کولیت اولسرو

Although prescribing biological drugs have been common in Iran for nearly a decade and is now more widely available than ever, some physicians may still be unfamiliar with them. This guideline is the first joint statement of the Iranian Association of Gastroenterologists and Hepatologists (IAGH) regarding the proper use of biological drugs in IBD treatment. Many of the current guidelines are based on internationally published data due to a lack of national and regional information (individual and racial differences affecting patients' responses to biologics as well as characteristics). In this guide, we have tried to address various issues, including the indication for starting biological drugs, contraindications, prevention of complications, screening before starting biological treatment, and other follow-ups during treatment in Crohn's disease and ulcerative colitis. The authors of the article hope that based on these strategies, they will provide helpful information based on scientific evidence to physicians around the country to treat their patients with biological drugs successfully. As far as we know, this consensus on the starting and continuing of biologics is the first case to be compiled and published on the use of biological drugs in Iran, and it shows the importance of its application. However, the physicians’ decision about treating their patients is a priority. Naturally, it will be necessary to review the provisions of this agreement after the next 2-3 years.

In many patients with ulcerative colitis,control of the disease is possible through medical methods, but in some cases,surgery is indicated.So far,no comprehensive study on the consequences of surgery in children with ulcerative colitis has been published in Iran. present study was conducted for the same purpose.

All children with ulcerative colitis admitted in Mofid Children Hospital with indication for surgery for ten years were included in the study.Information on demographic characteristics,surgical indications, duration of medical treatment,type of surgical procedure,complications of surgery, were evaluated.

21patients who underwent surgery during these years were included in the study. The mean age of patients was 11.12 ± 5.65 years. 42.9% were male. In terms of surgical indications, anemia in 100%, Intestinal bleeding in 33.3%, FTT in 14.3%, recurrent defecation in 9.5% and severe colic abdominal pain in14.3%.In terms of early surgical complications,intestinal perforation in4.8%, peritonitis 4.8%,wound infection23.8%, pelvic abscesses14.3%, deep vein thrombosis4.8%,intestinal obstruction9.5%, Pouchitis 9.5% and anal fissure 4.8% were reported.23.8% of patients underwent redo laparotomy for improvement surgical complications.The mean follow-up period of patients in terms of surgical outcomes was 6.79 ± 4.24years. During this period, improvement in gastrointestinal function was reported in 100% of patients. Long-term complications of surgery include , delayed fistulas were reported in 23.8% of cases. Fecal incontinence was reported at 4.8%. Long-term complication-free survival at 5 and 10 years after surgery was estimated to be 92.3% and 56.4%, respectively.

Surgical treatment in children with ulcerative colitis,candidate for surgery,accompanies with favorable outcomes and correctable short and long-term complications.

Ulcerative colitis (UC) is a chronic disease that specifically affects the mucosa of the rectum and colon. The pathogenesis of UC is not well defined, but it is proposed that genetic and environmental factors result in an aberrant immune response to a subset of commensal enteric bacteria.The aim of this study was to investigate whether miR-34b/c rs4938723 T/C polymorphism is associated with UC risk.

Blood samples were collected from 50 patients diagnosed with UC and 100 healthy control subjects. Genomic DNA was extracted from peripheral blood. Genetic variation of miR34b/c was determined by tetra-primers ARMS-PCR (amplification refractory mutation system-polymerase chain reaction). All statistical analyses were conducted using the MedCalc version 12.1.

There was a significant difference in genotype and allele distributions between cases and controls. It was observed that the CT heterozygotes had a 2.29-fold increase in risk of UC (OR=2.29, 95%CI=1.08-4.82, p=0.02).

It is suggested that the miR34b/c (rs4938723 T>C) polymorphism may be associated with the risk of UC. However, larger studies with more patients and controls are needed to confirm this result.

Crohn disease (CD) and ulcerative colitis (UC), collectively known as inflammatory bowel disease (IBD), are chronic illnesses that affect predominately the gastrointestinal tract. The pathogenesis and etiology remain unclear but the importance of environmental factors, in particular diet, is evidenced by the increased incidence rates of the recent decades that genetic inheritance cannot account for. In particular, the quantity of fatty acid consumption has been consistently linked with IBD risk. While several studies have investigated the connections between diet, etiology, signs and symptoms associated with IBD, very few have explored the relationship between disease state and specific fatty acid intake in the pediatric IBD population. In this cross-sectional study, 65 patients that all patients had colit ulcerative and it hadn’t passed more than 6 months of their desease. And also 137 healthy individual that matched for age, sex, contraceptive pills and smoking with patients. all participants in the study were recruited from Sari hospital. dietary record was used through mechanized food frequency questionnaire(MFFQ). A logistic regression and liner regression analysis was carried out to correlate disease severity with the dietary intake of omega 3, omega 6 fatty acid, omega 6/3 ratio. The findings showed that the highest quartile of intake of omega 6/3 fatty acid was associated with an increase risk of ulcerative colitis (OR, 3/48 95% CI, 1/43-8/45, P= 0/006) with a significant trend across quartiles (OR 1/09, Pt=0/008). highest quartile of intake of omega-6 fatty acid intake also was associated with increase the risk of ulcerative colitis)OR, 2/16 95% CI, 0/91-5/1, P=0/07) with a significant trend across quartiles (OR 1/02, Pt=0/08). also highest quartile of intake of omega-3 fatty acid was associated with a reduce risk of ulcerative colitis (OR, 0/43 95%CI, 0/15-1/21, P=0/11) but, this rate was not statistically significant (OR 0/17, Pt =0/94). While the western diet has high ratio of omega6 than omega 3,several studies, including this study show that increasing the ratio of omega 6/3 in the diet may also resulted in an increased incidence of many chronic disease like IBD. Overall, the findings obtained in the present study emphasizes the importance of choosing an appropriate dietary pattern that includes a good ratio of omega 6/3.

Pulmonary complication of IBD include airway inflammation involving small and large airways, pulmonary paranchymal disease, and serositis. The aim of this study was to determine the prevalence of Pulmonary Function Test (PFT) possible abnormality in ulcerative colitis (UC) patients. In this cross sectional study, during spring and summer of 2006, PFT (spirometry & body box plethysmography) of 50 UC patients were compared to 50 healthy people of the same age and sex (control). Data collection forms including demographic specification and UC condition were filled. Out, and then analyzed by SPSS 10. Mean age was 37.2(SD=14.57). Active UC was seen in 24.3% of patients. 24.9% of the patients had severe UC. PFT result demonstrated; 100% air trapping(only increase in Residual Volume/Total Lung Capacity); 20% small airway obstructive pattern (only decrease in maximal expiratory flow at 25-75% of vital capacity); 12% restrictive ventilation defect; 2% obstructive airway; 2% hyperinflation and 6% upper airway obstructive pattern. There was a significant relationship between small airway obstructive pattern and duration of UC, (PV<0.05), and no relationship between other pulmonary disorders and severity, activity, duration of UC was observed. Discussion & According to high prevalence of air trapping, small airway disease may be the prominent feature of lung involvement in UC patients. Therefore, a meticulous work-up for respiratory diseases seems necessary in UC patients.

Multiple sclerosis and ulcerative colitis are two chronic and disabling disease that cause many problems to patients. Until now there is not a good study to determine relation and similarity between this disease. The aim of this study is to compare the prevalence of ulcerative colitis in general population with MS patients. In this cross-sectional study from March 2008 to September 2009, 250 patients with MS were compared with 250 persons of general population without MS, to evaluate the prevalence of ulcerative colitis. The mean of age was not different in two groups. 2% (5 persons) of patients with multiple sclerosis had ulcerative colitis, but general population had not ulcerative colitis. This difference was clearly, significant (P = 0.03). In this study as the other study reports, the prevalence of ulcerative colitis among patients with multiple sclerosis is more than normal population and it seems that some predisposing factors are responsible in two diseases. So more gastrointestinal evaluation should be done in MS patients with gastrointestinal sign and symptoms to rule out ulcerative colitis.

Background and Recent studies show that bronchial hyper-responsiveness occurs in a high proportion of inflammatory bowel disease. Âirway inflammation is a common pattern of respiratory involvement in ÏBD patients and is a major finding in bronchial asthma. This study was designed to evaluate the prevalence of asthma and air way hyper-responsiveness among ulcerative colitis patients. Through a case-control study, spirometry was performed for 40 ulcerative colitis patients and 40 normal controls who were admitted to the Ïmam Khomeini hospital in Sari. The methacholine challenge test was performed in all cases with normal spirometry results. Then the data were analyzed using SPSS version 17. The results of the present study showed abnormal spirometry results for 55 % of ulcerative colitis patients compared to 22.5% of normal healthy controls (P<0.05). Ït has been found that air way hyper responsiveness occurred in 37.5% and 17.5% (P<0.05), asthma occured in 2.5% and 0% (P>0.05); and small airway disease occured in 15% and 5% (P>0.05) of cases and controls respectively. We observed that restrictive lung disease occured in 10% of both groups (P>0.05). There was also inverse correlation between duration of ÏBD and FËV1 (R=0.395, P=0.012) as well as FVÇ (R=0.367, P=0.02).Çonclusion: Ôur results show that air way hyper-responsiveness is one of most common respiratory manifestations of ulcerative colitis patients with no symptom of airway involvement.

It is claimed that the interaction of altering immune system bowel maturation, and measles vaccine predispose the body to inflammatory bowel diseasesAlso it is proposed that breastmilk components during infancy, regulatemucosal immune activity to antigen and have protective role for ulcerative colitis and Crohn's disease. This study was a case-control study. Data were collected from patient's evidences and questionnaires that were filled up by face to face method for each groups of patients (including ulcerative colitis and Crohn's disease) and control groups (including IBS and GERD) They were selected from the patients ‹ 40 years who came to 3 clinics in Tehran during 2005 to 2008.Statistical analysis was performed in two steps univariate and multivariate analysis, using SPSS-16 software. Ulcerative colitis group included 143 patients, Crohn's disease group involved 148 cases and control group included 307 patients. Breastfeeding in Ulcerative colitis and Crohn's groups had been less common than in control group (81.1% versus 88.3% and 83.8% versus 88.3% respectively), but the differences were not significant. (P-Values were 0.225 and 0.397 respectively) The difference between ulcerative colitis group and control group in measles vaccination rate (93% versus 89.9% respectively) was not significant (P=0.121). Both Crohn's disease group and control group had vaccination rate of 89.9% (P=0.481). There was not significant correlation between previous exposure to smoking, measles vaccination and breast feeding during infancy with extent and location of gastrointestinal involvement in ulcerative colitis and Crohn's disease (p›0.05). Breast feeding and measles vaccination during infancy do not correlate with later ulcerative colitis or Crohn's disease in adulthood. There was not any correlation between smoking, easles vaccination and breast feeding with extent and location of gastrointestinal involvement in ulcerative colitis and Crohn's disease.

Considering the unknown etiology of inflammatory bowel disease (IBD), the epidemiologic evaluation may help to identify the causative agents of the disease. Genetic (ethnic) and environmental (e.g., geographic) factors in Iran may influence the incidence of the disease. The objective of this study was to determine the demographic and clinical characteristics of the IBD in the city of Sari, northern Iran. All patients with IBD who referred to a private clinic of gastroenterology or Department of Gastroenterology of Imam Khomeini Hospital, Sari, Iran during 2000 to 2007 were included in this study. Age of onset, gender, level of education, resident place, extension of disease, extra-intestinal manifestations, the necessary surgical interventions, and associated diseases were assessed. Out of 302 IBD patients enrolled in this study, 265 (87.7%) had ulcerative colitis (UC), and 35 (11.5%) had Crohn's disease (CD). CD patients were younger than UC patients at the diagnosis. There was no significant difference between the gender and IBD involvement. Most of the patients aged between 20 and 40 years. Left-sided UC was the most common type (48.3%). Family history was positive in 3.4% of UC patients; it was negative among CD patients. Twenty-six (8.7%) patients with IBD had at least one extra-intestinal manifestation. The demographic and clinical characteristics of IBD are almost similar to other reports from developing countries. Although the true epidemiologic picture of IBD in Sari is still unknown, IBD is not as rare as was previously thought. Gradual acceptance of a Western lifestyle may be responsible for the observed continuing rise in the incidence of IBD.

There is evidence that pulmonary function abnormalities are present in patients with inflammatory bowel disease (IBD). The aim of this case-control study was to assess the frequency of pulmonary dysfunction in patients with IBD.

Pulmonary function of 37 patients with IBD (8 with CD and 29 with UC) without any known pulmonary disease was tested by body-box plethysmograph. As control 30 healthy subjects who were adjusted with patient group for age, sex, cigarette smoking and body mass index were also tested. Disease activity in IBD patients was assessed by the CD activity index for CD and the Truelove index for UC, respectively. Extension of gastrointestinal tract involvement was determined by endoscopic and radiograghic findings which had been documented before.

A total of 19% of patients with IBD had restrictive, obstructive or mixed pattern of pulmonary dysfunction in compare with 3% in control group. Forced expiratory flow 25-75% (FEF25-75%) and forced expiratory volume in 1s (FEV1) mean were significantly lower in inflammatory bowel disease compared with control group (p=0.02 and p=0.036, respectively). Inverse correlation between extension of involvement of colon in patients with ulcerative colitis and FEV1 (R= -0.528, p= 0.003) and FEF25-75% (R= 0.532, p= 0.003) was observed. There was also inverse correlation between duration of inflammatory bowel disease and FEF25-75% (R= -0.336, p= 0.042).

Pulmonary involvement is a relatively frequent extraintestinal manifestation of inflammatory bowel disease, it's not known whether it is due to disease process itself or other factors such as drugs.