pulmicort and Colorectal-Neoplasms

Topics: Adolescent; Adult; Age Factors; Aged; Anti-Inflammatory Agents; Anti-Inflammatory Agents, Non-Steroidal; Azathioprine; Budesonide; Child; Colitis, Ulcerative; Colorectal Neoplasms; Crohn Disease; Enteral Nutrition; Female; Glucocorticoids; Humans; Immunosuppressive Agents; Male; Mesalamine; Meta-Analysis as Topic; Middle Aged; Prednisone; Pregnancy; Randomized Controlled Trials as Topic; Risk Factors

Crohn's disease is an idiopathic, chronic inflammatory disorder of the digestive tract with heterogeneous clinical presentations. Crohn's is currently not a curable disease, and patients are faced with a lifetime of recurrent disease flare-ups and remissions. Management strategies for Crohn's must therefore be targeted toward lifelong management, taking into consideration not only the short-term but also the long-term aspects of the disease. With this in mind, here we review the classifications and natural history of Crohn's disease and discuss possible predictive factors for the disease evolution in a patient. Here we also evaluate the current preferable treatment practices, based on scientifically valid research and collective clinical experience, for the management of mild to moderate Crohn's disease.

Topics: Algorithms; Aminosalicylic Acids; Anti-Bacterial Agents; Anti-Inflammatory Agents; Anti-Inflammatory Agents, Non-Steroidal; Budesonide; Colorectal Neoplasms; Crohn Disease; Drug Administration Schedule; Humans; Patient Compliance; Patient Education as Topic; Quality of Life; Risk Factors; Severity of Illness Index; Time Factors; Treatment Outcome

Ulcerative colitis is a chronic inflammatory bowel disease. The disease is diagnosed on the basis of clinical parameters and endoscopic-histologic evaluation. 5-aminosalicylic acid (5-ASA, mesalamine) represents the first-line treatment of choice. For patients with distal and left-sided disease the use of rectal preparations is effective. Most patients respond to 5-ASA suppositories or to topic steroids such as budesonide suppositories or hydrocortisone foam. For patients with extended disease, oral medications are mandatory. In case of low- to moderate-grade inflammation, 5-ASA preparations should be implemented. In the case of severe disease treatment with steroids is required. Following induction of remission, prophylactic treatment with 5-ASA (1.5 g/d) should be maintained. For patients with frequent or severe relapses, immunosuppressive therapy with azathioprine or 6-mercaptopurine is indicated. In case of a fulminant course of disease, treatment with intravenous cyclosporine is required in patients who have not responded to high-dose intravenous steroids. When all conservative treatment options fail, proctocolectomy with construction of an ileoanal pouch should be performed. New therapeutic strategies such as infliximab and interferons are being evaluated in clinical trials. The long-term complications of ulcerative colitis include steroid-induced osteoporosis and anemia and should be treated adequately. Finally, the risk for development of colorectal cancer increases steadily with disease duration and dysplasia should be screened for by endoscopic surveillance programs.

Topics: Administration, Oral; Adrenal Cortex Hormones; Aminosalicylic Acids; Anemia; Anti-Inflammatory Agents; Anti-Inflammatory Agents, Non-Steroidal; Antibodies, Monoclonal; Antiviral Agents; Azathioprine; Budesonide; Clinical Trials as Topic; Colectomy; Colitis, Ulcerative; Colonic Pouches; Colonoscopy; Colorectal Neoplasms; Cyclosporins; Gastrointestinal Agents; Humans; Hydrocortisone; Immunosuppressive Agents; Infliximab; Injections, Intravenous; Interferons; Mercaptopurine; Mesalamine; Osteoporosis; Placebos; Practice Guidelines as Topic; Recurrence; Remission Induction; Risk Factors; Suppositories; Time Factors

Unpredictable and severe diarrhea (NCI grade > or =3) remains a life-threatening adverse event in patients treated with irinotecan (CPT-11). The aim of this study was to evaluate the efficacy and safety of orally administered budesonide for prevention of CPT-11-induced delayed diarrhea in patients with advanced colorectal cancer.. A total of 56 patients with advanced colorectal cancer receiving CPT-11 therapy (125 mg/m2 once weekly) were enrolled in this multicenter trial. Patients were randomly treated with 3 mg budesonide orally 3 times daily versus placebo. Detailed assessment of diarrhea by monitoring stool frequency, stool consistency and loperamide rescue medication was made by keeping a diary.. Diarrhea, defined as number of stools >4 occurring on a single day during the study period, could be prevented in 58.3% of the budesonide-treated patients compared to 38.5% of the patients under placebo. Patients in the budesonide group had less episodes (0.7 vs. 2.2 episodes) and a considerably shorter total duration of diarrhea (1.8 vs. 4.2 days) episodes than patients in the placebo group. Loperamide use was more frequent in the placebo than in the budesonide arm (55.6 vs. 41.7%). Also, exposure to rescue medication of loperamide was higher for placebo (36.2 capsules) than for budesonide (24.9 capsules). A superior prevention of diarrhea was observed for budesonide compared to placebo in the first cycle (14 vs. 10; p = 0.257), with more failures observed in the placebo group (16 vs. 10).. This double-blind randomized trial failed to show that budesonide has a significant benefit in preventing CPT-11-induced diarrhea. While a trend exists, further trials are warranted.

Topics: Administration, Oral; Anti-Inflammatory Agents; Antineoplastic Agents, Phytogenic; Budesonide; Camptothecin; Colorectal Neoplasms; Diarrhea; Double-Blind Method; Female; Humans; Irinotecan; Male; Middle Aged; Prospective Studies; Topoisomerase I Inhibitors; Treatment Outcome

Aromatized thioketal (ATK) linked the immunoregulatory molecule (budesonide, Bud) and the cytotoxic molecule (gemcitabine, Gem) to construct a ROS-activated Janus-prodrug, termed as BAG. Benefiting from the hydrogen bonding, π-π stacking, and other intermolecular interactions, BAG could self-assemble into nanoaggregates (BAG NA) with a well-defined spherical shape and uniform size distribution. Compared to the carrier-based drug delivery system, BAG NA have ultrahigh drug loading content and ROS concentration-dependent drug release. Colitis-associated colorectal cancer (CAC) is a typical disease in which chronic inflammation transforms into tumors. BAG NA can be internalized by colon cancer C26 cells and then triggered by excessive intracellular ROS to release nearly 100% of the drugs. Based on this, BAG NA showed a stronger pro-apoptotic effect than free Bud combined with free Gem. What is gratifying is that orally administered BAG NA can precisely accumulate in the diseased colon tissues of CAC mice induced by AOM/DSS and simultaneously release Bud and Gem. Bud can regulate the tumor immune microenvironment to restore and enhance the cytotoxicity of Gem. Therefore, BAG NA maximizes the synergistic therapeutic effect through co-delivery of Bud and Gem. This work provided a cutting-edge method for constructing self-delivery Janus-prodrug based on ATK and confirmed its potential application in inflammation-related carcinogenesis.

Topics: Animals; Antineoplastic Agents; Biocompatible Materials; Budesonide; Cell Line; Colitis-Associated Neoplasms; Colorectal Neoplasms; Deoxycytidine; Drug Delivery Systems; Gemcitabine; Materials Testing; Mice; Mice, Inbred BALB C; Molecular Dynamics Simulation; Molecular Structure; Prodrugs

Ulcerative colitis (UC) is an idiopathic inflammatory disorder. These guidelines indicate the preferred approach to the management of adults with UC and represent the official practice recommendations of the American College of Gastroenterology. The scientific evidence for these guidelines was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process. In instances where the evidence was not appropriate for GRADE, but there was consensus of significant clinical merit, "key concept" statements were developed using expert consensus. These guidelines are meant to be broadly applicable and should be viewed as the preferred, but not only, approach to clinical scenarios.

Topics: Adalimumab; Anti-Inflammatory Agents; Anti-Inflammatory Agents, Non-Steroidal; Biopsy; Budesonide; Colitis, Ulcerative; Colonoscopy; Colorectal Neoplasms; Disease Management; Early Detection of Cancer; Gastroenterology; Gastrointestinal Agents; Humans; Infliximab; Maintenance Chemotherapy; Mesalamine; Prognosis; Remission Induction; Severity of Illness Index; Societies, Medical; Tumor Necrosis Factor-alpha

Topics: Area Under Curve; Budesonide; Colorectal Neoplasms; Databases, Genetic; Drug Delivery Systems; Gene Expression Regulation; Gene Regulatory Networks; Humans; Internet; Phenotype; ROC Curve

Celecoxib is a COX-2 inhibitor drug that can be used to reduce the risk of colorectal adenocarcinoma. Glucocorticoids are used in the treatment of inflammatory bowel disease. A limitation to the use of both drug types is that they undergo absorption from the intestinal tract with serious side effects. The prodrug systems introduced here involve forming a nitro-substituted acylsulfonamide group in the case of celecoxib and a nitro-substituted 21-ester for the glucocorticoids. Drug release is triggered by the nitro reductase action of the colonic microflora, liberating a cyclization competent species. The release of the active parent drugs was evaluated in vitro using Clostridium perfringens and epithelial transport through Caco-2 monolayer evaluation was carried out to estimate the absorption properties of the prodrugs compared to the parental drugs.

Topics: Antineoplastic Agents; Budesonide; Caco-2 Cells; Celecoxib; Cell Membrane Permeability; Clostridium perfringens; Colorectal Neoplasms; Cyclooxygenase 2 Inhibitors; Humans; Lactones; Nitrobenzenes; Nitroreductases; Prednisolone; Prodrugs; Pyrazoles; Sulfonamides