• MeSH
• biologická terapie MeSH
• Crohnova nemoc terapie   MeSH
• management farmakoterapie MeSH
• management nemoci MeSH
• monoklonální protilátky terapeutické užití   MeSH
• střevní sliznice MeSH
• Publikační typ
• sborníky MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• gastroenterologie

Celiac disease (gluten-sensitive enteropathy) is an immune mediated disorder with characteristic histopathological small bowel mucosal changes that respond to a strict gluten-free diet. Recent studies have suggested that complete (rather than partial) mucosal recovery and healing is possible, but in some this may require a more prolonged period than is currently appreciated. In this study, 182 patients (60 males, 122 females) referred for evaluation of symptoms, including diarrhea and weight loss, were selected only if initial biopsies showed characteristic inflammatory changes with severe architectural disturbance. All patients were treated with a strict gluten diet alone and diet compliance regularly monitored. Up to 90% or more of patients showed a complete mucosal response or healing. A time-dependent rate of response was noted with most patients requiring more than 1 year, and even 2 years or more, to respond, however, complete mucosal healing was still possible within 6 months. In this evaluation, females in each of 4 different age ranges had mucosal response and healing rates superior to males, while elderly celiacs had lower rates. Such factors should be considered before labeling a patient with “non-responsive” disease. However, inflammatory changes with persistent architectural disturbance, especially in celiacs with a late diagnosis and resultant late initiation of a gluten-free diet treatment, may be at increased risk for a later small bowel complication, including lymphoma.

• MeSH
• bezlepková dieta MeSH
• celiakie * patofyziologie   MeSH
• dítě MeSH
• dospělí MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• obnova funkce MeSH
• senioři MeSH
• sliznice * patofyziologie   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH

• MeSH
• alanin analogy a deriváty   MeSH
• nemoci trávicího systému MeSH
• ochrana biologická MeSH
• protivředové látky MeSH
• střevní sliznice MeSH
• žaludeční sliznice MeSH
• Publikační typ
• sborníky MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• gastroenterologie
• farmacie a farmakologie

Different approaches to enhance healing of hard or soft tissues include the use of cytokines and growth factors to modify cellular behaviour. Numerous growth factors are found in autologous blood concentrates - platelet-rich plasma (PRP) and platelet-rich fibrin (PRF). Enamel matrix derivative (EMD) may improve tissue healing via amelogenins. Bilayered collagen matrix (CM) is used for soft tissue augmentation. The aim of the present study was to assess potential benefits of PRP, PRF and EMD in combination with bilayered collagen matrix or CM alone in treatment of oral mucosal defects in rabbits. Twenty-seven New Zealand white rabbits were included in this randomized controlled trial. Artificial oral mucosal defects were treated with one of these five approaches: PRP+CM, PRF+CM, EMD+CM, CM alone, or left untreated as a negative control - CO. The animals were euthanized 1 day, 7 days, or 28 days after surgery and necropsies were harvested. Histological and molecular biological analyses were performed. All defects were healed by day 28. No differences between PRP+CM, PRF+CM, CM alone and CO groups were recorded at any time point. Slower angiogenesis and a higher presence of inflammatory infiltrate were observed in the EMD+CM group 28 days after surgery. Molecular biological analyses did not reveal any statistically significant changes. In conclusion, no improvement in mucosal healing of wounds covered with a collagen membrane and PRP, PRF, or EMD was observed, compared with CM alone or untreated controls. Copyright© by the Polish Academy of Sciences.

• MeSH
• fibrin bohatý na krevní destičky * MeSH
• hojení ran * účinky léků   MeSH
• králíci MeSH
• náhodné rozdělení MeSH
• plazma bohatá na destičky * MeSH
• proteiny zubní skloviny * terapeutické užití   MeSH
• ústní sliznice * patologie   MeSH
• zvířata MeSH
• Check Tag
• králíci MeSH
• zvířata MeSH

INTRODUCTION: CT-P13 is the first biosimilar to infliximab that has been approved for the same indications as its originator infliximab. No data are available on the effect of infliximab biosimilar on mucosal healing. The aim of this study was to evaluate the efficacy of CT-P13 induction therapy on mucosal healing in patients with ulcerative colitis [UC]. PATIENTS AND METHODS: UC patients, who received CT-P13 therapy from its local introduction at three Hungarian and one Czech inflammatory bowel disease centres, were prospectively enrolled. Sigmoidoscopy was performed after the end of the induction therapy at week 14. Mucosal healing was defined as Mayo endoscopic subscore 0 or 1. Complete mucosal healing was defined as Mayo endoscopic subscore 0. Trough level of CT-P13 was measured at week 14. RESULTS: Sixty-three UC patients who underwent CT-P13 induction therapy were enrolled in the study. Indication for the therapy was acute, severe flare up and chronic, refractory activity in 24 and 39 patients, respectively. Cumulative clinical response and steroid-free remission at week 14 were achieved in 82.5% and 47.6% of the patients, respectively. Sigmoidoscopy revealed steroid-free mucosal healing in 47.6% of the patients, and complete mucosal healing was present in 27%. Mayo endoscopic subscore decreased significantly at week 14 compared to baseline. Trough levels of infliximab correlated with mucosal healing. CONCLUSION: This is, to our knowledge, the first study examining the efficacy of CT-P13 induction therapy on mucosal healing in UC. The results indicate that mucosal healing is achieved in two-thirds of UC patients by the end of the induction treatment with CT-P13.

• MeSH
• biosimilární léčivé přípravky terapeutické užití   MeSH
• dospělí MeSH
• gastrointestinální látky terapeutické užití   MeSH
• infliximab terapeutické užití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• monoklonální protilátky terapeutické užití   MeSH
• prospektivní studie MeSH
• senioři MeSH
• střevní sliznice patologie   MeSH
• ulcerózní kolitida farmakoterapie   patologie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• multicentrická studie MeSH

• Publikační typ
• abstrakt z konference MeSH

Úvod: Efektivita anti-TNFα terapie v navození slizničního hojení u Crohnovy nemoci (CN) v tenkém střevě je prozkoumána méně ve srovnání s tlustým střevem z důvodu obtížnější detekce slizničních změn. Cíl a metodika: Cílem této prospektivní studie bylo ověřit účinnost anti-TNFα léčby v dosažení slizničního hojení CN tenkého střeva s využitím kapslové endoskopie (CE). Do studie byli zařazeni pacienti s CN tenkého (+/- tlustého) střeva, kteří byli indikováni k léčbě anti-TNFα preparáty. Výsledky: 25 pacientů (18 léčených infliximabem, 7 adalimumabem) bylo vyšetřeno CE (Mirocam?, IntroMedic, Jižní Korea) při zahájení biologické terapie a 19 z nich v průběhu udržovací fáze léčby. Nález byl hodnocen pomocí Lewisova skóre (LS). Medián celkového LS byl při vstupu do studie 1 350 (rozmezí 337–7 840), 28 % pacientů mělo lehké slizniční zánětlivé změny (LS 135–790) a 72 % mělo změny střední až těžké (LS > 790). Po léčbě v trvání (medián) 32 týdnů došlo k signifikantnímu poklesu celkového LS na 402,5 (rozmezí 0–4 432; p < 0,001), přičemž 83 % pacientů mělo pouze lehké zánětlivé změny nebo normální slizniční nález (LS < 135). V jednom případě (2,3 %) došlo k retenci kapsle, jiné komplikace nebyly pozorovány. Závěr: Práce prokázala účinnost anti-TNFα terapie v indukci slizničního hojení CN tenkého střeva. Kapslová endoskopie byla v této situaci metodou efektivní, pacienty dobře tolerovanou a bezpečnou.

Background: Efficacy of anti-TNFα therapy in mucosal healing of Crohn's disease in the small bowel is examined less than in the large bowel due to more difficult detection of mucosal changes. Aim and methods: The aim of the prospective study was to assess the efficacy of anti-TNFα therapy in mucosal healing of small bowel CD using capsule endoscopy (CE). Patients with CD involving small (+/- large) bowel, who were indicated to anti-TNFα therapy were included. Results: 25 patients (18 treated with infliximab, 7 with adalimumab) were examined by CE (Mirocam(R), IntroMedic, South Korea) at the start of biologic treatment and 19 of them during the maintenance phase of therapy. Mucosal inflammatory changes were assessed by the Lewis score (LS). The median LS at base line was 1,350 (range 337–7,840) with 28% having mild (LS 135–790) and 72% moderate to severe mucosal inflammation (LS > 790). A significant reduction of LS to 402.5 with the range of 0–4,432 (p < 0.001) was observed after median of 32 weeks of treatment, with 83% of patients having only mild mucosal inflammation or normal mucosal finding (LS < 135). Only one (2.3%) capsule retention was observed; other complications were not observed. Conclusion: Anti-TNFα therapy is effective in mucosal healing of small bowel CD. Capsule endoscopy detected mucosal changes effectively, was well tolerated and relatively safe.

• MeSH
• adalimumab MeSH
• Crohnova nemoc * farmakoterapie   patologie   MeSH
• dospělí MeSH
• humanizované monoklonální protilátky terapeutické užití   MeSH
• infliximab MeSH
• kapslová endoskopie využití   MeSH
• kapslové endoskopy škodlivé účinky   využití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• monoklonální protilátky terapeutické užití   MeSH
• pilotní projekty MeSH
• prospektivní studie MeSH
• reprodukovatelnost výsledků MeSH
• statistika jako téma MeSH
• střevní sliznice * patologie   účinky léků   MeSH
• stupeň závažnosti nemoci MeSH
• tenké střevo patologie   účinky léků   MeSH
• TNF-alfa * antagonisté a inhibitory   terapeutické užití   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH

BACKGROUND: We hypothesised that different solutions for submucosal injection may influence early healing of endoscopic mucosal resection (EMR). The aim of this study was to evaluate histological and immunological changes after EMR in experimental pigs. MATERIALS AND METHODS: Two parallel EMRs on the anterior and posterior wall of the gastric body were performed by means of the cap technique in 21 female pigs. A glycerol-based solution (anterior EMR) and hydroxypropyl methylcellulose solution (posterior EMR) were applied for submucosal injection. The animals were sacrificed 7 days later, and tissue sections of all EMRs were stained using combined trichrome. Computer image analysis was used for objective evaluation of elastic and collagen fibres content. Two-colour indirect immunophenotyping of blood and gastric samples were performed using mouse anti-pig monoclonal antibodies. RESULTS: The values of collagen fibre content 7 days after EMR were significantly higher in lesions after the use of solution A in comparison with solution B (2.10 +/- 0.25% versus 1.57 +/- 0.25%, p = 0.009). Concordant results were found in elastic fibres (3.23 +/- 0.49% versus 2.93 +/- 0.61%, p = 0.018). No systemic changes in major leukocyte subpopulations were found. In gastric tissue, lymphocyte subsets exhibited only minor changes. CD4(+) T-lymphocytes were increased in the healing tissue after EMR using solution A (17.08 +/- 9.24% versus 9.76 +/- 7.97%, p = 0.011). Significant increase of SWC3(+) leukocytes was observed after EMR using solution B (47.70 +/- 25.41% versus 18.70 +/- 12.16%, p = 0.001). CONCLUSIONS: The use of glycerol-based solution for submucosal injection was associated with more pronounced histological signs of early healing of EMRs compared with hydroxypropyl methylcellulose.

• MeSH
• časové faktory MeSH
• elastická tkáň MeSH
• financování organizované MeSH
• gastroskopie MeSH
• glycerol aplikace a dávkování   farmakologie   terapeutické užití   MeSH
• hojení ran účinky léků   MeSH
• injekce MeSH
• kolagen analýza   MeSH
• lékové roztoky aplikace a dávkování   farmakologie   terapeutické užití   MeSH
• leukocyty účinky léků   MeSH
• methylcelulosa analogy a deriváty   aplikace a dávkování   farmakologie   terapeutické užití   MeSH
• podskupiny lymfocytů účinky léků   MeSH
• preklinické hodnocení léčiv MeSH
• Sus scrofa MeSH
• viskozita MeSH
• žaludeční sliznice chirurgie   patologie   účinky léků   MeSH
• zvířata MeSH
• Check Tag
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• práce podpořená grantem MeSH
• srovnávací studie MeSH

OBJECTIVES: Over the past few years, mucosal healing (MH) has emerged as a promising goal in the treatment of pediatric patients with Crohn's disease (CD). We aimed to assess whether combination therapy with infliximab (IFX) + azathioprine (AZA) was more effective than AZA therapy alone in achieving mucosal healing in pediatric patients with CD. METHODS: Newly diagnosed pediatric patients with CD at the Department of Pediatrics in University Hospital in Hradec Králové were retrospectively recruited (2000-2014). The patients were divided into two groups according to the therapy: (a) IFX + AZA ± corticosteroids ± 5-aminosalicylic acid (5-ASA) (n = 16); and (b) AZA ± corticosteroids ± 5-ASA (n = 40). The patients were also divided into two groups: "MH" and "no MH," according to their MH status. MH was defined as the complete endoscopic disappearance of all mucosal ulcerations (including aphthous ulcerations) and the absence of any sign of mucosal inflammation in the terminal ileum and the large bowel. RESULTS: Of 56 patients, MH was observed in 56% (9/16) treated with combined therapy in comparison with 15% (6/40) of patients in the AZA group (P = 0.006). The median dose of AZA in both groups was 2.1 mg/kg per day. We observed eight adverse events in seven patients from the IFX + AZA group. Adverse effects were less common in the AZA group (P = 0.002). CONCLUSION: Combined therapy (IFX + AZA) was more effective in achieving MH in pediatric CD than treatment with AZA alone.

• MeSH
• azathioprin terapeutické užití   MeSH
• Crohnova nemoc * farmakoterapie   MeSH
• dítě MeSH
• imunosupresiva MeSH
• infliximab terapeutické užití   MeSH
• lidé MeSH
• pediatrie * MeSH
• retrospektivní studie MeSH
• synergismus léků MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Úvod: Donedávna bola liečba pacientov s Crohnovou chorobou (CD) zameraná na zlepšenie príznakov a symptómov ochorenia, bez zamerania sa na slizničné hojenie (SH). SH sa však ukázalo v priebehu posledných rokov ako dôležitý liečebný cieľ u pacientov s CD. Záujem vzrástol aj vďaka nedávnym výsledkom ukazujúcim, že biologická liečba dokáže nielen rýchlo zlepšiť symptómy, ale aj indukovať hojenie ileokolonických lézií. Pre uvedené je SH v súčasnosti považované v klinických štúdiách za dôležitý cieľ liečby a je aj vo zvýšenej miere používané v klinickej praxi. Ciele práce: Cieľom štúdie bolo vyšetriť slizničné lezie na tenkom čreve kapsulovou enteroskopiou (KE) u pacientov s CD pred podaním infliximabu (IFX) alebo adalimumabu (ADA) a následne po jednoročnej udržiavacej biologickej liečbe. Druhým cieľom bolo zistiť toleranciu KE u pacientov, jej možné nežiadúce účinky a taktiež zistiť diagnostickú výťažnosť tohto vyšetrenia u pacientov s CD. Materiály a metódy: Po schválení etickou komisiou a podpísaní informovaného súhlasu sme prospektívne do štúdie zaradili a sledovali 50 pacientov s CD, ktorí neboli v minulosti liečení ako IFX (n = 25), tak ADA (n = 25), ale spínali indikačné kritériá na biologickú liečbu. Potom ako pacienti s CD boli zaradení do štúdie, realizovali sme u každého vyšetrenie KE (M2A kapsulou) pred podaním prvej dávky biologickej liečby a po ročnej liečbe. Nález sme hodnotili ako diagnostický v prípade, že sme našli zmeny svedčiace pre CD lokalizovanú v tenkom čreve: erytém, edém, strata črevných klkov, aftoidné lezie, ulcerácie, jazvy, ústie fistule, možná striktúra, krvácanie. Nález bol hodnotený ako podozrivý, ak zmeny neboli typické pre aktívnu CD: ojedinelé afty a ulcerácie (v počte menej ako tri) alebo normálny nález. Vyšetrenie sme považovali za úplné, ak kapsula dosiahla cékum (slepé črevo). Okrem nálezu sme sledovali aj toleranciu vyšetrenia KE zo strany pacienta a nežiadúce účinky vyšetrenia. Výsledky: Zo skupiny prospektívne zaradených pacientov (n = 50) sme museli vyradiť zo sledovania štyroch pacientov pre IFX infúzne reakcie a štyroch pacientov pre reaktiváciu CD (2 liečení IFX a 2 ADA). 42 pacientov (19 liečených IFX a 23 ADA) ukončilo prospektívne sledovanie spočívajúce v jednoročnom podávaní biologickej liečby a opakovanom vyšetrení KE. V skupine pacientov liečených ADA (n = 23) došlo pri porovnaní výsledkov KE pred biologickou udržiavacou liečbou a po nej u dvoch pacientov k vymiznutiu diagnostického nálezu a zmene na negatívny. U jedného pacienta sme zaznamenali zhoršenie nálezu v zmysle zmeny z podozrivého na diagnostický. Jeden pacient s podozrivým nálezom mal po ročnej liečbe negatívny nález. U ostatných pacientov nález ostal bez zmeny (u 9 diagnostický, u 9 negatívny a u 1 podozrivý). V skupine pacientov liečených IFX (n = 19) došlo pri porovnaní výsledkov KE pred biologickou udržiavacou liečbou a po nej u dvoch pacientov k vymiznutiu diagnostického nálezu a k zmene na negatívny. U ostatných pacientov nález ostal bez zmeny (u 6 diagnostický, u 8 negatívny a u 3 podozrivý). Vyšetrenie KE bolo u všetkých pacientov dobre tolerované, bez nežiadúcich účinkov. U siedmych pacientov kapsula nedosiahla k cékum. Záver: Napriek skutočnosti, že sme nezaznamenali štatisticky významný účinok udržiavacej ADA alebo IFX liečby na SH v tenkom čreve, zaznamenali sme v skupine pacientov s CD zlepšenie v zmysle pokles indexu aktivity (CDAI) počas 1-ročného podávania udržiavacej biologickej liečby. KE preto môže v budúcnosti byť skôr nápomocná pri selekcii pacientov so slizničnými léziami, v zmysle dosiahnutia čo najlepších klinických výsledkov biologickej liečby. Validitu tohto pristupuje potrebné určiť v prospektívnych štúdiách s CD pacientmi, kde SH by malo byť stanovené ako kľúčový cieľ. Ďalšie štúdie sú potrebné aj na vytvorenie štandardizovaného endoskopického skórovacieho systému pre SH, ktorý by sa overil v prospektívnych klinických štúdiách sledujúcich dlhodobý vývoj CD. Dovtedy nie je úplne jasné, ako by malo byt'SH používané v klinickej praxi.

Introduction: Until recently, the focus of treatment of patients with Crohn´s disease (CD) was on improvement of the signs and symptoms of the disease without aiming at mucosal healing (MH). However, in recent years MH has proven to be an important therapeutical goal in patients with CD. Interest was raised recently by findings showing that biological agents not only rapidly improve the symptoms but also induce healing of ileocolonic lesions. As a consequence, current clinical trials regard MH as an important therapeutical goal and it has also been implemented in clinical practice to a greater extent. Aim: The aim of the proposed study is to evaluate mucosal lesions in the small intestine by capsule endoscopy (CE) in patients with CD before the administration of infliximab (IFX) and adalimumab (ADA) and following one-year maintenance treatment with these agents. The secondary endpoint isto evaluate the tolerance of CE by the patient, the possible side effects of this procedure and also the diagnostic efficacy of this procedure in patients with CD. Material and methods: Following approval from the Ethics Committee and after signing the Informed Consent, the group of consequently included 50 patients with CD, not previously treated with IFX(n = 25) or ADA (n = 25), but suitable for biological treatment with respect to the indication criteria, were monitored. After patients with CD were included in the study, CE using the M2A capsule was performed in each patient before the first dose of biological treatment was administered. Results were seen as conclusive if the following signs of CD localized in the small intestine were observed: erythema, edema, villus abrasion, aphtous lesions, ulcerations, scars, openings of fistula, possible strictures, bleeding. Results were seen as inconclusive if the findings were not typical for active CD: isolated aphtous lesions and ulcerations (fewer than 3) and normal. Examination was regarded as complete if the capsule reached cecum. Tolerance of CE from the patient's side and side effects were also evaluated. The efficacy of the examination was assessed in each patient (conclusive findings, inconclusive findings or normal findings) before and after treatment with IFX and ADA. Results: From the group of prospectively enrolled patients with CD (n = 50) we had to exclude 4 patients due to IFX infusion reactions and 4 patients due to reactivation of CD (2 treated with IFX and 2 with ADA). 42 patients (19 treated with IFX and 23 with ADA) concluded the prospective evaluation by means of 1-year treatment with biological agents and repeated CE examination. In the group of ADA treated patients (n = 23) after one year we observed a change from conclusive to normal in 2 patients. We observed in 1 patient a deterioration of the findings from inconclusive to conclusive and in 1 patient from inconclusive to normal. In all the other patients the findings remained without change (in 9 conclusive, in 9 normal and in 1 inconclusive). In the group of IFX treated patients (n = 19) after one year we observed changes from conclusive to normal in 2 patients. In all the other patients the findings remained without change (in 6 conclusive, in 8 normal and in 3 inconclusive). The CE examination was well tolerated, without serious side effects, in all patients. In 7 patients the capsule did not reach cecum. Conclusion: Despite the fact that we did not observe statistically significant effect of ADA or IFX treatment on small bowel MH, we observed in our group of CD patients improvement by means of a drop in the Crohn's Disease Activity Index (CDAI) during 1-year maintenance biological treatment. CE could therefore in the future be helpful in selecting the right patient with mucosal lesions in terms of achieving the best clinical results for the biological treatment. The validity of this approach is necessarily to be determined in prospective studies with CD patients, where MH has to be established as the main treatment goal. Further studies are also needed to create a standardized endoscopic scoring system for MH, which has to be proven in prospective clinical studies evaluating long-term development of CD. Until then it is not clear what our approach to MH in clinical practice should be.

• Klíčová slova
• Crohn's disease, mucosal healing, capsulle endoscopy,
• MeSH
• adalimumab MeSH
• Crohnova nemoc farmakoterapie   radiografie   MeSH
• financování organizované MeSH
• gastrointestinální endoskopie metody   MeSH
• infliximab MeSH
• kapslová endoskopie metody   využití   MeSH
• lidé MeSH
• monoklonální protilátky aplikace a dávkování   MeSH
• prospektivní studie MeSH
• střevní sliznice patologie   účinky léků   MeSH
• TNF-alfa antagonisté a inhibitory   účinky léků   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH