A 76-year-old male patient with lung cancer developed thrombocytopenia due to chemotherapy.Three days after taking the Shengxuexiaoban capsules orally,he experienced abdominal pain and bloody stool and was admitted to the hospital.The blood test showed white blood cell count of 11.54×109·L-1,neutrophil percentage of 82.4％,platelet count of 93×109·L-1,and C-reactive protein level of 23.50 mg·L-1.Fecal occult blood test positive,and pathology indicatesd ischemic-like changes in the rectal mucosa.The patient was diagnosed with ischemic bowel disease.After treatment with fluid replacement and anti-infection,the patient's abdominal pain disappeared and his stool turned yellow.The Naranjo's Assessment Scale was used to evaluate the association between adverse effects of ischemic bowel disease and Shengxuexiaoban capsules,and the result was very likely related.This article analysed the clinical characteristics and drug treatment process of ischemic bowel disease caused by Shengxuexiaoban capsule through this case,aiming to provide references for the safe use of drugs in the clinically.

This article reports a case of a patient with Crohn's disease who had 1 to 2 loose stools per day,occasionally with a small amount of bloody stool.Despite treatment with multiple drugs in the past,the disease was still poorly controlled.The patient was switched to upadacitinib extended-release tablets 45 mg once daily for oral administration.The patient's hemoglobin level decreased continuously,with the lowest value of 68 g·L-1.After evaluation,it was determined that the decrease in hemoglobin was very likely related to upadacitinib extended-release tablets.The upadacitinib was discontinued,and vedolizumab was used for continued treatment.Symptomatic treatment was also given,and the patient's hemoglobin level gradually recovered.This article analyzes the clinical characteristics of upadacitinib-induced hemoglobin reduction in this case and the treatment plan optimization process,to provide a reference for safe clinical medication.

The clinical pharmacist was involved in the whole process of drug treatment and monitoring of a patient with ulcerative colitis(UC)and facial aseptic abscesses.After admission,clinical pharmacists and physicians jointly formulated an empirical anti-infection plan for meropenem and linezolid glucose injection.After the 5th day of medication,the patient continued to have high fever.After discussion with the physician and clinical pharmacist,it was considered that the patient's facial boil was caused by aseptic abscess syndrome,and UC with extraintestinal manifestations could not be ruled out.Hydrocortisone succinate sodium was added intravenously.After the 9th day of treatment,the patient's facial abscesses improved.Subsequently,the physician followed the clinical pharmacist's advice and used infliximab as the subsequent treatment plan.After the 11th day of treatment,the patient's symptoms improved significantly.During the 2-month follow-up,the facial abscesses completely disappeared,the stool was normal,and there were no special discomforts.The participation of clinical pharmacists in clinical practice improves patients' understanding of the disease and treatment compliance,providing patients with individualized medication support to ensure the safety and effectiveness of medication.

The clinical pharmacist was involved in the whole process of drug treatment and monitoring of a patient with ulcerative colitis(UC)and facial aseptic abscesses.After admission,clinical pharmacists and physicians jointly formulated an empirical anti-infection plan for meropenem and linezolid glucose injection.After the 5th day of medication,the patient continued to have high fever.After discussion with the physician and clinical pharmacist,it was considered that the patient's facial boil was caused by aseptic abscess syndrome,and UC with extraintestinal manifestations could not be ruled out.Hydrocortisone succinate sodium was added intravenously.After the 9th day of treatment,the patient's facial abscesses improved.Subsequently,the physician followed the clinical pharmacist's advice and used infliximab as the subsequent treatment plan.After the 11th day of treatment,the patient's symptoms improved significantly.During the 2-month follow-up,the facial abscesses completely disappeared,the stool was normal,and there were no special discomforts.The participation of clinical pharmacists in clinical practice improves patients' understanding of the disease and treatment compliance,providing patients with individualized medication support to ensure the safety and effectiveness of medication.

This article reports a case of a patient with Crohn's disease who had 1 to 2 loose stools per day,occasionally with a small amount of bloody stool.Despite treatment with multiple drugs in the past,the disease was still poorly controlled.The patient was switched to upadacitinib extended-release tablets 45 mg once daily for oral administration.The patient's hemoglobin level decreased continuously,with the lowest value of 68 g·L-1.After evaluation,it was determined that the decrease in hemoglobin was very likely related to upadacitinib extended-release tablets.The upadacitinib was discontinued,and vedolizumab was used for continued treatment.Symptomatic treatment was also given,and the patient's hemoglobin level gradually recovered.This article analyzes the clinical characteristics of upadacitinib-induced hemoglobin reduction in this case and the treatment plan optimization process,to provide a reference for safe clinical medication.

A 76-year-old male patient with lung cancer developed thrombocytopenia due to chemotherapy.Three days after taking the Shengxuexiaoban capsules orally,he experienced abdominal pain and bloody stool and was admitted to the hospital.The blood test showed white blood cell count of 11.54×109·L-1,neutrophil percentage of 82.4％,platelet count of 93×109·L-1,and C-reactive protein level of 23.50 mg·L-1.Fecal occult blood test positive,and pathology indicatesd ischemic-like changes in the rectal mucosa.The patient was diagnosed with ischemic bowel disease.After treatment with fluid replacement and anti-infection,the patient's abdominal pain disappeared and his stool turned yellow.The Naranjo's Assessment Scale was used to evaluate the association between adverse effects of ischemic bowel disease and Shengxuexiaoban capsules,and the result was very likely related.This article analysed the clinical characteristics and drug treatment process of ischemic bowel disease caused by Shengxuexiaoban capsule through this case,aiming to provide references for the safe use of drugs in the clinically.

Clinical pharmacists participated in the drug therapy and monitoring of a patient with Crohn's disease complicated with erythema multiforme.The patient,who had a previous diagnosis of Crohn's disease for many years and had been treated with infliximab to date,was admitted to the hospital with a scattered rash on the peripheral skin,normal stools,and fecal calprotectin＞1 800 μg-g-1,by collecting the patient's medical history,reviewing domestic and foreign literature,the clinical pharmacist assisted the physician in ruling out drug factors,and making a definitive diagnosis of Crohn's disease complicated with extraintestinal manifestations.Taking into account the patient's condition and guideline recommendations,the clinical pharmacist assisted doctors to adjust medication regimen,and determined that the next step in the patient's treatment program was ustekinumab combined with glucocorticoids therapy,and continuously monitoring the patient's condition.The patient's condition was effectively controlled immediately before discharge,with marked improvement in erythema multiforme,and the patient was followed up 3 months later with complete disappearance of erythema multiforme,normal bowel movements,and no specific discomfort.Since the extraintestinal manifestations of Crohn's disease are often similar to the adverse reactions caused by medications used in the treatment or other systemic diseases and disorders,it is necessary for the clinical pharmacist to assist the physician in screening.The case was studied and compiled with a view to providing references for the diagnosis and pharmacological treatment of such patients.

Background:Combined double-balloon enteroscopy(DBE)plays an important role in the diagnosis and treatment of patients with suspected small bowel bleeding(SSBB).Aims:To investigate the performance of combined DBE in patients with SSBB and their clinical features.Methods:A total of 94 patients with SSBB underwent combined DBE from June 2018 to April 2023 at the Third People's Hospital of Bengbu and the First Affiliated Hospital of Anhui Medical University were enrolled,and the clinical features were analyzed.Results:Fifty-four SSBB patients completed the combined DBE,and the combination rate was 57.4%.Ten patients(10.6%)stopped combined DBE due to discovery of bleeding lesions.Five patients(5.3%)stopped combined DBE due to intestinal stenosis.Twenty-five patients(26.5%)stopped combined DBE due to difficulty in insertion.Combined DBE rate in SSBB patients was correlated with the combination time and the number of previous DBE for endoscopists(P<0.05),but not the gender,age,bleeding manifestations,tobacco smoking and alcohol drinking,nutritional risk,abdominal operation history,perianal lesions,autoimmune diseases,preoperative anemia,preoperative albumin level,and enteroscopy approach(P>0.05).ROC curve showed that when the cut-off value of first insertion depth was 385 cm,the sensitivity and specificity for successful combined DBE in SSBB patients were 72.2%and 77.5%,respectively,and the area under ROC curve was 0.800(95%CI:0.705-0.875,P<0.001).Conclusions:The combined DBE rate in SSBB patients is correlated with the combination time and the number of previous DBE for endoscopists.80%of the SSBB patients are expected to complete the combined DBE when the first insertion depth is greater than 385 cm.

Background: The widespread use of biological agents in recent years can improve the nutritional status of partial patients with Crohn's disease (CD) and change the course of the disease. Aims: To investigate the correlation between the nutritional risk and clinical and endoscopic features in CD patients treated with biological agents. Methods: Sixty⁃eight CD patients treated with biological agents from June 2021 to June 2022 at the First Affiliated Hospital of Anhui Medical University were enrolled. Nutritional risk screening was conducted by nutritional risk screening 2002 (NRS2002), and its correlation with clinical and endoscopic features was analyzed. Results: In 68 CD patients treated with biological agents, incidence of nutritional risk was 66.2%. There was statistically significant difference in incidence of nutritional risk in patients with different disease behaviors, SES⁃CD score and postoperative Rutgeerts score (all P<0.05). The incidence of nutritional risk was not correlated with age, lesion location, perianal lesion, CDAI score, and the interval between CD diagnosis and the use of biological agents (all P>0.05). Conclusions: The incidence of nutritional risk is high in CD patients treated with biological agents, and is correlated with CD disease behavior, SES ⁃ CD score, and postoperative Rutgeerts score.

Objective To investigate the cumulative effective dose (CED) of ionizing radiation received by patients with Crohn's disease(CD) and to identify the risk factors associated with high levels of radiation in patients with Crohn's disease. Methods A total of 230 patients were enrolled. The classification of CD was according to the Montreal standards, and the CED of each patient was calculated retrospectively based on standards tables. High levels of radiation was defined as no less than 50 mSv CED. Patients who accepted no less than 50 mSv CED were assigned to high level of the radiation group, and those who accepted simultaneously less than 50 mSv CED were assigned to the control group. The risk factors for patients associating with high levels of radiation were analyzed by Logistic regression. Results CT enterography and abdominopelvic CT accounted for 52. 1％ and 39. 6％, respectively, and add up to 91. 7％ of total CED. The mean CED received per patient was 34. 07 mSv (95％ CI:30. 845～37. 304), and 51 patients (22. 2％ of total patients) with CD were exposed to no less than 50 mSv CED. Patients with long disease duration, surgical intervention, ileal location, stricturing or penetrating pattern received a higher dose of radiation. In a Logistic regression, stricturing or penetrating pattern(OR =3. 711, 95％ CI:2. 239 ～ 6. 151, P ＜0. 001) and the requirement for azathioprine (OR =4. 218, 95％ CI: 1. 221 ～14. 579,P=0. 023) were independent risk factors for the high levels of radiation in CD. Conclusion More than one in five of patients with CD are exposed to high levels of ionizing radiation, mainly caused by CT examination. Stricturing or penetrating pattern and the usage of azathioprine are independent risk factors for the high levels exposure of radiation in CD patients. During the clinical management and follow-up, it is important to either monitor the effective dose received per patient, minimizing unnecessary CT examination, or to transform to use no radiation imaging examination, such as MR enterography.