潰瘍性大腸炎

Evidence from multiple studies shows that the appendix may play a significant role in the pathogenesis of ulcerative colitis (UC). These findings have sparked interest in the possibility of appendicectomy as a potential adjunctive strategy in UC. This narrative review was conducted by synthesizing data from meta-analyses, immunological research, surgical case studies, population data reports, and prospective trials published since 2000. The evidence was appraised with a focus on appendicectomy and its clinical outcomes in UC, risks and limitations, as well as possible future directions. Observational studies show a reduced risk of colectomy and UC-related hospital admissions when appendicectomy is performed before UC diagnosis. On the other hand, appendicectomy post UC diagnosis in the presence of appendiceal inflammation has shown increased risk of colectomy. But if an appendicectomy is performed in the absence of inflammation, it might not correlate to the risk or reduce the risk of relapse and complications. Evidence also shows that patients with refractory UC may benefit from appendicectomy and may show longer periods of remission. However, some studies show appendicectomy might increase the colorectal cancer risk due to alterations in immunity and microbiota. While medical management remains the first line, appendicectomy may act as an adjunct surgical option in carefully selected cases before escalating to a colectomy. Large multicenter studies and randomized clinical trials are required to identify strategies for patient selection, potential complications, durability of response, and long-term outcomes.

Ulcerative colitis (UC) is a chronic inflammatory bowel disease whose complex etiology is increasingly linked to gut microbiota dysbiosis. While conventional pharmacological treatments often face limitations due to side effects, cost, and variable efficacy, synbiotics combinations of probiotics and prebiotics have emerged as a promising therapeutic strategy to restore intestinal homeostasis. This review synthesizes evidence from recent animal model studies to elucidate the multifaceted mechanisms and superior efficacy of synbiotic interventions in ameliorating colitis. We demonstrate that synbiotics, whether composed of traditional components like lactobacilli, bifidobacteria, inulin, and fructooligosaccharides, or novel formulations involving exopolysaccharides, engineered glucans, and specific fatty acid-producing consortia, consistently outperform their individual components. The therapeutic effects are mediated through a synergistic restoration of gut microbial diversity, enhanced production of protective metabolites (especially short-chain fatty acids and secondary bile acids), fortification of the intestinal barrier via upregulation of tight junction proteins, and modulation of key immune pathways, including NF-κB, MAPK, and AhR. Furthermore, we highlight the advanced strategy of microencapsulation using prebiotic wall materials to enhance probiotic viability and targeted colonic delivery. The collective evidence positions synbiotics not merely as nutritional supplements but as sophisticated, multi-targeted therapeutics. This review underscores the critical need for future research to focus on structure-function relationships, precision synbiotic formulations tailored to individual microbiota profiles, and robust human clinical trials to translate these compelling preclinical results into effective clinical management strategies for UC.

Inflammatory bowel disease (IBD), particularly ulcerative colitis (UC), remains a major global health challenge characterized by chronic, relapsing inflammation of the colonic mucosa. Although conventional pharmacotherapies, including corticosteroids and mesalamine are widely used for disease management, their long-term efficacy is often limited by systemic adverse effects, treatment resistance and reduced patient responsiveness. Consequently, growing attention has been directed toward plant-derived bioactive compounds owing to their multi-target therapeutic potential and distinct structural mechanisms. This review highlights the pharmacological potential of Gossypium barbadense L. (Egyptian cotton) root extract as a potential phytotherapeutic candidate for the management of colitis. We summarize current evidence regarding the molecular mechanisms through which its major phytochemical constituents, particularly gossypol and related polyphenolic compounds that modulate inflammatory and oxidative stress pathways. The principal mechanisms include inhibition of NF-κB and COX-2 signaling, enhancement of endogenous antioxidant defense system, preservation of intestinal epithelial barrier integrity and restoration of immune homeostasis. In addition, the immunomodulatory and redox-regulating properties of G. barbadense phytoconstituents are discussed in the context of intestinal inflammation. Furthermore, this review integrates recent advances in network pharmacology to elucidate the multi-component, multi-target interactions underlying the therapeutic effects of G. barbadense. By consolidating current preclinical evidence and computational pharmacology approaches, this review highlights the potential of G. barbadense root as a prospective source of novel therapeutic agent for IBD while identifying key knowledge gaps that should be addressed before clinical translation.

In patients with acute severe ulcerative colitis (ASUC) who have received infliximab rescue therapy, the need for and timing of further steroid therapy is unclear. This brief communication explores contemporary clinical practice across Australia regarding corticosteroid management following rescue therapy in ASUC. By describing variability in real-world practice patterns and potential risks and benefits of different approaches, this article highlights current evidence gaps and the need for further studies to better inform clinical practice.

ObjectiveThis prospective study evaluated the therapeutic efficacy of Diosgenin in mitigating Oxazolone-induced ulcerative colitis in male BALB/c mice.MethodMice aged 10-11 weeks were randomized into five groups and subjected to a nine-day protocol involving skin sensitization and intra-rectal Oxazolone challenge. Diosgenin was administered orally at 3 mg/kg and 30 mg/kg twice daily, with Tofacitinib at 60 mg/kg as a reference control. Disease severity was assessed via clinical activity scores, which include tested parameters.ResultsOxazolone-induced acute colitis was characterized by significant weight loss, increased diarrhoea scores, and an >8-fold increase in rectal bleeding scores compared with vehicle-treated mice, confirming successful disease induction (p < 0.05). Diosgenin-treated mice showed significant recovery. Disease Activity Index (DAI) scores improved by 40% in the 3 mg/kg Diosgenin group, 45% in the 30 mg/kg Diosgenin group, and 67% in the Tofacitinib-treated group by Day 2. Stool consistency improved by 52%, 33%, and 49% on Day 1, and by 33%, 61%, and 64% on Day 2 in the 3 mg/kg and 30 mg/kg Diosgenin groups, and the 60 mg/kg Tofacitinib groups respectively. Molecular analysis revealed a dose-dependent suppression of Th2 cytokines: IL-4 levels were reduced by 71%, 90%, and 86%, and IL-13 levels by 75%, 79%, and 90% in the Diosgenin 3mg/kg and 30 mg/kg groups, and Tofacitinib 60 mg/kg group respectively. Diosgenin markedly suppressed colonic pSTAT3 expression, with reductions of 92% and 99%, in the Diosgenin 3mg/kg and 30 mg/kg groups and >90% in the Tofacitinib 60 mg/kg group.ConclusionThese findings suggest Diosgenin offers substantial protection against Oxazolone-induced colitis via cytokine modulation and pSTAT3 inhibition, highlighting its potential as a natural anti-inflammatory agent for colitis management.