Tacrolimus Therapy in Steroid-Refractory Ulcerative Colitis: A Review

2019 ◽  
Vol 26 (1) ◽  
pp. 24-32 ◽  
Author(s):  
Biyu Wu ◽  
Jinglu Tong ◽  
Zhihua Ran
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Process ◽  
Calcineurin Inhibitor ◽  
Efficacy And Safety ◽  
Chronic Inflammatory Process ◽  
Increased Risk ◽  
Bowel Diseases ◽  
Tacrolimus Therapy ◽  
Inflammatory Bowel ◽  
Steroid Refractory

AbstractInflammatory bowel diseases are known for a chronic inflammatory process of the gastrointestinal tract and include Crohn’s disease and ulcerative colitis (UC). Patients who are dependent on or resistant to corticosteroids account for about 20% of severe UC patients. Tacrolimus is a calcineurin inhibitor that has recently been used in the treatment of steroid-refractory ulcerative colitis. Tacrolimus has been demonstrated to have remarkable therapeutic efficacy in UC patients, without increased risk of severe adverse effects such as induction of remission and maintenance therapy. This article reviews the mechanism of action, pharmacogenetics, efficacy, and safety of tacrolimus for patients with steroid-refractory ulcerative colitis.

scholarly journals Probiotics Can Cure Oral Aphthous-Like Ulcers in Inflammatory Bowel Disease Patients: A Review of the Literature and a Working Hypothesis

2019 ◽  
Vol 20 (20) ◽  
pp. 5026 ◽  
Author(s):  
Francesco Cappello ◽  
Francesca Rappa ◽  
Federica Canepa ◽  
Francesco Carini ◽  
Margherita Mazzola ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Inflammatory Bowel Diseases ◽  
Inflammatory Process ◽  
Primary Role ◽  
Extraintestinal Manifestations ◽  
Review Of The Literature ◽  
Chronic Inflammatory Process ◽  
Intestinal Dysbiosis ◽  
Bowel Diseases ◽  
Inflammatory Bowel

Dysbiosis has been associated with the onset of several chronic autoimmune or inflammatory pathologies (e.g., inflammatory bowel diseases—IBD), because of its primary role in the establishment of a chronic inflammatory process leading to tissue damage. Inflammatory bowel diseases can even involve areas far away from the gut, such as the extraintestinal manifestations involving the oral cavity with the onset of aphthous-like ulcers (ALU). Studies carried out on animal models have shown that intestinal dysbiosis may be related to the development of autoimmune diseases, even if the mechanisms involved are not yet well known. The aim of this paper is to verify the hypothesis that in inflammatory bowel diseases patients, aphthous-like ulcers are the result of the concomitance of intestinal dysbiosis and other events, e.g., the microtraumas, occurring in the oral mucosa, and that ex adiuvantibus therapy with probiotics can be employed to modify the natural course of the aphthous-like ulcers.

scholarly journals Minerals and Bone Mineral Density in Inflammatory Bowel Diseases

2020 ◽  
Author(s):  
Alicja Ewa Ratajczak ◽  
Anna Maria Rychter ◽  
Agnieszka Zawada ◽  
Agnieszka Dobrowolska ◽  
Iwona Krela-Kaźmierczak
Keyword(s):  
Bone Mineral Density ◽  
Ulcerative Colitis ◽  
Bone Mass ◽  
Bone Mineral ◽  
Inflammatory Bowel Diseases ◽  
Mineral Density ◽  
Low Bone Mineral Density ◽  
Increased Risk ◽  
Bowel Diseases ◽  
Inflammatory Bowel

The chronic character of inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis, results in various complications. One of them is osteoporosis, manifested by low bone mineral density, which leads to an increased risk of fractures. The aetiology of low bone mineral density is multifactorial and includes both diet and nutritional status. Calcium is the most often discussed minerals with regard to bone mineral density. Moreover, phosphorus; magnesium and sodium are also involved in the formation of bone mass. Patients suffering from inflammatory bowel diseases frequently consume inadequate amounts of the aforementioned minerals  or their absorption is disturbed, resulting innutritional deficiency and an increased risk of osteoporosis. 

scholarly journals Respiratory involvement in inflammatory bowel diseases

2010 ◽  
Vol 5 ◽  
Author(s):  
Nadia D’Andrea ◽  
Rossana Vigliarolo ◽  
Claudio M. Sanguinetti
Keyword(s):  
Ulcerative Colitis ◽  
Lung Function ◽  
Inflammatory Bowel Diseases ◽  
Inflammatory Process ◽  
Surgical Intervention ◽  
Bronchial Disease ◽  
Respiratory Involvement ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Careful Investigation

Inflammatory bowel diseases (IBD) include ulcerative colitis (UC) and Crohn’s disease (CD) and are due to a dysregulation of the antimicrobial defense normally provided by the intes- tinal mucosa. This inflammatory process may extend outside the bowel to many organs and also to the respiratory tract. The respiratory involvement in IBD may be completely asymptomatic and detected only at lung function assess- ment, or it may present as bronchial disease or lung parenchymal alterations. Corticosteroids, both systemic and aerosolized, are the mainstay of the therapeutical approach, while antibiotics must be also administered in the case of infectious and suppurative processes, whose sequels some- times require surgical intervention. The relatively high inci- dence of bronchopulmonary complications in IBD suggests the need for a careful investigation of these patients in order to detect a possible respiratory involvement, even when they are asymptomatic.

scholarly journals Ustekinumab in the Treatment of Ulcerative Colitis

2020 ◽  
Vol 16 (24) ◽  
pp. 46-53
Author(s):  
M.V. Shapina ◽  
◽  
B.A. Nanayeva
Keyword(s):  
Ulcerative Colitis ◽  
Efficacy And Safety ◽  
Phase 3 ◽  
Biological Drugs ◽  
New Methods ◽  
Good Safety Profile ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Histological Remission ◽  
Real Clinical Practice

Currently, new methods of therapy for inflammatory bowel diseases, including biological drugs, are being actively developed. Ustekinumab is an interleukin (IL) 12 and IL-23 antagonist recently approved for the treatment of ulcerative colitis (UC) and Crohn's disease. This review analyzes the efficacy and safety of this drug in patients with UC based on data from a phase 3 clinical trial and data from cohort studies of real clinical practice. In these studies, ustekinumab has shown high efficacy in both induction and maintenance therapy of UC, superior to placebo in most of the parameters assessed (such as clinical, endoscopic and histological remission). In addition, the drug has shown a good safety profile

scholarly journals Efficacy of fidaxomicin therapy, after failure of vancomycin therapy, for treating a C. difficile colitis in a patient with ulcerative colitis

2015 ◽  
Vol 9 (1S) ◽  
pp. 7-10
Author(s):  
Carlo Tascini ◽  
Federico Corti ◽  
Gualtiero Bottari ◽  
Paola Lambelet
Keyword(s):  
Ulcerative Colitis ◽  
Vancomycin Therapy ◽  
Increased Risk ◽  
Days Of Therapy ◽  
Bowel Diseases ◽  
Fluconazole Therapy ◽  
Inflammatory Bowel ◽  
Inflammatory Diarrhea ◽  
Anti Fungal

Patients with inflammatory bowel diseases (IBDs) have greater risk of developing C. difficile infection (CDI). In these patients, CDI have worse outcome, may be associated with increased risk of bacteremia and candidemia and may be misdiagnosed as relapse of IBD, also because ofthe absence of typical findings of CDI at colonoscopy.A 58-year-old man with acute ulcerative colitis treated with steroids was hospitalized for feverand recrudescence of inflammatory diarrhea. During the hospitalization, the fever was treated with broad spectrum antibiotics and systemic anti-fungal therapy. Candida mannan antigenand the molecular screening for C. difficile resulted positive. A first course of vancomycin by mouthwas unsuccessful, therefore we started a 10-day course of fidaxomicin. After five days of therapy, diarrhea disappeared. A few-week course of fluconazole therapy was performed to complete the treatment of invasive candidiasis. At six-month follow-up no relapse of CDI was documented.

Features of the complex treatment of ulcerative colitis in clinical practice

2020 ◽  
pp. 6-11
Author(s):  
Svetlana Svetlana ◽  
Mikhail Klimentov ◽  
Olga Neganova ◽  
Alina Nazmieva ◽  
Anastasiya Kochurova
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Practice ◽  
Statistical Study ◽  
Age Groups ◽  
Length Of Hospital Stay ◽  
Unknown Etiology ◽  
Number Of Patients ◽  
First Republic ◽  
Bowel Diseases ◽  
Inflammatory Bowel

Nowadays there are certain difficulties in the early diagnosis of ulcerative colitis, proceeding with minimal intestinal symptoms. The etiology of the disease remains unclear to this day; there is no exact information about the prevalence of the disease due to the large number of latent forms and the low number of patients seeking medical help. This article presents the results of a retrospective analysis of the incidence of ulcerative colitis in the coloproctology department of the First Republic Clinical Hospital of Izhevsk. The study was conducted to assess the frequency of occurrence and determine the internal picture of ulcerative colitis. To achieve this goal, we selected 34 patients with ulcerative colitis. A statistical study was conducted on the following criteria: gender composition, age groups, forms of the disease, localization, complications, and main complaints. The length of hospital stay often was not more than 20 days. The literature on this pathology was also studied and presented in the form of a theoretical basis, which consisted of the determination and etiology of inflammatory bowel diseases. Due to the unknown etiology, insufficiently studied pathogenesis, difficult differential diagnosis with other intestinal diseases and insufficiently perfect treatment methods, there are a large number of unresolved problems in the field of ulcerative colitis. That is why, in this article we tried to reveal the problem of the features of the course and complex therapy of that disease in clinical practice.

Thrombosis in IBD in the Era of JAK Inhibition

2020 ◽  
Vol 22 (1) ◽  
pp. 126-136
Author(s):  
Virginia Solitano ◽  
Gionata Fiorino ◽  
Ferdinando D’Amico ◽  
Laurent Peyrin-Biroulet ◽  
Silvio Danese
Keyword(s):  
Small Molecules ◽  
Arterial Thrombosis ◽  
Protective Role ◽  
Jak Inhibitors ◽  
Thrombotic Risk ◽  
Increased Risk ◽  
Bowel Diseases ◽  
Thrombotic Complications ◽  
Inflammatory Bowel ◽  
Inflammatory Effect

: Patients with inflammatory bowel diseases (IBD) have an increased risk of thrombosis. The interaction between inflammation and coagulation has been extensively studied. It is well-known that some drugs can influence the haemostatic system, but several concerns on the association between therapies and increased risk of thrombosis remain open. While biologics seem to have a protective role against thrombosis via their anti-inflammatory effect, some concerns about an increased risk of thrombosis with JAK inhibitors have been raised. We conducted a literature review to assess the association between biologics/small molecules and venous/arterial thrombotic complications. An increased risk of venous and arterial thrombosis was found in patients treated with corticosteroids, whereas anti-TNF were considered protective agents. No thromboembolic adverse event was reported with vedolizumab and ustekinumab. In addition, thromboembolic events rarely occurred in patients with ulcerative colitis (UC) after therapy with tofacitinib. The overall risk of both venous and arterial thrombosis was not increased based on the available evidence. Finally, in the era of JAK inhibitors, treatment should be individualized by evaluating the pre-existing potential thrombotic risk balanced with the intrinsic risk of the medication used.

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