Ulcerative colitis

2020 ◽  
pp. 2937-2950
Author(s):  
Jeremy Sanderson ◽  
Peter Irving
Keyword(s):  
Ulcerative Colitis ◽  
Severe Disease ◽  
Stool Culture ◽  
Volume Depletion ◽  
Mild Disease ◽  
Gradual Onset ◽  
Moderate Disease ◽  
Variable Extent ◽  
Maintenance Of Remission ◽  
Intravenous Steroids

Ulcerative colitis is a chronic relapsing and remitting disease in which chronic inflammation affects the rectum and extends proximally to a variable extent. The precise aetiology remains unknown but involves an interplay between reduced diversity in the gut microbiota and a genetically dysregulated gut immune system and epithelial barrier. Typical presentation of mild or moderate disease is with a gradual onset of symptoms including diarrhoea, rectal bleeding, and the passage of mucus. Severe disease is characterized by anorexia, nausea, weight loss, and severe diarrhoea, with the patient likely to look unwell with fever, tachycardia, and other signs of volume depletion, and the abdomen may be distended and tympanitic, with reduced bowel sounds and marked colonic tenderness. Diagnosis is usually made on the basis of exclusion of infective colitis by stool culture and the finding of typical diffuse inflammation in the rectum and above at sigmoidoscopy. Management requires rapid control of symptoms with induction therapy followed by maintenance of remission. Mild disease is typically treated with 5-aminosalicyclic acid delivered both orally and by enema, and moderate disease by 5-aminosalicyclic acid and steroids. Patients with severe disease require hospital admission, intravenous steroids, and daily review by both a physician and a surgeon experienced in the management of ulcerative colitis. Ciclosporin or infliximab are used as rescue therapies for steroid-resistant acute severe ulcerative colitis, but colectomy should not be delayed when this is required. Maintenance therapy with immunomodulators and biological therapies are both effective at maintaining remission, and several new biologicals are in clinical trials.

Medical Therapy of Ulcerative Colitis

2015 ◽  
Author(s):  
Kristin E. Burke ◽  
Joseph D. Feuerstein ◽  
Adam S. Cheifetz
Keyword(s):  
Ulcerative Colitis ◽  
Severe Disease ◽  
Mucosal Healing ◽  
Mucosal Inflammation ◽  
Total Proctocolectomy ◽  
Moderate Disease ◽  
Inpatient Management ◽  
Inflammatory Bowel ◽  
Maintenance Of Remission ◽  
Severity Of The Disease

Ulcerative colitis (UC) is a chronic idiopathic inflammatory bowel disease (IBD) characterized by continuous colonic mucosal inflammation that extends proximally from the rectum. Most patients present with bloody diarrhea, abdominal pain, tenesmus, and urgency. The course of UC is characterized by periods of flares and remission, and can significantly impact quality of life. Most patients are successfully treated medically, though 15 to 25% of patients require total proctocolectomy. Treatment of UC depends on the extent and severity of the disease, and response to prior therapies. This review outlines the medical treatment of UC and the therapies available for the induction and maintenance of remission. Figures include endoscopic and histologic images of UC, and algorithms cover outpatient inductions for mild-to-moderate disease and moderate-to-severe-disease, outpatient management of known steroid-refractory/steroid-intolerant patient, and approach to inpatient management of acute severe UC. Tables list disease severity by Truelove and Witts criteria, IBD medication adverse effects and monitoring parameters, induction dosing of 5-aminosalicylates, and rates of clinical response, remission, and mucosal healing in patients receiving anti-tumor necrosis factor (TNF) agents versus placebo by trial. This review contains 5 highly rendered figures, 4 tables, and 118 references. 

1329 Can One Size Fit All: Is Laparoscopic Roux-En-Y Gastric Bypass the Best Bariatric Procedure for Treating Type 2 Diabetes Mellitus (T2DM)?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
V Mahendran ◽  
P Ricart ◽  
S Robinson ◽  
A Perry ◽  
M Wadley
Keyword(s):  
Bariatric Surgery ◽  
Gastric Bypass ◽  
Retrospective Cohort ◽  
Severe Disease ◽  
Morbidly Obese ◽  
Disease Remission ◽  
Mild Disease ◽  
Moderate Disease ◽  
Remission Rates

Abstract Introduction Bariatric surgery produces superior weight loss and reversal of comorbidities in morbidly obese individuals compared to medical therapy alone. Laparoscopic Roux-en-Y gastric bypass (LRYGB) was traditionally considered to prolonged remission of T2DM compared to other procedures such as Laparoscopic Sleeve-Gastrectomy (LSG). But recently published studies seek to disprove this by emphasising on duration and severity of T2DM before surgery rather than the type of procedure. We aim to verify if the severity of T2DM and type of operation (LRYGB Vs LSG) influence remission rates. Method In this retrospective cohort study, 204 patients were diagnosed with T2DM pre-operatively and had undergone either LRYGB or LSG. We used the Individualised Metabolic Surgery Score (IMSS) tool to divide patients into mild, moderate, and severe categories. Results Results showed that of the 204 patients 15% (n = 31) had mild disease, 62%( n = 127) had moderate disease and 23% (n = 46) had severe disease. Remission rates in each category were as follows: Conclusions We agree that patients with longstanding and severe T2DM have low remission rates after bariatric surgery, probably due to diminished beta-cell reserve. It is in contrary to recent publications which recommend LSG over LRYGB in patients with severe disease. This evidence necessitates further prospective studies before deciding which is the best procedure for patients with severe and longstanding T2DM.

scholarly journals Some Clinical and Immunological Features of Imported COVID-19 Cases in Mongolia

2021 ◽  
Author(s):  
Tsogtsaikhan Sandag ◽  
Enkhsaikhan Lkhagvasuren ◽  
Munkhundrakh Batmunkh ◽  
Oyungerel Ravjir
Keyword(s):  
Immune Response ◽  
Severe Disease ◽  
Lower Percentage ◽  
Enzyme Linked Immunosorbent Assay ◽  
P Value ◽  
Mild Disease ◽  
Pulmonary Infiltrates ◽  
Cytokines And Chemokines ◽  
Moderate Disease ◽  
Serum Crp

SARS-CoV-2 disturbs the normal immune responses causing an uncontrolled inflammatory response in patients with severe COVID-19. The pattern of the immune response to the SARS-CoV-2 in individuals may fluctuate. Some have a virus-dependent protective immune response resulting in asymptomatic or mild disease with elimination of the virus within 7-10 days after onset of infection. Others develop virus non-dependent uncontrolled hyper-inflammation in the later period, leading to severe disease with cytokine storm, acute respiratory distress syndrome, disseminated intravascular coagulation and multi-organ failure. Methods: The serum of 72 patients was investigated for titers of 15 cytokines and chemokines using Enzyme-linked immunosorbent assay (ELISA) kits in the serum of peripheral blood samples. The means of groups were compared using ANOVA followed by Tukey multiple post hoc comparisons if the ANOVA p-value was <0.05. Results: Patients with pulmonary infiltrates on CT demonstrated a lower percentage of eosinophils (1.38±1.46%) and elevated level of serum CRP (8.57±19.10 mg/dL) compared to patients without pulmonary infiltrates (2.52±1.47% and 1.96±3.02 mg/dL respectively; p<0.05). ROC analysis for patients aged ≥35 years showed patients with mild disease (n=3) had a significantly higher titer of IL-1α and MCP-1 (AUC, 0.958 and 0.917 respectively, p<0.05) compared to patients with moderate disease (n=7).

Epidemic process of COVID-19 in the Russian Federation: interim results. 2nd report

2021 ◽  
pp. 10-15
Author(s):  
N.Yu. Pshenichnaya ◽  
◽  
I.A. Lizinfeld ◽  
G.Yu. Zhuravlev ◽  
A.A. Ploskireva ◽  
...  
Keyword(s):  
Russian Federation ◽  
Severe Disease ◽  
Age Groups ◽  
Social Institutions ◽  
Age Group ◽  
Epidemic Process ◽  
Mild Disease ◽  
Household Contacts ◽  
Moderate Disease ◽  
The Russian Federation

Objective. To perform an interim analysis of epidemiological parameters of COVID-19 related to contacts and secondary cases of infection in the Russian Federation. Materials and methods. We analyzed 190,856 primary COVID-19 cases and 146,996 people who had been in contact with them. We used some data of monitoring performed by the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing in January–June 2020. We characterized the foci of infection and people who had contacts with primary COVID-19 cases and secondary cases of infection. Results. Just over half (50.02%) of study participants who had contacts with COVID-19 contacted with primary patients with mild disease, whereas 45.40% of individuals contacted with patients with moderate disease and 4.58% of individuals had contacts with patients with severe disease. Patients with mild COVID-19 interacted with more people, which resulted in a greater number of secondary cases of infection. The highest proportion of both primary COVID-19 patients and people who had contact with COVID-19 was observed in the age group of 41–64 years (44.42% and 44.51%, respectively). Approximately one third of COVID-19 patients and people who had contact with COVID-19 were 18 to 40 years old (30.20% and 34.21% respectively). The proportions of children aged 0–6 years and 7–17 years among COVID-19 patients were 2.70% and 4.02%, respectively; the same proportions among those who had contact with COVID-19 cases were 1.94 and 3.13%, respectively. Household contacts were the most common ways of COVID-19 transmission in all age groups. Patients aged between 40 and 64 years played the most significant role in the transmission of this infection in different foci. Individuals from this age group comprised 42.02% of patients infected in social institutions, 43.40% of those who had household contacts, and 47.70% of those infected at work. Conclusion. Patients with mild and moderate disease aged 18 to 64 years had the highest number of contacts and, therefore, caused the highest number of secondary cases of infection. Household contacts played the most important role in COVID-19 transmission in all age groups. Among people aged 18 to 64 years, COVID-19 transmission at work was also important. In all foci of infection, the majority of patients were in the age group of 40–64 years. Our findings can be used to optimize the preventive measures for COVID-19. Key words: epidemic process, age groups, severity, contacts, COVID-19, Russia, household contacts

scholarly journals A Review of Delayed-Release MMX Mesalamine: It's Use in the Treatment of Ulcerative Colitis

2009 ◽  
Vol 1 ◽  
pp. CMT.S2293
Author(s):  
Reem Sharaiha ◽  
Arun Swaminath
Keyword(s):  
Ulcerative Colitis ◽  
Drug Delivery ◽  
Side Effects ◽  
Treatment Algorithm ◽  
First Line ◽  
Delayed Release ◽  
Moderate Disease ◽  
Maintenance Of Remission ◽  
Over 40 Years ◽  
The U.S

Ulcerative colitis affects approximately 500,000 people within the U.S. For mild to moderate disease, 5-ASA is considered the first line medication to achieve both induction of remission and maintenance of remission. Since the use of sulfasalazine over 40 years ago, numerous new formulations have been created to minimize side effects and maximize drug delivery to the affected colon. Here, we have detailed the currently available 5-ASA formulations and explain why there is room for new and improved 5-ASA formulations. In addition, we will summarize the latest trials detailing the use of MMX mesalamine and where it may fit into the treatment algorithm for our patients with mild to moderate ulcerative colitis.

scholarly journals Immune Profile and Clinical Outcome of Breakthrough Cases After Vaccination With an Inactivated SARS-CoV-2 Vaccine

2021 ◽  
Vol 12 ◽  
Author(s):  
Luisa F. Duarte ◽  
Nicolás M. S. Gálvez ◽  
Carolina Iturriaga ◽  
Felipe Melo-González ◽  
Jorge A. Soto ◽  
...  
Keyword(s):  
Phase 1 ◽  
Severe Disease ◽  
Interferon Γ ◽  
Vaccination Schedule ◽  
Symptomatic Infection ◽  
Mild Disease ◽  
Moderate Disease ◽  
Neutralizing Capacity ◽  
The World ◽  
Before And After

Constant efforts to prevent infections by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are actively carried out around the world. Several vaccines are currently approved for emergency use in the population, while ongoing studies continue to provide information on their safety and effectiveness. CoronaVac is an inactivated SARS-CoV-2 vaccine with a good safety and immunogenicity profile as seen in phase 1, 2, and 3 clinical trials around the world, with an effectiveness of 65.9% for symptomatic cases. Although vaccination reduces the risk of disease, infections can still occur during or after completion of the vaccination schedule (breakthrough cases). This report describes the clinical and immunological profile of vaccine breakthrough cases reported in a clinical trial in progress in Chile that is evaluating the safety, immunogenicity, and efficacy of two vaccination schedules of CoronaVac (clinicaltrials.gov NCT04651790). Out of the 2,263 fully vaccinated subjects, at end of June 2021, 45 have reported symptomatic SARS-CoV-2 infection 14 or more days after the second dose (1.99% of fully vaccinated subjects). Of the 45 breakthrough cases, 96% developed mild disease; one case developed a moderate disease; and one developed a severe disease and required mechanical ventilation. Both cases that developed moderate and severe disease were adults over 60 years old and presented comorbidities. The immune response before and after SARS-CoV-2 infection was analyzed in nine vaccine breakthrough cases, revealing that six of them exhibited circulating anti-S1-RBD IgG antibodies with neutralizing capacities after immunization, which showed a significant increase 2 and 4 weeks after symptoms onset. Two cases exhibited low circulating anti-S1-RBD IgG and almost non-existing neutralizing capacity after either vaccination or infection, although they developed a mild disease. An increase in the number of interferon-γ-secreting T cells specific for SARS-CoV-2 was detected 2 weeks after the second dose in seven cases and after symptoms onset. In conclusion, breakthrough cases were mostly mild and did not necessarily correlate with a lack of vaccine-induced immunity, suggesting that other factors, to be defined in future studies, could lead to symptomatic infection after vaccination with CoronaVac.

scholarly journals Case Report on Ulcerative Colitis in 16 year girl

2020 ◽  
pp. 287-290
Author(s):  
MD.Salma MD.Salma ◽  
Y.Siva Y.Siva ◽  
, J.Bhargava Narendra , J.Bhargava Narendra
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Presentation ◽  
Severe Disease ◽  
Topical Therapy ◽  
Calcineurin Inhibitors ◽  
Pharmacologic Therapy ◽  
Inflammatory Disorder ◽  
Aminosalicylic Acid ◽  
Intravenous Steroids ◽  
Factor Α

Ulcerative colitis (UC) is a chronic idiopathic inflammatory disorder that involves any part of the colon starting in the rectum in a continuous fashion presenting typically with symptoms such as bloody diarrhea, abdominal pain, and rectal urgency.The clinical presentation of the disease usually dictates the choice of pharmacologic therapy, where the goal is to first induce remission and then maintain a corticosteroid-free remission. UC is diagnosed based on clinical presentation and endoscopic evidence of inflammation in the colon starting in the rectum and extending proximally in the colon. The choice of treatment depends on severity, localization and the course of the disease. For proctitis, topical therapy with 5-aminosalicylic acid (5-ASA) compounds is used. More extensive or severe disease should be treated with oral and local 5-ASA compounds and corticosteroids to induce remission. Patients who do not respond to this treatment require hospitalization. Intravenous steroids or, when refractory, calcineurin inhibitors (cyclosporine, tacrolimus), tumor necrosis factor-α antibodies (infliximab) or immunomodulators (azathioprine, 6-mercaptopurine) are then called for. Indications for emergency surgery include refractory toxic megacolon, perforation, and continuous severe colorectal bleeding.

scholarly journals COVID-19 Severity and Neonatal BCG Vaccination among Young Population in Taiwan

2021 ◽  
Vol 18 (8) ◽  
pp. 4303
Author(s):  
Wei-Ju Su ◽  
Chia-Hsuin Chang ◽  
Jiun-Ling Wang ◽  
Shu-Fong Chen ◽  
Chin-Hui Yang
Keyword(s):  
Severe Disease ◽  
Clinical Syndrome ◽  
Vaccination Status ◽  
World Health ◽  
Age Group ◽  
Young Population ◽  
Individual Patient Level ◽  
Bcg Vaccination ◽  
Mild Disease ◽  
Moderate Disease

Background: Data have not been reported to explore the relation between COVID-19 severity and BCG vaccination status at the individual patient level. Methods: Taiwan has a nationwide neonatal BCG vaccination program that was launched in 1965. The Taiwan Centers for Disease Control established a web-based National Immunization Information System (NISS) in 2003 and included all citizens’ BCG vaccination records in NISS for those born after 1985. We identified COVID-19 Taiwanese patients born after 1985 between 21 January and 19 March 2021. Study participants were further classified into ages 4–24 years (birth year 1996–2016) and 25–33 years (birth year 1986–1995). We described their clinical syndrome defined by the World Health Organization and examined the relation between the COVID-19 severity and BCG vaccination status. Results: In the 4–24 age group, among 138 BCG vaccinated individuals, 80.4% were asymptomatic or had mild disease, while 17.4% had moderate disease, 1.5% had severe disease, and 0.7% had acute respiratory distress syndrome but none of them died. In contrast, all 6 BCG unvaccinated individuals in this age group experienced mild illness. In the 25–33 age group, moderate disease occurred in 14.2% and severe disease occurred in 0.9% of the 106 patients without neonatal BCG vaccination records, as compared to 19.2% had moderate disease and none had severe or critical disease of the 78 patients with neonatal BCG vaccination records. Conclusions: Our finding indicated that BCG immunization might not relate to COVID-19 severity in the young population.

scholarly journals Serum β2-microglobulin levels in Coronavirus disease 2019 (Covid-19): Another prognosticator of disease severity?

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247758
Author(s):  
Walter Conca ◽  
Mayyadah Alabdely ◽  
Faisal Albaiz ◽  
Michael Warren Foster ◽  
Maha Alamri ◽  
...  
Keyword(s):  
Disease Severity ◽  
Viral Infections ◽  
Linear Trend ◽  
Severe Disease ◽  
Tertiary Care ◽  
Care Hospital ◽  
Mhc I ◽  
Mild Disease ◽  
Moderate Disease ◽  
Single Center Study

β2-microglobulin (β2-m), a 11.8 kDa protein, pairs non-covalently with the α3 domain of the major histocompatibility class (MHC) I α-chain and is essential for the conformation of the MHC class I protein complex. Shed β2-m is measurable in circulation, and various disorders are accompanied by increases in β2-m levels, including several viral infections. Therefore, we explored whether β2-m levels could also be elevated in Coronavirus disease 2019 (Covid-19) and whether they predict disease severity. Serum β2-m levels were measured in a cohort of 34 patients infected with SARS-CoV-2 on admission to a tertiary care hospital in Riyadh, Saudi Arabia, as well as in an approximately age-sex matched group of 34 uninfected controls. Mean β2-m level was 3.25±1.68 mg/l (reference range 0.8–2.2 mg/l) in patients (mean age 48.2±21.6) and 1.98±0.61 mg/l in controls (mean age 48.2±21.6). 17 patients (mean age 36.9± 18.0) with mean β2-m levels of 2.27±0.64 mg/l had mild disease by WHO severity categorization, 12 patients (mean age 53.3±18.1) with mean β2-m levels of 3.57±1.39 mg/l had moderate disease, and five patients (of whom 2 died; mean age 74.4±13.8) with mean β2-m levels of 5.85±1.85 mg/l had severe disease (P < = 0.001, by ANOVA test for linear trend). In multivariate ordinal regression β2-m levels were the only significant predictor of disease severity. Our findings suggest that higher β2-m levels could be an early indicator of severity of disease and predict outcome of Covid-19. As the main limitations of the study are a single-center study, sample size and ethnicity, these results need confirmation in larger cohorts outside the Arabian Peninsula in order to delineate the value of β2-m measurements. The role of β2-m in the etiology and pathogenesis of severe Covid-19 remains to be elucidated.

scholarly journals Correlation between Histological Activity and Endoscopic, Clinical, and Serologic Activities in Patients with Ulcerative Colitis

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Dae Bum Kim ◽  
Kang-Moon Lee ◽  
Ji Min Lee ◽  
Yoon Yung Chung ◽  
Hea Jung Sung ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Severe Disease ◽  
Rank Correlation ◽  
Normal Mucosa ◽  
Mild Disease ◽  
Protein Levels ◽  
Spearman’S Rank Correlation ◽  
Biopsy Specimens ◽  
Spearman’S Rank Correlation Coefficient ◽  
Histological Activity

Objectives. Recent studies suggest that histological healing is a treatment goal in ulcerative colitis (UC). We aimed to evaluate the correlation between histological activity and clinical, endoscopic, and serologic activities in patients with UC.Methods. We retrospectively reviewed medical records from patients with UC who underwent colonoscopy or sigmoidoscopy with biopsies. The Mayo endoscopic subscore was used to assess endoscopic activity. Biopsy specimens were reviewed by two blinded pathologists and scored using the Geboes scoring system.Results. We analyzed 154 biopsy specimens from 82 patients with UC. Histological scores exhibited strong correlation with endoscopic subscores (Spearman’s rank correlation coefficientr=0.774,p<0.001) and moderate correlation with C-reactive protein levels (r=0.422,p<0.001) and partial Mayo scores (r=0.403,p<0.001). Active histological inflammation (Geboes score ≥ 3.1) was observed in 6% (2 of 33) of the endoscopically normal mucosa samples, 66% (19 of 29) of mild disease samples, and 98% (90 of 92) of moderate-to-severe disease samples.Conclusions. Histological activity was closely correlated with the endoscopic, clinical, and serologic UC activities. However, several patients with mild or normal endoscopic findings exhibited histological evidence of inflammation. Therefore, histological assessment may be helpful in evaluating treatment outcomes and determining follow-up strategies.

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