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Glucocorticosteroid therapy in inflammatory bowel diseases: From clinical practice to molecular biology

World Journal of Gastroenterology 2017年第36期23卷 6628-6638页

作者： Karen Dubois-Camacho Payton A Ottum Daniel Franco-Munoz Marjorie De la Fuente alejandro torres-riquelme David Díaz-Jiménez Mauricio Olivares-Morales Gonzalo Astudillo Rodrigo Quera Marcela A Hermoso Innate Immunity Laboratory Immunology ProgramInstitute of Biomedical SciencesFaculty of MedicineUniversidad de Chile Neuroimmunology Laboratory Immunology ProgramInstitute of Biomedical SciencesFaculty of MedicineUniversidad de Chile Division of Research Clínica Las Condes Gastroenterology Department Inflammatory Bowel Disease ProgramClínica Las Condes

Inflammatory bowel diseases(IBDs),such as ulcerative colitis and Crohn's disease,are chronic pathologies associated with a deregulated immune response in the intestinal mucosa,and they are triggered by environmental factors in genetically susceptible *** glucocorticoids(GCs)are widely used as anti-inflammatory therapy in *** the past,patients with moderate or severe states of inflammation received GCs as a first line therapy with an important effectiveness in terms of reduction of the disease activity and the induction of ***,this treatment often results in detrimental side *** downside drove the development of second generation GCs and more precise(non-systemic)drugdelivery *** clinical trials show that most of these new treatments have similar effectiveness to first generation GCs with fewer adverse *** remaining challenge in successful treatment of IBDs concerns the refractoriness and dependency that some patients encounter during GCs treatment.A deeper understanding of the molecular mechanisms underlying GC response is key to personalizing drug choice for IBDs patients to optimize their response to *** this review,we examine the clinical characteristics of treatment with GCs,followed by an in depth analysis of the proposed molecular mechanisms involved in its resistance and dependence associated with *** thorough analysis of current clinical and biomedical literature may help guide physicians in determining a course of treatment for IBDs patients and identifies important areas needing further study.

关键词： Inflammatory bowel diseases Ulcerative colitis Crohn's disease Glucocorticoid dependence Glucocorticoid resistance

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Management of Helicobacter pylori infection in Latin America: A Delphi technique-based consensus

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World Journal of Gastroenterology 2014年第31期20卷 10969-10983页

作者： Antonio Rollan Juan Pablo Arab M Constanza Camargo Roberto Candia Paul Harris Catterina Ferreccio Charles S Rabkin Juan Cristóbal Gana Pablo Cortés Rolando Herrero Luisa Durán Apolinaria García Claudio Toledo Alberto Espino Nicole Lustig Alberto Sarfatis Catalina Figueroa Javier torres Arnoldo riquelme Clínica Alemana de Santiago Facultad de Medicina Clínica Alemana Universidad del Desarrollo Departamento de Gastroenterología Facultad de Medicina Pontificia Universidad Católica de Chile Division of Cancer Epidemiology and Genetics National Cancer InstituteRockville MD 20852 United States Programa de Salud Basada en Evidencia Pontificia Universidad Católica de Chile Departamento de Gastroenterología y Nutrición Pediátrica Facultad de Medicina Pontificia Universidad Católica de Chile Departamento de Salud Pública Facultad de Medicina Pontificia Universidad Católica de Chile International Agency for Research on Cancer World Health Organization Departamento de Microbiología Facultad de Ciencias Biológicas Universidad de Concepción Unidad de Gastroenterología Hospital de Valdivia. Facultad de Medicina Universidad de Austral de Chile Unidad de Investigación en Enfermedades Infecciosas Instituto Mexicano del Seguro Social

AIM: To optimize diagnosis and treatment guidelines for this geographic region, a panel of gastroenterologists, epidemiologists, and basic scientists carried out a structured evaluation of available ***: Relevant questions were distributed among the experts, who generated draft statements for consideration by the entire panel. A modified three-round Delphi technique method was used to reach consensus. Critical input was also obtained from representatives of the concerned medical community. The quality of the evidence and level of recommendation supporting each statement was graded according to United States Preventive Services Task Force ***: A group of ten experts was established. The survey included 15 open-ended questions that were distributed among the experts, who assessed the articles associated with each question. The levels of agreement achieved by the panel were 50% in the first round, 73.3% in the second round and 100% in the third round. Main consensus recommendations included:(1) when available, urea breath and stool antigen test(HpSA) should be used for non-invasive diagnosis;(2) detect and eradicate Helicobacter pylori(H. pylori) in all gastroscopy patients to decrease risk of peptic ulcer disease, prevent o retard progression in patients with preneoplastic lesions, and to prevent recurrence in patients treated for gastric cancer;(3) further investigate implementation issues and health outcomes of H. pylorieradication for primary prevention of gastric cancer in high-risk populations;(4) prescribe standard 14-d triple therapy or sequential therapy for first-line treatment;(5) routinely assess eradication success post-treatment in clinical settings; and(6) select second- and third-line therapies according to antibiotic susceptibility ***: These achievable steps toward better region-specific management can be expected to improve clinical health outcomes.

关键词： Helicobacter pylori Consensus development conferen

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