Query: colitis review

title: Microscopic colitis and its associations with complications observed in classic inflammatory bowel disease: a systematic review
abstract: Crohn's disease and ulcerative colitis are associated with an increased risk to develop anemia, cutaneous diseases, liver diseases, malignancy, osteoporosis, rheumatic diseases, thromboembolism and uveitis. The association between these diseases and microscopic colitis (MC) is not known. The aim of the present systematic review was to examine associations between MC and diseases observed in association with Crohn's disease and ulcerative colitis.  According to the review protocol, original articles which described the prevalence of abovementioned diseases in relation to MC, were searched for in PubMed, Embase and Web of Science.  After exclusion of duplicates, 928 articles remained. Based on relevancy of their title, abstract or type of article, 16 articles were ordered in full text and after assessment, nine articles could be included in the review. A second research strategy with individual diseases rendered further two articles. Seven articles covered malignancy/neoplasia, where four showed no association with malignancy and three a reduced association compared with controls. Four articles covering rheumatic diseases showed an association between these diseases and MC. One study showed an association between MC and osteoporosis, whereas one did not. One study showed an association between MC and cutaneous diseases, whereas anemia, eye diseases and thromboembolism showed no associations.  Due to short follow up time in small studies, with selection bias due to exclusion of former or prevalent malignancy in an older population, no conclusions can be drawn concerning the true association between MC and malignancy. Rheumatic diseases seem to be associated with MC.

title: Modified two stage restorative proctocolectomy with ileal pouch anal anastomosis for ulcerative colitis: a systematic review and meta analysis of observational research
abstract: Restorative proctocolectomy (RPC) is performed for patients with refractory ulcerative colitis (UC) This operation is performed in 2 or 3 stages and involves forming a diverting loop ileostomy thought to protect patients from complications related to anastomotic leak. However, some advocate for a modified 2 stage approach, consisting of subtotal colectomy followed by completion proctectomy and ileal pouch anal anastomosis without diverting ileostomy. We present a systematic review and meta analysis comparing postoperative complication rates between modified 2 stage and traditional RPC with ileal pouch anal anastomosis. Records were sourced from PubMed/Embase databases. Studies comparing postoperative complications following RPC for ulcerative colitis (UC) were selected according to PRISMA guidelines comparing modified 2 stage (exposure) classic 2 stage, and 3 stage approaches (comparators) The primary outcome measure was safety as measured by postoperative complication rates. We employed random effects meta analysis. We included ten observational studies including 1727 patients (38% modified 2 stage) Among pediatric patients, modified 2 stage approaches had higher rates of anastomotic leak than 3 stage approaches (p 0.03) Among adult cohorts with lower preoperative biologic use rates, modified 2 stage approaches had lower leak rates than classic 2 stage approaches (p 0.001) The modified 2 stage approach may be safe for adult patients who otherwise require a 3 stage approach while reducing costs and length of stay. Pediatric patients may benefit from lower leak rates when receiving 3 stage compared with modified 2 stage approaches, especially when on biologics. The modified 2 stage approach may be safer than the classic 2 stage approach for adult patients with lower biologic exposure.

title: Review of the epidemiology and burden of ulcerative colitis in Latin America
abstract: The incidence and prevalence of ulcerative colitis (UC) has been reported to be rising in newly industrialised regions, such as Latin America. Here, we review data from published studies reporting demographics and clinical aspects of UC in Latin America to further understand epidemiology and disease burden. The incidence and prevalence of UC in Latin America varied between regions and studies, ranging between 0.04 to 8.00/100,000 and 0.23 to 76.1/100,000, respectively, and generally increased over the period from 1986 to 2015. The majority of patients with UC were female (53.6 72.6% and urban residents (77.8 97.4% Extraintestinal manifestations were reported in approximately 26 89.4% of patients. Use of biologic therapies was generally low (0.8 16.2% with the exception of Mato Grosso do Sul, Brazil, with a greater proportion of patients tending to receive 5 aminosalicylates, immunosuppressants or corticosteroids; colectomy rates varied between studies (1.5 22% A high proportion of patients had moderate to severe UC (45.9 73.0% and, in 11 of 19 studies, the greatest proportion of patients had extensive disease (pancolitis) Colorectal cancer (0 1.7% and mortality rates (0 7.6% were low. This evaluation of published studies may influence therapeutic approaches and the development of strategies to improve healthcare access and patient outcomes, although further high quality studies are required in patients with UC in Latin America.

title: Effects of Vitamin D Supplementation on Inflammation, Colonic Cell Kinetics, and Microbiota in Colitis: A Review
abstract: Vitamin D is widely known to regulate bone health, but there is increasing evidence that it may also ameliorate colitis through inflammation, cell proliferation and apoptosis, and the microbiota. The purpose of this review is to systematically examine the mechanisms by which vitamin D reduces colitis. PubMed and Web of Science were searched for articles published between 2008 and 2019 using key words such as "vitamin D," "colitis," "inflammatory bowel disease," "inflammation," "apoptosis," "cell proliferation," and "gut bacteria" Retrieved articles were further narrowed and it was determined whether their title and abstracts contained terminology pertaining to vitamin D in relation to colitis in human clinical trials, animal studies, and cell culture/biopsy studies, as well as selecting the best match sorting option in relation to the research question. In total, 30 studies met the established criteria. Studies consistently reported results showing that vitamin D supplementation can downregulate inflammatory pathways of COX 2, TNF a, NF kB, and MAPK, modify cell kinetics, and alter gut microbiome, all of which contribute to an improved state of colitis. Although vitamin D and vitamin D analogs have demonstrated positive effects against colitis, more randomized, controlled human clinical trials are needed to determine the value of vitamin D as a therapeutic agent in the treatment of colitis.

title: Curcumin therapy for ulcerative colitis remission: systematic review and meta analysis
abstract: Despite significant advances in the study of Ulcerative colitis (UC) management, up to a third of patients may be refractory to conventional therapy, and specialists have considered natural compounds such as curcumin. Area covered The meta analyzes found in the literature compare the effects of curcumin used in different administration routes or compare patients in remission with patients with active disease. Due to the biases in these studies, we performed a systematic review and meta analysis of randomized clinical trials (RCTs) that investigated the efficacy of orally administrated curcumin in mild to moderate active UC. Expert opinion Curcumin produces relevant anti inflammatory and antioxidant effects that are crucial in inducing remission in UC patients. Unfortunately, in the treatment of UC, we have not observed studies with standardization of dose and routes of administration. Existing meta analyses are biased because they compare studies using different administration routes and patients in different stages of the disease. Our meta analysis is the only one that tried to make a comparison with a few of biases as possible and show that curcumin can help in the induction of remission in UC subjects.

title: Effects of the Use of Curcumin on Ulcerative Colitis and Crohn's Disease: A Systematic Review.
abstract: Inflammatory bowel disease (IBD) is an umbrella term used to describe chronic inflammatory disorders related to a substantial reduction in the quality of life of patients. Some patients with Crohn's disease (CD) and ulcerative colitis (UC) are refractory to conventional therapies, and Curcuma longa derivatives have been considered as adjuvants. Owing to the anti inflammatory and antioxidant effects, some clinical trials used this plant in the therapeutic approach of IBD, and some meta analyses evaluated the outcomes found in these studies. Owing to controversial findings, our systematic review aimed to evaluate these studies to show whether C. longa compounds can still be considered in the therapeutic approach of patients with CD and UC. MEDLINE PubMed, EMBASE, and Cochrane were searched, and Preferred Reporting Items for a Systematic Review and Meta Analysis guidelines were followed. The results of the randomized clinical trials (RCTs) showed promising results with the use of curcumin in the therapeutic approach of both UC and CD patients. Some meta analyses show controversial results, possibly due to the presence of bias in the included studies. The actions of curcumin are achieved by several mechanisms, such as reducing the expression of interleukin (IL) 1, IL 6, IL 12, and tumor necrosis factor a. Moreover, it reduces the levels of reactive oxygen species, such as superoxide anions and malondialdehyde. The results of using curcumin in CD and UC patients are challenging to be evaluated because RCTs are variable in the dose and the formulations of curcumin, in the time of treatment, and the route of administration. The number of patients in the samples is also usually small.

title: Real world clinical effectiveness and safety of vedolizumab and anti tumor necrosis factor alpha treatment in ulcerative colitis and Crohn's disease patients: a German retrospective chart review
abstract: Real world comparisons of biologic treatment outcomes for ulcerative colitis (UC) or Crohn's disease (CD) patients are limited. We sought to evaluate the real world effectiveness of vedolizumab (VDZ) and anti tumor necrosis factor alpha (anti TNFa) in UC and CD patients in Germany.  A retrospective chart review (15 sites) investigated UC and CD patients who were biologic treatment naive (biologic naive) or had received no more than one prior anti TNFa before initiating treatment with VDZ or anti TNFa between 15 July 2014 and 20 October 2015. Kaplan Meier analyses assessed time to first chart documented clinical remission (CR) and symptom resolution (UC: rectal bleeding [RB] stool frequency [SF] CD: abdominal pain [AP] liquid stools [LS] and outcome duration.  A total of 133 UC (76 VDZ; 57 anti TNFa) and 174 CD (69 VDZ; 105 anti TNFa) patients were included. By Week 26, estimated cumulative rates of patients achieving CR or symptom resolution with VDZ vs anti TNFa treatment were for UC: CR, 53.7% vs 31.7% RB, 66.8% vs 55.8% and SF, 59.8% vs 50.7% respectively; and for CD: CR, 14.4% vs 32.8% AP, 62.5% vs 56.0% and LS, 29.9% vs 50.3% respectively. Outcomes were sustained similarly between treatments, except RB (VDZ vs anti TNFa: median 38.1 vs 15.1 weeks, P 0.03) Treatment related adverse events occurred in 5.3% vs 7.0% (UC) and 8.7% vs 19.0% (CD) of VDZ vs anti TNFa patients, respectively.  Although there were differences in CR, symptom resolution, and safety profiles, real world data support both VDZ and anti TNFa as effective treatment options in UC and CD.

title: Therapeutic applications of probiotics in ulcerative colitis: An updated review
abstract: Ulcerative colitis (UC) is a chronic inflammatory disorder limited to colon and rectum. UC carries considerable burden and causes mortality of many patients so there is a continuous challenge for new advancements to be made in the present medical therapies. Probiotics are live microorganisms that are intended to have health benefits when consumed or applied to the body. Probiotic bacteria plays a crucial role in maintaining gut microbiota homeostasis, strengthening of gut barrier function and host immune responses. Thus, in order to combat chronic inflammation during UC and to improve quality of life in patients, probiotic supplementation is emerging as a therapeutic option of great interest. We have searched PubMed, Web of Science, Embase, Science Direct and Google Scholar databases, to evaluate the clinical efficacy of probiotics. Several studies have shown probiotics are as effective as traditional drug therapy used in treatment of UC. Herein, we have summarized the main findings of clinical studies conducted on UC patients where probiotics are used alone or in combination with conventional therapy against UC.

title: Comparative of the Effectiveness and Safety of Biological Agents, Tofacitinib, and Fecal Microbiota Transplantation in Ulcerative Colitis: Systematic Review and Network Meta Analysis
abstract: Biological agents are commonly used for the treatment of ulcerative colitis (UC) As new treatments, tofacitinib, and fecal microbiota transplantation (FMT) have demonstrated efficacy in treating UC. This network meta analysis aims to determine the efficacy and safety of biological agents, tofacitinib, and FMT.  A network meta analysis was conducted by systematically searching the PubMed, Embase, and Cochrane Libraries. According to strict inclusion and exclusion criteria, we included randomized controlled trials (RCTs) of biological agents, tofacitinib, and FMT in UC. A random effect model was chosen by the network meta analysis and sensitivity analysis. Heterogeneity test and publication bias test were performed to determine the efficacy of treatments.  Data were extracted from 16 RCTs and we found that all treatments were more effective than the placebos. A total of 21 comparisons were made to determine efficiency. We found that infliximab, vedolizumab, and FMT performed better curative effect in terms of absolute effects and relative ranks. Furthermore, there was no statistical difference in the efficacy of biological agents, tofacitinib, and FMT. Moreover, no treatments were found to increase the occurrence of adverse events when compared with placebos, except infliximab. However, vedolizumab seemed to reduce the occurrence of adverse events compared with infliximab.  Of the biological agents, vedolizumab and infliximab were the most effective, suggesting that biological agents are still a better choice. Nevertheless, tofacitinib and FMT may be promising alternatives with high efficacies. However, more safety and maintenance studies need to be conducted in future for the acquisition of more accurate results.  Fecal microbiota transplantation; UC: Ulcerative colitis; RCTs: Randomized controlled trials; IBD: Inflammatory bowel disease; CD: Crohn's disease; IBS: Irritable bowel syndrome; CDI: Clostridium difficile infections; ITT: Intention to treat; RR: Relative risk; CI: Confidence interval; CrI: Credible intervals; IFX: Infliximab; ADA: Adalimumab; TFB: Tofacitinib; GLM: Golimumab; VDZ: Vedolizumab; PBO: Placebo; wk: week; F: Female; M: Male; AEs: Adverse events; SAEs: Serious adverse events; anti TNF: Anti tumor necrosis factors

title: Efficacy and safety of fecal microbiota transplantation for treating patients with ulcerative colitis: A systematic review and meta analysis
abstract: To assess the effect of donor selection, stool procedures and pretreatment with antibiotics on the efficacy and safety of fecal microbiota transplantation (FMT) treated ulcerative colitis (UC)