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A Systematic Review and Meta-analysis of the Efficacy and Adverse Events of Infliximab in Comparison to Corticosteroids and Placebo in Active Ulcerative Colitis  [PDF]
Shekoufeh Nikfar,Solmaz Ehteshami-Afshar,Mohammad Abdollahi
International Journal of Pharmacology , 2011,
Abstract: The proinflammatory cytokine tumor necrosis factor alpha (TNF-a) plays a major role in severity of Ulcerative Colitis (UC) and thus inhibition of TNF-a is used to control severe cases of UC. The present meta-analysis was performed to collect and review all the clinical trials that investigated the efficacy and tolerability of infliximab in order to determine whether infliximab is more effective than placebo or corticosteroids in inducing response and remission in UC. All bibliographic databases such as PubMed, Scopus, Web of Science and Cochrane Central Register of Controlled Trials were searched for studies investigated the efficacy of infliximab for the management of UC. Data were collected from 1966 to September 2010. Three trials represented 57 patients with UC who were randomized to receive infliximab or corticosteroids and 5 trials represented 827 patients with UC who were randomized to receive infliximab or placebo were included in the analysis. The summary Relative Risk (RR) for clinical remission in comparison of infliximab with placebo was 1.93 with a 95% Confidence Interval (CI) of 1.62-2.3 and a significant RR (p<0.0001). Summary RR for adverse events of infliximab comparing to placebo was 1.07 with a 95% CI of 0.99-1.14, a non-significant RR (p = 0.0725). The summary RR for serious adverse events of infliximab comparing to placebo was 0.83 with a 95% CI of 0.44-1.54 as a non-significant RR (p = 0.5472). The summary RR for clinical remission of infliximab comparing to corticosteroids was 1.07 with a 95% CI of 0.87-1.31 as a non-significant RR (p = 0.5353). Patients receiving infliximab were 1.93 and 1.07 times more likely to go to the remission as compared to those receiving placebo and corticosteroids, respectively. Meanwhile, the risk of adverse events in the patients receiving infliximab was 1.07 times more than placebo group. The risk of opportunistic infection was high in patients who have failed steroids and cyclosporine and were using infliximab. Although infliximab is more effective than corticosteroids in inducing clinical remission, we believe further trials are still needed to judge stronger in this respect.
Effects of Moxibustion Stimulation on the Intensity of Infrared Radiation of Tianshu (ST25) Acupoints in Rats with Ulcerative Colitis
Xiaomei Wang,Shuang Zhou,Wei Yao,Hua Wan,Huangan Wu,Luyi Wu,Huirong Liu,Xuegui Hua,Peifeng Shi
Evidence-Based Complementary and Alternative Medicine , 2012, DOI: 10.1155/2012/704584
Abstract: ST25 is a key acupoint used in the treatment of ulcerative colitis by moxibustion stimulation, but the biophysical mechanism underlying its effects is still unknown. The aim of the present study was to explore the biophysical properties of ST25 acupoint stimulated by moxibustion in a rat model of ulcerative colitis. The infrared radiation intensity of fourteen wavelengths of ST25 showed significant differences between the normal and model control groups. The intensity of infrared radiation of forty wavelengths showed significant differences compared with the corresponding control points in normal rats. The intensity of infrared radiation of twenty-eight wavelengths showed significant differences compared with the corresponding control points in model rats. The intensity of infrared radiation of nine wavelengths in the herb-partition moxibustion group, eighteen wavelengths in the ginger-partition moxibustion group, seventeen wavelengths in the garlic-partition moxibustion group, and fourteen wavelengths in the warming moxibustion group of the left ST25 showed significant differences compared with that of the model control group. For the right-hand-side ST25, these values were 33, 33, 2, and 8 wavelengths, respectively. This indicated that one possible biophysical mechanism of moxibustion on ST25 in ulcerative colitis model rats might involve changes in the intensity of infrared radiation of ST25 at different wavelengths.
Moxibustion inhibits interleukin-12 and tumor necrosis factor alpha and modulates intestinal flora in rat with ulcerative colitis  [cached]
Xiao-Mei Wang,Yuan Lu,Lu-Yi Wu,Shu-Guang Yu
World Journal of Gastroenterology , 2012, DOI: 10.3748/wjg.v18.i46.6819
Abstract: AIM: To investigate the effect of moxibustion on intestinal flora and release of interleukin-12 (IL-12) and tumor necrosis factor-α (TNF-α) from the colon in rat with ulcerative colitis (UC). METHODS: A rat model of UC was established by local stimulation of the intestine with supernatant from colonic contents harvested from human UC patients. A total of 40 male Sprague-Dawley rats were randomly divided into the following groups: normal (sham), model (UC), herb-partition moxibustion (HPM-treated), and positive control sulfasalazine (SA-treated). Rats treated with HPM received HPM at acupuncture points ST25 and RN6, once a day for 15 min, for a total of 8 d. Rats in the SA group were perfused with SA twice a day for 8 d. The colonic histopathology was observed by hematoxylin-eosin. The levels of intestinal flora, including Bifidobacterium, Lactobacillus, Escherichia coli (E. coli), and Bacteroides fragilis (B. fragilis), were tested by real-time quantitative polymerase chain reaction to detect bacterial 16S rRNA/DNA in order to determine DNA copy numbers of each specific species. Immunohistochemical assays were used to observe the expression of TNF-α and IL-12 in the rat colons. RESULTS: HPM treatment inhibited immunopathology in colonic tissues of UC rats; the general morphological score and the immunopathological score were significantly decreased in the HPM and SA groups compared with the model group [3.5 (2.0-4.0), 3.0 (1.5-3.5) vs 6.0 (5.5-7.0), P < 0.05 for the general morphological score, and 3.00 (2.00-3.50), 3.00 (2.50-3.50) vs 5.00 (4.50-5.50), P < 0.01 for the immunopathological score]. As measured by DNA copy number, we found that Bifidobacterium and Lactobacillus, which are associated with a healthy colon, were significantly higher in the HPM and SA groups than in the model group (1.395 ± 1.339, 1.461 ± 1.152 vs 0.045 ± 0.036, P < 0.01 for Bifidobacterium, and 0.395 ± 0.325, 0.851 ± 0.651 vs 0.0015 ± 0.0014, P < 0.01 for Lactobacillus). On the other hand, E. coli and B. fragilis, which are associated with an inflamed colon, were significantly lower in the HPM and SA groups than in the model group (0.244 ± 0.107, 0.628 ± 0.257 vs 1.691 ± 0.683, P < 0.01 for E. coli, and 0.351 ± 0.181, 0.416 ± 0.329 vs 1.285 ± 1.039, P < 0.01 for B. fragilis). The expression of TNF-α and IL-12 was decreased after HPM and SA treatment as compared to UC model alone (4970.81 ± 959.78, 6635.45 ± 1135.16 vs 12333.81 ± 680.79, P < 0.01 for TNF-α, and 5528.75 ± 1245.72, 7477.38 ± 1259.16 vs 12550.29 ± 1973.30, P < 0.01 for IL-12). CONCLUSION: HPM treatment can regula
Moxibustion for cancer care: a systematic review and meta-analysis
Myeong Soo Lee, Tae-Young Choi, Ji-Eun Park, Song-Shil Lee, Edzard Ernst
BMC Cancer , 2010, DOI: 10.1186/1471-2407-10-130
Abstract: We searched the literature using 11 databases from their inceptions to February 2010, without language restrictions. We included randomised clinical trials (RCTs) in which moxibustion was employed as an adjuvant treatment for conventional medicine in patients with any type of cancer. The selection of studies, data extraction, and validations were performed independently by two reviewers.Five RCTs compared the effects of moxibustion with conventional therapy. Four RCTs failed to show favourable effects of moxibustion for response rate compared with chemotherapy (n = 229, RR, 1.04, 95% CI 0.94 to 1.15, P = 0.43). Two RCTs assessed the occurrence of side effects of chemotherapy and showed favourable effects of moxibustion. A meta-analysis showed significant less frequency of nausea and vomiting from chemotherapy for moxibustion group (n = 80, RR, 0.38, 95% CIs 0.22 to 0.65, P = 0.0005, heterogeneity: χ2 = 0.18, P = 0.67, I2 = 0%).The evidence is limited to suggest moxibustion is an effective supportive cancer care in nausea and vomiting. However, all studies have a high risk of bias so effectively there is not enough evidence to draw any conclusion. Further research is required to investigate whether there are specific benefits of moxibustion for supportive cancer care.Most cancer patients experience multiple symptoms related to either the cancer itself or late treatment effects [1]. The frequently experienced and severe adverse events associated with such treatments lead patients to seek supportive complementary and alternative medicine (CAM) [2]. Most patients use CAM as an adjunct to conventional treatments [3-5]. Acupuncture type interventions are one of the most popular forms of CAM [6]. It is now a widely accepted intervention for the treatment of a variety of conditions [7]. Several reviews claim that acupuncture offers therapeutic benefits for cancer patients [8-10]. Moxibustion is a traditional Chinese method that uses the heat generated by burning herbal prep
The Effectiveness of Moxibustion: An Overview During 10 Years  [PDF]
Song-Yi Kim,Younbyoung Chae,Seung Min Lee,Hyejung Lee,Hi-Joon Park
Evidence-Based Complementary and Alternative Medicine , 2011, DOI: 10.1093/ecam/nep163
Abstract: Moxibustion has been used to treat various types of disease. However, there is still insufficient evidence regarding its effectiveness. This study was performed to summarize and evaluate the effectiveness of moxibustion. A search was performed for all randomized controlled trials in PubMed between January 1998 and July 2008 with no language restriction. The results yielded 47 trials in which six moxibustion types were applied to 36 diseases ranging from breech presentation to digestive disorders. Moxibustion was compared to three types of control group: general care, Oriental medical therapies or waiting list. Moxibustion was superior to the control in 14 out of 54 control groups in 46 studies. There were no significant differences among groups in 7 studies, and the outcome direction was not determined in 33 studies. Seven studies were included in a meta-analysis. Moxibustion was more effective than medication in two ulcerative colitis studies (relative risk (95% CI), 2.20 (1.37, 3.52), P = .001, I2 = 0%). Overall, our results did not support the effectiveness of moxibustion in specific diseases due to the limited number and low quality of the studies and inadequate use of controls. In order to provide appropriate evidence regarding the effectiveness of moxibustion, more rigorous clinical trials using appropriate controls are warranted. 1. Introduction Acupuncture and moxibustion, representative therapeutic modalities in traditional medicine for more than 2500 years [1], are still being used in primary healthcare systems in East Asia [2]. Traditional treatments including acupuncture-related therapies (acupuncture, moxibustion and acupressure) and herbal remedies account for 40% of all healthcares in China [3]. In Korea, it was reported that 67% of Korean medical doctors use moxibustion as a therapeutic tool alone or in addition to their clinical practice [4, 5]. Acupuncture and moxibustion are similar regarding stimulation of acupuncture points on the Meridian [6]. Moxibustion uses thermal and chemical stimulants by burning herbal materials, including mugwort (Artemisia vulgaris, moxa), whereas acupuncture uses physical stimulation via insertion of needles [7]. The therapeutic components of moxibustion are assumed that the combination of heat (burning pain and heat stress), tar (extract), aroma (fume) and psychological stress [8]. Among them, heat stimulation and chemical action of ignited moxa is the most important variable for moxibustion [9]. As the method of acupuncture and moxibustion is different, there are functional distinctions between them.
Remission induction and maintenance effect of probiotics on ulcerative colitis: A meta-analysis  [cached]
Li-Xuan Sang, Bing Chang, Wen-Liang Zhang, Xiao-Mei Wu, Xiao-Hang Li, Min Jiang
World Journal of Gastroenterology , 2010,
Abstract: AIM: To evaluate the induction of remission and maintenance effects of probiotics for ulcerative colitis.METHODS: Information was retrieved from MEDLINE, EMBASE, and the Cochrane Controlled Trials Register. The induction of remission and promotion of maintenance were compared between probiotics treatment and non-probiotics treatment in ulcerative colitis.RESULTS: Thirteen randomized controlled studies met the selection criteria. Seven studies evaluated the remission rate, and eight studies estimated the recurrence rate; two studies evaluated both remission and recurrence rates. Compared with the non-probiotics group, the remission rate for ulcerative colitis patients who received probiotics was 1.35 (95% CI: 0.98-1.85). Compared with the placebo group, the remission rate of ulcerative colitis who received probiotics was 2.00 (95% CI: 1.35-2.96). During the course of treatment, in patients who received probiotics for less than 12 mo compared with the group treated by non-probiotics, the remission rate of ulcerative colitis was 1.36 (95% CI: 1.07-1.73). Compared with the non-probiotics group, the recurrence rate of ulcerative colitis patients who received probiotics was 0.69 (95% CI: 2.47-1.01). In the mild to moderate group who received probiotics, compared to the group who did not receive probiotics, the recurrence rate was 0.25 (95% CI: 0.12-0.51). The group who received Bifidobacterium bifidum treatment had a recurrence rate of 0.25 (95% CI: 0.12-0.50) compared with the non-probiotics group.CONCLUSION: Probiotic treatment was more effective than placebo in maintaining remission in ulcerative colitis.
5-Aminosalicylates Reduce the Risk of Colorectal Neoplasia in Patients with Ulcerative Colitis: An Updated Meta-Analysis  [PDF]
Li-Na Zhao, Jie-Yao Li, Tao Yu, Guang-Cheng Chen, Yu-Hong Yuan, Qi-Kui Chen
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0094208
Abstract: Background Although the chemopreventive effect of 5-aminosalicylates on patients with ulcerative colitis has been extensively studied, the results remain controversial. This updated review included more recent studies and evaluated the effectiveness of 5-aminosalicylates use on colorectal neoplasia prevention in patients with ulcerative colitis. Methods Up to July 2013, we searched Medline, Embase, Web of Science, Cochrane CENTRAL, and SinoMed of China for all relevant observational studies (case-control and cohort) about the effect of 5-aminosalicylates on the risk of colorectal neoplasia among patients with ulcerative colitis. The Newcastle-Ottawa Scale was used to assess the quality of studies. Adjusted odds ratios (ORs) were extracted from each study. A random-effects model was used to generate pooled ORs and 95% confidence intervals (95%CI). Publication bias and heterogeneity were assessed. Results Seventeen studies containing 1,508 cases of colorectal neoplasia and a total of 20,193 subjects published from 1994 to 2012 were analyzed. 5-aminosalicylates use was associated with a reduced risk of colorectal neoplasia in patients with ulcerative colitis (OR 0.63; 95%CI 0.48–0.84). Pooled OR of a higher average daily dose of 5-aminosalicylates (sulfasalazine ≥ 2.0 g/d, mesalamine ≥ 1.2 g/d) was 0.51 [0.35–0.75]. Pooled OR of 5-aminosalicylates use in patients with extensive ulcerative colitis was 1.00 [0.53–1.89]. Conclusion Our pooled results indicated that 5-aminosalicylates use was associated with a reduced risk of colorectal neoplasia in patients with ulcerative colitis, especially in the cases with a higher average daily dose of 5-aminosalicylates use. However, the chemopreventive benefit of 5-aminosalicylates use in patients with extensive ulcerative colitis was limited.
Infliximab in ulcerative colitis
Avi Levin,Oren Shibolet
Biologics: Targets and Therapy , 2008,
Abstract: Avi Levin, Oren ShiboletGastroenterology and Liver Units, Division of Medicine, Hadassah-Hebrew University Medical center, Jerusalem, IsraelAbstract: Infliximab, a monoclonal anti-TNF-α antibody, is commonly used for treatment of moderate to severe Crohn’s disease (CD). Its role in the treatment for ulcerative colitis (UC) remains controversial. We review the role of TNF-α in the pathogenesis of UC and describe the randomized, double-blind, placebo-controlled trials and systematic reviews that assess the efficacy of infliximab in the treatment of moderate to severe UC.Keywords: infliximab, ulcerative colitis, anti-TNF-α antibody, crohn’s disease
Does moxibustion work? An overview of systematic reviews
Myeong Soo Lee, Jung Won Kang, Edzard Ernst
BMC Research Notes , 2010, DOI: 10.1186/1756-0500-3-284
Abstract: Electronic searches were conducted to locate all SRs of moxibustion for any condition. Data were extracted by two authors according to predefined criteria.Ten SRs met our inclusion criteria, which related to the following conditions: cancer, ulcerative colitis, stroke rehabilitation, constipation, hypertension, pain conditions and breech presentation. Their conclusions were contradictory in several instances. Relatively clear evidence emerged to suggest that moxibustion is effective for breech presentation.Based on evidence from the currently available SRs, the effectiveness of moxibustion has been demonstrated for several conditions; however, due to the poor quality of the primary studies, there remains considerable uncertainty.Moxibustion is an East Asian therapeutic method that uses the heat generated by burning herbal preparations containing Artemisia vulgaris to stimulate acupuncture points [1]. According to the theory of traditional medicine, heat is usually applied to acupuncture points during moxibustion to cure diseases by regulating the function of meridians and visceral organs. A possible explanation for how moxibustion works is that the heat stimulates acupuncture points, which increases qi circulation and relieves qi stagnation, leading to an improved disease state [2].Acupuncture stimulation, which involves thrusting or twisting needles, results in various biochemical reactions that can have effects throughout the body. Unlike acupuncture, moxibustion uses heat stimulation at various temperature levels, ranging from mild skin warming to tissue damage from burning. This heat stimulation can yield inflammatory responses and induce vascular changes [2].Although moxibustion is often used as a symptomatic treatment for a wide range of conditions in clinical practice, e.g., arthritis, gastrointestinal problems, gynaecological complaints and stroke rehabilitation, its clinical effectiveness remains uncertain [3-5], and many experts doubt its biological plausi
Association between Variants of the Autophagy Related Gene – IRGM and Susceptibility to Crohn’s Disease and Ulcerative Colitis: A Meta-Analysis  [PDF]
Xiao Cheng Lu, Yi Tao, Chen Wu, Peng Lai Zhao, Kai Li, Jin Yu Zheng, Li Xin Li
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0080602
Abstract: Background Polymorphisms in immunity-related GTPase family M (IRGM) gene may be associated with inflammatory bowel disease (IBD) by affecting autophagy. However, the genetic association studies on three common variants in IRGM gene (rs13361189, rs4958847 and rs10065172) have shown inconsistent results. Methodology/ Principal Findings The PubMed and Embase were searched up to June 5, 2013 for studies on the association between three IRGM polymorphisms and IBD risk. Data were extracted and the odd ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. Finally, we performed a meta-analysis of 25 eligible studies in 3 SNPs located at IRGM gene by using a total of 20590 IBD cases and 27670 controls. The analysis showed modest significant association for the rs13361189, rs4958847 and rs10065172 variants in Crohn’s disease (CD): the risk estimates for the allele contrast were OR=1.306 (1.200-1.420), p=5.2×10-10, OR=1.182 (1.082-1.290), p=0.0002, and OR=1.248 (1.057-1.473), p=0.009 respectively (still significant when the p value was Bonferroni adjusted to 0.017). When stratified by ethnicity, significantly increased CD risk was observed in Europeans, but not in Asians. Conversely, there was no association of rs13361189 or rs4958847 variant with risk of ulcerative colitis (UC). Conclusions/ Significance These results indicated that autophagy gene-IRGM polymorphisms appear to confer susceptibility to CD but not UC, especially in Europeans. Our data may provide further understanding of the role of autophagy in the pathogenesis of CD.
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