Ahmed Mohamed Ali Hussein Alhurry, A. Rezaianzadeh, S. Rahimikazerooni, Mohammad Abdzaid Akool, F. Bahrami, Seyedeh Saeedeh Shahidinia, Mahboobeh Pourahmad
Background: Colorectal cancer (CRC) accounts for about 10% of cancers and is the third most prevalent cancer worldwide. It is also one of the leading causes of cancer-related mortality. The objective of the current study was to investigate the incidence of CRC East by reviewing reports on number and age standardized incidences of CRC in both genders in different areas of the Middle East. Methods: All the published reports citing the incidence of CRC in the Middle East were collected by conducting a literature search using Pubmed. Data was extracted from the included articles, and summarized in tables and charts, according to “country of origin”, “gender”, and “ASR”. Data presented by GLOBOCAN on the incidence/prevalence and mortality rates of CRC are also showed in separate charts and tables. Results: This research identified 194 articles, through the Pubmed search. After removing duplicate and triplicate publications, 96 full-text articles were assessed for eligibility and 78 were excluded. According to data from Reviewed articles, the highest and the lowest ASR for colorectal cancer were respectively 48.3 (European-American Jews) and 4.2 (Shiraz, south Iran) in males and 35 (European-American Jews) and 2.72 (Shiraz, south Iran) in females (1, 2). According to GLOBOCAN, the highest ASR was 35 (Israel) and the lowest was 4.48 (Yemen) in both genders. Except for Jews, the mean age of patients was 53 to 54.9. Conclusions: Although Middle East is generally a low risk region for CRC, the incidence rate of CRC is more in western regions, including countries located on the coast of the Mediterranean sea, compared to eastern and southern regions. Moreover, males and females are at risk at younger ages compared to western countries.
{"title":"A Review of the Incidence of Colorectal Cancer in the Middle East","authors":"Ahmed Mohamed Ali Hussein Alhurry, A. Rezaianzadeh, S. Rahimikazerooni, Mohammad Abdzaid Akool, F. Bahrami, Seyedeh Saeedeh Shahidinia, Mahboobeh Pourahmad","doi":"10.5812/ACR.46292","DOIUrl":"https://doi.org/10.5812/ACR.46292","url":null,"abstract":"Background: Colorectal cancer (CRC) accounts for about 10% of cancers and is the third most prevalent cancer worldwide. It is also one of the leading causes of cancer-related mortality. The objective of the current study was to investigate the incidence of CRC East by reviewing reports on number and age standardized incidences of CRC in both genders in different areas of the Middle East. Methods: All the published reports citing the incidence of CRC in the Middle East were collected by conducting a literature search using Pubmed. Data was extracted from the included articles, and summarized in tables and charts, according to “country of origin”, “gender”, and “ASR”. Data presented by GLOBOCAN on the incidence/prevalence and mortality rates of CRC are also showed in separate charts and tables. Results: This research identified 194 articles, through the Pubmed search. After removing duplicate and triplicate publications, 96 full-text articles were assessed for eligibility and 78 were excluded. According to data from Reviewed articles, the highest and the lowest ASR for colorectal cancer were respectively 48.3 (European-American Jews) and 4.2 (Shiraz, south Iran) in males and 35 (European-American Jews) and 2.72 (Shiraz, south Iran) in females (1, 2). According to GLOBOCAN, the highest ASR was 35 (Israel) and the lowest was 4.48 (Yemen) in both genders. Except for Jews, the mean age of patients was 53 to 54.9. Conclusions: Although Middle East is generally a low risk region for CRC, the incidence rate of CRC is more in western regions, including countries located on the coast of the Mediterranean sea, compared to eastern and southern regions. Moreover, males and females are at risk at younger ages compared to western countries.","PeriodicalId":8370,"journal":{"name":"Annals of Colorectal Research","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89396296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Inflammatory bowel disease (IBD) questionnaire is a disease-specific questionnaire to measure the health related quality of life (QOL) in patients with inflammatory bowel disease. Objectives: The current study aimed at assessing the validity of the Persian version of the QOL questionnaire in patients with inflammatory bowel disease referred to the clinics and hospitals affiliated to Birjand University of Medical Sciences, Iran. Methods: The current cross sectional study included 87 patients who referred to the clinics and hospitals affiliated to Birjand University of Medical Sciences from 2014 to 2015; IBD diagnosis was confirmed in the subjects by the pathological analyses and accordingly they were asked to complete the Persian version of IBDQ. Data were analyzed by SPSS (15) using descriptive statistics, internal consistency reliability, construct validity (by the short-form 36), and factor analysis was used for the structural validity of the questionnaire. Results: A total of 87 patients with the mean age of 38.80 ± 16.17 years enrolled in the study. Mean score of QOL based on IBDQ questionnaire, was 158.99 ± 24.9 out of 224. The factor analysis of the Persian version did not confirm the structural factor of the original questionnaire. Cronbach’s alpha for the questionnaire was 0.94, in domains from 0.68 to 0.89. The correlation between the domains of QOL in IBDQ and SF-36 inventory were 0.44 to 0.69 Conclusions: Due to the high internal consistency and correlation coefficients with SF-36 inventory, it can be used in the studies to evaluate the QOL in the patients.
{"title":"Validation of the Persian Version of Inflammatory Bowel Disease Questionnaire in Patients Who Referred to Clinics and Hospitals of Birjand University of Medical Sciences, Iran","authors":"B. Bijari, B. Soltani","doi":"10.5812/ACR.46367","DOIUrl":"https://doi.org/10.5812/ACR.46367","url":null,"abstract":"Background: Inflammatory bowel disease (IBD) questionnaire is a disease-specific questionnaire to measure the health related quality of life (QOL) in patients with inflammatory bowel disease. Objectives: The current study aimed at assessing the validity of the Persian version of the QOL questionnaire in patients with inflammatory bowel disease referred to the clinics and hospitals affiliated to Birjand University of Medical Sciences, Iran. Methods: The current cross sectional study included 87 patients who referred to the clinics and hospitals affiliated to Birjand University of Medical Sciences from 2014 to 2015; IBD diagnosis was confirmed in the subjects by the pathological analyses and accordingly they were asked to complete the Persian version of IBDQ. Data were analyzed by SPSS (15) using descriptive statistics, internal consistency reliability, construct validity (by the short-form 36), and factor analysis was used for the structural validity of the questionnaire. Results: A total of 87 patients with the mean age of 38.80 ± 16.17 years enrolled in the study. Mean score of QOL based on IBDQ questionnaire, was 158.99 ± 24.9 out of 224. The factor analysis of the Persian version did not confirm the structural factor of the original questionnaire. Cronbach’s alpha for the questionnaire was 0.94, in domains from 0.68 to 0.89. The correlation between the domains of QOL in IBDQ and SF-36 inventory were 0.44 to 0.69 Conclusions: Due to the high internal consistency and correlation coefficients with SF-36 inventory, it can be used in the studies to evaluate the QOL in the patients.","PeriodicalId":8370,"journal":{"name":"Annals of Colorectal Research","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85431558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Robin Irons, Michael E. Kwiatt, M. Minarich, J. Gaughan, F. Spitz, S. McClane
Background: Ideal operative timing for non-emergent, acute diverticulitis (AD) remains unclear. Medical management is initially attempted to convert a high risk urgent surgery to a less morbid elective surgery, or to avoid surgery altogether. A large proportion of patients will fail medical treatment and require colectomy. Objectives: To evaluate the effect of operative delay on sepsis and mortality in patients with AD. Methods: Patients from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database who underwent colectomy with a primary diagnosis of diverticulitis between 2005 and 2014 were included. Multiple patient variables were analyzed to see their combined effect on death and sepsis. Patients undergoing surgical intervention on hospital day 0, emergent cases and those with preoperative sepsis were excluded. The impact of operative delay on mortality and sepsis was evaluated using day from admission as the predictor of the primary outcomes. Secondary outcomes included urinary tract infection (UTI), pneumonia (PNA), need for blood transfusion, septic shock, return to the operating room, length of stay (LOS), readmission, wound dehiscence, and surgical site infections (SSI). Frequency of patient variables was recorded and a multiple variable logistic regression analysis was performed to control for possible confounders. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for primary and secondary outcomes. Results: 32,399 patients underwent colectomy for AD on hospital day 1 20. Adjusted for other factors, days to operation was found to be a significant predictor for death (OR = 1.038, 95% CI 1.020 1.057; P < 0.0001) and sepsis (OR = 1.051, 95% CI, 1.035 1.067; P < 0.0001). Each day in which surgical intervention was delayed was associated with a 3.8% increased risk of mortality and 5.1% increased risk of sepsis. Delay of surgery was also associated with an increased risk of blood transfusion, return to the operating room and increased LOS. Conclusions: Delaying operation for patients with AD has a significant impact on sepsis and mortality. While non-operative approaches may be attempted, with each additional day operative therapy is delayed there is a significant increase in the risk of morbidity and mortality. This data suggests that surgeons should pursue operative therapy earlier in the hospital course to improve patient outcomes.
{"title":"Impact of Operative Delay on Sepsis and Mortality in Patients with Acute Diverticulitis","authors":"Robin Irons, Michael E. Kwiatt, M. Minarich, J. Gaughan, F. Spitz, S. McClane","doi":"10.5812/ACR.48494","DOIUrl":"https://doi.org/10.5812/ACR.48494","url":null,"abstract":"Background: Ideal operative timing for non-emergent, acute diverticulitis (AD) remains unclear. Medical management is initially attempted to convert a high risk urgent surgery to a less morbid elective surgery, or to avoid surgery altogether. A large proportion of patients will fail medical treatment and require colectomy. Objectives: To evaluate the effect of operative delay on sepsis and mortality in patients with AD. Methods: Patients from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database who underwent colectomy with a primary diagnosis of diverticulitis between 2005 and 2014 were included. Multiple patient variables were analyzed to see their combined effect on death and sepsis. Patients undergoing surgical intervention on hospital day 0, emergent cases and those with preoperative sepsis were excluded. The impact of operative delay on mortality and sepsis was evaluated using day from admission as the predictor of the primary outcomes. Secondary outcomes included urinary tract infection (UTI), pneumonia (PNA), need for blood transfusion, septic shock, return to the operating room, length of stay (LOS), readmission, wound dehiscence, and surgical site infections (SSI). Frequency of patient variables was recorded and a multiple variable logistic regression analysis was performed to control for possible confounders. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for primary and secondary outcomes. Results: 32,399 patients underwent colectomy for AD on hospital day 1 20. Adjusted for other factors, days to operation was found to be a significant predictor for death (OR = 1.038, 95% CI 1.020 1.057; P < 0.0001) and sepsis (OR = 1.051, 95% CI, 1.035 1.067; P < 0.0001). Each day in which surgical intervention was delayed was associated with a 3.8% increased risk of mortality and 5.1% increased risk of sepsis. Delay of surgery was also associated with an increased risk of blood transfusion, return to the operating room and increased LOS. Conclusions: Delaying operation for patients with AD has a significant impact on sepsis and mortality. While non-operative approaches may be attempted, with each additional day operative therapy is delayed there is a significant increase in the risk of morbidity and mortality. This data suggests that surgeons should pursue operative therapy earlier in the hospital course to improve patient outcomes.","PeriodicalId":8370,"journal":{"name":"Annals of Colorectal Research","volume":"149 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91550839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Water used as a single sharp stream in toilet commode for post defecation cleansing is a common practice in several countries across the globe including India. Repeated hitting of the anus by water stream could potentially cause injury to the anal canal epithelium and lead to development of fissure-in-ano. As the water stream is emanating from the backside of the toilet commode, the possible injury, if any, would be on the anterior anal canal. Objectives: The present study aimed at determining whether water stream usage in toilet commodes increased the incidence of anterior fissure-in-ano; this was determined by the incidence of anterior fissure-in-ano the study and control groups. Methods: All consecutive fissure-in-ano patients referring to a colorectal clinic from February 2012 to 2015 were included in the study. The patients were classified as a study group (who were using water stream for cleansing purposes in toilet commodes) and a control group (patients who were not using water stream). The characteristics and location (position) of the fissure-in-ano was noted. Results: Inthisstudy,165patientswereprospectivelyenrolled. Male/femaleratiowas96/69,andthemeanagewas36.3 ± 11.2years. The anterior fissure-in-ano in the study group was 55.9% (47/84), while it was 17.3 % (14/81) in the control group (P < 0.0001, odds ratio: 6.08, 95% CI: 2.96 - 12.47]. Conclusions: Water used as a single sharp stream to cleanse after defecation in toilet commodes is hazardous and should be avoided.
{"title":"Water Stream in Bidet Toilet Commode as a Cause of Anterior Anal Fissure: A Case-Control Study","authors":"P. Garg, Pratiksha Singh","doi":"10.5812/ACR.46479","DOIUrl":"https://doi.org/10.5812/ACR.46479","url":null,"abstract":"Background: Water used as a single sharp stream in toilet commode for post defecation cleansing is a common practice in several countries across the globe including India. Repeated hitting of the anus by water stream could potentially cause injury to the anal canal epithelium and lead to development of fissure-in-ano. As the water stream is emanating from the backside of the toilet commode, the possible injury, if any, would be on the anterior anal canal. Objectives: The present study aimed at determining whether water stream usage in toilet commodes increased the incidence of anterior fissure-in-ano; this was determined by the incidence of anterior fissure-in-ano the study and control groups. Methods: All consecutive fissure-in-ano patients referring to a colorectal clinic from February 2012 to 2015 were included in the study. The patients were classified as a study group (who were using water stream for cleansing purposes in toilet commodes) and a control group (patients who were not using water stream). The characteristics and location (position) of the fissure-in-ano was noted. Results: Inthisstudy,165patientswereprospectivelyenrolled. Male/femaleratiowas96/69,andthemeanagewas36.3 ± 11.2years. The anterior fissure-in-ano in the study group was 55.9% (47/84), while it was 17.3 % (14/81) in the control group (P < 0.0001, odds ratio: 6.08, 95% CI: 2.96 - 12.47]. Conclusions: Water used as a single sharp stream to cleanse after defecation in toilet commodes is hazardous and should be avoided.","PeriodicalId":8370,"journal":{"name":"Annals of Colorectal Research","volume":"122 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78442352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ahmed Mohamed Ali Hussein Alhurry, Masoomeh Rahimi
{"title":"Does CT Imaging Change the Clinical Management in Patients with Suspected Acute Colonic Diverticulitis","authors":"Ahmed Mohamed Ali Hussein Alhurry, Masoomeh Rahimi","doi":"10.5812/ACR.46002","DOIUrl":"https://doi.org/10.5812/ACR.46002","url":null,"abstract":"","PeriodicalId":8370,"journal":{"name":"Annals of Colorectal Research","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84613270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Perianal abscesses remain one of the most frequent surgical cases encountered by both general and colorectal surgeons. The use of broad-spectrum empirical antibiotics for perianal abscesses after drainage also remains common, although with questionable benefit. Objectives: The aim of the study conducted was to evaluate the role and efficacy of intraand post-operative empirical antibiotic combination with a wide antibacterial spectrum for the treatment of perianal abscess and fistula-in-ano. Methods: An observational longitudinal study consisted of 150 patients; 50% of them underwent incision and drainage of their perianal abscess. The rest had fistula-in-ano and were treated with fistulotomy. Patients were prescribed a course of empiric antibiotics at the time of diagnosis. The prescribed antibiotic consisted of two regimes. The mechanism of the first regime was based on inhibiting bacterial cell wall synthesis, whereas the second regime included antibiotics inhibiting protein synthesis of the bacteria. Afterwards, analysis of the effect of postoperative use of empiric antibiotics was performed regarding symptom assessment, recurrence rate of abscess, fistula formation, cellulitis, bacteremia and sepsis. Results: Among 150 patients included in the study, 92% were male and 8% were female. The age range was 20 to 66 years (mean 39.97 ± 0.16 years). Seventy-five of them had perianal abscess and the rest had fistula-in-ano. They were prescribed a course of empiric antibiotics. Patients who had perianal abscess showed an abscess recurrence rate of 10% and 5% after six and twelve months respectively. Perianal fistula formation occurred at the rate of 25% and 5% after six and twelve months respectively when Lincomycin treatment was used. Patients with perianal fistula treated with both fistulotomy and Lincomycin were followed up for six and twelve months. Follow-up showed an 11.42% rate of abscess formation after six months, however no recurrence of fistula was found. Conclusions: The results of this study concluded that antibiotics administered after incision and drainage had reduced the rate of fistula formation, abscess recurrence, cellulitis and sepsis. Our limited patient sampling does not provide a definite conclusion, although it is clear that fistula formation is of clinical importance in the role of empiric antibiotics in preventing recurrence and merits further study.
{"title":"Postoperative Empirical Antibiotic Use for Uncomplicated Perianal Abscess and Fistula","authors":"R. Hasan","doi":"10.5812/ACR.40795","DOIUrl":"https://doi.org/10.5812/ACR.40795","url":null,"abstract":"Background: Perianal abscesses remain one of the most frequent surgical cases encountered by both general and colorectal surgeons. The use of broad-spectrum empirical antibiotics for perianal abscesses after drainage also remains common, although with questionable benefit. Objectives: The aim of the study conducted was to evaluate the role and efficacy of intraand post-operative empirical antibiotic combination with a wide antibacterial spectrum for the treatment of perianal abscess and fistula-in-ano. Methods: An observational longitudinal study consisted of 150 patients; 50% of them underwent incision and drainage of their perianal abscess. The rest had fistula-in-ano and were treated with fistulotomy. Patients were prescribed a course of empiric antibiotics at the time of diagnosis. The prescribed antibiotic consisted of two regimes. The mechanism of the first regime was based on inhibiting bacterial cell wall synthesis, whereas the second regime included antibiotics inhibiting protein synthesis of the bacteria. Afterwards, analysis of the effect of postoperative use of empiric antibiotics was performed regarding symptom assessment, recurrence rate of abscess, fistula formation, cellulitis, bacteremia and sepsis. Results: Among 150 patients included in the study, 92% were male and 8% were female. The age range was 20 to 66 years (mean 39.97 ± 0.16 years). Seventy-five of them had perianal abscess and the rest had fistula-in-ano. They were prescribed a course of empiric antibiotics. Patients who had perianal abscess showed an abscess recurrence rate of 10% and 5% after six and twelve months respectively. Perianal fistula formation occurred at the rate of 25% and 5% after six and twelve months respectively when Lincomycin treatment was used. Patients with perianal fistula treated with both fistulotomy and Lincomycin were followed up for six and twelve months. Follow-up showed an 11.42% rate of abscess formation after six months, however no recurrence of fistula was found. Conclusions: The results of this study concluded that antibiotics administered after incision and drainage had reduced the rate of fistula formation, abscess recurrence, cellulitis and sepsis. Our limited patient sampling does not provide a definite conclusion, although it is clear that fistula formation is of clinical importance in the role of empiric antibiotics in preventing recurrence and merits further study.","PeriodicalId":8370,"journal":{"name":"Annals of Colorectal Research","volume":"41 1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91016590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Expanding over Crohn’s disease in the Far East, and easily biased to chronicity, ulcerative colitis (UC) continues to pose a challenge. Traditional remedies have been based on control of inflammation and immune suppression, effected by such classic drugs as mesalamines, corticosteroids, and thiopurines. However, these molecules have long proven unable to fully control the disease or modify disease history, leaving an alternative fully desirable. Objectives: In this study, we aimed at highlighting the indications for biological therapy in UC. Methods: Literature review. Results: Recently, it has been demonstrated that the proinflammatory cytokine tumor necrosis factor (TNF) plays a significant role in UC, opening a way for anti-TNF biologics to join the therapeutic arsenal. These monoclonal antibodies, now available as hybrids or fully human preparations, are able to attain at least 50% response rate of refractory UC. However, primary non-response amounts to 20% 40%, and loss of response to 40%. Optimization protocols allow for biologic molecule switching (disease symptoms, antibody positive) or replacement with another drug class (symptoms but no antibodies). Infectious/neoplastic /autoimmune toxicities together with high costs continue to be a problem (52%). Conclusions: These results warrant further therapeutic leaps forward: personalized therapy plans based on the patiens’ genetic profile, and pre-emptive measures based on people’s education to modify diet and life habits.
{"title":"Biologics for Ulcerative Colitis: Status of the Art and General Considerations","authors":"G. Actis","doi":"10.5812/ACR.42868","DOIUrl":"https://doi.org/10.5812/ACR.42868","url":null,"abstract":"Background: Expanding over Crohn’s disease in the Far East, and easily biased to chronicity, ulcerative colitis (UC) continues to pose a challenge. Traditional remedies have been based on control of inflammation and immune suppression, effected by such classic drugs as mesalamines, corticosteroids, and thiopurines. However, these molecules have long proven unable to fully control the disease or modify disease history, leaving an alternative fully desirable. Objectives: In this study, we aimed at highlighting the indications for biological therapy in UC. Methods: Literature review. Results: Recently, it has been demonstrated that the proinflammatory cytokine tumor necrosis factor (TNF) plays a significant role in UC, opening a way for anti-TNF biologics to join the therapeutic arsenal. These monoclonal antibodies, now available as hybrids or fully human preparations, are able to attain at least 50% response rate of refractory UC. However, primary non-response amounts to 20% 40%, and loss of response to 40%. Optimization protocols allow for biologic molecule switching (disease symptoms, antibody positive) or replacement with another drug class (symptoms but no antibodies). Infectious/neoplastic /autoimmune toxicities together with high costs continue to be a problem (52%). Conclusions: These results warrant further therapeutic leaps forward: personalized therapy plans based on the patiens’ genetic profile, and pre-emptive measures based on people’s education to modify diet and life habits.","PeriodicalId":8370,"journal":{"name":"Annals of Colorectal Research","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73570602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Tanideh, M. Bahrani, M. J. Khoshnood-Mansoorkhani, D. Mehrabani, D. Firoozi, O. koohi-Hosseinabadi, A. Iraji
Background: Ulcerative colitis (UC) is a form of inflammatory bowel disease (IBD) that is characterized by acute and chronic inflammation. The etiology and pathophysiology of IBD is unidentified, and there are many obstacles on the definite treatment of this disease. Recently, the useful effects of some herbal medicine on improving UC have been studied. Melillotus officinalis L. ( M. officinalis ) is an herb with antioxidant and anti-inflammatory effects used as food, forage and medicine. Objectives: Thisstudyevaluatedtheantioxidanteffectsof M.officinalis aqueousextractsintheaceticacid-inducedulcerativecolitis in rats. Methods: Fifty rats were randomly divided into five equal groups. Group I (Control healthy group) received 1 mL/kg of normal saline orally. Group II (control colitis group) received 1 mL/kg of normal saline orally. Group III (positive control) received 3 mg/kg prednisolone orally. Group IV received 1000 mg/kg M. officinalis aqueous extracts orally. Group V received 2000 mg/kg M. officinalis aqueous extracts orally. Ulcerative colitis was induced by intra-rectal acetic acid (3% v/v) administration. All treatments were done 24 hours after induction of colitis and continued for seven days. On the eighth day, the rats were sacrificed and colonic biopsies were taken for histopathological and biochemical studies. Data analysis was performed, using SPSS software and significance level was set at P ≤ 0.05. Results: Treatment with M. officinalis aqueous extract could enhance colonic antioxidant capacity and decrease inflammation and acutecolonicinjuryinducedbyaceticacid,whichisdose-dependent. Inaddition,administratingtheextractsignificantly(P ≤ 0.05) reduced the colonic level of malondialdehyde and myeloperoxidase, and significantly (P ≤ 0.05) increased the level of reduced glutathione (P ≤ 0.05). The extract had more effects at the dose of 2000 mg/kg than 1000 mg/kg dosage and prednisolone. Conclusions: Thisstudyrevealedthat M.officinalis hadapparentcurativeeffectsontreatingUCbecauseof itsantioxidantandanti-inflammatory activities.
{"title":"Evaluating the Effect of Melillotus officinalis L. Aqueous Extracts on Healing of Acetic Acid-Induced Ulcerative Colitis in Male Rats","authors":"N. Tanideh, M. Bahrani, M. J. Khoshnood-Mansoorkhani, D. Mehrabani, D. Firoozi, O. koohi-Hosseinabadi, A. Iraji","doi":"10.17795/ACR-42856","DOIUrl":"https://doi.org/10.17795/ACR-42856","url":null,"abstract":"Background: Ulcerative colitis (UC) is a form of inflammatory bowel disease (IBD) that is characterized by acute and chronic inflammation. The etiology and pathophysiology of IBD is unidentified, and there are many obstacles on the definite treatment of this disease. Recently, the useful effects of some herbal medicine on improving UC have been studied. Melillotus officinalis L. ( M. officinalis ) is an herb with antioxidant and anti-inflammatory effects used as food, forage and medicine. Objectives: Thisstudyevaluatedtheantioxidanteffectsof M.officinalis aqueousextractsintheaceticacid-inducedulcerativecolitis in rats. Methods: Fifty rats were randomly divided into five equal groups. Group I (Control healthy group) received 1 mL/kg of normal saline orally. Group II (control colitis group) received 1 mL/kg of normal saline orally. Group III (positive control) received 3 mg/kg prednisolone orally. Group IV received 1000 mg/kg M. officinalis aqueous extracts orally. Group V received 2000 mg/kg M. officinalis aqueous extracts orally. Ulcerative colitis was induced by intra-rectal acetic acid (3% v/v) administration. All treatments were done 24 hours after induction of colitis and continued for seven days. On the eighth day, the rats were sacrificed and colonic biopsies were taken for histopathological and biochemical studies. Data analysis was performed, using SPSS software and significance level was set at P ≤ 0.05. Results: Treatment with M. officinalis aqueous extract could enhance colonic antioxidant capacity and decrease inflammation and acutecolonicinjuryinducedbyaceticacid,whichisdose-dependent. Inaddition,administratingtheextractsignificantly(P ≤ 0.05) reduced the colonic level of malondialdehyde and myeloperoxidase, and significantly (P ≤ 0.05) increased the level of reduced glutathione (P ≤ 0.05). The extract had more effects at the dose of 2000 mg/kg than 1000 mg/kg dosage and prednisolone. Conclusions: Thisstudyrevealedthat M.officinalis hadapparentcurativeeffectsontreatingUCbecauseof itsantioxidantandanti-inflammatory activities.","PeriodicalId":8370,"journal":{"name":"Annals of Colorectal Research","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90833180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Derakhshani, Arash Mohammadi Tofigh, B. N. Honar, Gholamhossein Hayatollah, Maryam Derakhshani
Introduction: The restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) is currently the preferred surgical method for most patients with ulcerative colitis and familial adenomatous polyposis and sometimes, functional bowel diseases. Infection around the pouch, remaining rectal stump, stricture at anastomosis site, pouch dysfunction and refractory pouchitis can lead to pouch failure. Pouch salvage surgery could prevent pouch failure in some cases. Case Presentation: In this report, five patients were introduced, who underwent pouch salvage surgery after RPC/IPAA surgery failure. Two of the patients were male and three were female and the relevant age range was 16 to 41. Initially, RPC/IPAA surgery was performed on these five patients. Four of the patients underwent RPC/IPAA surgery as a result of ulcerative colitis and, one of the patients as a result of familial adenomatous polyposis. However, due to pouch failure from the RPC/IPAA surgery, pouch-salvage surgery was performed on each of these five patients. Two of the patients underwent pouch-salvage surgery due to infection and pouch fistula, and the other three underwent this surgery due to the remaining rectal stump, anastomosis stenosis and pouch dysfunction. The average time for when pouch-salvage surgery was performed was 3.5 years (three months to five years) after the initial operation and the patients were under follow-up care for two to seven years. Conclusions: After performing pouch salvage operation, pouch function was acceptable in all patients and we could close ileostomies of all of them.
{"title":"Pouch Salvage Surgery for Treatment of Colitis and Familial Adenomatous Polyposis: Report of Five Cases","authors":"S. Derakhshani, Arash Mohammadi Tofigh, B. N. Honar, Gholamhossein Hayatollah, Maryam Derakhshani","doi":"10.17795/ACR-34169","DOIUrl":"https://doi.org/10.17795/ACR-34169","url":null,"abstract":"Introduction: The restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) is currently the preferred surgical method for most patients with ulcerative colitis and familial adenomatous polyposis and sometimes, functional bowel diseases. Infection around the pouch, remaining rectal stump, stricture at anastomosis site, pouch dysfunction and refractory pouchitis can lead to pouch failure. Pouch salvage surgery could prevent pouch failure in some cases. Case Presentation: In this report, five patients were introduced, who underwent pouch salvage surgery after RPC/IPAA surgery failure. Two of the patients were male and three were female and the relevant age range was 16 to 41. Initially, RPC/IPAA surgery was performed on these five patients. Four of the patients underwent RPC/IPAA surgery as a result of ulcerative colitis and, one of the patients as a result of familial adenomatous polyposis. However, due to pouch failure from the RPC/IPAA surgery, pouch-salvage surgery was performed on each of these five patients. Two of the patients underwent pouch-salvage surgery due to infection and pouch fistula, and the other three underwent this surgery due to the remaining rectal stump, anastomosis stenosis and pouch dysfunction. The average time for when pouch-salvage surgery was performed was 3.5 years (three months to five years) after the initial operation and the patients were under follow-up care for two to seven years. Conclusions: After performing pouch salvage operation, pouch function was acceptable in all patients and we could close ileostomies of all of them.","PeriodicalId":8370,"journal":{"name":"Annals of Colorectal Research","volume":"116 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79730453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Colon microbiota, as a complex and diverse population, has been shown to be either proor anti-tumorigenic, depending on its content. The composition of microbiota critically determines the differentiation, activation, and expansion of T cells by which proor anti-tumorigenic effects of microbes are frequently reported to be mediated. In this review study, we specified an imbalance in microbiota and T cells in particular regulatory T cells and Th17 cells in colon cancer. We also aimed to discuss evidence, suggesting the contribution of microbiota to carcinogenesis or anti-carcinogenesis through influencing T cells.
{"title":"Permissive/Protective Interplay of Microbiota with T Cell Adaptive Immune Response in Colon Cancer","authors":"Z. Mojtahedi, Somayeh Rezaeifard, Z. Faghih","doi":"10.17795/ACR-43883","DOIUrl":"https://doi.org/10.17795/ACR-43883","url":null,"abstract":"Colon microbiota, as a complex and diverse population, has been shown to be either proor anti-tumorigenic, depending on its content. The composition of microbiota critically determines the differentiation, activation, and expansion of T cells by which proor anti-tumorigenic effects of microbes are frequently reported to be mediated. In this review study, we specified an imbalance in microbiota and T cells in particular regulatory T cells and Th17 cells in colon cancer. We also aimed to discuss evidence, suggesting the contribution of microbiota to carcinogenesis or anti-carcinogenesis through influencing T cells.","PeriodicalId":8370,"journal":{"name":"Annals of Colorectal Research","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91191023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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