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 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In this review I have described the pathophysiology of allergic disorders of the gastrointestinal tract. Situations where the intestine cannot be a complete barrier to foreign allergens and antigens were discussed and etiological factors of gastrointestinal allergy were detailed. Clinical features of gastrointestinal allergy include diarrhea, vomiting, abdominal pain and colic, intestinal hemorrhage and malabsorption as well as symptoms and signs outside the gastrointestinal tract such as chronic rhinitis and asthma in the respiratory system, urticaria, angioedema and eczema as dermatological signs, headache, insomnia, hyperkinesis as central nervous system manifestations, failure to thrive and anaphylaxis as constitutional reactions. Milk allergy was discussed as an example of food allergy. Immunology of the gastrointestinal tract was presented, with examples of four types of hypersensitivity reactions, and gastrointestinal disturbances of immunodeficiency disorders and syndromes were named. Lastly, the autoimmune mechanism and the gut were described, with particular discussion of ulcerative colitis as an example of an autoimmune disease.
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PMID:The intestine in allergic diseases. 78 84

Sulfasalazine is an important therapeutic agent in the management of chronic inflammatory bowel disease (CIBD). Unfortunately, adverse reactions to this drug have been reported in 5-55% of treated patients. These include dose-related side effects like nausea, malaise, and headache or hypersensitivity reactions such as rash, fever, hives, arthralgia, hepatitis, etc. Studies in adults with successful reintroduction of sulfasalazine after a desensitization program have been reported; however, with regard to children, no such data are available. Fourteen children and adolescents (5-16 yr old) diagnosed to have CIBD manifested hypersensitivity to sulfasalazine within 2 months of onset of treatment. All had pancolitis--secondary to Crohn's disease (CD) in four and to ulcerative colitis (UC) in 10. All of them were on steroids. Sulfasalazine was discontinued in all after symptoms of hypersensitivity developed. Three patients with severe reaction were diagnosed prior to desensitization experience. Desensitization, beginning with 5-50 mg of sulfasalazine/day, was attempted in the other 11 children. The dose was gradually increased by 5-50 mg increments every 3 days. Desensitization was successful in only five children, who were ultimately able to tolerate 1.5-3.0 g of sulfasalazine daily again. In the rest (six of 11 patients), oral 5-ASA (Asacol) was administered, and three could not tolerate it. One of these three with intolerance to Asacol required colectomy. One did not tolerate Asacol or Dipentum. Our findings suggest that sulfasalazine desensitization should be attempted in all patients developing hypersensitivity reactions before trying alternative therapy.
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PMID:Sulfasalazine desensitization in children and adolescents with chronic inflammatory bowel disease. 809 41

We describe a rare case of superior sagittal sinus thrombosis in a young man (26 years) with undiagnosed ulcerative colitis. The patient was hospitalized with headache and paresis of the right arm and leg. he had had rectal bleeding and diarrhea for the previous 4 weeks. Despite the fact that heparin therapy is still considered controversial, we successfully treated our patient with low doses of sub-cutaneous heparin. He did not suffer any side-effect.
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PMID:[Thrombosis of the superior sagittal sinus and ulcerative colitis. A case report]. 145 58

A questionnaire investigation was undertaken to compare the employment of alternative treatment in patients with irritable colon (CI) and ulcerative colitis (CU) as compared with a control group of appendectomized (A). A total of 430 questionnaires were sent out. The percentage of replies was 83 without significant difference between the patient groups. Alternative therapists were consulted more frequently by the CI group than the two other groups which did not differ from one another in this respect. Both CI and CU had employed "natural medicine" more frequently than the control group. Women and younger patients were the most frequent employers of the alternative system. The effect of alternative treatment was frequently experienced in the form of headache and discomfort in the locomotor system. The average expense of treatment was 1,000 Danish crowns (approximately 83 pounds). 23% of the CU group and 41% of the CI group experienced aggravated or unchanged abdominal symptoms compared with their complaints during the period of hospitalization 1-10 years prior to the current investigation. No correlation could be demonstrated between a favourable course and employment of the alternative system.
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PMID:[Irritable colon and ulcerative colitis. Alternative treatment is used frequently]. 195 88

Sulphasalazine, devised by Dr Nana Svartz for the treatment of 'infective polyarthritis', has been used in the treatment of inflammatory bowel disease for more than 40 years. Many controlled trials have shown that sulphasalazine 4g daily will induce remissions in between one-half and three-quarters of patients with acute attacks of ulcerative colitis. When given in a dosage of 2g daily it will prevent relapses in quiescent colitis. Relapses are 5 times more likely in untreated patients. It is less effective in Crohn's disease, where it exerts only a transient benefit in patients with active colonic disease and fails to prevent relapse or recurrence. Sulphasalazine is absorbed from the small intestine, re-excreted in bile and carried to the colon, where its azo bond is split by bacteria to release sulphapyridine, which is absorbed and is responsible for most of the drug's side effects, and 5-aminosalicylic acid, which is the active therapeutic moiety of the drug and exerts a beneficial topical action on the colonic mucosa. Side effects are common but are mainly reversible and not serious. Those related to high concentrations of sulphapyridine and to poor acetylation of the drug include gastrointestinal intolerance, malaise, headache, arthralgia, drug fever, effects on red blood cells and reversible male infertility. More serious, idiosyncratic side effects are skin rashes, leucopenia and agranulocytosis. Rarely, neurotoxicity, hepatotoxicity, polyarteritis, pulmonary fibrosis, a lupus-like syndrome and haemorrhagic colitis are produced. It is possible to desensitise most patients with drug-induced skin rashes. A number of less toxic alternatives to sulphasalazine have been devised and are undergoing trial. They either convey 5-aminosalicylic acid in a coated tablet to the colon or, when conjugated to a non-toxic carrier, release 5-aminosalicylic acid by bacterial cleavage there. Sulphasalazine remains a most useful drug in the treatment of inflammatory bowel disease after 40 years of use.
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PMID:Sulphasalazine: a review of 40 years' experience. 287 47

To assess the safety and efficacy of delayed-release mesalazine (5-aminosalicylic acid) as maintenance treatment for patients with ulcerative colitis, 100 patients with quiescent colitis were randomly grouped to receive either delayed-release mesalazine or an equivalent dose of enteric-coated sulfasalazine in a 48-wk trial. Groups were comparable for age, sex, and duration and extent of disease. Relapse rates at 48 wk were as follows: sulfasalazine 38.6% (95% confidence limits, 24%-54%) and mesalazine 37.5% (95% confidence limits, 24%-53%), chi 2 = 0.01, p greater than 0.90. Mean time to relapse, cumulative relapse rate, and relapse severity were similar in the two groups. Headaches and upper gastrointestinal symptoms--common at trial entry--improved to a greater extent in patients receiving mesalazine. Delayed-release mesalazine is an effective treatment for maintaining ulcerative colitis remission and is associated with fewer side effects than equivalent doses of enteric-coated sulfasalazine.
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PMID:Comparison of delayed-release 5-aminosalicylic acid (mesalazine) and sulfasalazine as maintenance treatment for patients with ulcerative colitis. 289 39

A patient with ulcerative colitis developed eosinophilic pneumonia, sinus tachycardia, skin rashes, headache and insomnia following treatment with Salazopyrin. The pneumonia as well as the other side effects resolved spontaneously following discontinuation of the drug and reappeared when Salazopyrin was readministered.
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PMID:Salazopyrin-induced eosinophilic pneumonia. 610 54

Thirty-four patients with ulcerative colitis completed a double-blind assessment comparing the efficacy of two weeks of treatment with nightly retention enemas containing 3 g sulphasalazine or placebo. Symptom grading, sigmoidoscopic appearance, rectal biopsy specimens, and diary records were used to assess benefit and side effects. The active drug conferred significant benefit compared with placebo as shown by several criteria, but this benefit was confined to patients not already taking sulphasalazine by mouth. Overall assessment showed improvement in 11 of the 16 patients (70%) given the active treatment but in only two of the 18 (11%) given placebo. No side effects attributable to the drug were observed, even in patients previously intolerant to oral preparations. The logical therapeutic role of sulphasalazine enemas in ulcerative colitis would appear to be in patients who experience side effects such as nausea, abdominal discomfort, or headaches when taking the drug by mouth.
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PMID:Sulphasalazine retention enemas in ulcerative colitis: a double-blind trial. 611 21

A study was carried out in 14 patients with quiescent ulcerative colitis to compare serum levels of sulphasalazine and some of its metabolites after 7-days' treatment orally with 1 g sulphasalazine 3-times daily followed by 7-days' treatment with a 3 g sulphasalazine enema daily. The results showed that, although there were wide individual variations in levels after oral and rectal administration, with the same dosage the levels were far higher when the drug was given orally. Dose-related side-effects such as nausea and headache have been shown previously to occur more commonly with high serum levels of sulphapyridine to which sulphasalazine is metabolized. Levels after rectal administration were below those normally associated with side-effects. In view of the finding that at least 70% of patients with mild to moderate ulcerative colitis respond to rectal treatment it is suggested that this route of administration should be considered for patients experiencing side-effects after oral sulphasalazine.
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PMID:A comparison of serum concentrations of sulphasalazine and some of its metabolites after therapy by the oral or rectal route. 614 65

Sulfasalazine is metabolized by intestinal bacteria, resulting in the release of sulfapyridine and 5-aminosalicylate. The drug is useful in the treatment of active ulcerative colitis as well as in preventing relapses of the disease in remission. Although effective in active Crohn's disease as well, sulfasalazine appears to be of greater benefit to patients with colitis and ileocolitis than those with ileitis alone. 5-Aminosalicylate itself is efficacious when given in enema and suppository form; oral agents capable of delivering 5-aminosalicylate to distal disease sites are now under study. The drug's mechanism of action may relate to its effects on prostaglandin synthesis or interference with arachidonic acid metabolism by the lipoxygenase pathway. Common adverse reactions of sulfasalazine, including nausea, headache, and anorexia, as well as hemolysis, are associated with high serum sulfapyridine levels and often can be avoided by lowering the dose of sulfasalazine. Mild allergic reactions, such as rash and fever, may be overcome by gradual desensitization.
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PMID:Sulfasalazine. Pharmacology, clinical use, toxicity, and related new drug development. 614 10


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