pulmicort and Gastrointestinal-Hemorrhage

The aim was to compare budesonide enema, 2 mg/100 mL (Entocort) and hydrocortisone acetate foam enema, 125 mg (Colifoam) in patients with active haemorrhagic proctitis.. The trial was a controlled, randomized, investigator-blind study with two parallel groups. Endoscopy, histology and diary cards were used to assess the response to therapy. Safety was assessed by laboratory tests and adverse event recording.. Seventy-two patients were included. Investigations were made before treatment and after 2 and 4 weeks. Both treatment groups showed statistically significant improvement in endoscopic scores but significant differences between the groups were not found. In the hydrocortisone group, plasma cortisol was significantly lowered after 4 weeks compared with budesonide. Bowel habits and quality of life variables did not differ between the treatments. The recorded adverse events were mild or moderate and may have been due to the proctitis.. These results suggest that budesonide enema is as effective as hydrocortisone foam enema, but without the potential for side-effects associated with suppression of plasma cortisol.

Topics: Adult; Aged; Anti-Inflammatory Agents; Biopsy; Budesonide; Female; Gastrointestinal Hemorrhage; Humans; Hydrocortisone; Male; Middle Aged; Pregnenediones; Proctitis; Quality of Life; Sigmoidoscopy

Topics: Adalimumab; Anti-Bacterial Agents; Anti-Inflammatory Agents; Budesonide; Colonoscopy; Colostomy; Constriction, Pathologic; Crohn Disease; Disease Management; Embolization, Therapeutic; Endoscopy, Digestive System; Esophageal Diseases; Esophagitis; Female; Gastric Artery; Gastrointestinal Hemorrhage; Hematemesis; Humans; Infliximab; Magnetic Resonance Imaging; Middle Aged; Omeprazole; Proton Pump Inhibitors; Rectovaginal Fistula; Recurrence; Sigmoid Diseases; Tumor Necrosis Factor Inhibitors

Glucocorticoids are widely used for the management of inflammatory bowel disease, albeit with known limitations for long-term use and relevant adverse effects. In turn, they have harmful effects in experimental colitis. We aimed to explore the mechanism and possible implications of this phenomenon. Regular and microbiota depleted C57BL/6 mice were exposed to dextran sulfate sodium (DSS) to induce colitis and treated with budesonide. Colonic inflammation and animal status were compared. In vitro epithelial models of wound healing were used to confirm the effects of glucocorticoids. Budesonide was also tested in lymphocyte transfer colitis. Budesonide (1-60μg/day) exerted substantial colonic antiinflammatory effects in DSS colitis. At the same time, it aggravated body weight loss, increased rectal bleeding, and induced general deterioration of animal status, bacterial translocation and endotoxemia. As a result, there was an associated increase in parameters of sepsis, such as plasma NOx, IL-1β, IL-6, lung myeloperoxidase and iNOS, as well as significant hypothermia. Budesonide also enhanced DSS induced colonic damage in microbiota depleted mice. These effects were correlated with antiproliferative effects at the epithelial level, which are expected to impair wound healing. In contrast, budesonide had significant but greatly diminished deleterious effects in noncolitic mice or in mice with lymphocyte transfer colitis. We conclude that budesonide weakens mucosal barrier function by interfering with epithelial dynamics and dampening the immune response in the context of significant mucosal injury, causing sepsis. This may be a contributing factor, at least in part, limiting clinical usefulness of corticoids in inflammatory bowel disease.

Topics: Animals; Anti-Inflammatory Agents; Bacterial Translocation; Biomarkers; Budesonide; Colon; Dextran Sulfate; Disease Models, Animal; Dose-Response Relationship, Drug; Dysbiosis; Endotoxemia; Female; Gastrointestinal Agents; Gastrointestinal Hemorrhage; Glucocorticoids; Homeodomain Proteins; Inflammatory Bowel Diseases; Intestinal Mucosa; Mice, Inbred C57BL; Mice, Knockout; Specific Pathogen-Free Organisms; Weight Loss

Topics: Abdominal Pain; Adult; Budesonide; Diagnosis, Differential; Diarrhea; Enema; Female; Gastrointestinal Hemorrhage; Humans; Hydrogen Peroxide; Proctitis; Rectum

Topics: Adult; Anti-Bacterial Agents; Antibodies, Monoclonal; Azathioprine; Blood Transfusion; Budesonide; Colitis, Ulcerative; Drug Resistance; Drug Therapy, Combination; Enteral Nutrition; Female; Gastrointestinal Hemorrhage; Humans; Immunosuppressive Agents; Infliximab; Mesalamine; Methylprednisolone; Prednisone; Remission Induction; Tumor Necrosis Factor-alpha