Trends in medication use and treatment patterns in Chinese patients with inflammatory bowel disease

Poria cocos Attenuated DSS-Induced Ulcerative Colitis via NF-κB Signaling Pathway and Regulating Gut Microbiota

Ulcerative colitis (UC), as a chronic inflammatory disease, presents a global public health threat. However, the mechanism of Poria cocos (PC) in treating UC remains unclear. Here, LC-MS/MS was carried out to identify the components of PC. The protective effect of PC against UC was evaluated by disease activity index (DAI), colon length and histological analysis in dextran sulfate sodium (DSS)-induced UC mice. ELISA, qPCR, and Western blot tests were conducted to assess the inflammatory state. Western blotting and immunohistochemistry techniques were employed to evaluate the expression of tight junction proteins. The sequencing of 16S rRNA was utilized for the analysis of gut microbiota regulation. The results showed that a total of fifty-two nutrients and active components were identified in PC. After treatment, PC significantly alleviated UC-associated symptoms including body weight loss, shortened colon, an increase in DAI score, histopathologic lesions. PC also reduced the levels of inflammatory cytokines TNF-α, IL-6, and IL-1β, as evidenced by the suppressed NF-κB pathway, restored the tight junction proteins ZO-1 and Claudin-1 in the colon, and promoted the diversity and abundance of beneficial gut microbiota. Collectively, these findings suggest that PC ameliorates colitis symptoms through the reduction in NF-κB signaling activation to mitigate inflammatory damage, thus repairing the intestinal barrier, and regulating the gut microbiota.

Geographical heterogeneity in the disease characteristics and management of patients with inflammatory bowel disease, the preliminary results of a Chinese database for IBD (CHASE-IBD)

Background

The incidence of inflammatory bowel disease (IBD) is rapidly increasing in China, a vast country with significant geographical differences. The socioeconomic status of Eastern China is significantly higher than that of Western China.

Objectives

This study aimed to describe the geographical heterogeneity in the characteristics and management of patients with IBD in both Eastern and Western China.

Design

This was a multicenter, cross-sectional study.

Methods

Patients with IBD with ages ⩾18 years up to 18 January 2023 were included in the analysis from the Chinese database for IBD. Logistic regression was used to identify risk factors associated with surgeries among patients with IBD.

Results

Among 8305 patients with IBD, the ratio of ulcerative colitis (UC) to Crohn's disease (CD) was 4.13 and 0.33 in Western and Eastern China, respectively. The median age at diagnosis of UC and CD was 40.69 and 28.58 years, respectively. There was a male predominance among patients with UC (54.3%) and CD (68.0%). The two regions exhibited a similar distribution of disease locations in UC. However, Western China had a higher proportion of L2 involvement (30.0% versus 19.1%) and more advanced disease behavior (B2 and B3) (48.8% versus 39.8%) than Eastern China. Patients with IBD in Western China received more 5-aminosalicylic acid and corticosteroids and fewer immunomodulators and biologicals. In terms of surgical risk, Eastern China [versus Western China, odds ratios (OR): 5.36, 95% confidence intervals (CI): 2.96-9.68] was associated with a higher risk of surgery in UC, while Western China (versus Eastern China, OR: 3.39, 95% CI: 2.37-4.86) was associated with a higher risk of surgery in CD.

Conclusion

Geographical heterogeneity exists in the disease characteristics and management of IBD in Eastern and Western China. These findings have the potential to guide the formulation of location-specific strategies aimed at enhancing the long-term outcomes of patients with IBD.

Temporal trends in surgery for Crohn's disease: a ten-year single-center retrospective study

PURPOSE

Crohn's disease (CD) is a chronic inflammatory bowel disease that requires surgery in many cases. The aim of this article is to present the experience of a referral center regarding surgical interventions for CD, while also exploring the transformations that have occurred over 10 years.

METHODS

The data of patients underwent abdominal surgery for CD between 2013 and 2022 were collected prospectively. Data were compared between two periods (2013-2017 and 2018-2022). Temporal trends were assessed with the Mann-Kendall trend test.

RESULTS

A total of 1059 individuals underwent 1176 surgical procedures, of which 67.1% were male. The median age of patients at the time of surgery was 36.0 years, and an overall increasing trend was observed in surgical volume (z = 3.04; p = 0.002). The proportion of patients treated with biologics increased from the first period (2013-2017) to the second (2018-2022), rising from 19.2% to 33.5% (p < 0.001). In the second stage, the proportion of patients who underwent surgery for abscesses or fistulas increased (47.8% vs. 40.0%, p = 0.028), while the percentage of emergency surgeries declined (3.0% vs. 7.1%, p = 0.001). Furthermore, there was a rise in the proportion of laparoscopic surgeries (76.5% vs. 63.7%, p < 0.001), coupled with a decrease in stoma rates (15.4% vs. 30.5%, p < 0.001) and postoperative complications (23.0% vs. 30.5%, p = 0.007).

CONCLUSION

The frequency of biologics use in CD surgery have increased over time, and the proportion of penetrating patients has grown. Minimally invasive surgical methods have become the norm, and surgical outcomes have markedly enhanced, evidenced by a substantial reduction in both stoma rates and complication rates.

Temporal Trends of Inflammatory Bowel Disease Burden in China from 1990 to 2030 with Comparisons to Japan, South Korea, the European Union, the United States of America, and the World

Purpose

To identify and predict the epidemiological burden and trends of inflammatory bowel disease (IBD) in China and compare them globally.

Methods

We collected incidence, prevalence, deaths, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and the age-standardized rates (ASRs) of IBD from 1990 to 2019 in China, four developed countries and the world, from the Global Burden of Disease Study 2019. The average annual percentage change (AAPC) was calculated to evaluate the temporal trends.

Results

From 1990 to 2019, the numbers of incident and prevalent cases, age-standardized incidence rate (ASIR), and age-standardized prevalence rate (ASPR) of IBD increased in China, regardless of gender and age; decreased YLLs and increased YLDs caused a stable number of DALYs; the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) decreased. In 2019, the ASIR, ASPR, ASMR, and ASDR were 3.01/100,000 person-years (/100,000) (95% UI: 2.59, 3.50), 47.06/100,000 (95% UI: 40.05, 54.99), 0.30/100,000 (95% UI: 0.24, 0.35), and 13.1/100,000 (95% UI: 10.29, 16.31), respectively; almost all disease burden data were higher in males. In 2017, the ASDR in different socio-demographic index provinces ranged from 24.62/100,000 (95% UI: 16.95, 33.81) to 63.97/100,000 (95% UI: 44.61, 91.48). When compared globally, the ASIR and ASPR in China had opposite trends and the highest AAPCs. In 2019, the ASIR and ASPR in China were in the middle of the world and lower than in some developed countries. The numbers and ASRs of incidence, prevalence, and DALYs were expected to increase by 2030.

Conclusion

The IBD burden in China significantly increased from 1990 to 2019 and was expected to rise further by 2030. China had the world's opposite and most dramatic trends in ASIR and ASPR from 1990 to 2019. Strategies should be adjusted to adapt to the significantly increased disease burden.

Low-dose ganciclovir ameliorates dextran sulfate sodium-induced ulcerative colitis through inhibiting macrophage STING activation in mice

Ganciclovir (GCV) is a prodrug nucleoside analogue and is clinically used as antiviral drug for the treatment of cytomegalovirus (CMV) and other infections. Based on the potential anti-inflammatory activity of GCV, this study aimed to investigate the therapeutic effects of ganciclovir on dextran sulfate sodium (DSS)-induced ulcerative colitis (UC), which may involve cyclic GMP-AMP synthase (cGAS)-stimulator of interferon genes (STING) pathways. Our results demonstrated that incubation of GCV (50 μM) inhibited cGAS-STING pathway in macrophage RAW264.7 cells. Then, it was found that intestinal cGAS-STING pathways were upregulated in UC patients, Crohn's disease colitis (CD) patients, and DSS-induced colitis mice. Intraperitoneal injection of low-dose GCV (10 mg/kg/day) attenuated DSS-induced colitis and abdominal pain in mice. GCV treatment significantly inhibited the upregulation of cGAS-STING pathway in DSS-induced colitis mice. Moreover, DSS-induced colitis and gut dysbiosis was markedly attenuated in STING deficient mice compared with that of wild-type (WT) mice. Finally, there was lacking therapeutic effect of GCV on DSS-induced colitis in STING deficient mice. Together, our results indicated that low-dose GCV ameliorated DSS-induced UC in mice, possibly through inhibiting STING signaling in colonic macrophages, indicating that GCV may be useful for the treatment of UC.