nystatin-a1 and Crohn-Disease

In a randomised clinical trial, patients with moderately active Crohn's disease received either prednisolone 0.5 mg/kg/day plus a normal diet, or an elemental diet plus oral framycetin, colistin and nystatin. Patients were assessed using the Crohn's disease activity index (CDAI), ESR, and faecal granulocyte excretion quantified by 111In-autologous leucocytes. Five patients were intolerant of the elemental diet plus antibiotics and were withdrawn from the trial within 72 hours. Sixteen patients completed 10 days treatment on each regime. Fifteen of 16 patients on elemental diet plus antibiotics and all 16 patients on prednisolone improved with marked, but statistically indistinguishable falls in CDAI, ESR, and faecal granulocyte excretion between the two groups. Thus a regime decreasing the intraluminal concentration of bacteria and complex food molecules, was associated with rapid improvement in activity of Crohn's disease. This suggests that these intraluminal factors play a role in maintaining inflammation and that their removal or alteration offers an approach to management.

Topics: Adult; Anti-Bacterial Agents; Clinical Trials as Topic; Colistin; Crohn Disease; Female; Food Additives; Food, Formulated; Framycetin; Humans; Male; Middle Aged; Nystatin; Organic Chemicals; Prednisolone

Electrolyte transport pathways in distal colonic mucosa from patients with noninflammatory and inflammatory (ulcerative colitis, Crohn's colitis) disease of the large bowel were studied in vitro with electrophysiological techniques. Noninflamed tissues exhibited substantial amiloride-sensitive electrogenic sodium transport. In contrast, inflamed but structurally intact tissues exhibited only a modest degree of electrogenic sodium transport, significant increases in total tissue conductance and apical membrane conductance, and a 100% increase in the arachidonic acid content of the cell membrane fraction of mucosal homogenates. Replacement of chloride with gluconate decreased total tissue conductance to a greater extent in inflamed than in noninflamed tissues, and total tissue conductance was higher in inflamed than in noninflamed tissues in the presence of transepithelial potassium and sodium gradients, suggesting enhanced mucosal "leakiness" to anions and cations in acute colitis. Apical addition of nystatin virtually abolished amiloride-sensitive apical sodium uptake in both groups, indicating that the ionophore formed channels in the apical membrane of noninflamed and diseased mucosa. Additional studies showed that mucosal inflammation decreased maximal activity of the basolateral sodium pump by 76%. Thus, defects in the biophysical properties of colonic epithelial cell membranes are likely to be important factors in the pathogenesis of diarrhea in ulcerative and Crohn's colitis.

Topics: Adult; Aged; Aged, 80 and over; Biological Transport; Colitis, Ulcerative; Crohn Disease; Electrolytes; Electrophysiology; Female; Humans; Intestinal Mucosa; Male; Membrane Lipids; Middle Aged; Nystatin

At the present time most authors do not believe, that allergic processes do play a role in the etiology of Crohn's disease or of ulcerative colitis. Data are presented however demonstrating a pathogenic role of mould fungus allergens in these diseases. Diagnostic and therapeutic implications of these results are discussed.

Topics: Adolescent; Adult; Amphotericin B; Child; Colitis, Ulcerative; Crohn Disease; Desensitization, Immunologic; Humans; Intestinal Mucosa; Middle Aged; Nystatin

Topics: Adult; Chlorhexidine; Colistin; Crohn Disease; Diet Therapy; Female; Framycetin; Humans; Nystatin; Sterilization

Topics: Administration, Topical; Adolescent; Anti-Inflammatory Agents; Barium Sulfate; Biopsy; Crohn Disease; Epithelium; Humans; Hydrocortisone; Male; Mouth Diseases; Mouth Mucosa; Mouthwashes; Nystatin; Oral Manifestations; Physical Examination; Prednisone; Radiography; Sulfasalazine; Tetracycline; Ulcer