nemoci-sympt/GASTROENTEROLOGIE/ulcerozni-kolitida/zlepseni
V přírodě
- Většina zvířat a rostlin si syntetizuje
- Nedokážou ho tvořit pouze:
- člověk, některé druhy primátů
- Morčata
- Kapybara
- Indický netopýr
- Z ptáků červení bulbulové
- Pstruh duhový
- Losos
- Asi genetický defekt
- Následně hypotéza částečně vyvrácená:
- Pokud by se jeho hladina u člověka vyrovnala s hladinou u zvířat, vedlo by to ke zlepšení jeho celkového zdravotního stavu.
Zdroje vitamínu C
- šípek
- Rakytník
- Citrusy
- Limetka, citrón, pomeranč, grapefruit
- Brambory nebo rajčata
- Papriky, papája, brokolice, černý rybíz, jahody, květák, špenát, kiwi, brusinky
Potravinářství
- K omezení oxidace v potravinách
V potravě
- Zelí ve formě ascorbigen A (ev. B), kteráý je rozložena při vaření na k. L-askorbovou
- Brambory
- Citrusové plody
Vařením
Terapie
Antibiotics
- Could change the environmental conditions of microbiota
- Trigger resistance
Sulfasalazine
- Can exacerbate colitis
- Resulting in diarrhea, abdominal cramps and discomfort [11]
5-aminosalicylates
- Stimulation of class of nuclear receptors which generally control the inflammation and cell proliferation
- Reducing the production of chemoattractant leukotrienes
- Inhibits the cellular release of interleukin-1 and 2 (Zhou et al., 1999) [6]
- Inhibits the transcriptional activity of nuclear-factor ?B
- Regulates the genes responsible for immunity and inflammation
- Extensively metabolized in liver
- Poor systemic bioavailability
- Induce remission in 40–80% of patients (Riley et al., 1988, Baron et al., 1962)[6]
- Oral sustained release tablet or granule
- Suppositories, enemas etc.
- Sulphapyridine-related intolerance (Egan et al., 1999)[6]
Ciprofloxacin
- Moderate to severe UC (Turunen et al., 1998) [6]
pH dependentní systémy medikamentů
- Lack of site specificity of pH dependent polymers in colon
- Controversy for reliability of targeting method
- Need of combining two polymers
- One is delayed release/time controlled
- Other is pH dependent
- So that maximum amount of drug releases in the colon and show its therapeutic effect
Eudragit S
- An enteric coated polymer
- Starts dissolving at pH more than 6
- Causes the lack of site specificity of drug at colonic region
- Therefore, he combined both Eudragit S 100 and ethylcellulose
- Only 20% drug released in small intestine
- While due to delayed release polymer, rest 80% will release in colon [6]
Asacol tablet
- 5-amino salicylic acid coated with Eudragit S 100
- PH dependent release (Schroeder et al., 1987)
Lialda - mesalamine
- Locally acting delayed release tablet
- Approved in January, 2007
- Completely dispersed in lipophilic matrix [6]
5-aminosalicylic acid loaded methacrylic acid/perlite composites
- PH dependent release [6]
Budenofalk
- Multiparticulate pH dependent systems
- Commercially available
- PH dependent polymers
- Eudragit RL, Eudragit S, Eudragit L, etc. [6]
Entocort
- Delayed release polymers
- Ethylcellulose
- Time dependent release (Rodríguez et al., 1998) [6]
PLGA coated budesonide
- Loaded nanospheres
- For sustained release at pH 7.4.
Combined therapy
- Corticosteroids + infliximab
- Does not appear to provide any additional benefit
Prognoza
- In the long term cca 25–33% of patients with UC
- Will require surgery
- Pharmacological treatments are not successful
- Case of complications
- Fistulae
- Stenosis
- Abscesses [11]¨
- The potential benefits of herbal medicine could lie in their high acceptance by patients, efficacy, relative safety, and relatively low cost. [19]
- Herbal medicine has been tested in hundreds of clinical trials in the management of UC [20]
- The evidences on herbal medicine are incomplete, complex, and confusing, and certainly associated with both risks and benefits. [20]
- Chen et al reported that 118 cases of UC patients were treated with integration of TCM and that 86 cases of UC were treated with prednisone as controls.[20]
- The therapeutic effects were observed and compared after two therapeutic courses of 40 consecutive days.
- TCM: 39 cases cured, 60 cases improved and 19 cases failed, = total effective rate of 84% [20]
- Prednison: 15 cases cured, 37 cases improved and 34 cases failed, = total effective rate of 60.5% (P < 0.01) [20]
- Treatment of UC by the integrated TCM method is superior to that by simple Western drugs, such as prednisone [20]
- And that it is also safe and effective in maintaining remission of UC [20]
- curcumin was superior to placebo in maintaining remission; Boswellia serrata gum resin and Plantago ovata seeds were as effective as mesalazine, whereas Oenothera biennis (evening primrose oil) had similar relapse rates as omega-3 fatty acids in the treatment of UC. In CD, Artemisia absinthium (wormwood) and Tripterygium wilfordii were superior to placebo in inducing remission, and preventing clinical recurrence of post-operative CD respectively.">http://onlinelibrary.wiley.com/doi/10.1111/apt.12464/abstract;jsessionid=70AEC83F3107E6D5D2B2C39F3E389FE8.f04t03;Twenty-one randomised controlled trials (14 UC; 7 CD) including a total of 1484 subjects (mean age 41, 50% female) were analysed. In UC, aloe vera gel, Triticum aestivum (wheat grass juice), Andrographis paniculata extract (HMPL-004) and topical Xilei-san were superior to placebo in inducing remission or response, and curcumin was superior to placebo in maintaining remission; Boswellia serrata gum resin and Plantago ovata seeds were as effective as mesalazine, whereas Oenothera biennis (evening primrose oil) had similar relapse rates as omega-3 fatty acids in the treatment of UC. In CD, Artemisia absinthium (wormwood) and Tripterygium wilfordii were superior to placebo in inducing remission, and preventing clinical recurrence of post-operative CD respectively.
Alternativní / podpůrná terapie
Abecední seznam dohledaných kvant informací viz zde
Smysluplné potraviny = funkční jídlo
Hippocrates, the Father of Medicine, who proclaimed almost 25 centuries ago, “Let food be thy medicine and medicine be thy food.” To further substantiate the importance and relevance of this adage, observations from around the world clearly indicate that the incidence of diet-related diseases is progressively increasing due to greater availability of hypercaloric food and a sedentary lifestyle, which cause low-grade inflammation in the individual.[18]Recent reports also suggest that the functional foods and nutraceuticals rich in polyphenols and antioxidants are beneficial due to their intrinsic ability to scavenge free radicals, induce anti-inflammatory responses, maintaining a homeostatic regulation of the gut microbiota, and activate the intestinal T regulatory cells.[18] All these properties are extremely beneficial in the prevention and mitigation of the IBD. Studies have shown that the dietary agents like apple, bilberry, black raspberry, cocoa, bael, green tea (?? Lu Chá); spices like garlic (?? Da Suan), Malabar tamarind, saffron (??? Fan Hóng Hua), fenugreek, ginger (?? Sheng Jiang), turmeric (?? Jiang Huáng); oil of olive; nutraceuticals like grape seed polyphenols; and the dietary phytochemicals like resveratrol, ellagic acid, zerumbone, quercetin, kaempferol, rutoside, and rutin are consumed regularly and are commonly used. They will be addressed in detail by emphasizing on the mechanism of action.
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