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Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel...
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Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2...
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Tumor Necrosis Factor (TNF), a proinflammatory cytokine, contributes significantly to the inflammation seen in Crohn's disease. It exists as soluble TNF and membrane-bound TNF, with actions mediated through TNF receptors (TNFR). TNFR activation leads to the release of proinflammatory cytokines, T-cell activation, collagen production, and leukocyte migration, all contributing to inflammation in Crohn's disease. Anti-TNF monoclonal antibodies, namely infliximab (Remicade), adalimumab...
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Upon diagnosis, managing Inflammatory Bowel Disease (IBD) involves addressing several crucial aspects. The primary goals include resting the bowel, correcting malnutrition, and providing symptomatic relief. Resting the bowel may consist of medications to reduce inflammation and promote healing. Correcting malnutrition is essential, often requiring dietary adjustments and nutritional supplements. Symptomatic relief aims to ease pain, diarrhea, and other discomforts in IBD.
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Diarrhea-predominant irritable bowel syndrome (IBS-D) is a subtype of IBS characterized primarily by frequent, loose, or watery stools, abdominal pain, and abdominal discomfort. Therapeutic approaches to managing IBS-D include dietary changes, stress management techniques, and pharmaceutical interventions.
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Evaluating Therapeutic Interventions in the SHIP-deficient Mouse Model of Crohn Disease-like Ileitis and Fibrosis
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Thalidomide for inflammatory bowel disease: Systematic review.

Matteo Bramuzzo1, Alessandro Ventura, Stefano Martelossi

  • 1Pediatric Department, Institute for Maternal and Child Health IRCCS "Burlo Garofolo" Department of Medical Sciences, University of Trieste WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS "Burlo Garofolo," via dell'Istria, Trieste, Italy.

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Thalidomide shows promise for refractory inflammatory bowel diseases, with significant remission rates and symptom improvement. However, careful monitoring for adverse events, particularly neurological disturbances, is crucial.

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Area of Science:

  • Gastroenterology
  • Immunology
  • Pharmacology

Background:

  • Thalidomide, an immunomodulatory drug, is explored for refractory Crohn disease and ulcerative colitis.
  • Inflammatory bowel diseases (IBD) present significant treatment challenges for patients unresponsive to standard therapies.

Purpose of the Study:

  • To systematically review the efficacy and safety of thalidomide in treating inflammatory bowel diseases.
  • To synthesize evidence on thalidomide's impact on remission, steroid reduction, fistula healing, and endoscopic outcomes in IBD patients.

Main Methods:

  • Comprehensive literature search across multiple databases (CENTRAL, MEDLINE, LILACS, etc.) up to March 2016.
  • Inclusion of randomized controlled trials and uncontrolled studies, excluding single case reports.
  • Evaluation of outcomes including clinical and endoscopic remission, steroid reduction, fistula closure, and adverse events.

Main Results:

  • Thalidomide achieved clinical response in 69.3% and remission in 51.5% of 427 IBD patients.
  • Significant improvements were noted in remission maintenance (80% at 6 months), steroid reduction (71.7%), fistula healing (60.5%), and endoscopic healing (53.0%).
  • Adverse events occurred in 75.6% of patient-months, with neurological disturbances being the most common (64.3%) and leading to withdrawal in 19.7% of cases.

Conclusions:

  • Thalidomide demonstrates potential as an effective treatment for inflammatory bowel diseases refractory to conventional therapies.
  • The drug offers benefits in achieving and maintaining remission and improving disease-specific complications.
  • Risk-benefit assessment is essential due to the notable incidence of adverse events, particularly neurological side effects.