Management of acute severe ulcerative colitis in children

Siow, Vei Shaun; Bhatt, Riha; Mollen, Kevin P.

doi:10.1053/j.sempedsurg.2017.10.006

Cited by 26 publications

(14 citation statements)

References 100 publications

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“…Current studies have shown that the pathogenesis of UC is complex, involving the combined effects of various factors such as genetic susceptibility, epithelial barrier defects, dysregulated immune responses, and environmental factors [ 4 , 5 ]. The main treatments for UC include the following: (1) Sulfasalazine salicylic acid preparations, such as Mesalazine; (2) corticosteroids, such as prednisone or dexamethasone; and (3) immunosuppressants [ 6 , 7 ]. However, these drugs are limited due to their limited clinical efficacy and large side effects.…”

Section: Introductionmentioning

confidence: 99%

Exploring the Mechanism of Berberine Intervention in Ulcerative Colitis from the Perspective of Inflammation and Immunity Based on Systemic Pharmacology

Jiang

Zhao

Chen

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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Background. Ulcerative colitis (UC) is a chronic nonspecific inflammatory disease of the colon and rectum. Recent studies found that berberine had effects on inflammatory diseases and immune diseases. Methods. The PharmMapper database was used to predict the berberine potential target and GeneCards database and OMIM database were utilized to collect UC genes. The Cytoscape software was used to construct and analyze the networks and DAVID was utilized to perform enrichment analysis. Then, animal experiments were performed to validate the prediction results. The experimental rats were randomly divided into normal group (control group), model group, and berberine group. The general condition, body weight, gross morphology of colon tissue, and colonic mucosal damage index (CMDI) score were observed. The pathological changes of colon tissue were observed by H&E staining. The levels of serum interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and IL-4 were detected by ELISA. The expressions of IL-1β, TNF-α, and IL-4 protein in colon tissue were detected by immunohistochemistry. Results. A total of 211 Berberine’s potential targets and 210 UC genes were obtained. The enrichment analysis showed that berberine may regulate inflammation, inflammatory cytokines, and their mediated inflammation signal pathways such as inflammatory bowel disease (IBD), rheumatoid arthritis, cytokine-cytokine receptor interaction, TNF, T cell receptor, Toll-like receptor, and JAK/STAT signaling pathway. Compared with the model group, the body mass of rats in the berberine group was significantly increased ( P < 0.05); the general morphology and pathological changes of colon tissue were significantly improved; CMDI score, serum and colon tissue IL-1β, TNF-α content, and protein expression were decreased significantly ( P < 0.05); and IL-4 content and protein expression increased significantly ( P < 0.05). Conclusion. Berberine can interfere with UC through related biological processes and signal pathways related to inflammation and immunity. In-depth exploration of the mechanism of berberine in the treatment of UC will provide a basis for clinical application.

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Section: Introductionmentioning

confidence: 99%

Exploring the Mechanism of Berberine Intervention in Ulcerative Colitis from the Perspective of Inflammation and Immunity Based on Systemic Pharmacology

Jiang

Zhao

Chen

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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“…Elective procedures (one, two, or three stage operations) are generally for curative intent and are indicated when the patient has been diagnosed with early malignant disease or when the patient has become steroid dependent for adequate symptom control. Emergent (two or three stage operations) procedures are performed for acute complications of the disease including toxic megacolon, perforation, and uncontrolled bleeding (5,8). This dichotomy between indications for surgery was evident in our cohort as the majority of proctocolectomies in our patient population (74%) were performed electively.…”

Section: Discussionmentioning

confidence: 95%

“…Medical management is the mainstay for treatment, but surgical intervention plays a role in the more advanced or severe presentations. It is often reserved for those who are critically ill or are refractory to medical management, resulting in a high proportion of urgent or emergent cases (8). For those requiring surgery, the two most common surgical procedures in the US are total colectomy and total proctocolectomy (9).…”

Section: Introductionmentioning

confidence: 99%

A retrospective comparison of outcomes for open vs. laparoscopic surgical techniques in pediatric ulcerative colitis

Willobee

Nguyen

Ferrantella

et al. 2021

Transl Gastroenterol Hepatol

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Background: Ulcerative colitis (UC) is an aggressive disease in the pediatric population and a cause of significant, lifelong morbidity. The aim of this study is to compare surgical complications in pediatric patients undergoing laparoscopic vs. open surgical treatment for UC.Methods: We queried the Kids' Inpatient Database (KID) for all cases of UC undergoing surgical treatment in 2009 and 2012. We identified patients who received total colectomy without proctectomy (n=413) or total proctocolectomy (n=196) and performed univariate and multivariate analyses comparing laparoscopic vs. open procedures. Results:In pediatric UC patients undergoing total colectomy without proctectomy, open procedures were associated with more complications than laparoscopic, including fluid and electrolyte disorders (40% vs. 28%), surgical wound dehiscence (6% vs. 2%), septicemia (18% vs. 2%), and gastrointestinal disorders (16% vs. 7%) among others, all P<0.05. Likewise, in patients with UC undergoing total proctocolectomy, there were more complications in open vs. laparoscopic technique, including increased transfusion requirements (25% vs. 7%, P=0.001) and significantly more gastrointestinal upset, including nausea, vomiting, and diarrhea (11% vs. 1%, P=0.003). In multivariate analysis, patients who underwent total colectomy with or without proctectomy had an increased risk of experiencing any complication when their procedure was performed in an open or non-elective fashion (all odds ratio >2.4; all P<0.001). Conclusions:The laparoscopic approach was associated with significantly lower rates of surgical complications in pediatric patients undergoing total colectomy with or without proctectomy for UC. These findings demonstrate that laparoscopic technique compares favorably, and may be preferable, to the open approach in selected pediatric patients with UC.

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“…Nevertheless, pediatric IBD patients have been generally thought to present more common UGI involvement than adult patients. This discrepancy may be because UGI endoscopy was less routinely performed on asymptomatic adult patients with IBD than on their pediatric counterparts[ 20 ]. UC patients receive targeted treatment at various organizations ranging from community hospitals and public hospitals to clinics.…”

Section: Introductionmentioning

confidence: 99%

Mucosal lesions of the upper gastrointestinal tract in patients with ulcerative colitis: A review

Sun¹,

Zhang²,

Cheng³

et al. 2021

WJG

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Ulcerative colitis (UC) is a chronic, nonspecific, relapsing inflammatory bowel disease. The colorectum is considered the chief target organ of UC, whereas upper gastrointestinal (UGI) tract manifestations are infrequent. Recently, emerging evidence has suggested that UC presents complications in esophageal, stomachic, and duodenal mucosal injuries. However, UC-related UGI tract manifestations are varied and frequently silenced or concealed. Moreover, the endoscopic and microscopic characteristics of UGI tract complicated with UC are nonspecific. Therefore, UGI involvement may be ignored by many clinicians. In addition, no standard criteria have been established for patients with UC who should undergo fibrogastroduodenoscopy. Furthermore, specific treatment recommendations may be needed for patients with UC-associated UGI lesions. Herein, we review the esophageal, gastric, and duodenal mucosal lesions of the UC-associated UGI tract, as well as the potential pathogenesis and therapy.

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Management of acute severe ulcerative colitis in children

Cited by 26 publications

References 100 publications

Exploring the Mechanism of Berberine Intervention in Ulcerative Colitis from the Perspective of Inflammation and Immunity Based on Systemic Pharmacology

Exploring the Mechanism of Berberine Intervention in Ulcerative Colitis from the Perspective of Inflammation and Immunity Based on Systemic Pharmacology

A retrospective comparison of outcomes for open vs. laparoscopic surgical techniques in pediatric ulcerative colitis

Mucosal lesions of the upper gastrointestinal tract in patients with ulcerative colitis: A review

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