Study On The Intervention Of Curcumin In Patients With Ulcerative Colitis After Operation

Objective: Curcumin has been used to prevent and treat many organ and tissue diseases,mainly related to its anti-inflammatory and antioxidant stress effects.The anti-inflammatory effect of curcumin in ulcerative colitis(UC)has been demonstrated in many animal experiments and clinical trials.The prevent and treatment of ileal pouchitis is still the main difficulty for clinical physicians of UC patients who underwent total colorectal resection,ileum pouch anal anastomosis(IPAA).The purpose of this study was to investigate the effect of curcumin on the prevention and treatment of ileal pouchitis,and to evaluate the safety of curcumin.Methods: UC patients who received IPAA surgery and visited the outpatient or wards of gastroenterology and or general surgery in Tianjin medical university general hospital from December 2018 to December 2019 were selected successively.Finally,52 eligible patients were included.According to the pouchitis diseases activity index(PDAI)score,patients were divided into the pouchitis group(group A,PDAI≥7,13cases)and the non-pouchitis group(group B,PDAI<7,39 cases).Patients in the group A were randomly divided into the control group(group A1,7cases)and the intervention group(group A2,6cases).Patients in the group B were randomly divided into the control group(group B1,20cases)and the intervention group(group B2,19cases).All enrolled patients maintained a stable dose of oral probiotics prior to the start of the trial and maintained the existing oral probiotics during the trial.Dietary education was conducted for all patients before the trial.At the beginning of the trial,patients in A2 group and B2 group were given curcumin capsules of 2g/d orally(500mg×2 tablets,once in the morning and once in the evening),no special treatment for group A1 and group B1.All patients underwent endoscopy and pouch mucosal biopsy,laboratory examination of blood routine,liver function,renal function,electrolyte,C-reactive protein(CRP),blood sedimentation(ESR),fecal calprotectin(FC)and inflammatory bowel diseases questionnaire(IBDQ)before the start of the trial and 8 weeks after intervention respectively.Patients were followed up regularly during the trial,including clinical symptoms(stool frequency and characteristics,hematochezia,stool urgency,abdominal pain and fever),adverse reactions and other drug use.During the experiment,the patients with severe disease or intolerance to drug intervention were promptly discontinued and treated accordingly.PDAI,inflammatory index,nutritional status,quality of life and adverse reactions were analyzed before and after the test.Results: For patients in group A,after 8 weeks of the trial,the clinical remission was 3/6(50%)and clinical improvement was 1/6(16.7%)in group A2,and the clinical remission was 0/7,clinical improvement was 0/7 in group A1.PDAI and clinical symptom scores in group A2 were significantly improved than before and also significantly improved compared with those in group A1(p<0.05),while there was no significant difference in endoscopic and histological scores(p > 0.05).However,the degree of endoscopic abnormality in group A2 was improved than before and was significantly reduced than group A1(p<0.05);Scores of fecal frequency and fecal character in group A2 were significantly improved than before and also significantly improved than group A1(p < 0.05),and there was no significant change in group A1.ESR,CRP and FC in group A2 were significantly improved than before and significantly improved than group A1(p<0.05),and there was no statistical difference of WBC.There were no significant differences in WBC,ESR,CRP and FC in group A1(p>0.05).The overall nutritional status of group A2 was better than that of group A1,among which ALB and PAB had significant advantages(p<0.05).IBDQ scores in both groups were improved,while group A2 had a significant advantage over group A1(p<0.05). For group B,the incidence of pouchitis was 0/19 in group B2 and 2/20(10%)in group B1 after 8 weeks.PDAI,clinical symptoms,endoscopic and histological scores of group B2 were significantly improved compared with group B1(p<0.05).The degree of endoscopic abnormality in group B1 was worse than before(p<0.05).The score of stool frequency and characteristics in group B2 was significantly superior to that in group B1(p<0.05).ESR,CRP and FC in group B2 were significantly improved than before and significantly superior to that in group B1(p<0.05).The nutritional status of group B2 was superior to that of group B1,with ALB and PAB being the most significant(p<0.05).IBDQ scores in both groups were improved,while those in group B2 were significantly improved compared with those in group B1(p<0.05).During the whole experiment period,3 cases of transient adverse reactions occurred in group B2,including 2 cases of mild transient diarrhea and 1 case of mild transient alopecia.Conclusion: Curcumin intervention has certain advantages in improving the prognosis of patients after IPAA,including PDAI,fecal frequency and characteristics,degree of endoscopic abnormality,inflammatory indicators,nutritional status and quality of life.For patients with non-pouchitis,curcumin intervention seesms to have certain advantages in preventing the occurrence of pouchitis.For patients with pouchitis,curcumin can effectively induce clinical remission and improvement.The overall safety of curcumin was better.However,this study is the first to preliminarily explore the intervention effect of curcumin in patients with UC after IPAA surgery,The sample size is small,the dose is small,and the duration is short,so much more clinical studies with large samples and more centers are needed to confirm the efficacy of curcumin in the prevention and treatment of pouchitis.