Visible Blood In Stool Research Articles

Lunasin protease inhibitor concentrate decreases pro-inflammatory cytokines and improves histopathological markers in dextran sodium sulfate-induced ulcerative colitis

Lunasin protease inhibitor concentrate (LPIC) is a novel combination of soy bioactive peptide lunasin, Kunitz and Bowman-Birk protease inhibitors. The reported anti-inflammatory and anticancer properties of each one of them suggest LPIC as a promising candidate for the treatment of inflammatory-related diseases. Our objective was to assess the in vivo anti-inflammatory properties of LPIC. First, an in vitro test was performed in lipopolysaccharide (LPS)-activated RAW264.7 murine macrophages by measuring the production of nitric oxide (NO), interleukin-6 (IL-6), and tumor necrosis factor α (TNF-α) as inflammatory markers. For the in vivo model, ulcerative colitis (UC) was induced in mice via oral administration of dextran sodium sulfate (DSS). LPIC treatment was performed via daily intraperitoneal injection of 50 mg/kg body weight. Body weight, visible blood in stool and stool consistency were scored daily as macroscopic indicators of disease progression. Occult blood was evaluated by the presence of hemoglobin in stool every third day. Colon length, caecum weight, colonic myeloperoxidase activity (MPO), presence of pro-inflammatory cytokines in blood and colon, changes in the architecture, and expression of inducible nitric oxide synthase (iNOS) in colonic tissue were evaluated. In vitro, LPIC induced production of NO and maintained cytokine levels in comparison to activated untreated macrophages. In vivo, LPIC increased colonic bleeding and did not improve macroscopic markers of the disease, but reduced colonic IL-1β and IL-6, decreased systemic circulation of TNF-α, attenuated neutrophils infiltration and iNOS expression in colonic tissue, and diminished the damage in colonic architecture. Our results suggest that combinations of peptides in LPIC may counteract the anti-inflammatory properties in vitro; while in vivo, LPIC can significantly reduce the histopathological damage, hence is a possible therapeutic strategy to attenuate UC.

Acute bloody diarrhea in children below five years of age in Babylon Province, Iraq

Objectives: The aim of study is to find the causes, how optimal diagnosis and what is the most causative agents of bloody diarrhea in infants and children.
 Methods: One hundred children with bloody diarrhea (three or more loose bowel motion / day with visible blood in stool) from total 1660 of gastroenteritis where studied in Babylon hospital for maternity and children in Hilla from (1st of March to 31 August 2012), all of them were less than five years of age. Those with surgical condition excluded from the study.
 Results: Higher percentage with E. histolytica 50 (50%).Their stool culture was showed growth of normal flora. Second microorganism was E. Coli 20 (20%), Third microorganism was Shigella 7 (7%). There is no relationship between types of microorganisms in bloody diarrhea and different age group. More than 50% of the patients with bloody diarrhea was found in those who were below 2 years. There is no significant difference between type of microorganisms and gender of the patient’s. There is significant difference between total number of cases and gender of the patient’s. Male more affected 56 (56%) than female 44 (44%). There is a significant difference between total number of patients and residence of patients. Patient come from rural area were more 60 (60%) than those from urban area 40 (40%).
 Conclusion: Entamoeba Histolytica one of the most frequent offending pathogen in-patient with bloody diarrhea in our society. Children below 2 years are the main affected group and male sex affected more than female.

A Prospective Assessment of Clinical Characteristics and Responses to Dietary Elimination in Food Protein–Induced Allergic Proctocolitis

Some aspects of diagnostic elimination/challenge diets in food protein-induced allergic proctocolitis (FPIAP) are still poorly defined. This study investigated the symptom spectrum, time required for resolution of each symptom, triggering foods, and risk factors for multiple food allergies (MFA) in FPIAP. Infants referred with visible blood in stool were enrolled after etiologies other than FPIAP had been excluded. Laboratory evaluation, clinical features, and elimination/challenge steps were performed prospectively during diagnostic management. Ninety-one of 102 infants (53 boys) were diagnosed with FPIAP. Eleven children did not bleed during challenges. Visible blood in stool began before 2 months of age in 63.6% of the infants not diagnosed with FPIAP, compared with 18.9% of the patients with FPIAP (P= .003). Offending foods were identified as cow's milk (94.5%), egg (37.4%), beef (10.9%), wheat (5.5%), and nuts (3.3%). MFA was determined in 42.9% of patients. Multivariate logistic regression analysis identified atopic dermatitis (AD) (odds ratio [OR]: 2.98, 95% confidence interval [CI]: 1.18-7.55, P= .021) and an eosinophil count ≥300 cells/μL (OR: 2.72, 95% CI: 1.09-6.80, P= .032) as independent risk factors for MFA. Blood and mucus in stool disappeared in a median 3 days (interquartile range [IQR]: 1-14.5 days) and 30 days (IQR: 8-75 days), respectively. A tendency to transient bleeding occurs in infants who present with bloody stool before 2 months of age. A 2-week duration of elimination for blood in stool is sufficient to reach a judgment of suspected foods for FPIAP. Mucus in stool is the last symptom to disappear. Concurrent AD suggests a high probability of MFA in FPIAP.

Efficacy of Plantago major seed in management of ulcerative colitis symptoms: A randomized, placebo controlled, clinical trial

ObjectiveEvaluation of the effect of Plantago major (P. major) seed on ulcerative colitis (UC) symptoms. MethodsIn this randomized double-blind clinical trial, 61 subjects received 3600 mg/day roasted P. major seed in intervention group (n = 31) and roasted wheat flour in control group (n = 30), for 8 weeks, as a complementary to standard medications. Variables were assessed using the Lichtiger Colitis Activity Index (LCAI) at baseline, week 4, and week 8. Results51 patients completed the trial (n = 28 in Plantago and n = 23 in placebo groups). Abdominal tenderness (p = 0.011), gastroesophageal reflux and gastric pain (p = 0.049 for both), were significantly less severe in P. major group. Visible blood in stool (p = 0.001), distension (p = 0.001), and anal pain (p = 0.051), decreased significantly in P. major group, although no significant difference was observed between the two groups: (p = 0.224), (p = 0.283), and (p = 0.455) respectively. ConclusionP. major seems to be effective in complementary management of UC.

P191 Non-specific terminal ileitis: prevalence, clinical course and association with later diagnosis of Crohn’s disease

Abstract Background The existing literature does not provide adequate guidance on the diagnosis and management of patients with non-specific terminal ileitis, while the data regarding the percentage of patients that finally develop Crohn’s disease are scarce. Methods The aim of this study was to evaluate the prevalence and natural course of non-specific terminal ileitis in patients who underwent colonoscopy in our department during the last decade. All patients with endoscopic findings of terminal ileitis and non-specific histological findings between 2008 and 2018 were included in the study. Patient characteristics, initial symptoms, biopsy findings, and the patients’ clinical and endoscopic course were recorded. Patients with a history of Crohn’s disease or histological findings related to specific diseases were excluded. Results Out of 5.353 colonoscopies in total, 92 patients (mean age: 50 years, men: 56.5%, asymptomatic: 72.5%) with non-specific terminal ileitis were identified (prevalence: 1.7%). Among 92 patients, 56 (61%) had available follow-up information for at least 6 months after initial endoscopy. In these patients, the reasons for performing endoscopy were chronic diarrhea (21/56, 37.5%), screening (16/56, 28.6%), abdominal pain (12/56, 21.4%), iron deficiency (5/56, 9%) and visible blood in stool (2/56, 3.5%). Endoscopic findings included erosions/ulcerations (62.5%), mucosal edema (23.2%), mucosal erythema (10.7%) and ileal valve stenosis (3.6%). Among 56 patients, 16 (28.6%) received medical treatment that included aminosalicylates (25%), budesonide (62.5%) and antibiotics (12.5%). Recession of symptoms was recorded in 20 out of 40 symptomatic patients (50%). Interestingly, symptomatic relief was more frequent in patients who did not receive any treatment (75%) comparing to those who received medications (26.3%), (p=0.02). In total, 23/56 (41%) patients underwent 2nd endoscopy with persisting endoscopic findings in 15/23 (65.2%). Eleven out of 56 (19.6%) patients were eventually diagnosed with Crohn’s disease. The probability of Crohn’s disease diagnosis was significantly higher in symptomatic patients (27.5%) comparing to asymptomatic (0%) (p=0.019). The majority of patients with Crohn’s disease (9/11, 81.8%) remained symptomatic after initial endoscopy (p= 0.002), while 90% of them had persisting endoscopic findings in follow-up endoscopy (p=0.019). Conclusion Non-specific terminal ileitis has a generally benign clinical course regardless of the administered treatment. However, patients with persisting symptoms and endoscopic findings should be followed closely to monitor later development of Crohn’s disease.

Pathogen-specific risk of seizure in children with moderate-to-severe diarrhoea: Case control study with follow-up.

To determine the pathogen-specific risk of seizure in under-five children hospitalised with moderate-to-severe diarrhoea (MSD) in rural settings. This was a prospective case-control study with follow-up, conducted in a sentinel facility of Global Enteric Multicenter Study in Mirzapur, a rural community of Bangladesh between 2007 and 2010. Children aged 0-59months who presented with MSD and seizure constituted the cases whereas those who did not have seizure comprised the controls. MSD was defined if the episodes were associated with dehydration or dysentery or required hospitalisation with diarrhoea or dysentery. All enrolled children were followed up at home within 50-90days of enrolment. A total of 64 cases and 128 randomly selected controls formed the analysable dataset. The result of logistic regression analysis after adjusting for potential confounders revealed that shigellosis (Shigella species, OR=5.34, 95% CI=2.37-12.04) particularly S. flexneri (OR=3.34, 95% CI=1.48-7.57), S. flexneri 6 (OR=23.24, 95% CI=2.79-193.85), S. sonnei (OR=6.90, 95% CI=2.34-19.85); norovirus (OR=6.77, 95% CI=1.69-27.11), fever (OR=16.75, 95% CI=1.81-154.70) and loss of consciousness (OR=35.25, 95% CI=1.71-726.20) were the independent risk factors for seizure in MSD children. At enrolment, cases had lower WHZ (P=0.006) compared to their peers, follow-up anthropometrics showed significant improvement in WHZ (P<0.001) and WAZ (P<0.05), whereas deterioration in HAZ (P<0.001) in both cases and controls. Childhood MSD episodes particularly due to Shigella and norovirus are often associated with seizure. Prompt identification and appropriate management of children with shigellosis may reduce occurrence and adverse consequences of seizure linked with MSD.

A large proportion of fecal immunochemical test-positive participants in colorectal cancer screening is symptomatic.

BackgroundSymptomatic invitees are advised not to participate in colorectal cancer (CRC) screening but to directly consult their general practitioner (GP), because fecal immunochemical test (FIT) sensitivity for cancer is not optimal. This recommendation may not always be followed in daily practice. We evaluated how many FIT-positive participants had CRC-related symptoms and whether the presence of symptoms was associated with the presence and location of CRC/advanced neoplasia.MethodsWe prospectively collected data on CRC-related symptoms in all FIT-positive participants in the Dutch CRC screening program, referred to our endoscopy centers between 2014 and 2016, and evaluated whether symptoms were associated with detected CRC/advanced neoplasia at colonoscopy.ResultsOf 527 FIT-positive participants, 314 had advanced neoplasia, of which 41 had CRC. Overall, 246 (47%; 95% confidence interval (CI) 0.42–0.51) reported CRC-related symptoms. A change in bowel habits (odds ratio (OR) 2.86, CI 1.23–6.62) and visible blood in stool (OR 8.65, CI 2.34–32.0) were associated with the detection of CRC at colonoscopy. We did not observe significant associations between evaluated symptoms and advanced neoplasia.ConclusionsA large proportion of FIT-positive screening participants have CRC-related symptoms. This suggests that current instructions do not retain symptomatic screening invitees from participation and awareness of CRC-related symptoms is inadequate.

Endoscopic ultrasound-assisted gastrointestinal hemostasis: an evolving technique.

Gastrointestinal bleeding can range from grossly visible blood in stool or vomitus to microscopic bleed. However, any kind of bleeding can lead to potential life-threatening consequences. A small proportion of patients with gastrointestinal bleeding remain refractory to initial endoscopic hemostasis. While some are successfully managed by repeat endoscopic intervention, a few fail to respond or are not amenable to endoscopic hemostasis. As of now, the next level of intervention is passed on to either surgeons or interventional radiologists. There is new evidence suggesting the increased utility of endoscopic ultrasound (EUS) in diagnosis and treatment of culprit vascular lesions across the gut. In addition, EUS-assisted technique has also been used in the primary prevention of bleeding from gastroesophageal varices. In this review article, we have summarized case series and reports describing the use of EUS-assisted hemostasis. Indications, techniques, complications and success rates reported are discussed. While most of the authors describe their experience with primary and secondary treatment of gastric varices, treatment of other gastrointestinal lesions with EUS assisted hemostatic techniques is also discussed.

Dysentery - a risk factor for zinc deficiency

Background: The study was carried out to determine the prevalence of zinc deficiency among under-five children with dysentery, and to compare the prevalence of zinc deficiency in children with dysentery with those who have acute non-bloody diarrhoea.Methods: Serum zinc levels were determined using Atomic absorption spectrometry in under-five children with dysentery as well as those with non-bloody diarrhoea. A total of 250 children with diarrhoea were studied at the Wesley Guild Hospital, Ilesa, Nigeria.Results: Twenty seven (10.8%) of the 250 children had dysentery, while the remaining 223 children had non-bloody watery stools. Children with dysentery had a significantly lower mean serum (SD) zinc level of 65.1 (25.0) µg/dl, compared with a mean (SD) of 80.5 (36.3) µg/dl among those without visible blood in their stools (p = 0.034). Zinc deficiency (serum zinc &lt;65 µg/dl) was also more prevalent among the dysentery group than those without visible blood in their stools (48.1% versus 28.3%; p = 0.034).Conclusions: Presence of visible blood in stools is a risk factor for zinc deficiency among children with diarrhoea.

Effects of an Oral Supplementation of Germinated Barley Foodstuff on Serum CRP Level and Clinical Signs in Patients with Ulcerative Colitis.

The present study was aimed to determine the effect of Germinated Barley Foodstuff (GBF) administration on serum C-reactive protein (CRP) levels and clinical signs in patients with Ulcerative Colitis (UC). Forty-six patients were randomly allocated into GBF group and control group. Subjects in control group received only conventional drug therapy, while the GBF group received 30g GBF per day (3 times a day) by oral administration during 2 month along with routine medications. The mean serum CRP in the GBF group decreased significantly (P=0.017) compared with the baseline. Although the frequency of clinical signs including the number of episodes diarrhea, degree of visible blood in stool, degree of abdominal pain or cramping, nausea, vomiting, and anorexia decreased in the GBF group but it was statistically significant only in the case of abdominal pain and cramping. However, this reduction was only significant in the case of abdominal pain and cramping (P=0.016) CONCLUSIONS: The consumption of GBF along with the current medication may be efficient in attenuating the inflammation and clinical signs of UC patients.

Colon cancer: association of histopathological parameters and patients' survival with clinical presentation

Available data correlating symptoms of colon cancer patients with the severity of the disease are very limited. In a population-based setting, we correlated information on symptoms of colon cancer patients with several pathological tumor parameters and survival. Information on all patients diagnosed with colon cancer in Iceland in 1995-2004 for this retrospective, population-based study was obtained from the Icelandic Cancer Registry. Information on symptoms of patients and blood hemoglobin was collected from patients' files. Pathological parameters were obtained from a previously performed standardized tumor review. A total of 768 patients entered this study; the median age was 73 years. Tumors in patients presenting at diagnosis with visible blood in stools were significantly more likely to be of lower grade, having pushing border, conspicuous peritumoral lymphocytic infiltration, and lower frequency of vessel invasion. Patients with abdominal pain and anemia were significantly more likely to have vessel invasion. Logistic regression showed that visible blood in stools was significantly associated with protecting pathological factors (OR range 0.38-0.83, p < 0.05). Tumors in patients presenting with abdominal pain were strongly associated with infiltrative margin and scarce peritumoral lymphocytic infiltration (OR = 1.95; 2.18 respectively, p < 0.05). Changes in bowel habits were strongly associated with vessel invasion (OR = 2.03, p < 0.05). Cox regression showed that blood in stools predicted survival (HR = 0.54). In conclusion, visible blood in stools correlates significantly with all the beneficial pathological parameters analyzed and with better survival of patients. Anemia, general symptoms, changes in bowel habits, acute symptoms, and abdominal pain correlate with more aggressive tumor characteristics and adverse outcome for patients.

Risk Factors for Development of Hemolytic Uremic Syndrome in a Cohort of Adult Patients with STEC 0104:H4 Infection

The outbreak of Shiga toxin producing E.coli O104:H4 in northern Germany in 2011 was one of the largest worldwide and involved mainly adults. Post-diarrheal hemolytic uremic syndrome (HUS) occurred in 22% of STEC positive patients. This study’s aim was to assess risk factors for HUS in STEC-infected patients and to develop a score from routine hospital parameters to estimate patient risks for developing HUS. In a cohort analysis, adult patients with STEC infection were included in five participating hospitals in northern Germany between May and July 2011. Clinical data were obtained from questionnaires and medical records, laboratory data were extracted from hospitals’ electronic data systems. HUS was defined as thrombocytopenia, hemolytic anemia and acute renal dysfunction. Random forests and multivariate logistic regression were used to identify risk factors for HUS and develop a score using the estimated coefficients as weights. Among 259 adults with STEC infection, vomiting (OR 3.48,95%CI 1.88–6.53), visible blood in stools (OR 3.91,95%CI1.20–16.01), age above 75 years (OR 3.27, 95%CI 1.12–9.70) and elevated leukocyte counts (OR 1.20, 95%CI 1.10–1.31, per 1000 cells/mm3) were identified as independent risk factors for HUS. A score using these variables has an area under the ROC curve of 0.74 (95%CI 0.68–0.80). Vomiting, visible blood in stools, higher leukocyte counts, and higher age indicate increased risk for developing HUS. A score using these variables might help to identify high risk patients who potentially benefit from aggressive pre-emptive treatment to prevent or mitigate the devastating consequences of HUS.

Diarrhées infectieuses aiguës de l’adulte : épidémiologie et prise en charge

Acute diarrhea is defined as an abnormally frequent discharge of semisolid or fluid fecal matter from the bowel, lasting less than 14 days. More than three millions cases of acute diarrhea, presumably due to intestinal infections, are seen in general practice every year in France. Most of the cases are benign and resolve under symptomatic treatment within 3 days, without need for biological tests or antibiotics. In special contexts (septicemic syndrome, visible blood in stools, severe dehydration, patients at risk of severe sepsis [valvulopathy]), biologic tests and probabilist antibiotic treatment are required. Hygiene, rehydration and diet recommendations are always part of the treatment of acute diarrhea, in addition to the symptomatic treatment of diarrhea and other digestive symptoms. Antibiotic-associated diarrhea is clinically benign in most cases, and attributed to transient dysbiosis of gut microbiota. In the remaining cases, diarrhea is the clinical expression of intestinal infection by Clostridium difficile, that should be treated with metronidazole, or the clinical expression of a Klebsiella oxytoca-associated colitis that usually spontaneously resolves after stopping antibiotics.

Association of symptoms of colon cancer patients with tumor location and TNM tumor stage

Objective. Colon cancer is the second most common cause of cancer death in Iceland and accounts for 8% of malignancies. We related information on symptoms of colon cancer patients with information on tumor location and pTNM-stage. Material and methods. The study is retrospective and population-based. Information on all patients diagnosed with colon cancer in Iceland in 1995–2004 was obtained. Information on symptoms of patients and blood hemoglobin was collected from patients' files. The pathological parameters were derived from a previously performed study. Results. A total of 768 patients (422 males, 346 females) participated in this study. Median age was 73 years. Nearly 60% had anemia at the time of diagnosis, 53% had visible blood in stools, and 65% had changes in bowel habits. Around 84% had visible blood in stools and/or anemia. Of those with right-sided tumors, 75% had anemia and were more likely to be diagnosed incidentally (40%) than those with left-sided tumors (20%). Left-sided tumors were associated with blood in stools (68% compared to 41%, p < 0.05) and changes in bowel habits (74% compared to 57%, p < 0.05). Multivariate analysis indicated that blood in stools was strongly associated with a lower TNM-stage (OR = 0.75, p < 0.05). Anemia was strongly associated with a higher TNM-stage (OR = 1.84, p < 0.05). Conclusion. Right-sided tumors were associated with anemia and incidental diagnosis; left-sided tumors were associated with visible blood in stools and changes in bowel habits. Visible blood in stools was significantly associated with lower TNM-stage, whereas abdominal pain, general and acute symptoms were associated with higher TNM-stage.

Rapid Symptom Resolution with Delayed-Release Mesalamine 4.8g/d Compared to 2.4g/d in Moderately Active Ulcerative Colitis Patients with a History of More Difficult to Treat Disease

Purpose: To evaluate the time to resolution of the hallmark symptoms of ulcerative colitis (UC) (increased stool frequency [SF], rectal bleeding [RB]) in patients with moderately active UC with a history of more difficult to treat disease (i.e., patients previously treated with UC medical therapies). Methods: Data from 2 Phase III, multi-center, randomized, double-blind, 6-week active-control studies (ASCEND I and II) were combined and analyzed. Median time to resolution of the hallmark symptoms of UC with delayed-release mesalamine 4.8g/d (Asacol® HD 800mg tab) was compared to 2.4g/d (Asacol® 400mg tab) in patients with moderately active UC (Physician's Global Assessment=2) who had been previously treated with oral 5-ASAs, rectal therapies, steroids, or multiple medications. Time to resolution (score=0) of UC symptoms was based on first day of resolution according to daily reports from patients via an interactive voice response system. Resolution of SF was defined as a patient's return to normal number of stools per day and resolution of RB was defined as the absence of visible blood in stool. Results: A total of 423 analyzable patients had moderately active UC. Results of the median time to resolution analysis for the overall moderate population and according to previous UC medical therapies are shown in the Table. Conclusion: In general, the magnitude of the dose benefit (Hazard Ratio) for 4.8g/d vs 2.4g/d was greater in patients previously treated with UC medical therapies. Delayed-release mesalamine at a dose of 4.8g/d decreased the median time to resolution of the hallmark symptoms of UC compared to 2.4g/d in moderate UC patients with a history of more difficult to treat disease. Disclosure: Dr Sandborn - Consultant, Advisory Committee, Grant/Research Support from Procter & Gamble Pharmaceuticals, Inc. David Ramsey - Employee of Procter & Gamble Pharmaceuticals, Inc. Dr Sninsky - Consultant, Promotional Speaker, Research support from Procter & Gamble Pharmaceuticals, Inc.Table

Prospective Case‐Control Study of the Association between Common Enteric Protozoal Parasites and Diarrhea in Bangladesh

The parasitic causes of diarrhea have historically been identified by use of microscopy; however, the use of this technique does not allow one to distinguish between subspecies or genotypes of parasites. Our objective was to determine, by use of modern diagnostic methods, the proportion of diarrhea cases in Bangladesh attributable to Cryptosporidium hominis, Cryptosporidium parvum, Entamoeba histolytica, and Giardia lamblia assemblages A and B. A prospective case-control study was performed involving 3646 case patients (both children and adults) who presented with diarrhea to the Dhaka hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh, and 2575 control subjects with asymptomatic infection. Parasitic infection was detected by use of a stool parasite antigen test, and the parasite load and the species and/or genotypes were determined by use of polymerase chain reaction (PCR). Cryptosporidium species and E. histolytica were more prevalent in patients with acute diarrhea than in healthy control subjects, for all ages (2.1% vs. 1.4%; P = .039) and, specifically, for those 0-12 months of age (2.2% vs. 0.4%; P = .009). G. lamblia assemblage A was also more prevalent in case patients with diarrhea than in healthy control subjects (20% vs. 5%; P = .001). For case patients with diarrhea, the parasite load in feces, as measured by quantitative real-time PCR cycle threshold, was not higher that that for control subjects with asymptomatic infection. Case patients with diarrhea and cryptosporidiosis were less likely to have abdominal pain, compared with control subjects (15% vs. 37%; P = .001); case patients with amebiasis more likely to have visible blood in stool, compared with control subjects (8% vs. 1.6%; P = .001); and case patients with giardiasis more likely to be dehydrated, compared with control subjects (81% vs. 71%; P = .001). E. histolytica, C. hominis, C. parvum, and G. lamblia assemblage A infections are important causes of diarrheal illness in Bangladesh.

Rapid Symptom Resolution with Delayed Release Mesalamine in Mildly and Moderately Active UC

Purpose: To evaluate time to clinical remission in patients with mild and moderate active UC receiving 2.4 g/d of Asacol (mesalamine) delayed-release tablets. Methods: Data from 2 multi-center, randomized, double-blind, active-controlled, 6-wk studies of similar design (ASCEND I&II) were combined and analyzed. The studies included patients with mild (PGA = 1) and moderate (PGA = 2) active UC. This analysis includes data from the 2.4 g/d active control arms of these studies. Clinical remission was defined as resolution (score = 0) of both rectal bleeding (RB) and stool frequency (SF). Resolution of RB was defined as the absence of visible blood in stools and resolution of SF was defined as a patient's return to his/her normal number of stools/day. To be included in analysis patients had to have symptoms at baseline. Time to clinical remission was defined as the first day of 3 consecutive days of complete symptom resolution based on symptoms recorded by patients daily through an integrated voice response system (IVRS). Results: 687 patients were randomized in the 2 studies, of which 349 received 2.4 g/d. Based on IVRS data, the median time to clinical remission in patients with mild and moderate active UC was 26 days (95% CI 24,33). Time to clinical remission by disease severity is shown below:[figure1]In addition, results of the time to complete resolution analysis by individual symptoms and disease severity are shown below:FigureTableAsacol 2.4 g/d was well-tolerated, with adverse events consistent with those described in the current prescribing information. In pivotal clinical studies of active UC, the most frequent adverse events reported for Asacol were headache, abdominal pain, and eructation. Conclusion: In active UC, rapid symptom relief is a key treatment goal. Asacol 2.4 g/d provided rapid symptom relief in patients with mild and moderate active UC.

Rectal Bleeding in Infancy: Clinical, Allergological, and Microbiological Examination

Rectal Bleeding in Infancy: Clinical, Allergological, and Microbiological Examination

Treatment of ulcerative colitis patients by long-term administration of germinated barley foodstuff: Multi-center open trial

Germinated barley foodstuff (GBF), which mainly consists of dietary fiber and glutamine-rich protein, is a prebiotic for ulcerative colitis (UC). In our previous study, we carried out a clinical trial of GBF with mildly to moderately active UC patients and showed that GBF treatment was able to attenuate the symptoms of UC in a relatively short-term. The aim of this study was to investigate the efficacy of long-term administration of GBF in the treatment of UC in a multi-center open trial. Twenty-one patients with mildly to moderately active UC received 20-30 g of GBF for 24 weeks in an open-label protocol while baseline treatments (5-amino-salicyrate compounds and/or steroids) were continued. The response to the GBF treatment was evaluated using a clinical scoring and after 24 weeks of observation, the GBF group showed a significant decrease in clinical activity index (especially, the degree of visible blood in stools and the presence of nocturnal diarrhea) compared with the control group (p<0.05). No side effects related to GBF were observed. In conclusion, GBF can reduce the clinical activity of UC over long-term as well as short-term administration. Nutraceutical GBF therapy may have a place in long-term management of UC, but controlled studies are needed to demonstrate its efficacy in the treatment of this disorder.

Idiosyncratic adverse reactions to 6-mercaptopurine (6-MP) and azathioprine(AZA) can be averted by switching to thiioguanine(6-TG) in patients with IBD

were either started on mesalazine 1.2 gm/day or had the dose increased by an equivalent amount. They were taught to self-administer enemas which contained either EGF (5 mcg EGF in 100 ml) or an inert carrier (control) once a day for 14 days. They were reviewed at 14 and 28 days. Results: Eleven patients received EGF and 12 placebo. Both groups had similar baseline characteristics. Eight patients in the EGF group and nine in the p~acebo group were on mesalazine before recruitment to the study. Two patients from the placebo group developed worsening colitis and were withdrawn. After 2 weeks of enema treatment, there were significant improvements in the EGF treated group in symptom score (score 0 or 1 for the absence or presence of liquid stools, nocturnal diarrhoea and visible blood in stools) from median 3 to 1 (p=O.O02), diarrhoea from median 5 to 2 motions/24 hours (p<O.05), sigmoidoscopic score (Baron et al Br Med J 1:89-92, 1964) from median 3 to 1 (p = 0.004) and histological score (Richards eta/ Br Med J 1:160-165, 1960) from median 3 to 1 (p=O.O02). These parameters were significantly better in the EGF group than in the placebo group at 2 and 4 weeks (p<O.O05 for all). No significant change in these parameters was seen in the placebo group. Nine (82%) patients in the EGF group as compared to one (8%) in the placebo group achieved remission after 2 weeks (p = 0.005). Eight of these 9 maintained their remission up to the end of the study. At 4 weeks, nine patients in the EGF group and three in the placebo group were in remission (p<O.O01). Conclusions: EGF enema is an effective treatment for left-sided ulcerative colitis. A dose increase of 1.2 gm mecalazine had little effect in inducing remission in these patients.