalicylic acid (mesalazine).There were no changes in these measurements during normal treatment, i.e. 1.5 g per day with a slow-release formulation, nor after an intravenous dose of 250 mg. Also in vitro tests were negative, in contrast to the inhibition seen with aspirin (acetylsalicylic acid).We conclude that treatment with mesalazine does not constitute a hazard to these patients in regard to prolonged bleeding time caused by an influence on platelet aggregation or fibrinolytic activity.     

BENEFICIAL EFFECT OF ORAL MESALAZINE POWDER ADMINISTRATION ON GASTRIC INVOLVEMENT OF BEHÇET's DISEASE

Behçet's disease (BD) is a multisystem immune‐mediated inflammatory disorder that involves the gastrointestinal tract. Although intestinal BD chiefly affects the ileocecum and colon, it may involve the entire alimentary tract. Upper gastrointestinal involvements of BD are not common, and its treatment has been rarely reported. Mesalazine is known to be an effective anti‐inflammatory agent for treatment of distal intestinal lesions of inflammatory bowel disease by its delayed drug release system. Here we show a case of chronic active, steroid‐dependent BD involving the upper gastrointestinal tract who was treated with ground mesalazine powder. Endoscopy performed 8 weeks after the treatment showed marked improvement of the gastric ulcers. This is the first report of intestinal BD treated with oral administration of mesalazine powder, and our results suggest that it may be a beneficial and effective new therapy for the upper gastrointestinal lesion of BD.     

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。     

The risks and the benefits of mesalazine as a treatment for ulcerative colitis

Mesalazine is a 5-aminosalicylic acid compound that is the primary treatment for mild-to-moderate ulcerative colitis. In both oral and topical formulations it has demonstrated efficacy in both induction of active colitis and maintenance of remission, regardless of the extent of inflammation. In addition, there is indirect evidence of a role in the chemoprophylaxis of colorectal cancer in these patients. Mesalazine is generally well tolerated by patients, although serious adverse effects have been reported. In particular, worsening of colitis, interstitial pneumonitis and nephritis are of concern to clinicians. Fortunately these reactions are mostly reversible with cessation of therapy.     

Mesalazine for diverticular disease of the colon – a new role for an old drug

Colonic diverticulosis is among the most common diseases of developed countries. Its prevalence is ～ 5 – 10% of the population by age 50, and 30, 50 and 66% of those > 50, > 70 and > 85years of age, respectively. Antibiotics have been successfully used in the treatment of uncomplicated diverticular disease; however, the use of mesalazine (alone or in combination with antibiotics) in treating uncomplicated diverticulitis has been successfully developed in recent years. Indeed, mesalazine (with or without antibiotics) showed significant superiority in improving the severity of symptoms, bowel habits, and in preventing symptomatic recurrence of diverticulitis over antibiotics alone. More-over, in light of some preliminary results, it is probable that the association of mesalazine with probiotics may in the future be the first-choice treatment for mild-to-moderate uncomplicated attacks of acute diverticulitis.     

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.     

中药组方联合美沙拉嗪/柳氮磺吡啶治疗溃疡性结肠炎有效性及安全性的系统评价

目的： 系统评价中药组方联合美沙拉嗪或柳氮磺吡啶治疗溃疡性结肠炎患者的疗效及安全性。方法： 在PubMed、Web of Science、中国知网、万方、维普数据库以"中药"、"溃疡性结肠炎"等为检索词,检索并筛选相关文献,以临床有效率及不良反应为结局指标,采用Revman 5.4进行Meta分析。结果： 本次研究共检索文献2 124篇,最终纳入117篇;Meta分析发现,美沙拉嗪联合中药组方口服（OR=3.49,95% CI[2.75,4.43]）或灌肠（OR=4.42,95% CI[3.56,5.48]）治疗均能提高临床有效率,且并未增加不良反应的发生风险（OR=0.55,95% CI[0.28,1.06];OR=0.39,95% CI[0.26,0.58]）;柳氮磺吡啶联合中药组方口服（OR=5.95,95% CI[3.76,9.40]）或灌肠（OR=3.75,95% CI[2.80,5.01]）治疗同样可提高临床有效率,不良反应的风险并未因中药组方的使用而增加（OR=0.33,95% CI[0.05,2.07];OR=0.27,95% CI[0.01,5.66]）。结论： 在美沙拉嗪/柳氮磺吡啶的基础上联合中药组方口服或灌肠治疗能有效提高溃疡性结肠炎的治愈率,且并未增加不良反应的发生风险,但中药组方联合治疗溃疡性结肠炎仍需高质量的研究。