Mesalazine-associated interstitial nephritis

BACKGROUND.: When used for oral treatment of inflammatory bowel disease,Asacol (a coated form of mesalazine = 5-aminosalicylic acid)can cause interstitial nephritis. The spectrum of severity,frequency of occurrence and the best renal function test todetect this complication are not known. The value of immunosuppressionin addition to drug withdrawal is similarly undetermined. METHODS.: Four cases of interstitial nephritis which occurred in associationwith oral Asacol treatment are presented and a further 12 caseswho received similar treatment are reviewed. Clinical trialspublished previously were scrutinized to assess the frequencyof impaired renal function. RESULTS.: The available evidence suggests that renal impairment of anyseverity may occur in up to 1 in 100 patients, but that clinicallysignificant interstitial nephritis occurs in less than 1 in500 patients. This is most reliably detected by an elevatedserum creatinine concentration. If the diagnosis of nephrotoxicityis delayed until 18 months after commencement of medication,restoration of renal function, which is seen on withdrawal ofmedication alone up to 10 months, does not occur and there isno evidence to date to indicate that addition of immunosuppressionconfers any significant advantage at this later stage. CONCLUSIONS.: It is suggested that serum creatinine concentration should bemeasured each month for the first 3 months of treatment, 3-monthlyfor the remainder of the first year and annually thereafter.The use of concurrent immunosuppressive therapy may necessitateextension to the period of intensive monitoring. Any elevationof serum creatinine which cannot be related to a relapse ofinflammatory bowel disease should prompt immediate withdrawalof Asacol and related medications and substitution of alternativetherapy. Neither the lack of urinary abnormalities on routinetesting nor the absence of clinical or laboratory features ofdrug allergy can be relied upon to rule out interstitial nephritisduring oral therapy with these drugs.     

复方苦参结肠溶胶囊治疗湿热内蕴型溃疡性结肠炎多中心、随机、双盲、对照研究

目的 观察复方苦参结肠溶胶囊治疗溃疡性结肠炎(ulcerative colitis, UC)湿热内蕴证的临床疗效及安全性,并同美沙拉嗪缓释颗粒(艾迪莎)进行比较。     

花生四烯酸代谢物在湿热型溃疡性结肠炎大鼠的表达与调节

目的:探讨花生四烯酸(AA)代谢物在湿热型溃疡性结肠炎(UC)大鼠发病的作用以及黄芩汤的调节。方法:采用高脂高糖饲料结合人工气候箱法造成大鼠湿热,使用三硝基苯磺酸灌肠造成湿热型UC模型;将造模大鼠分为模型组(n=12)、黄芩汤治疗组(n=13)及美沙拉嗪组(n=12)。治疗两周后用ELISA法检测大鼠前列腺素E2(PGE2)、血小板活化因子(PAF)、白三烯B4(LTB4)及环氧合酶-2(COX-2)含量;检测甘油三酯(TG)及总胆固醇(CH)含量并计算粪便脂肪球数量从而反映湿热程度;对结肠进行肉眼组织学评分从而评价UC的严重程度;将AA代谢物与以上湿热型UC指标进行相关性分析。结果:与空白组(n=12)比较,造模组血清及结肠PGE2、PAF、LTB4及COX-2含量明显升高(P<0.05);治疗后黄芩汤组的PGE2及LTB4均显著低于美沙拉嗪组(P<0.05),但PAF及COX-2无组间差异。湿热指标方面,治疗后黄芩汤组血脂及粪便脂肪球数量均显著低于美沙拉嗪组(P<0.05);UC方面,黄芩汤及美沙拉嗪组的组织学评分无统计学差异。相关性分析显示组织评分与AA代谢物、血脂及粪便脂肪球均呈显著正相关性(r>0.930,P<0.01)。结论:AA代谢物在湿热型UC大鼠血清及结肠明显升高,且与反映湿热的血脂及粪便脂肪球、与反映UC程度的组织学评分均呈正相关性;黄芩汤对代谢物PGE2、LTB4及对湿热指标的调节作用优于美沙拉嗪。     

肠炎康联合美沙拉嗪治疗溃疡性结肠炎

目的:比较肠炎康联合美沙拉嗪与美沙拉嗪治疗溃疡性结肠炎的疗效,为临床治疗溃疡性结肠炎提供合理用药的建议.方法:将吉林大学第一医院2010年6月-2011年5月门诊收治的溃疡性结肠炎患者90例,随机分为治疗组45例和对照组45例,分别接受肠炎康联合美沙拉嗪与美沙拉嗪的治疗方法,用药后对两组的治疗有效率、结肠镜下形态变化及C-反应蛋白及血沉等进行比较,评价其疗效及安全性.结果:两组治疗后的有效率、结肠镜下形态变化比较均具有统计学意义(P＜0.05).结论:肠炎康联合美沙拉嗪的疗效优于美沙拉嗪,值得临床推广应用.     

巴柳氮钠联合康复新液治疗溃疡性结肠炎的临床疗效观察

目的观察联合应用巴柳氮钠和康复新液治疗溃疡性结肠炎的临床疗效。方法将溃疡性结肠炎58例随机分为治疗组30例和对照组28例,治疗组口服巴柳氮钠和康复新液治疗,对照组口服美沙拉嗪颗粒治疗。结果治疗组在治疗后的完全缓解率明显高于对照组（P〈0.05）,治疗后脓血便以及腹胀症状较对照组明显减轻（P〈0.05）,两组间不良反应对比类似。结论巴柳氮联合康复新液灌肠治疗溃疡性结肠炎可有效改善相关症状,临床疗效稳定可靠,是一种值得临床推广应用的治疗方法。     

Design of a colonic delivery system based on cationic polymethacrylate (Eudragit E100)-mesalamine complexes

In this work, the design and evaluation of a colonic drug delivery system containing mesalamine (M) is presented. The main goal was to enable M to reach the first part of the colon, where the drug could then be released. To facilitate this, a tablet core was coated with two thin layers. The first compounded by chitosan, which was responsible for core protection in the small intestine until it reached the colon. Once at the colon, microbiological enzymatic activity of the caecal content would degrade the Ch layer, thus triggering drug release. The second layer, the outer one, was compounded with Eudragit L100 (EL), with its function being to avoid the dissolution of the Ch-covered core along the gastro intestinal tract (GIT). In order to achieve a modulated drug release, carbomer P934 (1%) was also included. Dissolution studies showed that the formulation seemed to behave as predicted. The amount of M released from the coated tablet was less than 10% at pH?=?1.2 and 6.8. However, when the coated tablet was evaluated in a medium with a caecal content of pH?=?7.4, the M delivery was immediately triggered owing to enzymatic activity of the microflora. In this medium, ～ 60% of M was released in a period of 3?h. Although these results are promising, further studies are still necessary to evaluate the possible in vitro/in vivo correlations.     

美沙拉嗪肠溶片治疗肠易激综合征的临床疗效

目的探讨美沙拉嗪肠溶片(惠迪)治疗肠易激综合征(IBS)患者的临床疗效。方法选取2010年2月-2012年6月至上海市第八人民医院就诊的52例不同亚型的IBS患者进行自身对照试验,均予惠迪口服,500mg,4次/d,治疗1个月(30d)。监测治疗前后的腹痛强度、腹胀、大便情况。结果 (1)所有亚型的IBS患者在治疗后疼痛得分均降低[腹泻型由(7.3±0.4)降至(2.2±0.8),便秘型由(6.4±0.7)降至(1.1±0.2),混合型由(8.1±0.6)降至(2.7±0.5),不定型由(8.9±0.5)降至(3.6±0.8)],疼痛强度明显降低。(2)大便的各种异常症状发病率均明显降低,(腹泻型由100.0%降至6.3%,便秘型由100.0%降至38.1%,混合型由100%降至20.0%,不定型由100.0%降至40.0%)。(3)腹部不适的症状也得到减轻。发病率明显降低(腹泻型由68.8%降至18.8%,便秘型由95.2%降至19.0%,混合型由90.0%降至30.0%,不定型由80.0%降至40.0%)。结论惠迪能有效缓解IBS患者的多种症状,明显的减低患者的疼痛强度,显著改善腹部不适和大便异常。     

New medical strategies for the management of acute diverticulitis

Acute diverticulitis, defined as acute inflammation of a colonic diverticulum, is a common emergency presentation managed by both surgeons and physicians. There have been advances in the medical treatments offered to patients in recent years. Factors predisposing individuals to the development of acute diverticulitis include obesity, smoking, lack of physical activity and medication use, such as NSAIDs. Although widely used, there is limited evidence on the efficacy of individual antibiotic regimens and antibiotic treatment may not be required in all patients. Mesalazine seems to be the only effective treatment for the primary prevention of acute diverticulitis. Finally, evidence of effective measures for the prevention of recurrence is lacking. Furthermore, high-quality randomized controlled trials are required for medical treatments in patients with acute diverticulitis, if management is to be evidence based.     

美沙拉秦中有机杂质的探讨

对美沙拉秦中有机杂质的测定进行了探讨。采用4种体系对其可能含有的水杨酸、苯胺、5－苯偶氮水杨酸、对苯醌、对苯二酚、龙胆酸、对氨基酚等7种有关物质进行了测定。     

Effect of mesalazine, metronidazole and gentamicin on bacterial translocation in experimental colitis

BACKGROUND AND AIM: In inflammatory bowel disease it has been established that enteric microorganisms are present in the final stage of the active inflammatory process. The purpose of the present study was to investigate the effects of mesalazine, and metronidazole-gentamicin combination, on bacterial translocation in an animal colitis model. METHODS: Fifty rats were stratified into five groups. The control group (group NC) was given only 2 mL saline enema and the remaining four groups were given 2 mL acetic acid enema. Group CC was the diseased control group. The treatment regimens started on the fifth day: mesalazine enema in group MesC, metronidazole-gentamicin in group MGC, and mesalazine + metronidazole + gentamicin in group MesMGC. After death on day 10, 2.5-cm colonic segments from all groups were weighed separately. In all rats, histopathological scoring was done, and samples from feces, blood, liver and spleen underwent microbiological analyses. RESULTS: For all diseased rats, both mean weight loss and colonic segment weight/bodyweight ratio was significantly higher than that in the sham group. As compared with other groups, body and colonic segment changes as well as histopathological scoring in rats receiving mesalazine enema either solely or in combination with the antibiotics were lower. No bacterial growth was found in the blood, liver and spleen of the rats in the control group while enteric bacteria, mainly Escherichia coli (35%) were the most common bacteria translocated to that in the latter. Antibiotic combination, alone or in combination with mesalazine was effective in reducing the bacterial translocation while mesalazine administration did not properly influence its regression. CONCLUSIONS: Gram-negative enteric bacteria, predominantly E. coli, was the most common bacteria isolated in bacterial translocation occurring in acetic acid-induced colitis. This trial showed that mesalazine alone did not incorporate the reduction of infectious events, despite its beneficial effect on inflammatory changes in experimental colitis. Metronidazole and gentamicin combination given intraperitoneally was more effective than topical mesalazine in decreasing bacterial translocation.