Refractory Ulcerative Colitis Patients Research Articles

Leukocyte apheresis using a centrifugal cell separator in refractory ulcerative colitis: a multicenter open label trial.

Recently, successful results of ulcerative colitis (UC) treatments with leukocyte apheresis have been reported by several institutes. To certify the efficacy of leukocyte apheresis in refractory UC patients, a multicenter open label trial was conducted, and results were analyzed. Fifty patients diagnosed with active steroid-resistant UC were enrolled in this study from 14 medical centers. Using a centrifugal cell separator (Component Collection System, Haemonetics), leukocyte apheresis was performed once a week for 5 weeks. General conditions and abdominal symptoms were recorded daily, and laboratory tests were followed weekly. Changes of colonoscopic and histological manifestations of luminal activity through the study period were evaluated. At the end of the study period, stool frequency was decreased to less than 4 times a day in 68.4% (26 of 38) and serum C-reactive protein (CRP) concentration was normalized in 56.7% (17 of 30) of the patients. Colonoscopic remission was achieved in 57.7% (26 of 45), and histological improvement was noted in 54.1% (20 of 37) of the patients tested. Improved disease activity was demonstrated in 74% (37 of 50) of the patients by general assessment criteria. Analysis of the trial data confirmed the valid clinical efficacy of leukocyte apheresis by centrifugal cell separator in refractory UC patients.

Remission-inducing potential of centrifugal leukocyte apheresis in refractory patients with active ulcerative colitis

Background/Aim: We have reported that mass leukocyte removal from circulating blood in patients with ulcerative colitis (UC) by ultracentrifugal cell separator could reduce their symptoms and macroscopic/microscopic inflammation in their colon. This method, namely centrifugal leukocyte apheresis (CFLA), is going to be widely accepted as an alternative therapy for refractory UC patients in Japan. In this study, we analyzed our experience of CFLA for patients with UC who did not respond conventional glucocrticoid administrations, to specify the standard protocol and indication of CFLA treatment for UC patients. Patients/Methods: Through 1995 to 1999, we have experienced 51 patients who underwent CFLA in Asahikawa Medical College Hospital. CFLA using Multi Component System (Haemonetics, Braintree, MA) was performed to remove 2 to 3 billions of leukocytes from circulating blood through single venous access. This CFLA was undergone at once a week, and repeated for 3 to 8 weeks until the patient got into remission. Relationship between patients' characteristics (disease duration, disease extent, concomitant drugs administrated, pretreatment disease activity (evaluated by clinical activity index; CAl) ) and results of CFLA were analyzed by logistic regression analysis. Results: During CFLA treatment, mean CAl of these patients were gradually decreased and no remarkable side effects were noted. Cumulative remission-inducing rates (RIR) (remission is defined as CAl <=4) at the end of each week were 15.7% (1 week), 41.2% (2 weeks), 60.8% (3 weeks), 62.7% (4 weeks), 64.7% (5 weeks), 68.6% (6 weeks) and 70.6% (8 weeks). Logistic regression analysis revealed that CFLA was significantly effective 3036

Treatment of corticosteroid-resistant ulcerative colitis with oral low molecular weight heparin.

The etiology and pathogenesis of ulcerative colitis (UC) have remained unclear. Treatment is nonspecific based on the anti- inflammatory agents corticosteroid and sulfasalazine. A significant proportion fail to respond to this therapy[1]. As the relapse, refractory or serious UC patients had a hypercoagulable state and an increased incidence of thromboembolic events[2-4], heparin has been used by some authors[5-7]. Yet, its half-life period is short, needing long-term injection, which restricts its further clinical application. Our previous studies have demonstrated oral LMWH not only overcomes the shortcomings of common heparin[8,9], but also has anti-inflammatory effects[10,11]. The aim of this paper is to study the therapeutic effects and mechanism of oral LMWH in patients with corticosteroid-resistant UC.