Many data coming from animal models and clinical observations support an involvement of intestinal microbiota in the pathogenesis of Crohn's disease(CD). It is hypothesized in fact,that the development of chronic ...Many data coming from animal models and clinical observations support an involvement of intestinal microbiota in the pathogenesis of Crohn's disease(CD). It is hypothesized in fact,that the development of chronic intestinal inflammation is caused by an abnormal immune response to normal flora in genetically susceptible hosts.The involvement of bacteria in CD inflammation has provided the rationale for including antibiotics in the therapeutic armamentarium.However, randomized controlled trials have failed to demonstrate an efficacy of these drugs in patients with active uncomplicated CD,even if a subgroup of patients with colonic location seems to get benefit from antibiotics. Nitroimidazole compounds have been shown to be efficacious in decreasing CD recurrence rates in operated patients,and the use of metronidazole and ciprofloxacin is recommended in perianal disease.However,the appearance of systemic side effects limits antibiotic long-term employment necessary for treating a chronic relapsing disease.Rifaximin,characterized by an excellent safety profile,has provided promising results in inducing remission of CD.展开更多
5-aminosalicylic acid(5-ASA)compounds are a highly effective treatment for ulcerative colitis(UC).While UC patient compliance in clinical studies is over 90%, only 40%of patients in every day life take their prescribe...5-aminosalicylic acid(5-ASA)compounds are a highly effective treatment for ulcerative colitis(UC).While UC patient compliance in clinical studies is over 90%, only 40%of patients in every day life take their prescribed therapy.Adherence to medication has been emphasized recently by a Cochrane meta-analysis that has suggested that future trials of 5-ASA in UC should look at patient compliance rather than drug efficacy. Better compliance can be obtained by reducing the number of tablets and times of administration.Given that the 5-ASA formulations have different delivery systems that split the active moiety in various regions of the intestine,it is particularly important that an adequate dose of the drug arrives at the inflamed part of the colon.5-ASA Multi matrix(MMx)is a novel,high strength(1.2 g),oral formulation designed for oncedaily dosing.It releases the active moiety throughout the colon.Different studies with this compound have shown that it is as effective as 5-ASA enema in the treatment of mild-to-moderate,left-sided UC,and is comparable to a pH-dependent,delayed release 5-ASA (Asacol ),even if given once daily.Recently,the effectiveness in the acute phase of UC has been confirmed also in maintenance.In conclusion,at present,5-ASA MMx seems theoretically the best agent for maintaining patient compliance,and consequently,treatment effectiveness.展开更多
In a recent article,Longman and Swaminath analyzed our paper on the use of rifaximin in patients with moderately active Crohn’s disease(CD).Here we report some considerations concerning their article.The exploratory ...In a recent article,Longman and Swaminath analyzed our paper on the use of rifaximin in patients with moderately active Crohn’s disease(CD).Here we report some considerations concerning their article.The exploratory post-hoc subgroup analysis showed that early-stage disease and,differently from that written by Longman and Swaminath,also colonic involvement seemed to be associated with a significant higher efficacy of rifaximin-EIR 800 mg twice daily.Early-stage disease is generally considered as the more easily treatable phase of CD,and the better response to rifaximin in Crohn’s colitis is in accordance with the high concentration of bacteria in the colon.In addition,patients with C reactive protein level>5 mg/L achieved remission more significantly than patients with normal values,thus suggesting that the symptoms were probably caused by inflammation instead of by non-inflammatory causes.We also analyze the role of rifaximin against gut bacteria and the clinical situations that could obtain the best results from antibiotics.展开更多
文摘Many data coming from animal models and clinical observations support an involvement of intestinal microbiota in the pathogenesis of Crohn's disease(CD). It is hypothesized in fact,that the development of chronic intestinal inflammation is caused by an abnormal immune response to normal flora in genetically susceptible hosts.The involvement of bacteria in CD inflammation has provided the rationale for including antibiotics in the therapeutic armamentarium.However, randomized controlled trials have failed to demonstrate an efficacy of these drugs in patients with active uncomplicated CD,even if a subgroup of patients with colonic location seems to get benefit from antibiotics. Nitroimidazole compounds have been shown to be efficacious in decreasing CD recurrence rates in operated patients,and the use of metronidazole and ciprofloxacin is recommended in perianal disease.However,the appearance of systemic side effects limits antibiotic long-term employment necessary for treating a chronic relapsing disease.Rifaximin,characterized by an excellent safety profile,has provided promising results in inducing remission of CD.
文摘5-aminosalicylic acid(5-ASA)compounds are a highly effective treatment for ulcerative colitis(UC).While UC patient compliance in clinical studies is over 90%, only 40%of patients in every day life take their prescribed therapy.Adherence to medication has been emphasized recently by a Cochrane meta-analysis that has suggested that future trials of 5-ASA in UC should look at patient compliance rather than drug efficacy. Better compliance can be obtained by reducing the number of tablets and times of administration.Given that the 5-ASA formulations have different delivery systems that split the active moiety in various regions of the intestine,it is particularly important that an adequate dose of the drug arrives at the inflamed part of the colon.5-ASA Multi matrix(MMx)is a novel,high strength(1.2 g),oral formulation designed for oncedaily dosing.It releases the active moiety throughout the colon.Different studies with this compound have shown that it is as effective as 5-ASA enema in the treatment of mild-to-moderate,left-sided UC,and is comparable to a pH-dependent,delayed release 5-ASA (Asacol ),even if given once daily.Recently,the effectiveness in the acute phase of UC has been confirmed also in maintenance.In conclusion,at present,5-ASA MMx seems theoretically the best agent for maintaining patient compliance,and consequently,treatment effectiveness.
文摘In a recent article,Longman and Swaminath analyzed our paper on the use of rifaximin in patients with moderately active Crohn’s disease(CD).Here we report some considerations concerning their article.The exploratory post-hoc subgroup analysis showed that early-stage disease and,differently from that written by Longman and Swaminath,also colonic involvement seemed to be associated with a significant higher efficacy of rifaximin-EIR 800 mg twice daily.Early-stage disease is generally considered as the more easily treatable phase of CD,and the better response to rifaximin in Crohn’s colitis is in accordance with the high concentration of bacteria in the colon.In addition,patients with C reactive protein level>5 mg/L achieved remission more significantly than patients with normal values,thus suggesting that the symptoms were probably caused by inflammation instead of by non-inflammatory causes.We also analyze the role of rifaximin against gut bacteria and the clinical situations that could obtain the best results from antibiotics.
