The Efficacy of Probiotics, Prebiotic Inulin-Type Fructans, and Synbiotics in Human Ulcerative Colitis: A Systematic Review and Meta-Analysis

Studies of probiotics, fructan-type prebiotics, and synbiotics in patients with ulcerative colitis (UC) show significant heterogeneity in methodology and results. Here, we study the efficacy of such interventions and the reasons for the heterogeneity of their results. Eligible random controlled trials were collected from the PUBMED and SCOPUS databases. A total of 18 placebo-controlled and active treatment-controlled (i.e., mesalazine) studies were selected with a Jadad score ≥ 3, including 1491 patients with UC. Data for prebiotics and synbiotics were sparse and consequently these studies were excluded from the meta-analysis. The UC remission efficacy of probiotics was measured in terms of relative risk (RR) and odds ratio (OR). Significant effects were observed in patients with active UC whenever probiotics containing bifidobacteria were used, or when adopting the US Food and Drug Administration (FDA)-recommended scales (UC Disease Activity Index and Disease Activity Index). By the FDA recommended scales, the RR was 1.55 (CI95%: 1.13–2.15, p-value = 0.007, I2 = 29%); for bifidobacteria-containing probiotics, the RR was 1.73 (CI95%: 1.23–2.43, p-value = 0.002, I2 = 35%). No significant effects were observed on the maintenance of remission for placebo-controlled or mesalazine-controlled studies. We conclude that a validated scale is necessary to determine the state of patients with UC. However, probiotics containing bifidobacteria are promising for the treatment of active UC.

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5-Aminosalicylic Acid Enemas in the Maintenance of Remission in Distal Ulcerative Colitis and Proctitis

Canadian Journal of Gastroenterology ◽

10.1155/1987/846392 ◽

1987 ◽

Vol 1 (1) ◽

pp. 3-6 ◽

Cited By ~ 24

Author(s):

Lloyd R Sutherland ◽

Francois Martin

Keyword(s):

Ulcerative Colitis ◽

Disease Activity ◽

Repeated Measures ◽

Activity Index ◽

Disease Activity Index ◽

Distal Colon ◽

Aminosalicylic Acid ◽

Distal Ulcerative Colitis ◽

Patient Groups ◽

Maintenance Of Remission

A randomized clinical trial of the efficacy and safety of two different dosages of 5-aminosalicylic acid (5-ASA) enemas was carried out in 29 patients who had documented ulcerative colitis involving up to 50cm of distal colon. All patients were in remission or had minimal disease activity (Disease Activity Index [DAI] less than 4) at the time of study entry. The two patient groups were similar in terms of age, sex ratio and disease activity. Further significant reduction in DAI occurred during the first three months of the study. Five patients (two in the 2 g group and three in the 4g group) relapsed over the next six months. There were no significant differences in DAI of the two groups over the six month study period (ANOVA for repeated measures). Six patients dropped out of the study all of whom were in remission when last seen (mean follow-up 3. 3 months). In this preliminary study, 2 g enemas were shown to be as effective as 4 g enemas in maintaining remission in patients with ulcerative colitis confined to the distal colon.

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The Efficacy and Safety of Mesalamine and Probiotics in Mild-to-Moderate Ulcerative Colitis: A Systematic Review and Meta-Analysis

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2020/6923609 ◽

2020 ◽

Vol 2020 ◽

pp. 1-12

Author(s):

Chunying Tian ◽

Yang Huang ◽

Xiaoxia Wu ◽

Chuhan Xu ◽

Huaien Bu ◽

...

Keyword(s):

Ulcerative Colitis ◽

Adverse Events ◽

Disease Activity ◽

Activity Index ◽

Meta Analysis ◽

Disease Activity Index ◽

Efficacy And Safety ◽

Significant Difference ◽

Symptom Scores ◽

Endoscopic Score

Objective. To evaluate the efficacy and safety of mesalamine in conjunction with probiotics for ulcerative colitis. Methods. Random controlled trials (RCTs) were searched in PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, Wanfang, and VIP (VIP Database for Chinese Technical Periodicals) from inception to October 2019. Methodological quality was assessed by the Cochrane Collaboration tool. The quality of evidence was rated by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Data analysis was carried out in Review Manager 5.3. Results. A total of fifteen studies met the criteria for inclusion. Thirteen studies reported the clinical efficacy, three studies provided data on the clinical symptom scores, two trials reported disease activity index, four studies evaluated endoscopic score, and twelve studies reported adverse events. For ulcerative colitis (UC), mesalamine and probiotics had better clinical efficacy than mesalamine alone (≤8 weeks: RR = 1.12, 95% CI: 1.07–1.18, P<0.0001; >8 weeks: RR = 1.25, 95% CI: 1.11–1.41, P=0.0003). On the clinical symptom scores, disease activity index, and endoscopic score, UC patients receiving mesalamine and probiotics had significant difference than patients receiving mesalazine alone (MD = −2.02, 95% CI: −3.28 to −0.76, P=0.002; MD = −1.20, 95% CI: −1.76 to −0.65, P<0.001; and MD = −0.42, 95% CI: −0.61 to −0.23, P<0.0001, respectively). There was no statistically significant difference in adverse events between the two groups (RR = 0.88, 95% CI: 0.54 to 1.43, P=0.60). Conclusion. Our meta-analysis results supported that mesalamine and probiotics were effective and safe in treating ulcerative colitis.

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Efficacy of 5-Aminosalicylic Acid Enemas in the Treatment of Distal Ulcerative Colitis

Canadian Journal of Gastroenterology ◽

10.1155/1990/314931 ◽

1990 ◽

Vol 4 (7) ◽

pp. 468-471 ◽

Cited By ~ 3

Author(s):

MG Robinson ◽

DL Decktor

Keyword(s):

Ulcerative Colitis ◽

Disease Activity ◽

Activity Index ◽

Disease Activity Index ◽

First Episode ◽

High Dose ◽

Aminosalicylic Acid ◽

Open Label ◽

Distal Ulcerative Colitis ◽

The Mean

The efficacy of 4 g 5-aminosalicylic acid (5-ASA, mesalamine) enemas was assessed in 666 patients with distal ulcerative colitis. Patients were enrolled in an open-label compassionate use program. One 4 g 5-ASA enema was administered each night for a period of four weeks and the disease activity index was assessed at baseline and on days 14 and 28. On days 14 and 28, 78.0% and 88.1% of patients, respectively, demonstrated an improvement in disease activity index. The mean decline in disease activity index on day 14 was 40.7% (P=0.0001) and on day 28 it was 55.4% (P=0.0001). Efficacy was similar whether the disease was confined to or extended beyond 30 cm from the anus. There was no difference in efficacy in patients suffering their first episode of disease compared to patients suffering subsequent attacks. In conclusion, high dose 5-ASA enemas are a highly effective treatment for distal ulcerative colitis.

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Su1797 - Ultrasound for Assessing Disease Activity in Ulcerative Colitis Patients: Development of a Novel Ultrasonographic Disease Activity Index

Gastroenterology ◽

10.1016/s0016-5085(18)32143-7 ◽

2018 ◽

Vol 154 (6) ◽

pp. S-587-S-588

Author(s):

Steven Bots ◽

Kim Nylund ◽

Mark Löwenberg ◽

Krisztina Gecse ◽

Odd Helge Gilja ◽

...

Keyword(s):

Ulcerative Colitis ◽

Disease Activity ◽

Activity Index ◽

Disease Activity Index

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Validation of the “German Inflammatory Bowel Disease Activity Index (GIBDI)”: An Instrument for Patient-Based Disease Activity Assessment in Crohn’s Disease and Ulcerative Colitis

Zeitschrift für Gastroenterologie ◽

10.1055/a-0605-4080 ◽

2018 ◽

Vol 56 (10) ◽

pp. 1267-1275 ◽

Cited By ~ 1

Author(s):

Angelika Hüppe ◽

Jana Langbrandtner ◽

Winfried Häuser ◽

Heiner Raspe ◽

Bernd Bokemeyer

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Activity ◽

Bowel Disease ◽

Activity Index ◽

Disease Activity Index ◽

Inflammatory Bowel ◽

Activity Indices

Abstract Introduction Assessment of disease activity in Crohn’s disease (CD) and ulcerative colitis (UC) is usually based on the physician’s evaluation of clinical symptoms, endoscopic findings, and biomarker analysis. The German Inflammatory Bowel Disease Activity Index for CD (GIBDICD) and UC (GIBDIUC) uses data from patient-reported questionnaires. It is unclear to what extent the GIBDI agrees with the physicians’ documented activity indices. Methods Data from 2 studies were reanalyzed. In both, gastroenterologists had documented disease activity in UC with the partial Mayo Score (pMS) and in CD with the Harvey Bradshaw Index (HBI). Patient-completed GIBDI questionnaires had also been assessed. The analysis sample consisted of 151 UC and 150 CD patients. Kappa coefficients were determined as agreement measurements. Results Rank correlations were 0.56 (pMS, GIBDIUC) and 0.57 (HBI, GIBDICD), with p < 0.001. The absolute agreement for 2 categories of disease activity (remission yes/no) was 74.2 % (UC) and 76.6 % (CD), and for 4 categories (none/mild/moderate/severe) 60.3 % (UC) and 61.9 % (CD). The kappa values ranged between 0.47 for UC (2 categories) and 0.58 for CD (4 categories). Discussion There is satisfactory agreement of GIBDI with the physician-documented disease activity indices. GIBDI can be used in health care research without access to assessments of medical practitioners. In clinical practice, the index offers a supplementary source of information.

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POSITIVE CORRELATION BETWEEN DISEASE ACTIVITY INDEX AND MATRIX METALLOPROTEINASES ACTIVITY IN A RAT MODEL OF COLITIS

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032014000200007 ◽

2014 ◽

Vol 51 (2) ◽

pp. 107-112 ◽

Cited By ~ 8

Author(s):

Luiz Gustavo de OLIVEIRA ◽

André Luiz da CUNHA ◽

Amaury Caiafa DUARTE ◽

Maria Christina Marques Nogueira CASTAÑON ◽

Júlio Maria Fonseca CHEBLI ◽

...

Keyword(s):

Ulcerative Colitis ◽

Disease Activity ◽

Dextran Sulfate ◽

Tissue Injury ◽

Activity Index ◽

Disease Activity Index ◽

Blue Staining ◽

Control Group ◽

Alcian Blue Staining ◽

Increased Activity

ContextInflammatory bowel disease, including ulcerative colitis and Crohn’s disease, comprising a broad spectrum of diseases those have in common chronic inflammation of the gastrointestinal tract, histological alterations and an increased activity levels of certain enzymes, such as, metalloproteinases.ObjectivesEvaluate a possible correlation of disease activity index with the severity of colonic mucosal damage and increased activity of metalloproteinases in a model of ulcerative colitis induced by dextran sulfate sodium.MethodsColitis was induced by oral administration of 5% dextran sulfate sodium for seven days in this group (n=10), whereas control group (n=16) received water. Effects were analyzed daily by disease activity index. In the seventh day, animals were euthanized and hematological measurements, histological changes (hematoxylin and eosin and Alcian Blue staining), myeloperoxidase and metalloproteinase activities (MMP-2 and MMP-9) were determined.ResultsDextran sulfate sodium group showed elevated disease activity index and reduced hematological parameters. Induction of colitis caused tissue injury with loss of mucin and increased myeloperoxidase (P<0.001) and MMP-9 activities (45 fold) compared to the control group.ConclusionsIn this study, we observed a disease activity index correlation with the degree of histopathological changes after induction of colitis, and this result may be related mainly to the increased activity of MMP-9 and mieloperoxidase.

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Expression of guanylate cyclase-C, guanylin and uroguanylin is downregulated proportionally to the ulcerative colitis disease activity index

Scientific Reports ◽

10.1038/srep25034 ◽

2016 ◽

Vol 6 (1) ◽

Cited By ~ 14

Author(s):

Danfeng Lan ◽

Junkun Niu ◽

Jiarong Miao ◽

Xiangqian Dong ◽

Hong Wang ◽

...

Keyword(s):

Ulcerative Colitis ◽

Disease Activity ◽

Guanylate Cyclase ◽

Activity Index ◽

Disease Activity Index ◽

Guanylate Cyclase C

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Vitamin A supplementation decreases disease activity index in patients with ulcerative colitis: A randomized controlled clinical trial

Complementary Therapies in Medicine ◽

10.1016/j.ctim.2018.09.026 ◽

2018 ◽

Vol 41 ◽

pp. 215-219 ◽

Cited By ~ 7

Author(s):

Kourosh Masnadi Shirazi ◽

Zeinab Nikniaz ◽

Arman Masnadi Shirazi ◽

Mohammadreza Rohani

Keyword(s):

Ulcerative Colitis ◽

Clinical Trial ◽

Vitamin A ◽

Disease Activity ◽

Activity Index ◽

Disease Activity Index ◽

Controlled Clinical Trial ◽

Randomized Controlled Clinical Trial ◽

Vitamin A Supplementation ◽

Randomized Controlled

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Remission and low disease activity in psoriatic arthritis publications: a systematic literature review with meta-analysis

Rheumatology ◽

10.1093/rheumatology/keaa030 ◽

2020 ◽

Vol 59 (8) ◽

pp. 1818-1825 ◽

Cited By ~ 1

Author(s):

Benjamin Hagège ◽

Elina Tan ◽

Martine Gayraud ◽

Bruno Fautrel ◽

Laure Gossec ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Literature Review ◽

Disease Activity ◽

Systematic Literature Review ◽

Activity Index ◽

Meta Analysis ◽

Random Effect ◽

Disease Activity Index ◽

Low Disease Activity ◽

Pooled Prevalence

Abstract Objectives Remission (REM) or low disease activity (LDA) is the treatment target in psoriatic arthritis (PsA). The objective of this study was to assess the reporting and prevalence of REM/LDA in published studies of PsA. Methods This was a systematic literature review of all clinical papers published in PubMed, EMBASE or Cochrane database in English between 2012 and 2019 in the field of PsA. Data were collected regarding reporting of REM/LDA by very low disease activity/minimal disease activity (VLDA/MDA), Disease Activity index for Psoriatic Arthritis (DAPSA), or Disease Activity Score 28 joints (DAS28). The pooled rates of REM and LDA by each definition were calculated by random effect meta-analysis. Results In all, 258 publications (corresponding to 114 651 patients), of which 81 (31%) were randomized controlled trials, were analysed: patients’ mean age was 49.4 ( 4.4) years; with a mean disease duration of 8.5 ( 3.8) years. REM/LDA was reported in 91/258 (35.3%) publications. VLDA/MDA was used in 61/91 (67.0%) studies, DAPSA in 27/91 (29.6%) and DAS28 in 28/91 (30.7%), with 40/91 (43.9%) papers reporting several of these definitions. The pooled prevalence (lower–upper limits) of REM was 13.1% (10.9–15.4), 23.1% (16.8–30.1) and 42.1% (33.9–50.4) using VLDA, DAPSA-REM and DAS28, respectively. For LDA the pooled prevalence was 36.3% (32.3–40.5), 52.8% (41.8–63.6) and 60.4% (52.5–68.0) using MDA, DAPSA-LDA and DAS28, respectively. Conclusion REM/LDA status was reported in only1/3 of recent studies on PsA, with important variations in the frequency of these outcomes according to the definition used: 13.1–42.1% for REM, and 36.3–60.4% for LDA. This highlights the need for consensus.

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