Colitis Trouble up High: A Case of Gastroduodenal Ulcerative Colitis and Literature ReviewCauchi, Van Venetien, Sciberras
et alJ Gastrointestin Liver Dis (2025) 34 (1), 128-132
Abstract: The presence of backwash ileitis, post-colectomy pre-pouch ileitis, or pouchitis has been widely described in the presentation of ulcerative colitis [UC]. However, over the years, a few cases of upper gastrointestinal [UGI] inflammation in patients with UC have been reported, most commonly post-colectomy. The aim of this review was to conduct an analysis of the current literature to identify the prevalence, risk factors and current treatment of UGI UC. Methods: Case report and review of the literature. An electronic search of five bibliographic databases [Pubmed, Cochrane, DOAJ, Science Direct, and JSTOR], was conducted. A combination of keywords and medical subject headings [MeSH] related to "small intestine" and "inflammation" or "enteritis" and "colectomy" or "post operative complications" or "ileostomy" or "stoma" and "ulcerative colitis" or "inflammatory bowel disease" were used. Referenced papers not fully available in English text were excluded from the study. The manuscripts were analysed for age, gender, extent of colonic and UGI disease, timing of UGI presentation, surgical history, treatment and follow-up.We present the case of a 59-year-old woman with diffuse upper gastrointestinal (UGI) ulcerative colitis (UC) that was refractory to steroid treatment, occurring nine years after a panproctocolectomy for medical treatment failure Upon initiation of an anti-TNFɑ [adalimumab], she achieved remission. We then systematically reviewed the literature to analyse previous reports of patients presenting with UGI UC to understand the prevalence and identify risk factors for developing this condition. To date, 43 cases have been published describing UGI UC with a male to female ratio 5:4 with a mean age of 37.52 years [IQ range 27 years] The majority [85.7%] of these patients were post-colectomy secondary to pancolitis. The mean time post-colectomy for UGI UC to occur is 14 months [range 0-12 years]. The prognosis of these patients were generally good; however, severe complications including haemorrhage, perforation and death have been reported. The inflammatory distribution affected the duodenum [74%] > ileum [57%] > jejunum [31%] > stomach [4%]. The majority of patients with reported changes in the stomach had a pangastritis pattern, with only one case describing isolated antral inflammation. No standardised treatment strategy is available, however, intravenous and oral corticosteroids, 5-aminosalicylates, thiopurines, calcineurin-inhibitors, and TNFα-inhibitors, have been found to be effective in treating UGI UC. Only one other case report reported the successful use of adalimumab to attain remission in UGI UC.This review sheds light on a rare presentation of UC. This highlights the need for further research into the pathogenesis of UC and treatment strategies for patients presenting with UGI UC. Our case further strengthens the use of anti-TNFɑ, particularly adalimumab for UGI UC and highlights the need for further research into the pathogenesis of inflammatory bowel disease.
Use of Biologic Therapy in AA Amyloidosis Patients Undergoing Dialysis-A Systematic Literature ReviewTorun, Kadıoğlu
Hemodial Int (2025)
Abstract: The advent of biological agents has provided significant therapeutic opportunities for patients with AA amyloidosis. However, when these patients reach end-stage renal disease and begin dialysis, some clinicians may discontinue biological treatments due to the heightened risk of infections. Given that AA amyloidosis is a progressive condition, there is a potential for the disease to affect additional organs in these patients. Consequently, we aimed to evaluate the benefits and risks associated with biological agents in AA amyloidosis patients receiving dialysis.We performed a systematic literature review in Cochrane Database and MEDLINE about the use of biologic agents in AA amyloidosis patients undergoing dialysis.We identified fifty-five patients across twenty-two studies. Familial Mediterranean fever was the etiology in 21 patients (71.4% anakinra and 28.6% canakinumab), rheumatoid arthritis in 17 patients (52.9% etanercept and 47.1% tocilizumab), unknown etiology in 8 patients (62.5% anakinra and 37.5% tocilizumab), ankylosing spondylitis in 5 patients (40% etanercept, 40% adalimumab, and 20% infliximab), hidradenitis suppurativa in 3 patients and tumor necrosis factor receptor-associated periodic syndrome (TRAPS) in 1 patient. Biologic agents were effective or partially effective for primary disease control in 52 patients (94.5%). Two patients were able to discontinue dialysis. Most frequent side effects were infections (8 episodes in 7 patients). Eight patients died (5 due to infections, one due to cardiac causes and two due to pulmonary hemorrhage).Biologic agents are effective in AA amyloidosis patients that are treated with dialysis and seem to have an acceptable safety profile.© 2025 International Society for Hemodialysis.
Genetic Polymorphisms on TNFA, TNFRSF1A, and TNFRSF1B Genes Predict the Effectiveness of Anti-TNF-α Treatment in Inflammatory Bowel Disease PatientsRottura, Pirrotta, Giorgi
et alBiomedicines (2025) 13 (3)
Abstract: Background/Objectives: Tumor necrosis factor alpha (TNF-α) is the key inflammatory cytokine involved in the pathogenesis of inflammatory bowel diseases (IBDs). Anti-TNF-α therapy has been successfully used for IBD treatment, although the therapeutic response differs among patients due to the genetic background. The aim of this study was to investigate whether the presence of single nucleotide polymorphisms (SNPs) on TNFA, TNFRSF1A, and TNFRSF1B genes could affect anti-TNF-α treatment effectiveness in IBD patients. Methods: In this prospective cohort study, 83 European IBD patients treated with infliximab or adalimumab (with or without steroid bridge therapy) as first-line therapy were enrolled. Genomic DNA was extracted from peripheral blood, and TNF-α (rs1800629, rs361525, rs1799724), TNFRSF1A (rs767455), and TNFRSF1B (rs1061622, rs1061624, rs3397, rs976881) SNPs were assessed. Steroid-free remission (SFR) (clinical remission together with steroid interruption) and anti-TNF-α therapy persistence after 12 months of follow-up were evaluated. Patients who stopped anti-TNF-α therapy before the end of follow-up, due to side effects or treatment failure, were defined as discontinuers. Results: A higher frequency of the G/G genotype in rs1800629 and the A/A genotype in rs1061624 was observed in the SFR group compared to non-SFR (97.7% vs. 82.8%; p = 0.025 and 32.6% vs. 10.3%; p = 0.029, respectively). Moreover, carriers of the A/A genotype in rs361525 and the C/C genotype in rs767455 had a lower probability of achieving SFR than wild-type patients (OR = 0.14; 95% CI= 0.03-0.69; p = 0.016 and OR = 0.10; 95% CI = 0.02-0.60; p = 0.012, respectively). Furthermore, an increased frequency of rs1800629 A allele was observed in patients who discontinued treatment compared to completers (27.3% vs. 6.9%; p = 0.033), as well as a high risk of interrupting therapy (HR = 6.47; 95% CI = 1.15-36.38). Conclusions: These results suggest that the evaluation of SNPs in TNF-α, TNFR1A, and TNFR1B genes could improve the management of IBD, leading to more effective, individualized treatment plans and a reduction in healthcare costs associated with ineffective therapies and disease complications.
Comparative efficacy and safety of etanercept and adalimumab in the treatment of polyarticular juvenile idiopathic arthritisGe, Gao, Chen
et alBMC Pediatr (2025) 25 (1), 242
Abstract: This study aims to evaluate the efficacy and safety of Etanercept and Adalimumab in the treatment of polyarticular juvenile idiopathic arthritis (pJIA).From Jan 2021 to Oct 2023, 66 pJIA patients were prospectively randomized into Etanercept (n = 33) and Adalimumab (n = 33) groups at our hospital. Efficacy, via Juvenile Arthritis Disease Activity Score 10 (JADAS-10), and anti-cyclic citrullinated peptide (CCP), tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell count (WBC) were assessed pre-treatment and at 1-, 3-, 6-month intervals post-treatment. Adverse reactions were monitored.Two groups showed comparable efficacy (P > 0.05) at baseline in anti-CCP, TNF-α, CRP, ESR, WBC, and JADAS-10 score. Treatment for a period of 1 to 3 months led to statistically significant reductions in these markers over time (P < 0.05). Adalimumab group was found significantly lower levels of mentioned markers than Etanercept group at 1-3 months (P < 0.05), but after 6 months, statistical differences vanished (P > 0.05). Normal total bilirubin, alanine transaminase, aspartate aminotransferase, serum creatinine levels were detected post-3 months in both groups; with similar adverse reaction rates (P > 0.05).Both Etanercept and Adalimumab are effective and safe for managing pJIA, demonstrating significant reductions in inflammatory markers and disease activity with no significant difference in efficacy or safety profiles.Not applicable.© 2025. The Author(s).
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