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Delayed-release oral mesalamine tablet mimicking a small jejunal gastrointestinal stromal tumor:A case report

World Journal of Clinical Cases 2022年第19期10卷 6710-6715页

作者： Fabio Frosio Emanuele Rausa Paolo Marra Marie-Christine Boutron-Ruault Alessandro Lucianetti Department of General Surgery ASST Papa Giovanni XXIII HospitalBergamo 24127Italy Department of Radiology ASST Papa Giovanni XXIII HospitalBergamo 24127Italy Paris-Saclay University UVSQInsermGustave RoussyExposome and Heredity TeamCentre for Epidemiology and Population Health(CESP U1018)Villejuif 94800France

BACKGROUND Enteric-coated medications are supposed to pass intact through the gastric environment and to release the drug content into the small intestine or the colon.Before dissolution of the enteric coating,they may appear hyperdense on computed tomography(CT).Unfortunately,few reports have been published on this topic so far.In this case report,the hyperdense appearance on contrastenhanced CT of an enteric-coated mesalamine tablet was initially misinterpreted as a jejunal gastrointestinal stromal tumor(GIST).CASE SUMMARY An asymptomatic 81-year-old male patient,who had undergone laparoscopic right nephrectomy four years earlier for stage 1 renal carcinoma,was diagnosed with a jejunal GIST at the 4-year follow-up thoraco-abdominal CT scan.He was referred to our hub hospital for gastroenterological evaluation,and subsequently underwent 18-fluorodeoxyglucose positron emission tomography,abdominal magnetic resonance imaging,and video capsule endoscopy.None of these examinations detected any lesion of the small intestine.After reviewing all the CT images in a multidisciplinary setting,the panel estimated that the hyperdense jejunal image was consistent with a tablet rather than a GIST.The tablet was an 800 mg delayed-release enteric-coated oral mesalamine tablet(Asacol®),which had been prescribed for non-specific colitis,while not informing the hospital physicians.CONCLUSION Delayed-release oral mesalamine(Asacol®),like other enteric-coated medications,can appear as a hyperdense image on a CT scan,mimicking a small intestinal GIST.Therefore,adetailed knowledge of the patients’medications and a multidisciplinary review of the images areessential.

关键词： mesalamine Enteric-coating Asacol Tablet Gastrointestinal stromal tumor Case report

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mesalamine treatment mimicking relapse in a child with ulcerative colitis

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World Journal of Pediatrics 2014年第4期10卷 371-373页

作者： Iva Hojsak Ana M Pavić Sanja Kolaček Referral Center for Pediatric Gastroenterology and Nutrition Children's Hospital ZagrebZagrebCroatia University of Zagreb Medical School ZagrebCroatia

Background:There are reports on mesalamine-induced bloody diarrhea mimicking ulcerative colitis(UC)relapse,mostly in adults.Methods:Herein we present a case of a child with UC who developed relapse of hemorrhagic colitis related to mesalamine.Results:A 10-year-old girl developed severe symptoms mimicking UC relapse 3 weeks after introduction of mesalamine therapy.After mesalamine was withdrawn,her symptoms improved,but deteriorated again during the challenge of mesalamine despite concomitant use of corticosteroids.Conclusion:This is the fi rst case report on such a young child during the concomitant use of corticosteroids.

关键词： 5-aminosalicylic acid mesalamine ulcerative colitis

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Diagnosis of acute intermittent porphyria in a renal transplant patient:A case report

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World Journal of Transplantation 2022年第1期12卷 8-14页

作者： Cristina Sirch Niloufar Khanna Lynda Frassetto Francesco Bianco Mary Louise Artero Nefrologia e Dialisi Azienda Sanitaria Universitaria Giuliano IsontinaTrieste 34100Italy Medicine California Northstate UniversityElk GroveCA 95757United States Internal Medicine Division of NephrologyUniversity of California San FranciscoSan FranciscoCA 94193United States

BACKGROUND Acute intermittent porphyria(AIP)is an inherited disorder of porphyrin metabolism with a worldwide distribution and a prevalence ranging from 1 to 9 per million population.AIP is caused by an autosomal dominant-inherited mutation of low penetrance resulting in a deficiency of porphobilinogen deaminase(PBGD)activity.Acute attacks are provoked by stressors such as certain medications,alcohol,and infection.We herein present the first case report of AIP detected in a post-renal transplant patient.CASE SUMMARY The patient was a 65-year-old man who underwent transplantation 2 years previously for suspected nephroangiosclerosis and chronic interstitial nephropathy.He subsequently developed diabetes mellitus which required insulin therapy.He had been treated in the recent past with local mesalamine for proctitis.He presented with classic but common symptoms of AIP including intense abdominal pain,hypertension,and anxiety.He had multiple visits to the emergency room over a 6-mo period for these same symptoms before the diagnosis of AIP was entertained.His urinary postprandial blood glucose level was 60 mg/24 h(normal,mesalamine treatment for proctitis may have led to an acute AIP crisis.A high index of suspicion is needed to consider the diagnosis of a heme synthesis disorder,which presents with the common symptoms of abdominal pain,high blood pressure,and anxiety.

关键词： Acute intermittent porphyria Post-transplantation diabetes mesalamine Tacrolimus Renal transplantation Case report

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mesalamine induced symptom exacerbation of ulcerative colitis: Case report and brief discussion

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2010年第6期1卷 132-134页

作者： Maneesh Kumar Gupta Scott Pollack John J Hutchings Department of Internal Medicine LSU Health Sciences Center Department of Medicine Section of Gastroen-terology and Hepatology Tulane University Health Sciences Center Department of Medicine Section of Gas-troenterology and Hepatology LSU Health Sciences Center

This paper describes a rare case in which the oral ad-ministration of mesalamine resulted in the exacerbation of ulcerative colitis (UC) in a patient who was previously responsive to mesalamine and whose colitis had been in remission for eight years. mesalamine and other 5-ami-nosalicylic acid compounds are the mainstay of treatment for UC; however up to 8% of patients are unable to take the medications due to intolerance or hypersensitivity reactions. Common drug reactions are fever, nausea, di-arrhea and abdominal pain; however, exacerbation of UC has rarely been reported. This study highlights the impor-tance of ruling out mesalamine as the causative agent in cases of UC exacerbations.

关键词： mesalamine Exacerbation Ulcerative coli-tis Inflammation Adverse drug reaction

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Ulcerative colitis flair induced by mesalamine suppositories hypersensitivity

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World Journal of Gastroenterology 2014年第13期20卷 3716-3718页

作者： Hao Ding Xiao-Chang Liu Qiao Mei Jian-Ming Xu Xiang-Yang Hu Jing Hu Department of Gastroenterology First Affiliated Hospital of Anhui Medical University Department of Pathology First Affiliated Hospital of Anhui Medical University

mesalamine suppositories have been used widely for the treatment of distal ulcerative colitis and considered to be safer than systemic administration for its limited systemic absorption.However,previous studies have shown that mesalamine suppository occasionally causes severe hypersensitivity reactions including fever,rashes,colitis exacerbation and acute eosinophilic pneumonia.Here we present a 25-year-old woman with ulcerative colitis with bloody diarrhea accompanied by abdominal pain and fever which were aggravated after introduction of mesalamine suppositories.In light of symptom exacerbation of ulcerative colitis,increased inflammatory injury of colon mucosa shown by colonoscopy and elevated peripheral eosinophil count after mesalamine suppositories administration,and the Naranjo algorithm score of 10,the possibility of hypersensitivity reaction to mesalamine suppositories should be considered,warning us to be aware of this potential reaction after administration of mesalamine formulations even if it is the suppositories.

关键词： mesalamine suppositories Hypersensitivity Ulcerati

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Conventional therapy for moderate to severe inflammatory bowel disease: A systematic literature review

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World Journal of Gastroenterology 2019年第9期25卷 1142-1157页

作者： Adérson Omar Mourao Cintra Damiao Matheus Freitas Cardoso de Azevedo Alexandre de Sousa Carlos Marcela Yumi Wada Taciana Valéria Marcolino Silva Flávio de Castro Feitosa Department of Gastroenterology University of Sao Paulo School of Medicine Department of Medical Affairs Takeda Pharmaceuticals

BACKGROUND Despite the advent of biological drugs, conventional therapy continues to be used in moderate to severe inflammatory bowel disease(MS-IBD). This study hypothesized that as a standard of treatment and the primary alternative to biologics, conventional therapy should present robust effectiveness results in IBD outcomes.AIM To investigate the effectiveness of conventional therapy for MS-IBD.METHODS A systematic review with no time limit was conducted in July 2017 through the Cochrane Collaboration, MEDLINE, and LILACS databases. The inclusion criteria encompassed meta-analyses, systematic reviews, randomized clinical trials, observational and case-control studies concerning conventional therapy in adult patients with MS-IBD, including Crohn's disease(CD) and ulcerative colitis(UC). Corticosteroids(prednisone, hydrocortisone, budesonide, prednisolone,dexamethasone), 5-aminosalicylic acid(5-ASA) derivatives(mesalazine and sulfasalazine) and immunosuppressants [azathioprine(AZA), methotrexate(MTX), mycophenolate, cyclosporine, tacrolimus, 6-mercaptopurine(6-MP)] were considered conventional therapy. The exclusion criteria were sample size below50; narrative reviews; specific subpopulations(e.g., pregnant women,comorbidities); studies on postoperative IBD; and languages other than English,Spanish, French or Portuguese. The primary outcome measures were clinical remission(induction or maintenance), clinical response and mucosal healing. As secondary outcomes, fecal calprotectin, hospitalization, death, and surgeries were analyzed. The quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation criteria.RESULTS The search strategy identified 1995 citations, of which 27 were considered eligible(7 meta-analyses, 20 individual studies). For induction of clinical remission, four meta-analyses were selected(AZA and 6-MP showed no advantage over placebo,MTX or 5-ASA in CD; MTX showed no statistically significant difference versus placebo, 6-MP, or 5-ASA in UC; tacr

关键词： Inflammatory bowel diseases Steroids Sulfasalazine mesalamine Azathioprine Methotrexate Mycophenolic acid Cyclosporine Tacrolimus 6-Mercaptopurine

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Nonasthmatic eosinophilic bronchitis in an ulcerative colitis patient-a putative adverse reaction to mesalazine:A case report and review of literature

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World Journal of Clinical Cases 2020年第18期8卷 4162-4168页

作者： Andrei Tudor Cernomaz Gabriela Bordeianu Cristina Terinte Cristina Maria Gavrilescu Department of Internal Medicine Grigore T.Popa University of Medicine and PharmacyIasi 700115Romania Department of Biochemistry Grigore T.Popa University of Medicine and PharmacyIasi 700115Romania Department of Pathology Regional Oncology InstituteIasi 700483Romania

BACKGROUND Lung and airway involvement in inflammatory bowel disease are increasingly frequently reported either as an extraintestinal manifestation or as an adverse effect of therapy.CASE SUMMARY We report a case of a patient with ulcerative colitis controlled under mesalazine treatment who presented with chronic cough and hemoptysis.Chest computed tomography and bronchoscopy findings supported tracheal involvement in ulcerative colitis;pathology examination demonstrated an unusual eosinophilrich inflammatory pattern,and together with clinical data,a nonasthmatic eosinophilic bronchitis diagnosis was formulated.Full recovery was observed within days of mesalazine discontinuation.CONCLUSION Mesalazine-induced eosinophilic respiratory disorders have been previously reported,generally involving the lung parenchyma.To the best of our knowledge,this is the first report of mesalamine-induced eosinophilic involvement in the upper airway.

关键词： mesalamine Ulcerative colitis Hemoptysis Bronchitis Drug-related side effects Case report

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Isolated fever induced by mesalamine treatment

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World Journal of Gastroenterology 2013年第7期19卷 1147-1149页

作者： Rita Slim Joseph Amara Roy Nasnas Khalil Honein Joseph Bou Jaoude Cesar Yaghi Fady Daniel Raymond Sayegh Department of Gastroenterology Hotel Dieu de France University HospitalSaint Joseph University Department of Infectious Diseases Hotel Dieu de France University HospitalSaint Joseph University

Adverse reactions to mesalamine,a treatment used to induce and maintain remission in inflammatory bowel diseases,particularly ulcerative colitis,have been described in the literature as case reports.This case illustrates an unusual adverse reaction.Our patient developed an isolated fever of unexplained etiology,which was found to be related to mesalamine treatment.A 22-year-old patient diagnosed with ulcerative colitis developed a fever with rigors and anorexia 10 d after starting oral mesalamine while his colitis was clinically resolving.Testing revealed no infection.A mesalamineinduced fever was considered,and treatment was stopped,which led to spontaneous resolution of the fever.The diagnosis was confirmed by reintroducing the mesalamine.One year later,this side effect was noticed again in the same patient after he was administered topical mesalamine.This reaction to mesalamine seems to be idiosyncratic,and the mechanism that induces fever remains unclear.Fever encountered in the course of a mesalamine treatment in ulcerative colitis must be considered a mesalamine-induced fever when it cannot be explained by the disease activity,an associated extraintestinal manifestation,or an infectious etiology.

关键词： mesalamine 5-aminosalicylic acid Side effects Adverse reactions Fever

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Efficacy of Wumei Baijiang prescription(乌梅败酱方)on regulatory T cells/helper T cells Immune balance in mice with ulcerative colitis

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Journal of Traditional Chinese Medicine 2022年第1期42卷 30-38页

作者： SU Xiaolan ZHANG Tao GUO Song WANG Xin CHEN Lin WEI Wei the Gastroenterology department Wangjing Hospital of China Academy of Chinese Medicinal SciencesBeijing 100102China TCM diagnosis and treatment Functional Gastroenteropathy Beijing Key Laboratory Beijing 100102China

OBJECTIVE:To observe the therapeutic effect of Wumei Baijiang prescription(乌梅败酱方),empirical prescription of Lu Zhizheng,on experimental ulcerative colitis(UC)mice,and to investigate the mechanism of the prescription in UC from the perspective of the immune balance of regulatory T cells(Treg)and helper T cells(Th17).METHODS:Sixty C57 BL/6 mice were randomly divided into 6 groups:normal group,model group,Chinese medicine group(high,medium and low dose group of Wumei Baijiang prescription)and control group(mesalazine sustained-release granules).Except for the normal group,the other groups used 2.5%dextran sulfate sodium to induce UC mice model.At the end of the model,the Chinese medicine group was given high,medium and low dose administration of Wumei Baijiang prescription,the control group was given slow-release granules of mesalazine,and the model group was given equal volume saline for 10 d.The changes of food intake,body weight,disease activity index(DAI)score,length of large intestine and histopathology were observed.The number of Treg,Th17,CD4+,CD8+cells in spleen was detected by flow cytometry.The expression of tumor necrosis factor-α(TNF-α),interleukin-10(IL-10)and C-reactive protein(CRP)in serum was detected by enzyme-linked immunosorbent assay.RESULTS:The middle and high-dose groups of Wumei Baijiang prescription were superior to the model group in terms of increasing food intake and body weight of colitis mice,restoring colon morphology,improving pathological damage,and reducing DAI(P0.05).Compared with the model group,the spleen Treg and CD4+of the mice in the high and middle dose groups of Wumei Baijiang prescription were higher,while Th17 and CD8+were lower(P0.05).In addition,compared with the model group,the serum levels of TNF-αand CRP in mice with high and middle doses of Wumei Baijiang prescription and mesalazine group were lower(P<0.05),and IL-1

关键词： colitis ulcerative mesalamine T-lymphocytes regulatory Th17 cells Wumei Baijiang prescription

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Low dose oral curcumin is not effective in induction of remission in mild to moderate ulcerative colitis: Results from a randomized double blind placebo controlled trial

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2017年第2期8卷 147-154页

作者： Saurabh Kedia Vikram Bhatia Sandeep Thareja Sushil Garg Venigalla Pratap Mouli Sawan Bopanna Veena Tiwari Govind Makharia Vineet Ahuja Department of Gastroenterology All India Institute of Medical Sciences Department of Gastroenterology Institute of Liver and Biliary Sciences Department of Gastroenterology Army Hospital - Research and Referral

AIM To evaluate the role of oral curcumin in inducing clinical remission in patients with mild to moderate ulcerative colitis(UC).METHODS A prospective randomized double-blind placebo-controlled trial comparing the remission inducing effect of oral curcumin and mesalamine 2.4 g with placebo and mesalamine 2.4 g in patients of ulcerative colitis with mild to moderate severity was conducted from January 2003 to March 2005. The included patients received 1 capsule thrice a day of placebo or curcumin(150 mg) for 8 wk. Patients were evaluated clinically and endoscopically at 0,4 and 8 wk. The primary outcome was clinical remission at 8 wk and secondary outcomes were clinical response, mucosal healing and treatment failure at 8 wk. The primary analysis was intention to treat worst case scenario(ITT-WCS).RESULTS Of 300 patients with UC, 62 patients(curcumin: 29, placebo: 33) fulfilled the inclusion criteria and were randomized at baseline. Of these, 21 patients did not complete the trial, 41 patients(curcumin: 16, placebo: 25) finally completed 8 wk. There was no significant difference in rates of clinical remission(31.3% vs 27.3%, P = 0.75), clinical response(20.7% vs 36.4%, P = 0.18), mucosal healing(34.5% vs 30.3%, P = 0.72), and treatment failure(25% vs 18.5%, P = 0.59) between curcumin and placebo at 8 wk.CONCLUSION Low dose oral curcumin at a dose of 450 mg/d was ineffective in inducing remission in mild to moderate cases of UC.

关键词： Curcumin mesalamine Ulcerative colitis Ulcerative colitis disease activity index Mucosal healing

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