Morphometric studies in rectal biopsy specimens from patients with ulcerative colitis: effects of oral 5 amino salicylic acid and rectal prednisolone treatment

Article Abstract:

Ulcerative colitis is an inflammatory bowel disease of the colon; symptoms include watery stools, abdominal pain, tenderness, and colic. Diagnosis and evaluation of treatment efficacy are frequently made on the basis of subjective evaluation of criteria such as mucosal ulceration, mucus depletion, or absence of epithelial granulomata (granular tumors or growths). The difficulty encountered in distinguishing ulcerative colitis from other similar conditions, such as Crohn's colitis or infective colitis, and in assessing response to treatment may be partly blamed on the lack of a quantitative metric for classifying intestinal morphology. Morphometric analysis, the evaluation of certain anatomical aspects of tissues (in this case the colon) according to predetermined quantitative criteria, might provide a more objective, reliable tool for assessing colonic status. To evaluate the suitability of morphometric analysis, as well as to investigate the effect of several anticolitis drugs on intestinal morphology, rectal biopsies were taken from 10 normal control subjects and from 33 patients with active ulcerative colitis. The biopsies were taken before and after treatment of four weeks with oral 5 amino salicylic acid or rectal corticosteroid (prednisolone) enemas. Computerized analysis was performed on microscopic sections of the biopsy tissue, and a variety of parameters were quantified for comparison. Differences were seen in the biopsy specimens from colitis patients on numerous aspects of cellular morphology. Treatment with both 5 amino salicylic acid and prednisolone yielded approximately equivalent improvements in colonic morphology, as determined both clinically and with morphometric criteria. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Ulcerative colitis, Rectum, Biopsy, Aminosalicylic acids

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Fluticasone propionate in Crohn's disease

Article Abstract:

Crohn's disease is an inflammatory condition that affects the digestive tract; most often, the small intestine and colon are involved. Because the cause of Crohn's disease is unknown, treatment strategies address the symptoms of the disease. Corticosteroid drugs are frequently prescribed for patients with this disorder, but the high incidence of side effects makes most corticosteroids less than ideally suited for use. Fluticasone propionate is a corticosteroid derivative which, when taken orally, is very poorly absorbed from the gastrointestinal tract. Since the site of action in the treatment of Crohn's disease is the lining of the gastrointestinal tract, this property should maximize the dose that can be given without systemic side effects. To evaluate the effectiveness and safety of fluticasone propionate in the treatment of Crohn's disease, a pilot study involving 12 patients with mild or moderate active disease was carried out. Oral fluticasone propionate was administered for three weeks. At the end of this period, there was a significant improvement in disease severity as determined by two independent methods (a standard Crohn's disease activity index and a test that measured the extent of inflammatory activity in the bowel). There were no serious side effects, and blood cortisol (a corticosteroid) values did not change, indicating little or no absorption of the drug from the gastrointestinal tract. Fluticasone propionate is a promising drug for treating Crohn's disease without causing the adverse side effects associated with other corticosteroids. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Gastrointestinal diseases, Crohn's disease

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A pilot study of fluticasone propionate in untreated coeliac disease

Article Abstract:

Celiac disease is a disorder of the small intestine characterized by diarrhea, malabsorption of nutrients, intestinal bleeding, and low calcium levels. It can sometimes be treated by lifelong adherence to a gluten-free diet. However, this diet is unpalatable and patient compliance is difficult to obtain. In addition, some patients are unresponsive to dietary manipulations. In either case, drug therapy is indicated. Corticosteroids, the most effective drugs in treating celiac disease, have unwanted systemic side effects. To test the efficacy of a novel corticosteroid with low bioavailability, a pilot study was carried out in which 12 adult patients with untreated celiac disease received fluticasone propionate for 6 weeks while maintaining a normal diet. (Low bioavailability means that the drug is exposed to the afflicted intestinal segments, but not absorbed into the bloodstream.) Two patients dropped out of the study for unrelated reasons. Among the remainder of the subjects, there was an improvement in clinical status: weight increased by about five pounds, absorption was improved, intestinal biopsies showed less evidence of pathology, and levels of digestive enzymes were increased. No dramatic side effects were noted, but small changes in corticosteroid metabolism were noted in 25 percent of the patients. Fluticasone propionate appears to be a useful adjunct to treatment of celiac disease. Further research should assess the prevalence and extent of the alterations in corticosteroid metabolism. (Consumer Summary produced by Reliance Medical Information, Inc.)

Celiac disease, Malabsorption syndromes

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