Journal of Yeungnam Medical Science

Original article

Factors associated with the prescription of probiotics in patients with inflammatory bowel disease: a cross-sectional study: Joo Kyung Kim, Jae Hee Cheon; J Yeungnam Med Sci. 2023;40(1):37-48. Published online April 18, 2022; DOI: https://doi.org/10.12701/jyms.2022.00031

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Background
Commensal bacteria play an important role in the pathogenesis of inflammatory bowel disease (IBD) and probiotics have been used as treatment options. We aimed to explore the current use of probiotics and factors associated with their prescription in patients with IBD.
Methods
This cross-sectional study was conducted on a single hospital-based cohort. Patients were eligible if they were ≥18 years old, visited the IBD clinic as an outpatient more than twice during the study period, and had a confirmed diagnosis of IBD. Patients were divided into two groups based on the prescription of probiotics. Clinical assessments were compared between the two groups.
Results
In total, 217 patients were enrolled in this study. In patients with Crohn disease (CD), moderate or severe abdominal pain; prior use of methotrexate (MTX), iron, thiopurines, or biologics; history of IBD-related surgery; and stool frequency were independently associated with the prescription of probiotics. In patients with ulcerative colitis (UC), moderate or severe abdominal pain, hematochezia, stool frequency, and moderate or severe physician global assessment score were independently associated with the prescription of probiotics.
Conclusion
Increased disease activity may be associated with fewer prescriptions of probiotics in patients with IBD. However, physicians prescribed probiotics to control symptoms, such as abdominal pain and increased stool frequency in patients with UC and CD, and hematochezia in patients with UC. Additionally, the use of MTX and iron, and a history of IBD-related surgeries were associated with more frequent probiotic prescriptions in patients with CD.

Citations

Citations to this article as recorded by

Probiotics for the treatment of ulcerative colitis: a review of experimental research from 2018 to 2022
Cuilan Huang, Wujuan Hao, Xuyang Wang, Renmin Zhou, Qiong Lin
Frontiers in Microbiology.2023;[Epub] CrossRef

Case reports

Successful treatment with vedolizumab in an adolescent with Crohn disease who had developed active pulmonary tuberculosis while receiving infliximab: Sujin Choi, Bong Seok Choi, Byung-Ho Choe, Ben Kang; Yeungnam Univ J Med. 2021;38(3):251-257. Published online February 19, 2021; DOI: https://doi.org/10.12701/yujm.2020.00878

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Abstract PDF

Vedolizumab (VDZ) has been approved for the treatment of inflammatory bowel diseases (IBDs) in patients aged ≥18 years. We report a case of a pediatric patient with Crohn disease (CD) who was successfully treated with VDZ. A 16-year-old female developed severe active pulmonary tuberculosis (TB) during treatment with infliximab (IFX). IFX was stopped, and TB treatment was started. After a 6-month regimen of standard TB medication, her pulmonary TB was cured; however, gastrointestinal symptoms developed. Due to the concern of the patient and parents regarding TB reactivation on restarting treatment with IFX, VDZ was started off-label. After the second dose of VDZ, the patient was in clinical remission and her remission was continuously sustained. Ileocolonoscopy at 1-year after VDZ initiation revealed endoscopic healing. Therapeutic drug monitoring conducted during VDZ treatment showed negative antibodies to VDZ. No serious adverse events occurred during the VDZ treatment. This is the first case report in Korea demonstrating the safe and effective use of VDZ treatment in a pediatric CD patient. In cases that require recommencement of treatment with biologics after recovery of active pulmonary TB caused by anti-tumor necrosis factor agents, VDZ may be a good option even in pediatric IBD.

Citations

Citations to this article as recorded by

The safety of vedolizumab in a patient with Crohn’s disease who developed anti-TNF-alpha agent associated latent tuberculosis infection reactivation: A case report
Yuya Sugiyama, Nobuhiro Ueno, Shion Tachibana, Yu Kobayashi, Yuki Murakami, Takahiro Sasaki, Aki Sakatani, Keitaro Takahashi, Katsuyoshi Ando, Shin Kashima, Kentaro Moriichi, Hiroki Tanabe, Toshikatsu Okumura, Mikihiro Fujiya
Medicine.2023; 102(28): e34331. CrossRef
Vedolizumab Is Safe and Efficacious for the Treatment of Pediatric-Onset Inflammatory Bowel Disease Patients Who Fail a Primary Biologic Agent
Sujin Choi, Eun Sil Kim, Yiyoung Kwon, Mi Jin Kim, Yon Ho Choe, Byung-Ho Choe, Ben Kang
Journal of Korean Medical Science.2022;[Epub] CrossRef

Co-existence of relapsing polychondritis and Crohn disease treated successfully with infliximab: Hye-In Jung, Hyun Jung Kim, Ji-Min Kim, Ju Yup Lee, Kyung Sik Park, Kwang Bum Cho, Yoo Jin Lee; Yeungnam Univ J Med. 2021;38(1):70-73. Published online June 19, 2020; DOI: https://doi.org/10.12701/yujm.2020.00304

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Abstract PDF

Relapsing polychondritis (RP) is a rare, progressive immune-mediated systemic inflammatory disease of unknown etiology, characterized by recurrent inflammation of cartilaginous structures. Approximately 30% of RP cases are associated with other autoimmune diseases. However, the co-occurrence of RP and Crohn disease (CD) has rarely been reported. Herein, we present a 35-year-old woman diagnosed with RP and CD, who was refractory to initial conventional medications, including azathioprine and glucocorticoid, but who subsequently responded to infliximab (IFX). For both diseases, remission was sustained with IFX. There has been no previous report regarding the successful treatment of co-existing RP and CD with IFX.

Citations

Citations to this article as recorded by

Relapsing Polychondritis in a Patient With Auricular Chondritis and Inflammatory Bowel Disease: A Case Report With Literature Review
David D Bickford, Thomas Ritter, Pinky Jha, Hari R Paudel
Cureus.2022;[Epub] CrossRef

Prevention of thiopurine-induced early leukopenia in a Korean pediatric patient with Crohn’s disease who turned out to possess homozygous mutations in NUDT15 R139C: Jaewoan Bae, Byung-Ho Choe, Ben Kang; Yeungnam Univ J Med. 2020;37(4):332-336. Published online May 22, 2020; DOI: https://doi.org/10.12701/yujm.2020.00178

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Abstract PDF

Homozygous mutations in NUDT15 R139C are known as the major factor associated with thiopurine-induced early leukopenia, particularly in Asian patients. Therefore, NUDT15 genotyping is currently recommended before thiopurine treatment to identify patients who are NUDT15 poor metabolizers and consider the use of an alternative immunomodulatory therapy. We report a case of a 12-year-old Korean girl with Crohn’s disease (CD), in whom thiopurine-induced leukopenia was prevented by initiation of azathioprine (AZA) therapy at a low dose (0.5 mg/kg/day) and early detection of significant hair loss and white blood cell (WBC) count decrease at 17 days from the start of AZA treatment. The WBC count dropped from 8,970/μL to 3,370/μL in 2 weeks, and AZA treatment was stopped because of concerns of potential leukopenia in the near future. Her WBC count recovered to 5,120/μL after 3 weeks. Gene analysis later revealed that she had a homozygous mutation in NUDT15 R139C, resulting in a poor metabolizing activity of NUDT15. In situations when NUDT15 genotyping is unavailable, initiation of AZA therapy at 0.5 mg/kg/day with close observation of hair loss and WBC counts within 2 weeks may be an alternative way to prevent thiopurine-induced early leukopenia in Asian children with CD.

Citations

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Identification of Candidate Genes for Min Pig Villi Hair Traits by Genome-Wide Association of Copy Number Variation
Xinmiao He, Ming Tian, Wentao Wang, Yanzhong Feng, Zhongqiu Li, Jiahui Wang, Yan Song, Jinfeng Zhang, Di Liu
Veterinary Sciences.2023; 10(5): 307. CrossRef
Case report: NUDT15 polymorphism and severe azathioprine-induced myelosuppression in a young Chinese female with systematic lupus erythematosus: a case analysis and literature review
Juan Gu, Yupei Lin, Yuhe Wang
Frontiers in Pharmacology.2023;[Epub] CrossRef
KASL clinical practice guidelines for management of autoimmune hepatitis 2022

Clinical and Molecular Hepatology.2023; 29(3): 542. CrossRef

Review Article

Clinical Update: Inflammatory Bowel Disease: Byung Ik Jang; Yeungnam Univ J Med. 2007;24(2 Suppl):S221-233. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S221

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Abstract PDF

Inflammatory bowel disease(IBD) which is well known as Crohn’s disease and ulcerative colitis is a chronic disorder that repeats improvement and exacerbation. The possible causes of the disease are environmental factors, genetic factors and immune deficiency resulted from bacterial infection. Recently, IL-23 is proved to be a main cytokine which has a central role in Crohn’s disease. The diagnosis of IBD is made by clinical manifestation, serologic test, endoscopic finding and histologic finding. The mainstay of remission and maintenance therapy of ulcerative colitis is 5-aminosalicylate(5-ASA). Steroid can be used in severe or refractory case and nowadays, budesonide shows a good effect with minimal side effects. In cases of steroid dependent, we can use the immunomodulators such as azathioprine, cyclosporin and 6-thioguanine. The cytokine associated with inflammation of IBD has been emphasized and the treatment which targets the cytokine such as tumor necrosis factor is tried. Infliximab and adalimumab block tumor necrosis factors-a and they are proved the efficacy by many clinical trial. Leukocytapheresis(LCAP) is tried in ulcerative colitis since 1980 in Japan. When we treat IBD patients, we need to consider all the things such as safety, side effects and economy of the patients. We expect that the development of new biologic agent which is more cost effective and more effect with more convinience.

Citations

Citations to this article as recorded by

Inflammatory Bowel Disease and Cytokine
Eun Young Choi, Kwang Keun Cho, In Soon Choi
Journal of Life Science.2013; 23(3): 448. CrossRef

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