Immune-checkpoint inhibitor-mediated colitis(IMC)is an increasingly recognized adverse event in cancer immunotherapy,particularly associated with immune checkpoint inhibitors(ICIs)such as anti-cytotoxic T-lymphocyte a...Immune-checkpoint inhibitor-mediated colitis(IMC)is an increasingly recognized adverse event in cancer immunotherapy,particularly associated with immune checkpoint inhibitors(ICIs)such as anti-cytotoxic T-lymphocyte antigen-4 and anti-programmed cell death protein-1 antibodies.As this revolutionary immunotherapy gains prominence in cancer treatment,understanding,diagnosing,and effectively managing IMC becomes paramount.IMC represents a unique challenge due to its immune-mediated nature and potential for severe complications.However,a precise picture of IMC pathophysiology is currently unavailable.Therefore,we aimed to summarize the existing data while acknowledging the need for further research.This comprehensive review explores the mechanisms underlying ICIs,gastrointestinal adverse effects,and,in particular,IMC’s incidence,prevalence,and features.Our review also emphasizes the importance of recognizing IMC’s distinct clinical and histopathological features to differentiate it from other forms of colitis.Furthermore,this paper highlights the urgentneed for evolving diagnostic methods,therapeutic strategies,and a multidisciplinary approach to effectively manage IMC.展开更多
BACKGROUND Ulcerative colitis(UC)increases the risk of colorectal dysplasia.While colectomy was once standard,advances in polypectomy,endoscopic mucosal resection(EMR),endoscopic submucosal dissection(ESD),and endosco...BACKGROUND Ulcerative colitis(UC)increases the risk of colorectal dysplasia.While colectomy was once standard,advances in polypectomy,endoscopic mucosal resection(EMR),endoscopic submucosal dissection(ESD),and endoscopic full-thickness resection(EFTR)now allow organ-sparing management in selected cases.AIM To summarize current evidence on the feasibility,safety,and outcomes of these techniques in UC-associated neoplasia.METHODS A scoping review was conducted using PubMed and EMBASE(1975-May 2025)with the search:(“endoscopic submucosal dissection”/exp OR“endoscopic mucosal resection”OR“full thickness resection”OR“polypectomy”)AND(“ulcerative colitis”/exp OR“ulcerative colitis”OR“pouch”).Screening followed PRISMA guidelines.Eligible studies included those reporting outcomes,feasibility,or novel techniques in the endoscopic management of UC-associated dysplasia.RESULTS Of 1075 identified records,754 were screened after duplicate removal,and 48 studies were included.Polypectomy was safe and effective for well-demarcated,lifting lesions without adjacent dysplasia.EMR has excellent outcomes for small,polypoid,or right-sided lesions that demonstrated adequate lifting.ESD is ind icated for flat,large,non-polypoid,or fibrotic lesions,particularly in the left colon.ESD achieved en bloc resection in 88%-100%and R0 resection in 73%-96%of cases.The overall complication rate with ESD was approximately 2%-10%,primarily bleeding or perforation.Local recurrence occurred in 0%-6.8%,and metachronous lesions developed in up to 31%of cases over follow-up durations of up to 15 years.Surgical intervention after ESD was required in 10%-20%of patients,typically for non-curative resection or new lesions.Submucosal fibrosis,a common obstacle in UC,limited lifting and increased procedural difficulty.Adjunctive strategies-such as water pressure-assisted dissection,pocket-creation method,self-assembling peptide injectables,and traction systems-enhanced technical success.EFTR,though limited to case series,was effective for non-lifting or anatomically complex lesions,particularly in post-surgical or pouch anatomy,but carried higher procedural risk including rare but serious adverse events.CONCLUSION Endoscopic resection offers a spectrum of curative,minimally invasive options for managing dysplasia in UC.EMR remains appropriate for simple,lifting lesions,while ESD and EFTR broaden the therapeutic landscape for complex or fibrotic pathology.Lesion morphology,lifting characteristics,and operator experience should guide technique selection.Long-term outcomes are favorable with appropriate surveillance,though the risk of metachronous neoplasia necessitates continued monitoring.展开更多
BACKGROUND Excessive endoplasmic reticulum(ER)stress in intestinal epithelial cells can lead to damage to the intestinal mucosal barrier,activate the signal transducer and activator of transcription 3(STAT3)/nuclear f...BACKGROUND Excessive endoplasmic reticulum(ER)stress in intestinal epithelial cells can lead to damage to the intestinal mucosal barrier,activate the signal transducer and activator of transcription 3(STAT3)/nuclear factor kappa B(NF-κB)signaling pathway,and exacerbate the inflammatory response,thus participating in the pathogenesis of ulcerative colitis(UC).Mesalazine is a commonly used drug in the clinical treatment of UC.However,further studies are needed to determine whether mesalazine regulates the ER stress of intestinal epithelial cells,downregulates the STAT3/NF-κB pathway to play a role in the treatment of UC.AIM To study the therapeutic effects of mesalazine on spontaneous colitis in interleukin-10(IL-10)-/-mice.METHODS The 24-week-old IL-10-/-mice with spontaneous colitis were divided into the model group and the 5-amino salicylic acid group.Littermates of wild-type mice of the same age group served as the control.There were eight mice in each group,four males and four females.The severity of symptoms of spontaneous colitis in IL-10-/-mice was assessed using disease activity index scores.On day 15,the mice were sacrificed.The colon length was measured,and the histopathological changes and ultrastructure of colonic epithelial cells were detected.The protein expressions of STAT3,p-STAT3,NF-κB,IκB,p-IκB,and glucoseregulated protein 78 were identified using Western blotting.The STAT3 and NF-κB mRNA expressions were identified using real-time polymerase chain reaction.The glucose-regulated protein 78 and C/EBP homologous protein expressions in colon sections were detected using immunofluorescence.RESULTS Mesalazine reduced the symptoms of spontaneous colitis in IL-10 knockout mice and the histopathological damage of colonic tissues,and alleviated the ER stress in epithelial cells of colitis mice.Western blotting and quantitative real-time polymerase chain reaction results showed that the STAT3/NF-κB pathway in the colon tissue of model mice was activated,suggesting that this pathway was involved in the pathogenesis of UC and might become a potential therapeutic target.Mesalazine could down-regulate the protein expressions of p-STAT3,NF-κB and p-IκB,and down-regulate the mRNA expression of STAT3 and NF-κB.CONCLUSION Mesalazine may play a protective role in UC by reducing ER stress by regulating the STAT3/NF-κB signaling pathway.展开更多
BACKGROUND Ulcerative colitis(UC)is a chronic inflammatory disease affecting the colon.The most common psychological issue in UC patients is varying degrees of depre-ssion,which affects the condition and quality of li...BACKGROUND Ulcerative colitis(UC)is a chronic inflammatory disease affecting the colon.The most common psychological issue in UC patients is varying degrees of depre-ssion,which affects the condition and quality of life of UC patients and may lead to deterioration of the patient’s condition.UC drugs combined with anti-anxiety and antidepression drugs can alleviate symptoms of both depression and UC.Brain-derived neurotrophic factor(BDNF)precursor(proBDNF)/p75 neurotrophin receptor(p75NTR)/sortilin and BDNF/tropomyosin receptor kinase B(TrkB)signalling balance is essential for maintaining brain homeostasis and preventing the development of depressive behaviours.AIM To explore the mechanism by which Wuling powder regulates the proBDNF/p75NTR/sortilin and BDNF/TrkB pathways in the treatment of UC with depre-ssion.METHODS Depression was established in C57BL/6J mice via chronic restraint stress,and the UC model was induced with dextran sodium sulfate(DSS).In the treatment stage,mesalazine(MS)was the basic treatment,Wuling powder was the experimental treatment,and fluoxetine was the positive control drug for treating depression.Changes in intestinal mucosal inflammation,behaviour,and the proBDNFp75NTR/sortilin and BDNF/TrkB pathways were evaluated.RESULTS In the depression groups,Wuling powder decreased the immobility time,increased the distance travelled in the central zone and the total distance travelled,and restored balance in the proBDNF/p75NTR/sortilin and BDNF/TrkB signalling pathways.In the DSS and chronic restraint stress+DSS groups,immobility time increased,distance travelled in the central zone and total distance travelled decreased,activity of the proBDNF/p75NTR/sortilin pathway was upregulated,and activity of the BDNF/TrkB pathway was downregulated,indicating that mice with UC often have comorbid depression.Compared with those of MS alone,Wuling powder combined with MS further decreased the colon histopathological scores and the expression levels of tumor necrosis factor-alpha and interleukin-6 mRNAs.CONCLUSION This study confirmed that Wuling powder may play an antidepressant role by regulating the balance of the proBDNF/p75NTR/sortilin and BDNF/TrkB signalling pathways and further relieve intestinal inflammation in UC.展开更多
OBJECTIVE:To evaluate the therapeutic effects of Xiahuo Pingwei San(夏藿平胃散,XHPWS)on ulcerative colitis(UC)in mice and to explore the underlying mechanisms through a network pharmacology approach.METHODS:Ultra-perf...OBJECTIVE:To evaluate the therapeutic effects of Xiahuo Pingwei San(夏藿平胃散,XHPWS)on ulcerative colitis(UC)in mice and to explore the underlying mechanisms through a network pharmacology approach.METHODS:Ultra-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry(UPLC-Q-TOF/MS)was utilized to identify the chemical composition and authenticate the active constituents of XHPWS,ensuring rigorous quality control across batches.A dextran sulfate sodium(DSS)-induced UC model was established in C57BL/6 mice,which were treated with XHPWS in vivo.The efficacy against UC was assessed by measuring parameters such as body weight,disease activity index(DAI)scores,and colon length.Levels of inflammatory cytokines,including interleukin-6(IL-6),interleukin-1β(IL-1β),and tumor necrosis factor-alpha(TNF-α),in colonic tissue were evaluated using enzymelinked immunosorbent assay(ELISA).Histological analysis of colon sections was conducted using hematoxylin and eosin staining.A network pharmacology approach was employed to explore the mechanisms of XHPWS and to predict its potential targets in UC treatment.Predicted protein expressions in colonic tissue were validated using immune-ohistochemistry(IHC)and Western blotting techniques.RESULTS:XHPWS effectively alle via ted DSS-induced UC symptoms in mice,as evidenced by restored body weight,reduced colon shortening,and decreased DAI scores.Histopathological examination revealed that XHPWS significantly reduced intestinal inflammatory infiltration,restored intestinal epithelial permeability,and increased goblet cell count.Network pharmacology analysis identified 63 active compounds in XHPWS and suggested that it might target 35 potential proteins associated with UC treatment.Functional enrichment analysis indicated that the protective mechanism of XHPWS could be related to the advanced glycation end products-receptor for advanced glycation end products(AGE-RAGE)signaling pathway.Notably,quercetin,kaempferol,wogonin,and nobiletin,the main components of XHPWS,showed strong correlations with the core targets.Additionally,experimental validation demonstrated that XHPWS significantly decreased levels of inflammatory cytokines interleukin 6(IL-6),interleukin 1 beta(IL-1β),and tumor necrosis factor alpha(TNF-α)in UC mice,while downregulating the expression of proteins related to the AGE-RAGE pathway.CONCLUSION:Our study demonstrated that XHPWS effectively alle via tes colitis symptoms and inflammation in UC mice,potentially through the regulation of the AGE-RAGE pathway.These findings provide strong evidence for the therapeutic potential of XHPWS in UC treatment,thereby broadening its clinical applications.展开更多
BACKGROUND Ulcerative colitis(UC)is a chronic inflammatory condition requiring continuous treatment and monitoring.There is limited pharmacokinetic data on vedolizumab during maintenance therapy and the effect of thio...BACKGROUND Ulcerative colitis(UC)is a chronic inflammatory condition requiring continuous treatment and monitoring.There is limited pharmacokinetic data on vedolizumab during maintenance therapy and the effect of thiopurines on vedolizumab trough concentrations is unknown.AIM To investigate the exposure-response relationship of vedolizumab and the impact of thiopurine withdrawal in UC patients who have achieved sustained clinical and endoscopic remission during maintenance therapy.METHODS This is a post-hoc analysis of prospective randomized clinical trial(VIEWS)involving UC patients across 8 centers in Australia from 2018 to 2022.Patients in clinical and endoscopic remission were randomized to continue or withdraw thiopurine while receiving vedolizumab.We evaluated vedolizumab serum trough concentrations,presence of anti-vedolizumab antibodies,and clinical outcomes over 48 weeks to assess exposure-response asso-ciation and impact of thiopurine withdrawal.RESULTS There were 62 UC participants with mean age of 43.4 years and 42%were females.All participants received vedolizumab as maintenance therapy with 67.7%withdrew thiopurine.Vedolizumab serum trough concentrations remained stable over 48 weeks regardless of thiopurine use,with no anti-vedolizumab antibodies detected.Pa-tients with clinical remission had higher trough concentrations at week 48.In quartile analysis,a threshold of>11.3μg/mL was associated with sustained clinical remission,showing a sensitivity of 82.4%,specificity of 60.0%,and an area of receiver operating characteristic of 0.71(95%CI:0.49-0.93).Patients discontinuing thiopurine required higher vedolizumab concentrations for achieving remission.CONCLUSION A positive exposure-response relationship between vedolizumab trough concentrations and UC outcomes suggests that monitoring drug levels may be beneficial.While thiopurine did not influence vedolizumab levels,its with-drawal may necessitate higher vedolizumab trough concentrations to maintain remission.展开更多
BACKGROUND Bullous pemphigoid(BP)is an autoimmune blistering skin disorder.It is associated with other autoimmune disorders and the use of certain drugs.We describe a case of BP in a patient with ulcerative colitis(UC...BACKGROUND Bullous pemphigoid(BP)is an autoimmune blistering skin disorder.It is associated with other autoimmune disorders and the use of certain drugs.We describe a case of BP in a patient with ulcerative colitis(UC)treated with mesalamine.CASE SUMMARY A 38-year-old male patient with UC and a history of multiple flares was maintained on mesalamine with good clinical response.One year after starting mesalamine,he sought medical care following the onset of a severe itchy rash of several weeks’duration with a recent appearance of skin bullae.A biopsy of the skin revealed subepidermal blistering dermatitis with focal eosinophilic spongiosis.Direct immunofluorescence studies revealed linear IgG and C3 immune reactant deposits at the dermoepidermal junction,consistent with the diagnosis of BP.Prednisone therapy alleviated his symptoms.However,tapering prednisone led to re-eruption of the bullae.CONCLUSION BP should be considered when patients with UC develop skin manifestations.Although BP is not one of the extraintestinal manifestations of UC,there may be an association between these two conditions.Whether treatment with mesalamine or other therapeutic agents plays a role in the development of BP remains unclear.展开更多
Objective Ulcerative colitis is a prevalent immunoinflammatory disease.Th17/Treg cell imbalance and gut microbiota dysregulation are key factors in ulcerative colitis pathogenesis.The actin cytoskeleton contributes to...Objective Ulcerative colitis is a prevalent immunoinflammatory disease.Th17/Treg cell imbalance and gut microbiota dysregulation are key factors in ulcerative colitis pathogenesis.The actin cytoskeleton contributes to regulating the proliferation,differentiation,and migration of Th17 and Treg cells.Wdr63,a gene containing the WD repeat domain,participates in the structure and functional modulation of actin cytoskeleton.Recent research indicates that WDR63 may serve as a regulator of cell migration and metastasis via actin polymerization inhibition.This article aims to explore the effect of Wdr63 deletion on Th17/Treg cells and ulcerative colitis.Methods We constructed Wdr63-/-mice,induced colitis in mice using dextran sulfate sodium salt,collected colon tissue for histopathological staining,collected mesenteric lymph nodes for flow cytometry analysis,and collected healthy mouse feces for microbial diversity detection.Results Compared with wild-type colitis mice,Wdr63-/-colitis mice had a more pronounced shortening of colonic tissue,higher scores on disease activity index and histological damage index,Treg cells decreased and Th17 cells increased in colonic tissue and mesenteric lymph nodes,a lower level of anti-inflammatory cytokine IL-10,and a higher level of pro-inflammatory cytokine IL-17A.In addition,WDR63 has shown positive effects on maintaining intestinal microbiota homeostasis.It maintains the balance of Bacteroidota and Firmicutes,promoting the formation of beneficial intestinal bacteria linked to immune inflammation.Conclusion Wdr63 deletion aggravates ulcerative colitis in mice,WDR63 inhibits colonic inflammation likely by regulating Th17/Treg balance and maintains intestinal microbiota homeostasis.展开更多
BACKGROUND Cytomegalovirus(CMV)infections can cause significant morbidity and mortality in immunocompromised individuals.CMV targets dysfunctional lymphocytes.Chronic rituximab(RTX)therapy can cause B-lymphocyte dysfu...BACKGROUND Cytomegalovirus(CMV)infections can cause significant morbidity and mortality in immunocompromised individuals.CMV targets dysfunctional lymphocytes.Chronic rituximab(RTX)therapy can cause B-lymphocyte dysfunction,increasing CMV risk.Rarely,CMV infections present with critical illness such as septic shock.CASE SUMMARY A 64-year-old African American woman presented with generalized weakness and non-bloody watery diarrhea of 4-6 weeks duration.She did not have nausea,vomiting or,abdominal pain.She had been on monthly RTX infusions for neuromyelitis optica.She was admitted for septic shock due to pancolitis.Blood investigations suggested pancytopenia and serology detected significantly elevated CMV DNA.Valganciclovir treatment led to disease resolution.CONCLUSION This case illustrates an extremely rare case of CMV colitis associated with RTX use presenting with septic shock.High suspicion for rare opportunistic infections is imperative in individuals with long-term RTX use.展开更多
BACKGROUND Tofacitinib is an oral,selective Janus kinase inhibitor that is approved for the treatment of ulcerative colitis(UC).The 8-week induction protocol involves the administration of 10 mg twice daily(bid)with t...BACKGROUND Tofacitinib is an oral,selective Janus kinase inhibitor that is approved for the treatment of ulcerative colitis(UC).The 8-week induction protocol involves the administration of 10 mg twice daily(bid)with the possibility of extending the induction period to 16 weeks.The maintenance dose of tofacitinib is either 5 mg or 10 mg bid.AIM To assess predictors for clinical remission and drug persistence in patients with UC receiving the extended induction tofacitinib protocol.METHODS This was a real-world multicenter retrospective study in patients with moderateto-severe UC.Patients received physician-directed extended induction tofacitinib treatment.We collected clinical and demographic data at baseline and data regarding clinical,laboratory,and endoscopic evaluations,therapeutic modifications,and adverse events at the 52-week follow-up.Possible predictors for clinical remission at week 52 was the primary endpoint.Differences between patients receiving 5 mg bid vs 10 mg bid at week 52 and identification of predictors for treatment persistence were secondary endpoints.RESULTS Thirty-seven consecutive patients from 11 medical centers were included[51.4%males with median age 39(17-64)years].Twenty-eight patients continued treatment until week 52(75.7%)with 67.9%receiving 10 mg tofacitinib;all had prior history of biologic use.We observed that 57.1%of patients achieved clinical remission(66.7%in the 5 mg tofacitinib group and 52.6%in the 10 mg tofacitinib group,P=0.483).De-escalation to 5 mg tofacitinib was attempted in 17 patients with a success rate of 52.9%.Prior biologic use was significantly more frequent in patients treated with 10 mg tofacitinib.Active smoking was significantly associated with treatment discontinuation at week 52.We identified eight adverse events,and only one led to treatment discontinuation.CONCLUSION Our results supported the extended induction strategy with tofacitinib in selected patients with UC.Patients with prior failure of advanced therapies particularly benefitted,highlighting the importance of personalized maintenance regimens.展开更多
BACKGROUND Ulcerative colitis(UC),a chronic and challenging condition,necessitates the development of more effective treatments owing to the unsatisfactory efficacy and side effects associated with current medications...BACKGROUND Ulcerative colitis(UC),a chronic and challenging condition,necessitates the development of more effective treatments owing to the unsatisfactory efficacy and side effects associated with current medications.Traditional Chinese medicine(TCM),known for its multi-stage and multi-targeted approach,has a long history in treating gastrointestinal diseases and offering a promising alternative UC treatment.Panax ginseng(P.ginseng),a commonly used remedy for UC in TCM,exemplifies this potential,although the specific components and mechanisms through which its therapeutic effects are exerted remain to be fully elucidated,highlighting the need for further research to unlock its full potential as a treatment option.AIM To investigate the key constituents and biological pathways through which P.ginseng exerts therapeutic effects on UC.METHODS Network pharmacology investigated the UC-alleviating mechanism of P.ginseng,including“active ingredient-target-disease”network analysis,and Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses.Panaxadiol(PD;active ingredient of P.ginseng)was tested in a mouse model of 3%dextran sulfate sodium-induced UC,with assessments of body weight,Disease Activity Index scores,and colon length.Colitis and intestinal barrier integrity were analyzed via hematoxylin-eosin and Alcian blue and periodic acid-Schiff staining,immunohistochemistry,real time-quantitative PCR,and western blotting.RESULTS By integrating and analyzing the targets of P.ginseng and UC,15 critical hub genes were discovered.Kyoto Encyclopedia of Genes and Genomes pathway analysis revealed the mechanisms involved to be linked to MAPK and PI3K-Akt signaling.Among the 10 main active ingredients identified as potentially effective,PD was most abundant and was validated in vivo to mitigate weight loss,reduce Disease Activity Index scores,and prevent colon shortening.PD also reduced inflammation and suppressed expression of pro-inflammatory cytokines and mediators.In addition,PD increased expression of mucin and tight junction proteins.Ultimately,PD counteracted effects of dextran sulfate sodium by inhibiting phosphorylation of NF-кB and MAPK,while increasing phosphorylation of AMPK and expression of NRF2 and NQO1.CONCLUSION PD alleviates colitis and aids intestinal barrier repair,partly via modulation of the MAPK/NF-кB and AMPK/NRF2/NQO1 pathways.These findings also suggest new research methods for treatment of UC with TCM.展开更多
BACKGROUND Pyoderma gangrenosum(PG)is one of the most severe extra-intestinal manifest-ations of ulcerative colitis(UC).The treatment of refractory UC combined with PG is challenging,particularly for patients with sch...BACKGROUND Pyoderma gangrenosum(PG)is one of the most severe extra-intestinal manifest-ations of ulcerative colitis(UC).The treatment of refractory UC combined with PG is challenging,particularly for patients with schizophrenia(SCZ)with a long-term history of risperidone use,and there have been no successfully treated patients reported in the literature.CASE SUMMARY A 36-year-old woman attended the gastroenterological clinic due to intermittent symptoms of diarrhea and mucous bloody stools.Prior to the emergence of these symptoms,the patient had a history of SCZ for 3 years.She had been receiving long-term risperidone treatment and had stable mental symptoms.In April 2023,she was diagnosed with UC E3 moderate and began taking mesalazine 3 g/day.In March 2024,her intestinal symptoms recurred and approximately 2 months later,PG developed in both lower limbs.Previous treatments with adalimumab and steroids were ineffective for PG and UC,and simultaneously,the patient experienced headache,confusion,and severe sleep disturbances.After switching to upadacitinib(UPA)45 mg/day,PG lesions showed complete healing and fecal calprotectin was<10μg/g after 7 weeks of treatment.Following approximately 12 weeks of UPA therapy,colonoscopy indicated that the patient had achieved mucosal healing.No adverse events occurred during UPA induction and main-tenance therapy for 6 months with risperidone.CONCLUSION UPA treatment led to successful resolution of both intestinal and extra-intestinal manifestations in this patient with new-onset UC who had a history of SCZ.No adverse effects were observed with concurrent UPA and risperidone use.展开更多
BACKGROUND Mesalamine is the recommended first-line treatment for inducing and maintaining remission in mild-to-moderate ulcerative colitis(UC).However,adherence in real-world settings is frequently suboptimal.Encoura...BACKGROUND Mesalamine is the recommended first-line treatment for inducing and maintaining remission in mild-to-moderate ulcerative colitis(UC).However,adherence in real-world settings is frequently suboptimal.Encouraging collaborative patient-provider relationships may foster better adherence and patient outcomes.AIM To quantify the association between patient participation in treatment decisionmaking and adherence to oral mesalamine in UC.METHODS We conducted a 12-month,prospective,non-interventional cohort study at 113 gastroenterology practices in Germany.Eligible patients were aged≥18 years,had a confirmed UC diagnosis,had no prior mesalamine treatment,and provided informed consent.At the first visit,we collected data on demographics,clinical characteristics,patient preference for mesalamine formulation(tablets or granules),and disease knowledge.Self-reported adherence and disease activity were assessed at all visits.Correlation analyses and logistic regression were used to examine associations between adherence and various factors.RESULTS Of the 605 consecutively screened patients,520 were included in the study.The median age was 41 years(range:18-91),with a male-to-female ratio of 1.1:1.0.Approximately 75%of patients reported good adherence at each study visit.In correlation analyses,patient participation in treatment decision-making was significantly associated with better adherence across all visits(P=0.04).In the regression analysis at 12 months,this association was evident among patients who both preferred and received prolonged-release mesalamine granules(odds ratio=2.73,P=0.001).Patients reporting good adherence also experienced significant improvements in disease activity over 12 months(P<0.001).CONCLUSION Facilitating patient participation in treatment decisions and accommodating medication preferences may improve adherence to mesalamine.This may require additional effort but has the potential to improve long-term management of UC.展开更多
BACKGROUND Endocytoscopy is an advanced imaging modality that provides real-time,ultrahigh magnification views of the intestinal mucosa.In ulcerative colitis(UC),the combined assessment of endoscopic and histological ...BACKGROUND Endocytoscopy is an advanced imaging modality that provides real-time,ultrahigh magnification views of the intestinal mucosa.In ulcerative colitis(UC),the combined assessment of endoscopic and histological remission is now becoming a standard practice.However,histological evaluation typically falls outside the scope of the endoscopist.By offering in vivo microscopic imaging,endocytoscopy has the potential to streamline workflow and enhance efficiency in assessing UC activity.AIM To evaluate the utility of real-time endocytoscopy in assessing endoscopic and histological disease activity in UC,and to validate endocytoscopic scoring systems.METHODS This study was conducted at Concord Hospital.Patients with UC who consented to undergo colonoscopy with endocytoscopy were enrolled.Data collected included patient demographics,clinical disease activity,Mayo endoscopic score(MES),and endocytoscopic features such as crypt architecture,intercrypt distance and cellular infiltration.Correlation between endocytoscopic findings were evaluated against MES and the Nancy histological index.Agreement and validation were assessed using the ErLangen Endocytoscopy in ColiTis(ELECT)score and the endocytoscopy score(ECSS),applying Kappa(κ)statistics and Spearman’s correlation coefficient(r).RESULTS A total of 61 colonic segments from 15 patients were assessed,with 187 analyzable endocytoscopic images.Endocytoscopy showed significant correlation with the MES using both the ECSS(κ=0.60,P<0.001;r=0.78,P<0.001)and ELECT(κ=0.88,P<0.001;r=0.81,P<0.001)scoring systems.Similarly,correlations with the Nancy histological index were significant for both ECSS(κ=0.47,P<0.001;r=0.69,P<0.001)and ELECT(κ=0.88,P<0.001;r=0.74,P<0.001).The ELECT score demonstrated superior diagnostic accuracy in identifying histological remission,with a sensitivity of 100%,specificity of 85%,and an area under the receiver operating characteristic curve of 0.90(95%confidence interval:0.78-1.00),compared to 68.3%,85%,and an area under the receiver operating characteristic curve of 0.88(95%confidence interval:0.75-1.00)for the ECSS.No serious adverse events occurred,except for transient urinary discoloration due to methylene blue excretion.CONCLUSION Endocytoscopy allows for real-time,simultaneous assessment of endoscopic and histological activity in UC and has been proven to be accurate,safe,and well-tolerated.Compared with the ECSS,the ELECT score showed superior concordance with histological findings.展开更多
Patients with ulcerative colitis(UC)have an increased risk of thromboembolic events,particularly venous thromboembolism(VTE),which encompasses deep vein thrombosis and pulmonary embolism.The incidence of VTE in patien...Patients with ulcerative colitis(UC)have an increased risk of thromboembolic events,particularly venous thromboembolism(VTE),which encompasses deep vein thrombosis and pulmonary embolism.The incidence of VTE in patients with UC is significantly higher than that in the general population,and a retrospective cohort study found that patients undergoing colectomy had a notable risk of developing VTE,with rates reaching as high as 22%among patients exposed to tofacitinib within a month prior to surgery.The GETAID FOCUS study also reported a high prevalence of self-reported VTE in patients with UC,with a pooled prevalence of approximately 12%across various studies.The risk of thromboembolism in UC is multifactorial and influenced by chronic inflammation,a wide range of medications used,potential surgical interventions,and possibly genetic factors or associations that are yet to be fully defined.Recognizing the various contributing factors is crucial for developing effective preventive strategies and improving patient outcomes.展开更多
BACKGROUND Ulcerative colitis(UC)is a complex inflammatory bowel disease,and its etiology and pathogenesis remain incompletely elucidated.AIM To analyze the effects of Saccharomyces boulardii in combination with sulfa...BACKGROUND Ulcerative colitis(UC)is a complex inflammatory bowel disease,and its etiology and pathogenesis remain incompletely elucidated.AIM To analyze the effects of Saccharomyces boulardii in combination with sulfasalazine on intestinal microbiota and intestinal barrier function in patients with UC.METHODS A retrospective analysis of clinical data from 127 UC patients admitted to our hospital between January 2021 and January 2023 was conducted.All patients met complete inclusion and exclusion criteria.Based on the treatment interventions received,they were divided into a control group(n=63)and an observation group(n=64).Both groups of patients received routine treatment upon admission.The control group received sulfasalazine in addition to routine interventions,while the observation group received a combination of Saccharomyces boulardii on the basis of the control group’s treatment.The clinical efficacy,improvement in symptoms,modified Baron endoscopic scores,quality of life“inflammatory bowel disease questionnaire(IBDQ)”,levels of intestinal microbial indicators(such as Lactobacillus,Bifidobacterium,Enterococcus,and Escherichia coli),intestinal mucosal barrier function indicators[diamine oxidase(DAO),lipopolysaccharide(LPS),D-lactic acid(D-LA)],and adverse reaction occurrences were compared between the two groups.RESULTS(1)Clinical efficacy:The total effective rate in the control group was 79.37%,while in the observation group,it was 93.75%,significantly higher than that of the control group(P<0.05);(2)Improvement in symptoms:The observation group showed significantly lower relief time for abdominal pain,diarrhea,rectal bleeding,fever symptoms,and mucosal healing time compared to the control group(P<0.05);(3)Baron endoscopic scores and IBDQ scores:Before treatment,there was no significant difference in Baron endoscopic scores and IBDQ scores between the two groups(P>0.05).However,after treatment,the observation group showed significantly lower Baron endoscopic scores and higher IBDQ scores compared to the control group(P<0.05);(4)Levels of intestinal microbial indicators:Before treatment,there was no significant difference in the levels of Lactobacillus,Bifidobacterium,Enterococcus,and Escherichia coli between the two groups(P>0.05).After treatment,the levels of Lactobacillus and Bifidobacterium in the observation group were significantly higher than those in the control group,while the levels of Enterococcus and Escherichia coli were significantly lower than those in the control group(P<0.05);(5)Levels of intestinal mucosal barrier function indicators:Before treatment,there was no significant difference in the levels of DAO,LPS,and D-LA between the two groups(P>0.05).However,after treatment,the levels of DAO,LPS,and D-LA in the observation group were significantly lower than those in the control group(P<0.05);and(6)Occurrence of adverse reactions:The incidence of adverse reactions in the control group was 9.52%,while in the observation group,it was 10.94%.There was no significant difference in the occurrence of adverse reactions between the two groups(P>0.05).CONCLUSION The application of Saccharomyces boulardii in combination with sulfasalazine in UC patients demonstrates significant effectiveness.Compared to sole sulfasalazine intervention,the combined application of Saccharomyces boulardii further promotes the relief of relevant symptoms in patients,alleviates intestinal mucosal inflammation,and improves the quality of life.Its action may be related to rectifying the imbalance in intestinal microbiota and improving intestinal mucosal barrier function.Moreover,the combined use of Saccharomyces boulardii does not increase the risk of adverse reactions in patients,indicating a higher level of medication safety and advocating for its clinical promotion and application.展开更多
Ulcerative colitis has baffled researchers since the early 20th century.The pre-vailing explanation attributes the chronic recurring episodes of bloody diarrhea and abdominal pain to some form of immune abnormality,de...Ulcerative colitis has baffled researchers since the early 20th century.The pre-vailing explanation attributes the chronic recurring episodes of bloody diarrhea and abdominal pain to some form of immune abnormality,despite the lack of supporting evidence.This highlights the critical need for innovative research directions and methodologies to uncover the cause and develop a cure for this disease.By analyzing existing data from less than a dozen previously published studies,a novel,evidence-based pathogenesis was constructed,implicating colonic epithelial hydrogen peroxide as a causal factor in the development of this disease.This newly identified mechanism informed the creation of a ground-breaking class of therapeutics,known as reducing agents,which have demon-strated remarkable success in resolving colonic inflammation and restoring colonic health in patients with refractory ulcerative colitis.This paper outlines the timeline of these publications and reinterprets the findings within the context of contemporary biomedical science.展开更多
Viral myocarditis is a rare but life-threatening complication in patients with ulcerative colitis.Management of myocarditis is primarily supportive,because there are currently no established targeted therapies.Recent ...Viral myocarditis is a rare but life-threatening complication in patients with ulcerative colitis.Management of myocarditis is primarily supportive,because there are currently no established targeted therapies.Recent studies have increasingly highlighted the association between the gut microbiota and myocarditis.Here,we report a case of acute severe ulcerative colitis complicated by cytomegalovirus and Epstein-Barr virus co-infections that led to viral myocarditis.The patient experienced rapid remission of both intestinal and cardiac symptoms following washed microbiota transplantation,suggesting this intervention may serve as a potential alternative treatment for these life-threatening conditions.展开更多
Essential thrombocythemia is classified as a chronic myeloproliferative disorder characterized by the overproduction of platelets stemming from a megakaryocytic clone. The diagnosis primarily relies on bone marrow bio...Essential thrombocythemia is classified as a chronic myeloproliferative disorder characterized by the overproduction of platelets stemming from a megakaryocytic clone. The diagnosis primarily relies on bone marrow biopsy findings and the detection of the JAK2 V617F mutation, after the exclusion of secondary thrombocytosis due to conditions such as inflammation, hemolysis, infection, and iron deficiency. On the other hand, Ulcerative colitis represents an inflammatory disorder of the colon. The diagnosis of ulcerative colitis is established through clinical assessment, endoscopic examination, and histological criteria, without a discernible alternative etiology. The concomitant occurrence of these two conditions is infrequent. We present the case of an 85-year-old patient with a history of essential thrombocythemia who exhibited gastrointestinal symptoms characterized by alternating episodes of diarrhea and constipation. A subsequent colonoscopy accompanied by a biopsy revealed histological features consistent with ulcerative colitis. The patient was administered cytoreductive therapy in combination with mesalazine, resulting in favorable outcomes. Current literature addressing this association is limited, indicating the need for further investigative studies to elucidate the causal relationships between these two pathologies and to achieve improved therapeutic management strategies.展开更多
BACKGROUND 5-aminosalicylates(5-ASA)are the primary treatment for mild to moderate ulcerative colitis(UC).Maintenance therapy with 5-ASA has been shown to reduce both the risk of relapse and colorectal cancer.AIM To e...BACKGROUND 5-aminosalicylates(5-ASA)are the primary treatment for mild to moderate ulcerative colitis(UC).Maintenance therapy with 5-ASA has been shown to reduce both the risk of relapse and colorectal cancer.AIM To evaluate the outcomes of 5-ASA withdrawal due to non-adherence in UC patients while in remission on monotherapy.METHODS Adult patients with UC who were followed up between July 2019 and April 2025 were screened.Patients in remission receiving 5-ASA monotherapy who experienced treatment withdrawal due to non-adherence were included in this study.RESULTS Among 880 patients with UC,30(3.4%)had 5-ASA withdrawal due to nonadherence while in remission on monotherapy.Twelve patients(40%)had disease relapse after a median of 20 months.The rate of patients in remission was 89%in the first year,decreasing to 73%in the second year,and to 64%in the third year.There were no significant differences between patients with and without relapse in terms of demographics,disease extent,remission duration before 5-ASA withdrawal,previous medications,steroid dependence,5-ASA formulation,baseline inflammatory markers,or partial and endoscopic Mayo scores.Most patients(75%)who experienced relapse were successfully treated with 5-ASA monotherapy,while one-fourth of them required corticosteroids.No patients required biologic agents,hospitalization,or surgical intervention.CONCLUSION Intermittent therapy may be safe and feasible for UC patients,especially those in long-term remission,with treatment interruption up to one year considered acceptable.展开更多
基金Supported by the European Union-NextGenerationEU,through the National Recovery and Resilience Plan of the Republic of Bulgaria,No.BG-RRP-2.004-0008.
文摘Immune-checkpoint inhibitor-mediated colitis(IMC)is an increasingly recognized adverse event in cancer immunotherapy,particularly associated with immune checkpoint inhibitors(ICIs)such as anti-cytotoxic T-lymphocyte antigen-4 and anti-programmed cell death protein-1 antibodies.As this revolutionary immunotherapy gains prominence in cancer treatment,understanding,diagnosing,and effectively managing IMC becomes paramount.IMC represents a unique challenge due to its immune-mediated nature and potential for severe complications.However,a precise picture of IMC pathophysiology is currently unavailable.Therefore,we aimed to summarize the existing data while acknowledging the need for further research.This comprehensive review explores the mechanisms underlying ICIs,gastrointestinal adverse effects,and,in particular,IMC’s incidence,prevalence,and features.Our review also emphasizes the importance of recognizing IMC’s distinct clinical and histopathological features to differentiate it from other forms of colitis.Furthermore,this paper highlights the urgentneed for evolving diagnostic methods,therapeutic strategies,and a multidisciplinary approach to effectively manage IMC.
文摘BACKGROUND Ulcerative colitis(UC)increases the risk of colorectal dysplasia.While colectomy was once standard,advances in polypectomy,endoscopic mucosal resection(EMR),endoscopic submucosal dissection(ESD),and endoscopic full-thickness resection(EFTR)now allow organ-sparing management in selected cases.AIM To summarize current evidence on the feasibility,safety,and outcomes of these techniques in UC-associated neoplasia.METHODS A scoping review was conducted using PubMed and EMBASE(1975-May 2025)with the search:(“endoscopic submucosal dissection”/exp OR“endoscopic mucosal resection”OR“full thickness resection”OR“polypectomy”)AND(“ulcerative colitis”/exp OR“ulcerative colitis”OR“pouch”).Screening followed PRISMA guidelines.Eligible studies included those reporting outcomes,feasibility,or novel techniques in the endoscopic management of UC-associated dysplasia.RESULTS Of 1075 identified records,754 were screened after duplicate removal,and 48 studies were included.Polypectomy was safe and effective for well-demarcated,lifting lesions without adjacent dysplasia.EMR has excellent outcomes for small,polypoid,or right-sided lesions that demonstrated adequate lifting.ESD is ind icated for flat,large,non-polypoid,or fibrotic lesions,particularly in the left colon.ESD achieved en bloc resection in 88%-100%and R0 resection in 73%-96%of cases.The overall complication rate with ESD was approximately 2%-10%,primarily bleeding or perforation.Local recurrence occurred in 0%-6.8%,and metachronous lesions developed in up to 31%of cases over follow-up durations of up to 15 years.Surgical intervention after ESD was required in 10%-20%of patients,typically for non-curative resection or new lesions.Submucosal fibrosis,a common obstacle in UC,limited lifting and increased procedural difficulty.Adjunctive strategies-such as water pressure-assisted dissection,pocket-creation method,self-assembling peptide injectables,and traction systems-enhanced technical success.EFTR,though limited to case series,was effective for non-lifting or anatomically complex lesions,particularly in post-surgical or pouch anatomy,but carried higher procedural risk including rare but serious adverse events.CONCLUSION Endoscopic resection offers a spectrum of curative,minimally invasive options for managing dysplasia in UC.EMR remains appropriate for simple,lifting lesions,while ESD and EFTR broaden the therapeutic landscape for complex or fibrotic pathology.Lesion morphology,lifting characteristics,and operator experience should guide technique selection.Long-term outcomes are favorable with appropriate surveillance,though the risk of metachronous neoplasia necessitates continued monitoring.
基金Supported by Xi’an Science and Technology Plan Project,No.23YXYJ0162Shaanxi Province Traditional Chinese Medicine Research and Innovation Talent Plan Project,No.TZKN-CXRC-16+2 种基金Project of Shaanxi Administration of Traditional Chinese Medicine,No.SZYKJCYC-2025-JC-010Shaanxi Province Key Research and Development Plan Project-Social Development Field,No.S2025-YF-YBSF-0391the Science and Technology Innovation Cultivation Program of Longhua Hospital affiliated to Shanghai University of Chinese Medicine,No.YD202220。
文摘BACKGROUND Excessive endoplasmic reticulum(ER)stress in intestinal epithelial cells can lead to damage to the intestinal mucosal barrier,activate the signal transducer and activator of transcription 3(STAT3)/nuclear factor kappa B(NF-κB)signaling pathway,and exacerbate the inflammatory response,thus participating in the pathogenesis of ulcerative colitis(UC).Mesalazine is a commonly used drug in the clinical treatment of UC.However,further studies are needed to determine whether mesalazine regulates the ER stress of intestinal epithelial cells,downregulates the STAT3/NF-κB pathway to play a role in the treatment of UC.AIM To study the therapeutic effects of mesalazine on spontaneous colitis in interleukin-10(IL-10)-/-mice.METHODS The 24-week-old IL-10-/-mice with spontaneous colitis were divided into the model group and the 5-amino salicylic acid group.Littermates of wild-type mice of the same age group served as the control.There were eight mice in each group,four males and four females.The severity of symptoms of spontaneous colitis in IL-10-/-mice was assessed using disease activity index scores.On day 15,the mice were sacrificed.The colon length was measured,and the histopathological changes and ultrastructure of colonic epithelial cells were detected.The protein expressions of STAT3,p-STAT3,NF-κB,IκB,p-IκB,and glucoseregulated protein 78 were identified using Western blotting.The STAT3 and NF-κB mRNA expressions were identified using real-time polymerase chain reaction.The glucose-regulated protein 78 and C/EBP homologous protein expressions in colon sections were detected using immunofluorescence.RESULTS Mesalazine reduced the symptoms of spontaneous colitis in IL-10 knockout mice and the histopathological damage of colonic tissues,and alleviated the ER stress in epithelial cells of colitis mice.Western blotting and quantitative real-time polymerase chain reaction results showed that the STAT3/NF-κB pathway in the colon tissue of model mice was activated,suggesting that this pathway was involved in the pathogenesis of UC and might become a potential therapeutic target.Mesalazine could down-regulate the protein expressions of p-STAT3,NF-κB and p-IκB,and down-regulate the mRNA expression of STAT3 and NF-κB.CONCLUSION Mesalazine may play a protective role in UC by reducing ER stress by regulating the STAT3/NF-κB signaling pathway.
文摘BACKGROUND Ulcerative colitis(UC)is a chronic inflammatory disease affecting the colon.The most common psychological issue in UC patients is varying degrees of depre-ssion,which affects the condition and quality of life of UC patients and may lead to deterioration of the patient’s condition.UC drugs combined with anti-anxiety and antidepression drugs can alleviate symptoms of both depression and UC.Brain-derived neurotrophic factor(BDNF)precursor(proBDNF)/p75 neurotrophin receptor(p75NTR)/sortilin and BDNF/tropomyosin receptor kinase B(TrkB)signalling balance is essential for maintaining brain homeostasis and preventing the development of depressive behaviours.AIM To explore the mechanism by which Wuling powder regulates the proBDNF/p75NTR/sortilin and BDNF/TrkB pathways in the treatment of UC with depre-ssion.METHODS Depression was established in C57BL/6J mice via chronic restraint stress,and the UC model was induced with dextran sodium sulfate(DSS).In the treatment stage,mesalazine(MS)was the basic treatment,Wuling powder was the experimental treatment,and fluoxetine was the positive control drug for treating depression.Changes in intestinal mucosal inflammation,behaviour,and the proBDNFp75NTR/sortilin and BDNF/TrkB pathways were evaluated.RESULTS In the depression groups,Wuling powder decreased the immobility time,increased the distance travelled in the central zone and the total distance travelled,and restored balance in the proBDNF/p75NTR/sortilin and BDNF/TrkB signalling pathways.In the DSS and chronic restraint stress+DSS groups,immobility time increased,distance travelled in the central zone and total distance travelled decreased,activity of the proBDNF/p75NTR/sortilin pathway was upregulated,and activity of the BDNF/TrkB pathway was downregulated,indicating that mice with UC often have comorbid depression.Compared with those of MS alone,Wuling powder combined with MS further decreased the colon histopathological scores and the expression levels of tumor necrosis factor-alpha and interleukin-6 mRNAs.CONCLUSION This study confirmed that Wuling powder may play an antidepressant role by regulating the balance of the proBDNF/p75NTR/sortilin and BDNF/TrkB signalling pathways and further relieve intestinal inflammation in UC.
基金the Guangdong Provincial Basic and Applied Basic Research Project:Mechanistic Study on the Regulation of Inflammatory Microenvironment and Improvement of Ulcerative Colitis by Lingnan Traditional Medicine Ficus Pandurata Hance through Wilms'Tumor 1-associating Protein-Mediated RNA Methyltransferase Promoting Toll Like Receptor 4 m6A Modification(2023A1515011699)the Zhongshan Medical Research Project:Mechanistic Study on the Action of Xiahuo Pingwei San in the Treatment of Ulcerative Colitis(2022A020446)。
文摘OBJECTIVE:To evaluate the therapeutic effects of Xiahuo Pingwei San(夏藿平胃散,XHPWS)on ulcerative colitis(UC)in mice and to explore the underlying mechanisms through a network pharmacology approach.METHODS:Ultra-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry(UPLC-Q-TOF/MS)was utilized to identify the chemical composition and authenticate the active constituents of XHPWS,ensuring rigorous quality control across batches.A dextran sulfate sodium(DSS)-induced UC model was established in C57BL/6 mice,which were treated with XHPWS in vivo.The efficacy against UC was assessed by measuring parameters such as body weight,disease activity index(DAI)scores,and colon length.Levels of inflammatory cytokines,including interleukin-6(IL-6),interleukin-1β(IL-1β),and tumor necrosis factor-alpha(TNF-α),in colonic tissue were evaluated using enzymelinked immunosorbent assay(ELISA).Histological analysis of colon sections was conducted using hematoxylin and eosin staining.A network pharmacology approach was employed to explore the mechanisms of XHPWS and to predict its potential targets in UC treatment.Predicted protein expressions in colonic tissue were validated using immune-ohistochemistry(IHC)and Western blotting techniques.RESULTS:XHPWS effectively alle via ted DSS-induced UC symptoms in mice,as evidenced by restored body weight,reduced colon shortening,and decreased DAI scores.Histopathological examination revealed that XHPWS significantly reduced intestinal inflammatory infiltration,restored intestinal epithelial permeability,and increased goblet cell count.Network pharmacology analysis identified 63 active compounds in XHPWS and suggested that it might target 35 potential proteins associated with UC treatment.Functional enrichment analysis indicated that the protective mechanism of XHPWS could be related to the advanced glycation end products-receptor for advanced glycation end products(AGE-RAGE)signaling pathway.Notably,quercetin,kaempferol,wogonin,and nobiletin,the main components of XHPWS,showed strong correlations with the core targets.Additionally,experimental validation demonstrated that XHPWS significantly decreased levels of inflammatory cytokines interleukin 6(IL-6),interleukin 1 beta(IL-1β),and tumor necrosis factor alpha(TNF-α)in UC mice,while downregulating the expression of proteins related to the AGE-RAGE pathway.CONCLUSION:Our study demonstrated that XHPWS effectively alle via tes colitis symptoms and inflammation in UC mice,potentially through the regulation of the AGE-RAGE pathway.These findings provide strong evidence for the therapeutic potential of XHPWS in UC treatment,thereby broadening its clinical applications.
基金Supported by Takeda Australia,No.IISR-2016-101883.
文摘BACKGROUND Ulcerative colitis(UC)is a chronic inflammatory condition requiring continuous treatment and monitoring.There is limited pharmacokinetic data on vedolizumab during maintenance therapy and the effect of thiopurines on vedolizumab trough concentrations is unknown.AIM To investigate the exposure-response relationship of vedolizumab and the impact of thiopurine withdrawal in UC patients who have achieved sustained clinical and endoscopic remission during maintenance therapy.METHODS This is a post-hoc analysis of prospective randomized clinical trial(VIEWS)involving UC patients across 8 centers in Australia from 2018 to 2022.Patients in clinical and endoscopic remission were randomized to continue or withdraw thiopurine while receiving vedolizumab.We evaluated vedolizumab serum trough concentrations,presence of anti-vedolizumab antibodies,and clinical outcomes over 48 weeks to assess exposure-response asso-ciation and impact of thiopurine withdrawal.RESULTS There were 62 UC participants with mean age of 43.4 years and 42%were females.All participants received vedolizumab as maintenance therapy with 67.7%withdrew thiopurine.Vedolizumab serum trough concentrations remained stable over 48 weeks regardless of thiopurine use,with no anti-vedolizumab antibodies detected.Pa-tients with clinical remission had higher trough concentrations at week 48.In quartile analysis,a threshold of>11.3μg/mL was associated with sustained clinical remission,showing a sensitivity of 82.4%,specificity of 60.0%,and an area of receiver operating characteristic of 0.71(95%CI:0.49-0.93).Patients discontinuing thiopurine required higher vedolizumab concentrations for achieving remission.CONCLUSION A positive exposure-response relationship between vedolizumab trough concentrations and UC outcomes suggests that monitoring drug levels may be beneficial.While thiopurine did not influence vedolizumab levels,its with-drawal may necessitate higher vedolizumab trough concentrations to maintain remission.
文摘BACKGROUND Bullous pemphigoid(BP)is an autoimmune blistering skin disorder.It is associated with other autoimmune disorders and the use of certain drugs.We describe a case of BP in a patient with ulcerative colitis(UC)treated with mesalamine.CASE SUMMARY A 38-year-old male patient with UC and a history of multiple flares was maintained on mesalamine with good clinical response.One year after starting mesalamine,he sought medical care following the onset of a severe itchy rash of several weeks’duration with a recent appearance of skin bullae.A biopsy of the skin revealed subepidermal blistering dermatitis with focal eosinophilic spongiosis.Direct immunofluorescence studies revealed linear IgG and C3 immune reactant deposits at the dermoepidermal junction,consistent with the diagnosis of BP.Prednisone therapy alleviated his symptoms.However,tapering prednisone led to re-eruption of the bullae.CONCLUSION BP should be considered when patients with UC develop skin manifestations.Although BP is not one of the extraintestinal manifestations of UC,there may be an association between these two conditions.Whether treatment with mesalamine or other therapeutic agents plays a role in the development of BP remains unclear.
文摘Objective Ulcerative colitis is a prevalent immunoinflammatory disease.Th17/Treg cell imbalance and gut microbiota dysregulation are key factors in ulcerative colitis pathogenesis.The actin cytoskeleton contributes to regulating the proliferation,differentiation,and migration of Th17 and Treg cells.Wdr63,a gene containing the WD repeat domain,participates in the structure and functional modulation of actin cytoskeleton.Recent research indicates that WDR63 may serve as a regulator of cell migration and metastasis via actin polymerization inhibition.This article aims to explore the effect of Wdr63 deletion on Th17/Treg cells and ulcerative colitis.Methods We constructed Wdr63-/-mice,induced colitis in mice using dextran sulfate sodium salt,collected colon tissue for histopathological staining,collected mesenteric lymph nodes for flow cytometry analysis,and collected healthy mouse feces for microbial diversity detection.Results Compared with wild-type colitis mice,Wdr63-/-colitis mice had a more pronounced shortening of colonic tissue,higher scores on disease activity index and histological damage index,Treg cells decreased and Th17 cells increased in colonic tissue and mesenteric lymph nodes,a lower level of anti-inflammatory cytokine IL-10,and a higher level of pro-inflammatory cytokine IL-17A.In addition,WDR63 has shown positive effects on maintaining intestinal microbiota homeostasis.It maintains the balance of Bacteroidota and Firmicutes,promoting the formation of beneficial intestinal bacteria linked to immune inflammation.Conclusion Wdr63 deletion aggravates ulcerative colitis in mice,WDR63 inhibits colonic inflammation likely by regulating Th17/Treg balance and maintains intestinal microbiota homeostasis.
文摘BACKGROUND Cytomegalovirus(CMV)infections can cause significant morbidity and mortality in immunocompromised individuals.CMV targets dysfunctional lymphocytes.Chronic rituximab(RTX)therapy can cause B-lymphocyte dysfunction,increasing CMV risk.Rarely,CMV infections present with critical illness such as septic shock.CASE SUMMARY A 64-year-old African American woman presented with generalized weakness and non-bloody watery diarrhea of 4-6 weeks duration.She did not have nausea,vomiting or,abdominal pain.She had been on monthly RTX infusions for neuromyelitis optica.She was admitted for septic shock due to pancolitis.Blood investigations suggested pancytopenia and serology detected significantly elevated CMV DNA.Valganciclovir treatment led to disease resolution.CONCLUSION This case illustrates an extremely rare case of CMV colitis associated with RTX use presenting with septic shock.High suspicion for rare opportunistic infections is imperative in individuals with long-term RTX use.
文摘BACKGROUND Tofacitinib is an oral,selective Janus kinase inhibitor that is approved for the treatment of ulcerative colitis(UC).The 8-week induction protocol involves the administration of 10 mg twice daily(bid)with the possibility of extending the induction period to 16 weeks.The maintenance dose of tofacitinib is either 5 mg or 10 mg bid.AIM To assess predictors for clinical remission and drug persistence in patients with UC receiving the extended induction tofacitinib protocol.METHODS This was a real-world multicenter retrospective study in patients with moderateto-severe UC.Patients received physician-directed extended induction tofacitinib treatment.We collected clinical and demographic data at baseline and data regarding clinical,laboratory,and endoscopic evaluations,therapeutic modifications,and adverse events at the 52-week follow-up.Possible predictors for clinical remission at week 52 was the primary endpoint.Differences between patients receiving 5 mg bid vs 10 mg bid at week 52 and identification of predictors for treatment persistence were secondary endpoints.RESULTS Thirty-seven consecutive patients from 11 medical centers were included[51.4%males with median age 39(17-64)years].Twenty-eight patients continued treatment until week 52(75.7%)with 67.9%receiving 10 mg tofacitinib;all had prior history of biologic use.We observed that 57.1%of patients achieved clinical remission(66.7%in the 5 mg tofacitinib group and 52.6%in the 10 mg tofacitinib group,P=0.483).De-escalation to 5 mg tofacitinib was attempted in 17 patients with a success rate of 52.9%.Prior biologic use was significantly more frequent in patients treated with 10 mg tofacitinib.Active smoking was significantly associated with treatment discontinuation at week 52.We identified eight adverse events,and only one led to treatment discontinuation.CONCLUSION Our results supported the extended induction strategy with tofacitinib in selected patients with UC.Patients with prior failure of advanced therapies particularly benefitted,highlighting the importance of personalized maintenance regimens.
基金Supported by Provincial Key Cultivation Laboratory for Digestive Disease Research,Shanxi Province’s“Si Ge Yi Pi”Science and Technology Driven Medical Innovation Project,No.2021SYS13,No.2020SYS13 and No.2021MX03.
文摘BACKGROUND Ulcerative colitis(UC),a chronic and challenging condition,necessitates the development of more effective treatments owing to the unsatisfactory efficacy and side effects associated with current medications.Traditional Chinese medicine(TCM),known for its multi-stage and multi-targeted approach,has a long history in treating gastrointestinal diseases and offering a promising alternative UC treatment.Panax ginseng(P.ginseng),a commonly used remedy for UC in TCM,exemplifies this potential,although the specific components and mechanisms through which its therapeutic effects are exerted remain to be fully elucidated,highlighting the need for further research to unlock its full potential as a treatment option.AIM To investigate the key constituents and biological pathways through which P.ginseng exerts therapeutic effects on UC.METHODS Network pharmacology investigated the UC-alleviating mechanism of P.ginseng,including“active ingredient-target-disease”network analysis,and Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses.Panaxadiol(PD;active ingredient of P.ginseng)was tested in a mouse model of 3%dextran sulfate sodium-induced UC,with assessments of body weight,Disease Activity Index scores,and colon length.Colitis and intestinal barrier integrity were analyzed via hematoxylin-eosin and Alcian blue and periodic acid-Schiff staining,immunohistochemistry,real time-quantitative PCR,and western blotting.RESULTS By integrating and analyzing the targets of P.ginseng and UC,15 critical hub genes were discovered.Kyoto Encyclopedia of Genes and Genomes pathway analysis revealed the mechanisms involved to be linked to MAPK and PI3K-Akt signaling.Among the 10 main active ingredients identified as potentially effective,PD was most abundant and was validated in vivo to mitigate weight loss,reduce Disease Activity Index scores,and prevent colon shortening.PD also reduced inflammation and suppressed expression of pro-inflammatory cytokines and mediators.In addition,PD increased expression of mucin and tight junction proteins.Ultimately,PD counteracted effects of dextran sulfate sodium by inhibiting phosphorylation of NF-кB and MAPK,while increasing phosphorylation of AMPK and expression of NRF2 and NQO1.CONCLUSION PD alleviates colitis and aids intestinal barrier repair,partly via modulation of the MAPK/NF-кB and AMPK/NRF2/NQO1 pathways.These findings also suggest new research methods for treatment of UC with TCM.
文摘BACKGROUND Pyoderma gangrenosum(PG)is one of the most severe extra-intestinal manifest-ations of ulcerative colitis(UC).The treatment of refractory UC combined with PG is challenging,particularly for patients with schizophrenia(SCZ)with a long-term history of risperidone use,and there have been no successfully treated patients reported in the literature.CASE SUMMARY A 36-year-old woman attended the gastroenterological clinic due to intermittent symptoms of diarrhea and mucous bloody stools.Prior to the emergence of these symptoms,the patient had a history of SCZ for 3 years.She had been receiving long-term risperidone treatment and had stable mental symptoms.In April 2023,she was diagnosed with UC E3 moderate and began taking mesalazine 3 g/day.In March 2024,her intestinal symptoms recurred and approximately 2 months later,PG developed in both lower limbs.Previous treatments with adalimumab and steroids were ineffective for PG and UC,and simultaneously,the patient experienced headache,confusion,and severe sleep disturbances.After switching to upadacitinib(UPA)45 mg/day,PG lesions showed complete healing and fecal calprotectin was<10μg/g after 7 weeks of treatment.Following approximately 12 weeks of UPA therapy,colonoscopy indicated that the patient had achieved mucosal healing.No adverse events occurred during UPA induction and main-tenance therapy for 6 months with risperidone.CONCLUSION UPA treatment led to successful resolution of both intestinal and extra-intestinal manifestations in this patient with new-onset UC who had a history of SCZ.No adverse effects were observed with concurrent UPA and risperidone use.
文摘BACKGROUND Mesalamine is the recommended first-line treatment for inducing and maintaining remission in mild-to-moderate ulcerative colitis(UC).However,adherence in real-world settings is frequently suboptimal.Encouraging collaborative patient-provider relationships may foster better adherence and patient outcomes.AIM To quantify the association between patient participation in treatment decisionmaking and adherence to oral mesalamine in UC.METHODS We conducted a 12-month,prospective,non-interventional cohort study at 113 gastroenterology practices in Germany.Eligible patients were aged≥18 years,had a confirmed UC diagnosis,had no prior mesalamine treatment,and provided informed consent.At the first visit,we collected data on demographics,clinical characteristics,patient preference for mesalamine formulation(tablets or granules),and disease knowledge.Self-reported adherence and disease activity were assessed at all visits.Correlation analyses and logistic regression were used to examine associations between adherence and various factors.RESULTS Of the 605 consecutively screened patients,520 were included in the study.The median age was 41 years(range:18-91),with a male-to-female ratio of 1.1:1.0.Approximately 75%of patients reported good adherence at each study visit.In correlation analyses,patient participation in treatment decision-making was significantly associated with better adherence across all visits(P=0.04).In the regression analysis at 12 months,this association was evident among patients who both preferred and received prolonged-release mesalamine granules(odds ratio=2.73,P=0.001).Patients reporting good adherence also experienced significant improvements in disease activity over 12 months(P<0.001).CONCLUSION Facilitating patient participation in treatment decisions and accommodating medication preferences may improve adherence to mesalamine.This may require additional effort but has the potential to improve long-term management of UC.
基金the Sydney Local Health District Human Research Ethics Committee,No.2023/ETH01690.
文摘BACKGROUND Endocytoscopy is an advanced imaging modality that provides real-time,ultrahigh magnification views of the intestinal mucosa.In ulcerative colitis(UC),the combined assessment of endoscopic and histological remission is now becoming a standard practice.However,histological evaluation typically falls outside the scope of the endoscopist.By offering in vivo microscopic imaging,endocytoscopy has the potential to streamline workflow and enhance efficiency in assessing UC activity.AIM To evaluate the utility of real-time endocytoscopy in assessing endoscopic and histological disease activity in UC,and to validate endocytoscopic scoring systems.METHODS This study was conducted at Concord Hospital.Patients with UC who consented to undergo colonoscopy with endocytoscopy were enrolled.Data collected included patient demographics,clinical disease activity,Mayo endoscopic score(MES),and endocytoscopic features such as crypt architecture,intercrypt distance and cellular infiltration.Correlation between endocytoscopic findings were evaluated against MES and the Nancy histological index.Agreement and validation were assessed using the ErLangen Endocytoscopy in ColiTis(ELECT)score and the endocytoscopy score(ECSS),applying Kappa(κ)statistics and Spearman’s correlation coefficient(r).RESULTS A total of 61 colonic segments from 15 patients were assessed,with 187 analyzable endocytoscopic images.Endocytoscopy showed significant correlation with the MES using both the ECSS(κ=0.60,P<0.001;r=0.78,P<0.001)and ELECT(κ=0.88,P<0.001;r=0.81,P<0.001)scoring systems.Similarly,correlations with the Nancy histological index were significant for both ECSS(κ=0.47,P<0.001;r=0.69,P<0.001)and ELECT(κ=0.88,P<0.001;r=0.74,P<0.001).The ELECT score demonstrated superior diagnostic accuracy in identifying histological remission,with a sensitivity of 100%,specificity of 85%,and an area under the receiver operating characteristic curve of 0.90(95%confidence interval:0.78-1.00),compared to 68.3%,85%,and an area under the receiver operating characteristic curve of 0.88(95%confidence interval:0.75-1.00)for the ECSS.No serious adverse events occurred,except for transient urinary discoloration due to methylene blue excretion.CONCLUSION Endocytoscopy allows for real-time,simultaneous assessment of endoscopic and histological activity in UC and has been proven to be accurate,safe,and well-tolerated.Compared with the ECSS,the ELECT score showed superior concordance with histological findings.
文摘Patients with ulcerative colitis(UC)have an increased risk of thromboembolic events,particularly venous thromboembolism(VTE),which encompasses deep vein thrombosis and pulmonary embolism.The incidence of VTE in patients with UC is significantly higher than that in the general population,and a retrospective cohort study found that patients undergoing colectomy had a notable risk of developing VTE,with rates reaching as high as 22%among patients exposed to tofacitinib within a month prior to surgery.The GETAID FOCUS study also reported a high prevalence of self-reported VTE in patients with UC,with a pooled prevalence of approximately 12%across various studies.The risk of thromboembolism in UC is multifactorial and influenced by chronic inflammation,a wide range of medications used,potential surgical interventions,and possibly genetic factors or associations that are yet to be fully defined.Recognizing the various contributing factors is crucial for developing effective preventive strategies and improving patient outcomes.
文摘BACKGROUND Ulcerative colitis(UC)is a complex inflammatory bowel disease,and its etiology and pathogenesis remain incompletely elucidated.AIM To analyze the effects of Saccharomyces boulardii in combination with sulfasalazine on intestinal microbiota and intestinal barrier function in patients with UC.METHODS A retrospective analysis of clinical data from 127 UC patients admitted to our hospital between January 2021 and January 2023 was conducted.All patients met complete inclusion and exclusion criteria.Based on the treatment interventions received,they were divided into a control group(n=63)and an observation group(n=64).Both groups of patients received routine treatment upon admission.The control group received sulfasalazine in addition to routine interventions,while the observation group received a combination of Saccharomyces boulardii on the basis of the control group’s treatment.The clinical efficacy,improvement in symptoms,modified Baron endoscopic scores,quality of life“inflammatory bowel disease questionnaire(IBDQ)”,levels of intestinal microbial indicators(such as Lactobacillus,Bifidobacterium,Enterococcus,and Escherichia coli),intestinal mucosal barrier function indicators[diamine oxidase(DAO),lipopolysaccharide(LPS),D-lactic acid(D-LA)],and adverse reaction occurrences were compared between the two groups.RESULTS(1)Clinical efficacy:The total effective rate in the control group was 79.37%,while in the observation group,it was 93.75%,significantly higher than that of the control group(P<0.05);(2)Improvement in symptoms:The observation group showed significantly lower relief time for abdominal pain,diarrhea,rectal bleeding,fever symptoms,and mucosal healing time compared to the control group(P<0.05);(3)Baron endoscopic scores and IBDQ scores:Before treatment,there was no significant difference in Baron endoscopic scores and IBDQ scores between the two groups(P>0.05).However,after treatment,the observation group showed significantly lower Baron endoscopic scores and higher IBDQ scores compared to the control group(P<0.05);(4)Levels of intestinal microbial indicators:Before treatment,there was no significant difference in the levels of Lactobacillus,Bifidobacterium,Enterococcus,and Escherichia coli between the two groups(P>0.05).After treatment,the levels of Lactobacillus and Bifidobacterium in the observation group were significantly higher than those in the control group,while the levels of Enterococcus and Escherichia coli were significantly lower than those in the control group(P<0.05);(5)Levels of intestinal mucosal barrier function indicators:Before treatment,there was no significant difference in the levels of DAO,LPS,and D-LA between the two groups(P>0.05).However,after treatment,the levels of DAO,LPS,and D-LA in the observation group were significantly lower than those in the control group(P<0.05);and(6)Occurrence of adverse reactions:The incidence of adverse reactions in the control group was 9.52%,while in the observation group,it was 10.94%.There was no significant difference in the occurrence of adverse reactions between the two groups(P>0.05).CONCLUSION The application of Saccharomyces boulardii in combination with sulfasalazine in UC patients demonstrates significant effectiveness.Compared to sole sulfasalazine intervention,the combined application of Saccharomyces boulardii further promotes the relief of relevant symptoms in patients,alleviates intestinal mucosal inflammation,and improves the quality of life.Its action may be related to rectifying the imbalance in intestinal microbiota and improving intestinal mucosal barrier function.Moreover,the combined use of Saccharomyces boulardii does not increase the risk of adverse reactions in patients,indicating a higher level of medication safety and advocating for its clinical promotion and application.
文摘Ulcerative colitis has baffled researchers since the early 20th century.The pre-vailing explanation attributes the chronic recurring episodes of bloody diarrhea and abdominal pain to some form of immune abnormality,despite the lack of supporting evidence.This highlights the critical need for innovative research directions and methodologies to uncover the cause and develop a cure for this disease.By analyzing existing data from less than a dozen previously published studies,a novel,evidence-based pathogenesis was constructed,implicating colonic epithelial hydrogen peroxide as a causal factor in the development of this disease.This newly identified mechanism informed the creation of a ground-breaking class of therapeutics,known as reducing agents,which have demon-strated remarkable success in resolving colonic inflammation and restoring colonic health in patients with refractory ulcerative colitis.This paper outlines the timeline of these publications and reinterprets the findings within the context of contemporary biomedical science.
文摘Viral myocarditis is a rare but life-threatening complication in patients with ulcerative colitis.Management of myocarditis is primarily supportive,because there are currently no established targeted therapies.Recent studies have increasingly highlighted the association between the gut microbiota and myocarditis.Here,we report a case of acute severe ulcerative colitis complicated by cytomegalovirus and Epstein-Barr virus co-infections that led to viral myocarditis.The patient experienced rapid remission of both intestinal and cardiac symptoms following washed microbiota transplantation,suggesting this intervention may serve as a potential alternative treatment for these life-threatening conditions.
文摘Essential thrombocythemia is classified as a chronic myeloproliferative disorder characterized by the overproduction of platelets stemming from a megakaryocytic clone. The diagnosis primarily relies on bone marrow biopsy findings and the detection of the JAK2 V617F mutation, after the exclusion of secondary thrombocytosis due to conditions such as inflammation, hemolysis, infection, and iron deficiency. On the other hand, Ulcerative colitis represents an inflammatory disorder of the colon. The diagnosis of ulcerative colitis is established through clinical assessment, endoscopic examination, and histological criteria, without a discernible alternative etiology. The concomitant occurrence of these two conditions is infrequent. We present the case of an 85-year-old patient with a history of essential thrombocythemia who exhibited gastrointestinal symptoms characterized by alternating episodes of diarrhea and constipation. A subsequent colonoscopy accompanied by a biopsy revealed histological features consistent with ulcerative colitis. The patient was administered cytoreductive therapy in combination with mesalazine, resulting in favorable outcomes. Current literature addressing this association is limited, indicating the need for further investigative studies to elucidate the causal relationships between these two pathologies and to achieve improved therapeutic management strategies.
文摘BACKGROUND 5-aminosalicylates(5-ASA)are the primary treatment for mild to moderate ulcerative colitis(UC).Maintenance therapy with 5-ASA has been shown to reduce both the risk of relapse and colorectal cancer.AIM To evaluate the outcomes of 5-ASA withdrawal due to non-adherence in UC patients while in remission on monotherapy.METHODS Adult patients with UC who were followed up between July 2019 and April 2025 were screened.Patients in remission receiving 5-ASA monotherapy who experienced treatment withdrawal due to non-adherence were included in this study.RESULTS Among 880 patients with UC,30(3.4%)had 5-ASA withdrawal due to nonadherence while in remission on monotherapy.Twelve patients(40%)had disease relapse after a median of 20 months.The rate of patients in remission was 89%in the first year,decreasing to 73%in the second year,and to 64%in the third year.There were no significant differences between patients with and without relapse in terms of demographics,disease extent,remission duration before 5-ASA withdrawal,previous medications,steroid dependence,5-ASA formulation,baseline inflammatory markers,or partial and endoscopic Mayo scores.Most patients(75%)who experienced relapse were successfully treated with 5-ASA monotherapy,while one-fourth of them required corticosteroids.No patients required biologic agents,hospitalization,or surgical intervention.CONCLUSION Intermittent therapy may be safe and feasible for UC patients,especially those in long-term remission,with treatment interruption up to one year considered acceptable.
