Estudio primario

No clasificado

Severe Clostridium difficile colitis.

Año 1995
Autores Rubin MS , Bodenstein LE , Kent KC
Revista Diseases of the colon and rectum
Enlaces Pubmed
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PURPOSE:

Reports of fatality related to Clostridium difficile colitis and a sharp increase in prevalence of this infection prompted a study of patients who develop a more aggressive form of this disease.

METHODS:

Over 38 months, 710 patients at our institution developed C. difficile colitis. Twenty-one (3 percent) of these patients either required intensive care unit admission or died as a result of their infection. A retrospective, case-controlled study was undertaken to compare these patients, who were considered to have severe C. difficile colitis, with the remaining patients with milder disease.

RESULTS:

Factors that predisposed to the development of severe C. difficile colitis included intercurrent malignancy, chronic obstructive pulmonary disease, immunosuppressive and antiperistaltic medications, renal failure, and administration of clindamycin (P < 0.05 for all). Patients with severe C. difficile colitis were more likely to have abdominal pain, tenderness and distention, peritonitis, hemoconcentration (> 5 points), hypoalbuminemia (< 3 mg/dl), and elevated or suppressed white blood cell count (> 25,000; < 1,500; P < 0.05 for all). These factors were used to create a scoring system that could distinguish between patients with severe C. difficile colitis and those with mild disease. Thirteen patients in the late stages of terminal illness with metastatic malignancy or age > 90 were considered poor or inappropriate surgical candidates. Only the remaining eight patients could have potentially recovered from operation with hope for long-term survival. Of these, seven were treated without colonic resection, and six of the seven survived, whereas one patient underwent colectomy and did not survive.

CONCLUSIONS:

Patients with severe C. difficile colitis can be readily identified. Often they have coexisting illness that precludes operation. In this series, only 1 of 21 patients with severe C. difficile might have benefited from an aggressive surgical approach.

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Revisión sistemática

No clasificado

Probióticos para el tratamiento de la colitis relacionada con el Clostridium difficile en adultos

Traducción oficial
Año 2008
Autores Pillai A , Nelson R
Revista Cochrane database of systematic reviews (Online)
Enlaces DOI , Pubmed
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ANTECEDENTES:


Los probióticos son microorganismos vivos que constan de levaduras y bacterias no patógenas que se cree que restauran el equilibrio microbiano del tubo digestivo alterado por la infección con .

OBJETIVOS:


Evaluar la eficacia de los probióticos en el tratamiento de la colitis asociada al . .

ESTRATEGIA DE BÚSQUEDA:


Se realizaron búsquedas en las bases de datos MEDLINE, EMBASE, el Registro Central Cochrane de Ensayos Controlados y el registro de ensayos especializados del Grupo Cochrane de Enfermedad Inflamatoria Intestinal y Trastornos Funcionales del Intestino (Cochrane IBD/FBD), a fin de ubicar todos los informes publicados desde 1966 hasta 2007.

CRITERIOS DE SELECCIÓN:


Resultaron aptos para su inclusión los estudios aleatorios prospectivos que utilizaron probióticos solos o junto con antibióticos convencionales para el tratamiento de la colitis por documentada.

OBTENCIÓN Y ANÁLISIS DE LOS DATOS:


Dos autores realizaron de forma independiente la extracción y el análisis de los datos.

RESULTADOS PRINCIPALES:


Cuatro estudios cumplieron los criterios de inclusión y fueron incluidos en la revisión. Los cuatro estudios examinaron el uso de probióticos junto con antibióticos convencionales (vancomicina o metronidazol) para el tratamiento de la recurrencia o un episodio inicial de colitis por en adultos. Los estudios fueron de tamaño pequeño y tuvieron problemas metodológicos. Se encontró un beneficio estadísticamente significativo para los probióticos combinados con antibióticos en un estudio. McFarland 1994 encontró que los pacientes que recibían tuvieron significativamente menos probabilidad que los pacientes que recibieron placebo de experimentar recurrencia de diarrea por (RR 0,59; IC del 95%: 0,35 a 0,98). No se encontraron beneficios del tratamiento con probióticos en los otros estudios.

CONCLUSIONES DE LOS AUTORES:


No hay pruebas suficientes para recomendar el tratamiento con probióticos como complemento del tratamiento con antibióticos para la colitis por . No hay pruebas para apoyar el uso de probióticos solos en el tratamiento de la colitis por .

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Estudio primario

No clasificado

Sulphasalazine and salicylazosulphadimidine in ulcerative colitis.

Año 1962
Revista Lancet
Enlaces Pubmed
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Este artículo no tiene resumen

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Estudio primario

No clasificado

Transdermal nicotine for ulcerative colitis.

Año 1997
Autores Guslandi M , Tittobello A
Revista Annals of internal medicine
Enlaces DOI , Pubmed
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Este artículo no tiene resumen

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Estudio primario

No clasificado

Indeterminate colitis: the real story.

Año 2002
Revista Diseases of the colon and rectum
Enlaces DOI , Pubmed
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PURPOSE:

Up to one in five patients undergoing surgery for ulcerative colitis will have ambiguous histology, with features of both ulcerative colitis and Crohn's disease, and are categorized as having indeterminate colitis. We hypothesized that functional outcomes in indeterminate colitis patients undergoing ileal pouch-anal anastomosis are comparable with those of ulcerative colitis patients undergoing ileal pouch-anal anastomosis.

METHODS:

Physician-conducted interviews of 120 consecutive ileal pouch-anal anastomosis patients with a preoperative diagnosis of ulcerative colitis were reviewed, with a mean follow-up of 54 months. All colectomy specimens were reviewed by a single pathologist. Any changes in histologic diagnosis from ulcerative colitis to indeterminate colitis or Crohn's disease, frequency of postoperative complications, pouch function, and long-term postoperative medication usage were recorded.

RESULTS:

Although postoperative fistulas were more common in indeterminate colitis than ulcerative colitis (26 vs. 10 percent; P = 0.02, chi-squared), no indeterminate colitis patient required a permanent ileostomy as compared with six ulcerative colitis patients. Long-term functional results were similar. Overall, two-thirds of patients developed pouchitis. Ulcerative colitis and Crohn's disease patients were more likely to have had >3 episodes of pouchitis (58 and 72 percent) compared with indeterminate colitis patients (29 percent; P = 0.006, chi-squared). A greater number of Crohn's disease patients required maintenance oral antibiotic therapy (64 percent) to achieve satisfactory functional results compared with both indeterminate colitis and ulcerative colitis patients (20 and 28 percent; P = 0.014, chi-squared).

CONCLUSIONS:

Although ileal pouch-anal anastomosis patients with indeterminate colitis have more postoperative fistulas, long-term function is equal to that of ulcerative colitis patients and better than Crohn's disease patients. Ileal pouch-anal anastomosis should be offered to patients with indeterminate colitis and those with severe colitis in whom clear differentiation between indeterminate colitis and ulcerative colitis cannot be made.

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Revisión sistemática

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Cytokine Networks in Animal Models of Colitis-associated Cancer.

Año 2015
Revista Anticancer research
Enlaces Pubmed

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Background/Aim: It is well-known that inflammatory bowel disease (IBD) poses an increased, yet not definitely estimated, risk of colitis-associated colon cancer (CAC), which is considered a more aggressive and distinct in both genetic and molecular levels clinical entity compared to sporadic colorectal cancer (CRC). The present review discusses the cytokine networks involved in CAC-based translational findings from suitable animal models of the disease. Moreover, we summarize the most prominent data concerning the role of Th1, Th2, Th17 and anti-inflammatory cytokines in the pathogenesis of CAC. Last, we briefly address the controversies between basic science findings in IBD and CAC and suggest further directions regarding research on cytokines. This review should serve as a primer for clinicians and surgeons to understand the rapidly evolving field of cytokines in the context of CAC. Materials and Methods: The MEDLINE database was thoroughly searched using the keywords: cytokines, colitis-associated cancer, animal models, carcinogenesis. Additional articles were gathered and evaluated.

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Revisión sistemática

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Type I interferons for induction of remission in ulcerative colitis.

Año 2015
Revista Cochrane Database of Systematic Reviews
Enlaces DOI , PMC , Pubmed
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BACKGROUND:

Interferons (IFNs) are cytokines which possess immunoregulatory properties and have been used to successfully treat a number of chronic inflammatory disorders. It has been postulated that Type I IFNs may be able to re-establish the Th1/Th2 balance in Th2 predominant diseases like ulcerative colitis.

OBJECTIVES:

To systematically evaluate the efficacy and safety of type I IFN therapy for induction of remission in ulcerative colitis.

SEARCH METHODS:

We searched MEDLINE, EMBASE, CENTRAL, the Cochrane IBD/FBD group specialised register, and ClinicalTrials.gov from inception to August 8, 2014. Reference lists of trials and review articles, as well as recent proceedings from major gastroenterology meetings were manually searched.

SELECTION CRITERIA:

Randomised controlled trials of type I IFNs for induction of remission in UC were included. The study population included patients of any age with active ulcerative colitis. There were no exclusions based on type, dose or duration of IFN treatment.

DATA COLLECTION AND ANALYSIS:

Two independent authors reviewed studies for eligibility, extracted the data and assessed study quality using the Cochrane risk of bias tool. The overall quality of the evidence supporting the outcomes was evaluated using the GRADE criteria. The primary outcome was induction of remission of ulcerative colitis. Secondary outcomes included: time to remission, mean change in disease activity index score, clinical, histological or endoscopic improvement, improvement in quality of life, and adverse events. We calculated the risk ratio (RR) and corresponding 95% confidence interval (CI) for dichotomous outcomes. We calculated the mean difference and corresponding 95% confidence interval for continuous outcomes. Meta-analysis was performed using RevMan 5.3.5 software.

MAIN RESULTS:

Six studies were eligible for inclusion (517 patients). Five studies compared type I IFNs to placebo injections (485 patients) and a single study compared IFNs to prednisolone enemas in patients with left-sided colitis (32 patients). The active comparator study was rated as high risk of bias due to an open-label design. Three studies were rated as unclear risk of bias for random sequence generation and allocation concealment. Two studies described as double blind were rated as unclear risk of bias for blinding. There was no significant benefit of type I IFNs over placebo for inducing clinical remission or improvement in patients with active ulcerative colitis. Thirty-six per cent (87/242) of patients in the type I IFNs group achieved clinical remission by 8 to 12 weeks compared to 30% (36/120) of placebo patients (RR 1.16, 95% CI 0.84 to 1.58; 4 studies, 362 patients). A GRADE analysis indicated that the overall quality of the evidence supporting the outcome clinical remission was moderate due to sparse data (123 events). Fifty-six per cent (149/264) of patients in the type I IFNs group improved clinically by 8 to 12 weeks compared to 48% (77/161) of placebo patients (RR 1.16, 95% CI 0.96 to 1.40; 4 studies, 425 patients). A GRADE analysis indicated that the overall quality of the evidence supporting the outcome clinical improvement was moderate due to sparse data (226 events). Patients who received type I IFNs were significantly more likely to withdraw from the studies due to adverse events than those who received placebo. Seven per cent (18/42) of type I IFNs patients withdrew due to adverse events compared to 2% (3/152) of placebo patients (RR 3.16, 95% CI 1.06 to 9.40). A GRADE analysis indicated that the overall quality of the evidence supporting the outcome withdrawal due to adverse events was low due to very sparse data (21 events). The study comparing type I IFNs to prednisolone enemas found no difference between the treatment groups in quality of life or disease activity scores. Common adverse events included headaches, arthralgias, myalgias, fatigue, back pain, nausea, application site reactions, rigors, and fevers. There were no statistically significant differences in the other secondary outcomes.

AUTHORS' CONCLUSIONS:

Moderate quality evidence suggests that type I IFNs are not effective for the induction of remission in UC. In addition, there are concerns regarding the tolerability of this class of treatment.

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Revisión sistemática

No clasificado

Defining surgical therapy for pseudomembranous colitis with toxic megacolon.

Año 2008
Revista Journal of clinical gastroenterology
Enlaces DOI , Pubmed
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BACKGROUND:

Pseudomembranous colitis has increased in incidence and severity over the past 10 years. Toxic megacolon is a rare but reported presentation of severe pseudomembranous colitis. This article reviews the reported cases of Clostridium difficile with toxic megacolon in the literature and introduces an additional case that underscores the importance of early diagnosis in guiding appropriate therapy.

METHODS:

A systematic review of the literature was performed to identify previous reports of pseudomembranous colitis presenting with toxic megacolon, and the outcomes of each of these cases was analyzed. The review was focused on atypical presentations in immunocompromised patients.

RESULTS:

Seventeen cases of C. difficile colitis presenting as toxic megacolon were identified. The overall mortality rate was 50% (9/18). Fifteen patients underwent surgery with an associated mortality rate of 50%. Thirteen patients had a subtotal colectomy. Seven of the patients (39%) were taking immunosuppressant medications, and 5 (28%) patients presented with atypical symptoms. Three (76%) of those were immunosuppressed. In several cases, failure to make an early diagnosis of C. difficile colitis resulted in a worse outcome because appropriate therapy was delayed.

CONCLUSIONS:

Toxic megacolon is well-established as an unusual presentation of C. difficile colitis. These patients are less likely to present with typical symptoms such as diarrhea or typical risk factors like recent administration of antibiotics, so diagnosis can be a challenge. A patient presenting with toxic megacolon without a history of inflammatory bowel disease should be assumed to have C. difficile colitis until proven otherwise, and medical or surgical therapy administered accordingly.

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Revisión sistemática

No clasificado

Systematic review: the costs of ulcerative colitis in Western countries.

Año 2010
Autores Cohen RD , Yu AP , Wu EQ , Xie J , Mulani PM , Chao J
Revista Alimentary pharmacology & therapeutics
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BACKGROUND:

Early onset and complications such as hospitalization and surgery contribute to the economic burden of ulcerative colitis.

AIM:

To review systematically the literature on costs of ulcerative colitis in Western countries.

METHODS:

Studies estimating costs of ulcerative colitis in Western countries were identified using Medline, EMBASE and ISI Web of Science and were rated based on relevance and reliability of estimates. All costs were adjusted to 2008 currency values. A parallel review focused on the impact of disease severity on costs, hospitalizations and surgeries.

RESULTS:

Estimated annual per-patient direct medical costs of ulcerative colitis ranged from $6217 to $11,477 in the United States and from euro8949 to euro10,395 in Europe. Hospitalizations accounted for 41-55% of direct medical costs. Indirect costs accounted for approximately one-third of total costs in the United States and 54-68% in Europe. Total economic burden of ulcerative colitis was estimated at $8.1-14.9 billion annually in the United States and at euro12.5-29.1 billion in Europe; total direct costs were $3.4-8.6 billion in the United States and euro5.4-12.6 billion in Europe. Direct costs, hospitalizations and surgeries increased with worsening disease severity.

CONCLUSIONS:

Ulcerative colitis is a costly disease. Hospitalizations contribute significantly to direct medical costs, and indirect costs are considerable, having previously been substantially underestimated.

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Revisión sistemática

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A meta-analysis of antibiotic therapy for active ulcerative colitis.

Año 2007
Autores Rahimi R , Nikfar S , Rezaie A , Abdollahi M
Revista Digestive diseases and sciences
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To systematically evaluate the efficacy of antibacterial therapy in ulcerative colitis, we carried out a meta-analysis of controlled clinical trials. Within the time period 1966 through September 2006, PUBMED, EMBASE, and SCOPUS were searched for clinical trial studies that investigated the efficacy of antibiotics in ulcerative colitis. We considered clinical remission as our key outcome of interest. Of 122 studies, 10 randomized placebo-controlled clinical trials matched our criteria and were included in the analysis (530 patients). All the studies used antibiotics as an adjunct therapy to conventional treatment of ulcerative colitis (i.e., corticosteroids and 5-aminosalycilic acid). Pooling of these trials yielded odds ratio (OR) of 2.14 (95% confidence interval [CI], 1.48-3.09; P<0.0001) in favor of antimicrobial therapy. Meta-analysis of short-term trials (5-14 days) showed a higher rate of clinical remission in patients treated with antibiotics (OR, 2.02; 95% CI, 1.36-3). These results suggest that adjunctive antibacterial therapy is effective for induction of clinical remission in ulcerative colitis.

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