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All Journal The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Journal of General Procedural Dermatology and Venereology Indonesia
Alvianto, Steven
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Medicine & Pharmacology

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Probiotics for Preventing Relapse in Ulcerative Colitis: A Systematic Review and Bayesian Network Meta-Analysis Alvianto, Steven; Muzellina, Virly Nanda; Widjanarko, Nicolas Daniel; Lee, Yeong Yeh; Wangidjaja, Olivia
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 26, No 2 (2025): VOLUME 26, NUMBER 2, AGUSTUS, 2025
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2622025130-142

Abstract

Background: Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by periods of relapse and remission. Preventing relapse is critical to improving long-term outcomes. This study aimed to compare the efficacy of probiotics, 5-aminosalicylic acid (5-ASA), probiotics combined with 5-ASA, and placebo in preventing relapse in UC.Methods: A comprehensive search from PubMed, Cochrane Library, MEDLINE, ProQuest, ScienceDirect, Clinical Trials. gov and Google Scholar databases were conducted. The primary outcome was clinical relapse. A Bayesian random-effects model calculated pooled odds ratios (ORs) with 95% CIs and treatment ranks were assessed using the surface under the cumulative ranking curve (SUCRA).Results: Of total 552 initial papers, 37 extracted, and 26 were removed due to exclusion criteria. Eleven RCTs involving 1,099 participants were eventually included for analysis. Probiotics combined with 5-ASA had the highest efficacy (OR = 0.23, 95% CI: 0.027–1.09; SUCRA = 71.43), followed by 5-ASA alone (OR = 0.25, 95% CI: 0.035–0.95; SUCRA = 66.90) and probiotics alone (OR = 0.275, 95% CI: 0.059–0.724; SUCRA = 59.69). Placebo ranked lowest (SUCRA = 1.98). The most commonly used probiotics included E. coli Nissle 1917, Lactobacillus GG, and Bifidobacterium species. The most frequently used 5-ASA preparation was mesalazine. Interventions were generally well-tolerated, with no significant adverse events reported. Conclusion: With the Bayesian NMA, Probiotics plus 5-ASA demonstrates the highest efficacy in preventing relapses in UC. Further research is needed to standardize probiotic regimens and to assess long-term outcomes with the combination approach.
Drug-induced hypersensitivity syndrome with liver injury due to phenytoin: A case report Wijaya, Lorettha; Adevita, Stella; Alvianto, Steven; Christiani, Yoseveline; Cahyadi, Alius; Yolanda, Raesa
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 8, No. 2
Publisher : UI Scholars Hub

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Abstract

Background: Drug-induced hypersensitivity syndrome (DIHS) is a rare and severe systemic drug reaction characterized by skin involvement, internal organ complications, and hematologic disorders. Management of this condition is challenging due to its wide range of cutaneous manifestations and 10% mortality rate. Case Illustration: A 52-year-old male presented with widespread redness throughout his body with a prior history of regular phenytoin consumption. The rash continued to spread despite the patient’s abrupt discontinuation of the suspected medication. He was diagnosed with atypical DIHS according to J-SCAR criteria and was given high-dose corticosteroid. Drastic clinical improvement was observed after nine days of therapy, and complete resolution of the rash was achieved after 14 days. The steroid was stopped after four weeks, and no relapse was observed after four months of follow-up. Discussion: Discontinuing the suspected medication is the first crucial step in DIHS management. No specific pharmaceutical strategy has been established for this syndrome; however, systemic corticosteroids have been frequently prescribed as a first-line therapy. Steroids need to be tapered off slowly over 6–8 weeks, even upon clinical resolution, to prevent relapse. In the current case, the steroid was tapered off slowly over four weeks. The lack of relapse observed after steroid discontinuation could be due to the fact that the patient stopped consuming the suspected medication immediately. Conclusion: Education on the consequences of prescribing high-risk medications is important. Early detection and prompt cessation of offending medications are needed for better DIHS outcomes.
Co-Authors Adevita, Stella Alius Cahyadi Christiani, Yoseveline Lee, Yeong Yeh Lorettha Wijaya Muzellina, Virly Nanda Raesa Yolanda, Raesa Wangidjaja, Olivia Widjanarko, Nicolas Daniel