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Sample records for bowel disease activity

  1. Gastric emptying and disease activity in inflammatory bowel disease

    DEFF Research Database (Denmark)

    Keller, Jutta; Binnewies, Ulrich; Rösch, Marie;

    2015-01-01

    BACKGROUND: Gastric emptying (GE) is delayed in a subset of patients with inflammatory bowel disease (IBD). We have shown before that altered release of gastrointestinal hormones may contribute to GE disturbances, but overall effects of disease activity remain unclear. Thus, we aimed to evaluate GE...... in patients with IBD during active disease and following therapy. DESIGN: A total of 20 healthy subjects (HC) and 26 patients with IBD hospitalized because of an acute episode of their disease (Crohn's disease (CD) n = 13, ulcerative colitis (UC) n = 13) underwent a standardized (13) C-octanoic acid GE breath...

  2. Established and emerging biological activity markers of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Nielsen, O H; Vainer, B; Madsen, S M;

    2000-01-01

    Assessment of disease activity in inflammatory bowel disease (IBD), i.e., ulcerative colitis (UC) and Crohn's disease (CD), is done using clinical parameters and various biological disease markers. Ideally, a disease marker must: be able to identify individuals at risk of a given disorder......, be disease specific, mirror the disease activity and, finally, be easily applicable for routine clinical purposes. However, no such disease markers have yet been identified for IBD. In this article, classical disease markers including erythrocyte sedimentation rate, acute phase proteins (especially...... molecules. It is concluded that none of the pertinent laboratory surrogate markers of disease activity in IBD are specific or sensitive enough to replace basic clinical observation such as the number of daily bowel movements, general well-being, and other parameters in parallel. Further studies are highly...

  3. Mitogen activated protein kinases: a role in inflammatory bowel disease?

    DEFF Research Database (Denmark)

    Broom, O J; Widjaya, B; Troelsen, J;

    2009-01-01

    Since their discovery more than 15 years ago, the mitogen activated protein kinases (MAPK) have been implicated in an ever-increasingly diverse array of pathways, including inflammatory signalling cascades. Inflammatory bowel diseases (IBD), such as ulcerative colitis and Crohn's disease...... and their related signalling proteins in influencing the progression of IBD....

  4. Established and emerging biological activity markers of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Nielsen, O H; Vainer, B; Madsen, S M;

    2000-01-01

    Assessment of disease activity in inflammatory bowel disease (IBD), i.e., ulcerative colitis (UC) and Crohn's disease (CD), is done using clinical parameters and various biological disease markers. Ideally, a disease marker must: be able to identify individuals at risk of a given disorder...... molecules. It is concluded that none of the pertinent laboratory surrogate markers of disease activity in IBD are specific or sensitive enough to replace basic clinical observation such as the number of daily bowel movements, general well-being, and other parameters in parallel. Further studies are highly...... warranted to identify and assess the clinical importance and applicability of new laboratory markers for the diagnosis or the disease activity of IBD....

  5. Bowel disease

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    2008069 The application of Montreal classification in inflammatory bowel disease. YANG Chuanhua(杨川华), et al. Renji Hosp, Shanghai Instit, Shanghai Jiaotong Univ Med Coll, Shanghai 200001. Chin J Intern Med 2008;47(1):7-10. Objective To investigate the clinical features of Crohn′s disease (CD) and ulcerative colitis (UC) according to the Montreal classification. Methods The clinical data of 110 cases of CD or UC were reviewed. The age at

  6. Magnetic resonance imaging of the small bowel in children with idiopathic inflammatory bowel disease: evaluation of disease activity

    Energy Technology Data Exchange (ETDEWEB)

    Alexopoulou, Efthymia; Loggitsi, Dimitra; Economopoulos, Nikos; Papakonstantinou, Olympia; Kelekis, Nikolaos L. [National and Kapodistrian University of Athens, General University Hospital, Second Department of Radiology, Athens (Greece); Roma, Eleftheria; Panagiotou, Ioanna; Pahoula, Ioanna [National and Kapodistrian University of Athens, Aghia Sofia Children' s Hospital, First Department of Paediatrics, Athens (Greece)

    2009-08-15

    Examinations using ionizing radiation are frequently used in the evaluation of disease activity in children affected by idiopathic inflammatory bowel disease (IBD). To develop an MR imaging protocol without the need for fluoroscopic insertion of an enteral tube and to assess the disease activity in children with IBD. Included in the study were 37 children (22 girls and 15 boys; age range 7-15 years, mean 11.67 years) with IBD who underwent MR imaging of the small bowel. Of these 37 children, 32 had Crohn disease and 5 had indeterminate colitis. A water solution containing herbal fibres was administered orally or through a nasogastric tube. Patients were imaged on a 1.5-T MR scanner with T1-weighted and {tau}2-weighted sequences followed by a dynamic study using 3-D T1-W images after intravenous administration of gadolinium. The percentage enhancement of the bowel wall was significantly increased in patients with abnormal C-reactive protein (CRP) values compared to patients with CRP values in the normal range (P<0.001). A relatively weak but significant correlation between percentage enhancement of the bowel wall and CRP values was noted during all phases of enhancement. This MR imaging protocol is a safe and well-tolerated method for evaluating disease activity and extraintestinal manifestations of IBD in children. (orig.)

  7. /sup 67/Ga citrate scintiscanning in active inflammatory bowel disease

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    Rheingold, O.J.; Tedesco, F.J.; Block, F.E.; Maldonado, A.; Miale, A. Jr.

    1979-05-01

    Twenty-five hospitalized patients were studied prospectively with /sup 67/Ga citrate (GA) abdominal scintillation scanning in an attempt to define its role in the evaluation of patients with active inflammatory bowel disease (IBD). There were nine patients with ulcerative colitis (UC), seven with Crohn's disease (CD), and nine controls. In four patients, two with UC and two with CD, a tissue/plasma radioactivity ratio was obtained and compared to normals. All the UC patients had positive GA scans and only one of seven of the CD patients had a positive scan. There were no false positive scans. Scans performed after a 3- or 5-day delay were more accurate than 6-hr scans alone. Well-delineated colinic radioactivity 6 hr after injection which persists for 3 to 5 days indicates the presence of UC in patients with IBD, while a negative scan is more consistent with active CD. Colonic uptake at 6 hr which clears by 48 or 72 hr is not indicative of UC. This procedure aided in following the course of UC, delineating the extent of disease, and in differentiating active CD from an intraabdominal abscess. Tissues from UC patients had increased tissue/plasma ratioactivity ratios while tissues from CD patients had normal or decreased ratios which were consistent with the imaging data.

  8. Quantitative analysis of contrast-enhanced ultrasonography of the bowel wall can predict disease activity in inflammatory bowel disease

    Energy Technology Data Exchange (ETDEWEB)

    Romanini, Laura, E-mail: laura.romanini@libero.it [Department of Radiology, Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123 Brescia (Italy); Passamonti, Matteo, E-mail: matteopassamonti@gmail.com [Department of Radiology-AO Provincia di Lodi, Via Fissiraga, 15, 26900 Lodi (Italy); Navarria, Mario, E-mail: navarria.mario@tiscali.it [Department of Radiology-ASL Vallecamonica-Sebino, Via Manzoni 142, 25040 Esine, BS (Italy); Lanzarotto, Francesco, E-mail: francesco.lanzarotto@spedalicivili.brescia.it [Department of Gastroenterology, Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123 Brescia (Italy); Villanacci, Vincenzo, E-mail: villanac@alice.it [Department of Pathology, Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123 Brescia (Italy); Grazioli, Luigi, E-mail: radiologia1@spedalicivili.brescia.it [Department of Radiology, Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123 Brescia (Italy); Calliada, Fabrizio, E-mail: fabrizio.calliada@gmail.com [Department of Radiology, University of Pavia, Viale Camillo Golgi 19, 27100 Pavia (Italy); Maroldi, Roberto, E-mail: rmaroldi@gmail.com [Department of Radiology, University of Brescia, P.le Spedali Civili, 1, 25123 Brescia (Italy)

    2014-08-15

    Purpose: To evaluate the accuracy of quantitative analysis of bowel wall enhancement in inflammatory bowel disease (IBD) with contrast enhanced ultrasound (CEUS) by comparing the results with vascular density in a biopsy sample from the same area of the intestinal tract, and to determine the usefulness of this analysis for the prediction of disease activity. Materials and methods: This prospective study was approved by our institute's ethics committee and all patients gave written informed consent. We enrolled 33 consecutive adult patients undergoing colonoscopy and biopsy for IBD. All patients underwent CEUS and the results were quantitatively analyzed. Vessel count per high-power field on biopsy specimens was compared with colonoscopy, baseline ultrasonography, and CEUS findings, and with analysis of peak intensity, time to peak, regional blood volume, mean transit time, and regional blood flow. Results in patients with high and low vascular density were compared using Fisher's test, t-test, Pearson's correlation test, and receiver operating characteristic curve (ROC) analysis. Cutoff values were determined using ROC analysis, and sensitivity and specificity were calculated. Results: High vascular density (>265 vessels per field) on histological examination was significantly correlated with active disease on colonoscopy, baseline ultrasonography, and CEUS (p < .0001). Quantitative analysis showed a higher enhancement peak, a shorter time to peak enhancement, a higher regional blood flow and regional blood volume in patients with high vascular density than in those with low vascular density. Cutoff values to distinguish between active and inactive disease were identified for peak enhancement (>40.5%), and regional blood flow (>54.8 ml/min). Conclusion: Quantitative analysis of CEUS data correlates with disease activity as determined by vascular density. Quantitative parameters of CEUS can be used to predict active disease with high sensitivity and

  9. Quantitative analysis of contrast-enhanced ultrasonography of the bowel wall can predict disease activity in inflammatory bowel disease

    International Nuclear Information System (INIS)

    Purpose: To evaluate the accuracy of quantitative analysis of bowel wall enhancement in inflammatory bowel disease (IBD) with contrast enhanced ultrasound (CEUS) by comparing the results with vascular density in a biopsy sample from the same area of the intestinal tract, and to determine the usefulness of this analysis for the prediction of disease activity. Materials and methods: This prospective study was approved by our institute's ethics committee and all patients gave written informed consent. We enrolled 33 consecutive adult patients undergoing colonoscopy and biopsy for IBD. All patients underwent CEUS and the results were quantitatively analyzed. Vessel count per high-power field on biopsy specimens was compared with colonoscopy, baseline ultrasonography, and CEUS findings, and with analysis of peak intensity, time to peak, regional blood volume, mean transit time, and regional blood flow. Results in patients with high and low vascular density were compared using Fisher's test, t-test, Pearson's correlation test, and receiver operating characteristic curve (ROC) analysis. Cutoff values were determined using ROC analysis, and sensitivity and specificity were calculated. Results: High vascular density (>265 vessels per field) on histological examination was significantly correlated with active disease on colonoscopy, baseline ultrasonography, and CEUS (p < .0001). Quantitative analysis showed a higher enhancement peak, a shorter time to peak enhancement, a higher regional blood flow and regional blood volume in patients with high vascular density than in those with low vascular density. Cutoff values to distinguish between active and inactive disease were identified for peak enhancement (>40.5%), and regional blood flow (>54.8 ml/min). Conclusion: Quantitative analysis of CEUS data correlates with disease activity as determined by vascular density. Quantitative parameters of CEUS can be used to predict active disease with high sensitivity and

  10. Functional bowel disease

    DEFF Research Database (Denmark)

    Rumessen, J J; Gudmand-Høyer, E

    1988-01-01

    Twenty-five patients with functional bowel disease were given fructose, sorbitol, fructose-sorbitol mixtures, and sucrose. The occurrence of malabsorption was evaluated by means of hydrogen breath tests and the gastrointestinal symptoms, if any, were recorded. One patient could not be evaluated...... with functional bowel disease. The findings may have direct influence on the dietary guidance given to a major group of patients with functional bowel disease and may make it possible to define separate entities in this disease complex....

  11. Pediatric inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Karen A Diefenbach; Christopher K Breuer

    2006-01-01

    Inflammatory bowel disease is an important cause of gastrointestinal pathology in children and adolescents.The incidence of pediatric inflammatory bowel disease is increasing; therefore, it is important for the clinician to be aware of the presentation of this disease in the pediatric population. Laboratory tests, radiology studies,and endoscopic procedures are helpful in diagnosing inflammatory bowel disease and differentiating between Crohn's disease and ulcerative colitis. Once diagnosed,the goal of medical management is to induce remission of disease while minimizing the side effects of the medication. Specific attention needs to be paid to achieving normal growth in this susceptible population.Surgical management is usually indicated for failure of medical management, complication, or malignancy.Algorithms for diagnostic evaluation and treatment of pediatric inflammatory bowel disease are presented.The specific psychosocial issues facing these patients are also discussed in this review as are the future goals of research in the complex problem of pediatric inflammatory bowel disease.

  12. Psychosocial Factors Contributing to Inflammatory Bowel Disease Activity and Health-Related Quality of Life

    OpenAIRE

    Faust, Alejandra H.; Halpern, Leslie F.; Danoff-Burg, Sharon; Cross, Raymond K.

    2012-01-01

    Objective: This study aimed to examine the contributions of coping and social constraint to disease activity and health-related quality of life (HRQOL) and to examine group differences in disease activity and HRQOL between patients with high versus low anxiety or depression symptoms in adults with inflammatory bowel disease (IBD). Methods: This study was a retrospective analysis in which disease activity was measured with either the Harvey-Bradshaw Index or the Simple Clinical Colitis Activit...

  13. Cytomegalovirus infection in inflammatory bowel disease is not associated with worsening of intestinal inflammatory activity.

    Directory of Open Access Journals (Sweden)

    Alexandre Medeiros do Carmo

    Full Text Available Cytomegalovirus is highly prevalent virus and usually occurs in immunocompromised patients. The pathophysiology and treatment of inflammatory bowel disease often induce a state of immunosuppression. Because this, there are still doubts and controversies about the relationship between inflammatory bowel disease and cytomegalovirus.Evaluate the frequency of cytomegalovirus in patients with inflammatory bowel disease and identify correlations.Patients with inflammatory bowel disease underwent an interview, review of records and collection of blood and fecal samples. The search for cytomegalovirus was performed by IgG and IgM blood serology, by real-time PCR in the blood and by qualitative PCR in feces. Results were correlated with red blood cell levels, C-reactive protein levels, erythrocyte sedimentation rates and fecal calprotectin levels for each patient.Among the 400 eligible patients, 249 had Crohn's disease, and 151 had ulcerative colitis. In the group of Crohn's disease, 67 of the patients had moderate or severe disease, but 126 patients presented with active disease, based on the evaluation of the fecal calprotectin. In patients with ulcerative colitis, only 21 patients had moderate disease, but 76 patients presented with active disease, based on the evaluation of the fecal calprotectin. A large majority of patients had positive CMV IgG. Overall, 10 patients had positive CMV IgM, and 9 patients had a positive qualitative detection of CMV DNA by PCR in the feces. All 400 patients returned negative results after the quantitative detection of CMV DNA in blood by real-time PCR. Analyzing the 19 patients with active infections, we only found that such an association occurred with the use of combined therapy (anti-TNF-alpha + azathioprine.The findings show that latent cytomegalovirus infections are frequent and active cytomegalovirus infection is rare. We did not find any association between an active infection of CMV and inflammatory bowel

  14. Immunosuppression after liver transplantation for primary sclerosing cholangitis influences activity of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Jørgensen, Kristin Kaasen; Lindström, Lina; Cvancarova, Milada;

    2013-01-01

    Previous studies have shown conflicting results regarding the course of inflammatory bowel disease (IBD) after liver transplantation in patients with primary sclerosing cholangitis (PSC). We studied the progression of IBD in patients with PSC who have undergone liver transplantation. We also...... studied risk factors, including medical therapy, that could influence on IBD disease activity....

  15. Advances in the assessment of disease activity in inflammatory bowel disease

    Energy Technology Data Exchange (ETDEWEB)

    Camilleri, M.; Proano, M. (Mayo Clinic, Rochester, MN (USA))

    1989-07-01

    Knowledge of the severity and extent of the inflammation in inflammatory bowel diseases provides a means of determining rational therapeutic strategies in affected patients. During the past 3 decades, several clinical, laboratory, and combined indices have been proposed for the assessment of inflammatory bowel disease; refinements in radiologic methods and the availability of endoscopy and biopsy have facilitated the accurate assessment of the extent and severity of the disease. In relapsing conditions such as inflammatory bowel disease, however, the use of such procedures is limited by the radiation exposure or the relatively invasive nature of the technique. In this article, we review the proposed methods and recent advances in assessment of patients with inflammatory bowel disease; we also discuss possible strategies at the time of diagnosis, during recurrence, and in evaluation of the efficacy of drug or dietic therapy. 58 references.

  16. Gallium-67 scanning at 6 hr in active inflammatory bowel disease: case report

    Energy Technology Data Exchange (ETDEWEB)

    Kaplan, L.R.; Griep, R.J.; Schuffler, M.D.; Silliman, R.A.

    1977-05-01

    Gallium citrate scanning at 6 hr was used to evaluate a patient with active ulcerative colitis. The localization of /sup 67/Ga in the colon correlated with the extent of the inflammatory process. When either colonoscopy or radiographic contrast studies are contraindicated, /sup 67/Ga scanning at 6 hr may prove useful in the evaluation of active inflammatory bowel disease.

  17. Inflammatory bowel disease activity assessed by fecal calprotectin and lactoferrin: correlation with laboratory parameters, clinical, endoscopic and histological indexes

    OpenAIRE

    Rossini Lucio; Steinwurz Flávio; Klug Wilmar; Rolim Ernani; Fang Chia; Vieira Andrea; Candelária Paulo

    2009-01-01

    Abstract Background Research has shown that fecal biomarkers are useful to assess the activity of inflammatory bowel disease (IBD). The aim of the study is: to evaluate the efficacy of the fecal lactoferrin and calprotectin as indicators of inflammatory activity. Findings A total of 78 patients presenting inflammatory bowel disease were evaluated. Blood tests, the Crohn's Disease Activity Index (CDAI), Mayo Disease Activity Index (MDAI), and Crohn's Disease Endoscopic Index of Severity (CDEIS...

  18. Cutaneous Manifestations in Inflammatory Bowel Diseases

    Directory of Open Access Journals (Sweden)

    Simona Roxana Georgescu

    2015-10-01

    Full Text Available Inflammatory bowel diseases have a high frequency in Europe. They are chronic disorders that evolve with relapses and remissions. Clinical features include the signs of underlying inflammatory bowel disease and also signs of extraintestinal manifestations. Cutaneous disorders are the most common extraintestinal manifestations associated with inflammatory bowel diseases, which can be dependent on or independent of gastrointestinal disease activity. The main cutaneous disorders are erythema nodosum and pyodermagangrenosum. The pathogenic mechanisms are not fully understood but it seems that related mechanisms are involved in the development of inflammatory bowel diseases and extraintestinal manifestations. Treatment should be aimed at both the cutaneous manifestations and the bowel inflammation

  19. Increased risk of atrial fibrillation and stroke during active stages of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Kristensen, Søren Lund; Lindhardsen, Jesper; Ahlehoff, Ole;

    2014-01-01

    AIMS: Inflammation is considered to play a role in the development of atrial fibrillation (AF). Hence inflammatory bowel disease (IBD) may be associated with AF. We therefore examined the incidence of AF and stroke in patients with IBD. METHODS AND RESULTS: From Danish nationwide registries 1996......-2011, we identified 24 499 patients with new-onset IBD and 236 275 age- and sex-matched controls. Poisson regression analyses with continuously updated covariates were used to estimate incidence rate ratios (IRRs) of AF and stroke. Disease activity stages of flare (new disease activity), persistent...... activity, and remission were defined by corticosteroid prescriptions, IBD hospital admissions, and biological treatment. Inflammatory bowel disease patients had a mean age of 43.9 years, 53.9% were women, and mean follow-up was 6.8 years. Among IBD patients, 685 had AF and 549 had a stroke, corresponding...

  20. An Evaluation of the Correlation between Hepcidin Serum Levels and Disease Activity in Inflammatory Bowel Disease

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    Zehra Betül Paköz

    2015-01-01

    Full Text Available Aim. While there are many well-defined serological markers for inflammatory bowel disease (IBD, there is limited evidence that they positively affect clinical outcomes. This study aimed to evaluate the correlation between hepcidin serum levels and disease activity in IBD. Materials and Methods. Eighty-five consecutive IBD patients were enrolled in the study. Hepcidin serum levels were assessed using an enzyme-linked immunosorbent assay (ELISA and were compared with disease activity as well as the interleukin-6 (IL-6 and C-reactive protein (CRP levels. Results. The mean hepcidin serum levels in Crohn’s disease (CD patients in remission and in the active phase were 3837±1436 and 3752±1274 pg/mL, respectively P=0.613. The mean hepcidin serum levels in ulcerative colitis (UC patients in remission and in the active phase were 4285±8623 and 3727±1176 pg/mL, respectively P=0.241. Correlation analysis between inflammatory markers and hepcidin serum levels indicated that there was no correlation between hepcidin levels and IL-6 P=0.582 or CRP P=0.783. Conclusion. As an acute-phase protein, hepcidin seems to have a lower efficacy than other parameters in the detection of activation in IBD.

  1. Assessment of inflammatory bowel disease activity by technetium 99m phagocyte scanning

    Energy Technology Data Exchange (ETDEWEB)

    Pullman, W.E.; Sullivan, P.J.; Barratt, P.J.; Lising, J.; Booth, J.A.; Doe, W.F.

    1988-10-01

    Autologous technetium 99m-labeled phagocyte scanning has been used to assess disease activity in inflammatory bowel disease in 51 consecutive patients. Strong correlations were found between the 24-h fecal excretion of isotope and the histologic score of mucosal biopsy specimens (rS = 0.84, p less than 0.001, where rS is Spearman's rank correlation coefficient), and between the 24-h fecal excretion of isotope and a clinical inflammatory bowel disease activity index based on the Crohn's disease activity index (rS = 0.87, p less than 0.001). To develop a clinically useful and objective measure of inflammatory bowel disease activity that did not require a 24-h stool collection, the intensity of bowel uptake on scanning was graded visually from 0 to 4, a ratio of count rates for the region of interest to the iliac crest reference region was calculated, and the rapidity of labeled phagocyte uptake into inflamed bowel was measured as the peak uptake time. Visual grading of disease activity on the scans was validated by comparing it with the ratio of count rates from inflamed bowel regions of interest and those from the iliac crest reference region. The ratio of count rates showed a significant correlation with the clinical disease activity index (r = 0.75, p less than 0.001). The visual scan grade also correlated well with the clinical activity index (r = 0.87, p less than 0.001). Count rates from hourly scans were also used to calculate the time of peak uptake of counts for a given region of interest. There was a strong negative correlation between this peak uptake time and the fecal excretion of isotope (rS = -0.81, p less than 0.001), a clinical activity index (r = -0.60, p less than 0.001), and the histologic score of the mucosal biopsy specimens (r = -0.84, p less than 0.001).

  2. Inflammatory bowel disease

    Energy Technology Data Exchange (ETDEWEB)

    Kottler, R.E.; Freson, M. (Groote Schuur Hospital, Cape Town (South Africa). Dept. of Radiology)

    1985-06-01

    Radiology is of considerable value in all forms of inflammatory bowel disease to establish its presence and extent, and to differentiate lesions. The most common inflammatory bowel diseases are Crohn's disease and ulcerative colitis. Crohn's disease may occur anywhere in the disgestive tract, but is most common in the terminal ileum. Since there is no practical endoscopic method of examining the small bowel, barium studies of the latter are most important. Modern radiological techniques, especially the double contrast barium enema, show excellent correlation between the macroscopic changes and the radiological features. Radiology alone does not provide the answers and the radiological features must be interpreted in conjunction with clinical investigation.

  3. Cutaneous Manifestations in Inflammatory Bowel Diseases

    OpenAIRE

    Simona Roxana Georgescu; Cristina Iulia Mitran; Madalina Irina Mitran; Monica Costescu; Vasile Benea; Maria Isabela Sarbu; Mircea Tampa

    2015-01-01

    Inflammatory bowel diseases have a high frequency in Europe. They are chronic disorders that evolve with relapses and remissions. Clinical features include the signs of underlying inflammatory bowel disease and also signs of extraintestinal manifestations. Cutaneous disorders are the most common extraintestinal manifestations associated with inflammatory bowel diseases, which can be dependent on or independent of gastrointestinal disease activity. The main cutaneous disorders are erythema nod...

  4. The association between the gut microbiota and the inflammatory bowel disease activity

    DEFF Research Database (Denmark)

    Prosberg, Michelle; Bendtsen, Flemming; Vind, Ida;

    2016-01-01

    BACKGROUND: The pathogenesis of inflammatory bowel diseases (IBD) involves complex interactions between the microbiome and the immune system. We evaluated the association between the gut microbiota and disease activity in IBD patients. METHODS: Systematic review of clinical studies based...... on a published protocol. Included patients had ulcerative colitis (UC) or Crohn's disease (CD) classified as active or in remission. We selected bacteria assessed in at least three studies identified through electronic and manual searches (November 2015). Bias control was evaluated with the Newcastle Ottawa...

  5. Quantification of disease activity in patients undergoing leucocyte scintigraphy for suspected inflammatory bowel disease

    Energy Technology Data Exchange (ETDEWEB)

    Cheow, Heok K.; Voutnis, Demetrius D.; Evans, John W.; Szczepura, Katy R.; Swift, E. Anna; Bird, Nicholas J.; Ruparelia, Prina; Solanki, Chandra K.; Ballinger, James R.; Chilvers, Edwin R.; Peters, A. Michael [Addenbrooke' s Hospital, Department of Nuclear Medicine, Cambridge (United Kingdom); Middleton, Stephen J. [Addenbrooke' s Hospital, Department of Gastroenterology, Cambridge (United Kingdom)

    2005-03-01

    Whole-body gamma camera counting is an alternative to faecal {sup 111}In collection for quantifying disease activity in inflammatory bowel disease (IBD) but requires administration of imaging activities of {sup 111}In. The aim of this study was to explore a dedicated whole-body counter which requires 20-fold less activity than gamma camera counting. Thirty patients with known or suspected IBD received {sup 99m}Tc-granulocytes ({proportional_to}200 MBq) and {sup 111}In-granulocytes ({proportional_to}0.5 MBq). The {sup 99m}Tc-cells were injected 45 min after the {sup 111}In-cells and immediately after a baseline {sup 111}In whole-body count. The decay-corrected count at 120 h was expressed as a fraction of baseline to give whole-body {sup 111}In retention (WBR). One patient was excluded as the injected cells were non-viable. Median 45-min intravascular {sup 111}In recovery was 35% in patients compared with 43% in six normal volunteers (p<0.05). WBR in normals ranged from 91% to 93% and in 11 patients with negative {sup 99m}Tc imaging from 87% to 96%. Only one of 11 patients with negative imaging had WBR <90% while 11/12 patients with WBR <90% had abnormal imaging. Ten of 13 patients with Crohn's disease (CD) had abnormal imaging. The lowest WBR in these ten was 77% and six had values of >90%. There was a significant association between WBR and {sup 99m}Tc image grade (R{sub s}=0.73, p<0.002) in 16 patients without CD, but not in 13 patients with CD (R{sub s}=0.54, p>0.05). Dedicated whole-body counting is able to quantify disease activity in IBD but may give normal values in active CD. (orig.)

  6. Inflammatory bowel disease epidemiology

    DEFF Research Database (Denmark)

    Burisch, Johan; Munkholm, Pia

    2013-01-01

    The occurrence of inflammatory bowel disease (IBD) is increasing worldwide, yet the reasons remain unknown. New therapeutic approaches have been introduced in medical IBD therapy, but their impact on the natural history of IBD remains uncertain. This review will summarize the recent findings...... in the epidemiology of IBD....

  7. Rapid fecal calprotectin testing to assess for endoscopic disease activity in inflammatory bowel disease: A diagnostic cohort study

    OpenAIRE

    Lukasz Kwapisz; Mahmoud Mosli; Nilesh Chande; Brian Yan; Melanie Beaton; Jessica Micsko; Mennill, Pauline W.; William Barnett; Kevin Bax; Terry Ponich; John Howard; Anthony Tirolese; Robert Lannigan; James Gregor

    2015-01-01

    Background and Aim: With increasing numbers of patients diagnosed with inflammatory bowel disease (IBD), it is important to identify noninvasive methods of detecting disease activity. The aim of this study is to examine the diagnostic accuracy of fecal rapid calprotectin (FC) testing in the detection of endoscopically active IBD. Patients and Methods: All consecutive patients presenting to outpatient clinics with lower gastrointestinal symptoms were prospectively recruited. Patients provided ...

  8. Localization and activity of inflammatory bowel disease using /sup 111/In leukocyte imaging

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    Hotze, A.; Biersack, H.J.; Biele, B.; Wolf, F.; Knapp, F.F.

    1988-06-01

    A prospective study was initiated to compare the clinically proven results concerning localization/extent and activity of inflammatory bowel diseases with those of /sup 111/In-oxine leukocyte imaging. All patients studied were completely examined with barium enema x-ray, clinical and laboratory investigations, and endoscopy with histopathology. A total of 31 leukocyte scans were performed in 15 patients (12 with Crohn's desease, 3 with ulcerative colitis). The scans were graded by comparing the cell uptake of a lesion (when present) and a bone marrow area providing a count ratio (CR). The inflammatory lesions were correctly localized on 26 leukocyte scans, and in 21 scans the scintigraphically estimated extent of disease was identical to endoscopy. In 5 cases the disease extent was underestimated, 4 scans in patients with relapse of Crohn's disease were falsely negative, and in one patient with remission truly negative. The scintigraphically assessed disease activity was also in a good agreement with clinical disease activity based on histopathology in all cases. We conclude that leukocyte imaging provides valuable information about localization and activity of inflammatory bowel disease.

  9. Nutritional Assessment and Disease Activity for Patients with Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Thomas E Wasser

    1995-01-01

    Full Text Available Using the Harvard/Willett Semi-Quantitative Food Frequency Questionnaire (H/WSQFFQ, nutritional information was gathered on patients enrolled in an inflammatory bowel disease (IBD registry. The registry lists 320 patients positive for either ulcerative colitis (n=124 or Crohn’s disease (n=196. The sample was limited to those 19 to 84 years old (mean ± SD 48.57±14.98, and comprised 136 males and 184 females. Using a battery of indices, quality of life, disease activity and general well-being were also assessed. Nutritional intake values from the Harvard-Willett data were compared with recommended dietary allowances (RDA tables by sex and age group (19 to 24 years, 25 to 50, 51 and older to discover any intake deficiencies. Results showed that IBD patients were below RDA guidelines for vitamin E, calcium, magnesium, zinc, iodine and selenium. Females were below RDA guidelines for iron while men were below for vitamin B6. There were also some deficiencies according to age in males and two nutrient deficiencies were seen by age group in women. There were no deficiencies by sex or age for vitamins A, C, D and niacin. There were no observed nutrient intake differences between ulcerative colitis and Crohn’s disease groups. Patients receiving vitamin or mineral supplementation showed significant decreases in quality of life, regardless of diagnosis (Crohn’s disease or ulcerative colitis group. The H/WSQFFQ is a useful tool for assessment of the nutritional status of the IBD patient because it not only provides valuable measurement data to the clinician, but also adds to patient awareness about nutritional problems associated with IBD.

  10. Disease activity and cancer risk in inflammatory bowel disease associated with primary sclerosing cholangitis

    Institute of Scientific and Technical Information of China (English)

    Harry Sokol; Jacques Cosnes; Olivier Chazouilleres; Laurent Beaugerie; Emmanuel Tiret; Raoul Poupon; Philippe Seksik

    2008-01-01

    AIM: To investigate the phenotype of inflammatory bowel disease associated with primary sclerosing cholangitis (PSC-IBD).METHODS: Data from 75 PSC-]BD patients evaluated in our tertiary center between 1963 and 2006 were collected and compared to 150 IBD patients without PSC, matched for sex, birth date, IBD diagnosis date and initial disease location regarding ileal, different colonic segments, and rectum, respectively.RESULTS: While PSC-IBD patients received more 5-aminosalicylates (8.7 years/patient vs 2.9 years/patient, P<0.001), they required less immunosuppressors (24% vs 46% at 10 years; P<0.001) and less intestinal resection (10% vs 44% at 10 years, P<0.001). The 25-year cumulative rate of colectomy was 25.1% in PSC-IBD and 37.3% in controls (P=0.004). The 25-year cumulative rate of colorectal cancer was 23.4% in PSC-IBD vs 0% in controls (P=0.002). PSC was the only independent risk factor for the development of colorectal cancer (OR=10.8; 95%CI, 3.7-31.3). Overall survival rate without liver transplantation was reduced in PSC-IBD patients (67% vs 91% in controls at 25 years, P=0.001).CONCLUSION: This study confirms that patients with PSC-IBD have a particular disease phenotype independent of the initial disease location. Although their disease is less active and they use more 5-aminosalicylates, they present a higher risk of colorectal cancer.

  11. The role of nuclear medicine in inflammatory bowel disease. A review with experiences of aspecific bowel activity using immunoscintigraphy with 99mTc anti-granulocyte antibodies

    International Nuclear Information System (INIS)

    The diagnosis of inflammatory bowel disease (IBD) needs a complex diagnostic work-up. Beside verifying the disease itself, it is fundamental to assess disease extent and activity and to detect associated complications, to find the most effective treatment and for follow up. Scintigraphy with radiolabelled leukocytes is able to provide a complete survey of the whole intestinal tract, both the small and large bowel, and detects septic complications successfully with negligible risk. Radionuclide procedures are useful in establishing or ruling out IBD in patients with intestinal complaints, in assessing disease severity, and in the evaluation of extraintestinal septic complications. Widely available radionuclide procedures are discussed, i.e. scintigraphy by 111Indium oxime or 99mTechnetium HMPAO labelled white blood cells and immunoscintigraphy with 99mTc anti-granulocyte antibodies. Advantages and disadvantages of all three methods are stressed out. Patients and methods: The immunoscintigraphies with 99mTc anti-granulocyte antibodies (ANTI-GRANULOCYTE[reg] BW 250/183) of 27 patients with suspicion of IBD were retrospectively analysed. Planar anterior and posterior images were obtained 4 and 24 h postinjection, respectively. The bowel was divided into six segments and the activity was visually graded with reference to bone marrow in each segments. The scans were compared with the results of radiological and endoscopical investigations. The diagnosis of IBD was proved or ruled out by means of enteroclysis, large bowel enema or endoscopy. Results: In the 27 patients, 74 bowel segments with increased activity were detected. In the case of 30 segments in 16 patients, bowel inflammation was revealed by the other methods (true positives). In the case of 44 bowel segments, no underlying bowel inflammation could be verified, and these activities were regarded as aspecific activity. We could not differentiate between true positive and aspecific activity based on scan pattern

  12. Bowel disease after radiotherapy

    International Nuclear Information System (INIS)

    The clinical presentation, operative findings and outcome in 40 patients who required surgery for bowel disease after radiotherapy are presented. The type of presentation varied according to the time after radiotherapy. In the first month, many patients had a proctitis but none required surgery. Five patients were operated on within one month, 2 for radiation-induced acute ileitis and 3 for exacerbations of pre-existing disease (diverticular disease 2, ulcerative colitis 1). The commonest time of presentation was between 3 and 18 months after radiotherapy, when 20 patients needed surgery for bowel disease caused by radiation-induced local ischaemia. Twelve of these patients had chronic perforation, 6 had severe rectal bleeding and 2 had painful anorectal ulceration. Fifteen patients presented between 2 and 24 years after radiotherapy, usually with incomplete intestinal obstruction due to a fibrous stricture, but 2 patients had rectal carcinoma. Wide resection of the involved bowel was the principal method of treatment but any anastomosis was protected by a proximal defunctioning stoma. There was no operative mortality but 10 patients have died subsequently. The danger of dismissing these patients as having incurable malignancy is stressed because, although the condition is infrequent, it is usually amenable to adequate surgery. (author)

  13. Kirsner's inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    R Balfour Sarto; William J Sandborn

    2005-01-01

    @@ Very few medical textbooks have so thoroughly dominated,and even defined a field, as has Inflammatory Bowel Diseases by Joe Kirsner. Originally co-edited with Roy Shorter of Mayo Clinic, this book, beginning with its first edition in 1975, encapsulated the science and art of caring for patients with Crohn's disease and ulcerative colitis. Thus it is with considerable respect, and indeed some awe and trepidation,that we eagerly embraced the opportunity to assume the editorship of this preeminent textbook and the obligation to transition it to reflect the changing, increasingly complex pathophysiology and treatment of these diseases.

  14. INFLAMMATORY BOWEL DISEASE

    Directory of Open Access Journals (Sweden)

    I Gusti Ayu Mahaprani Danastri

    2013-02-01

    Full Text Available Crohn disease (CD and ulcerative colitis (UC is an chronic inflammation in the gastrointestinal tract. Colecctively, they are called inflammatory bowel disease (IBD, and about 1,5 millions people in America suffering from UC and CD. The cause of UC and CD is unknown, but the expert believe that UC and CD are caused by a disturbed immune response in someone who has a genetic predisposition. UC and CD have a significant recurrency  and remission rate. Surgery in UC is a curative treatment for colon’s disease and a potentially colon’s malignancy, but it is not a curative treatment for CD.

  15. Use of thiopurines in inflammatory bowel disease

    DEFF Research Database (Denmark)

    Frei, Pascal; Biedermann, Luc; Nielsen, Ole Haagen;

    2013-01-01

    The use of thiopurines as immunosuppression for the treatment of refractory or chronic active inflammatory bowel disease is established for both Crohn's disease and ulcerative colitis. Nevertheless, many questions remain concerning the optimal treatment regimens of azathioprine, 6-mercaptopurine...

  16. The Case for Increased Physical Activity in Chronic Inflammatory Bowel Disease: A Brief Review.

    Science.gov (United States)

    Shephard, R J

    2016-06-01

    Regular physical activity reduces the risk of colon cancer, but there is little information on the merits of such activity in the prevention and management of chronic inflammatory bowel disease (CIBD). The present systematic review thus documents current levels of habitual physical activity and aerobic and muscular function in CIBD, and examines the safety, practicality and efficacy of exercise programmes in countering the disease process, correcting functional deficits and enhancing quality of life. A systematic search of the Ovid/Medline database from January 1996 to May 2015 linked the terms physical activity/motor activity/physical fitness/physical training/physical education/training/exercise/exercise therapy with Crohn's disease/colitis/ulcerative colitis/inflammatory bowel disease, supplementing this information by a scanning of reference lists and personal files.12 of 16 published studies show a low level of habitual physical activity in CIBD, with sub-normal values for aerobic power, lean tissue mass and muscular strength. 3 of 4 studies suggest physical activity may reduce the risk of developing IBD, and 11 interventions all note that exercise programmes are well tolerated with some decreases of disease activity, and functional gains leading to an increased health-related quality of life. Moreover, programme compliance rates compare favourably with those seen in the treatment of other chronic conditions. More information on mechanisms is needed, but regular moderate aerobic and/or resistance exercise improves the health status of patients with CIBD both by modulating immune function and by improving physical function. A regular exercise programme should thus become an important component in the management of CIBD. PMID:27116344

  17. A phylogenetic group of Escherichia coli associated with active left-sided inflammatory bowel disease

    DEFF Research Database (Denmark)

    Petersen, Andreas M; Nielsen, Eva M; Litrup, Eva;

    2009-01-01

    positive ExPEC gene among different groups, 86% were found positive among active IBD patients, significantly more than 13% among inactive IBD patients (p < 0.05), and 11% among healthy controls (p < 0.05). The B2 phylogenetic group was found in a specific cluster based on MLST, but no further separation......BACKGROUND: Escherichia coli have been found in increased numbers in tissues from patients with Inflammatory Bowel Disease (IBD) and adherent-invasive E. coli have been found in resected ileum from patients with Crohn's disease. This study aimed to characterize possible differences in phylogenetic...... 10 healthy controls. Disease activity was evaluated by sigmoidoscopy. Interestingly, E. coli strains of the phylogenetic group B2 were cultured from 60% of patients with IBD compared to 11% of healthy controls (p < 0.05). Furthermore, when comparing the number of E. coli B2 strains with at least one...

  18. Somatostatin in inflammatory bowel disease

    OpenAIRE

    van Bergeijk, J D; Wilson, J H P

    1997-01-01

    Intestinal inflammation is controlled by various immunomodulating cells, interacting by molecular mediators. Neuropeptides, released by enteric nerve cells and neuroendocrine mucosa cells, are able to affect several aspects of the general and intestinal immune system, with both pro- as well as anti-inflammatory activities. In inflammatory bowel disease (IBD) there is both morphological as well as experimental evidence for involvement of neuropeptides in the pathogenesis. Somatostatin is the m...

  19. Inflammatory bowel disease unclassified

    Institute of Scientific and Technical Information of China (English)

    Ning ZHOU; Wei-xing CHEN; Shao-hua CHEN; Cheng-fu XU; You-ming LI

    2011-01-01

    Objective: Inflammatory bowel diseases (IBDs) are idiopathic, chronic, and inflammatory intestinal disorders. The two main types, ulcerative colitis (UC) and Crohn's disease (CD), sometimes mimic each other and are not readily distinguishable. The purpose of this study was to present a series of hospitalized cases, which could not initially be classified as a subtype of IBD, and to try to note roles of the terms indeterminate colitis (IC) and inflammatory bowel disease unclassified (IBDU) when such a dilemma arises. Methods: Medical records of 477 patients hospitalized due to IBD, during the period of January 2002 to April 2009, were retrospectively studied in the present paper. All available previous biopsies from endoscopies of these patients were reanalyzed. Results: Twenty-seven of 477 IBD patients (5.7%) had been initially diagnosed as having IBDU. Of them, 23 received colonoscopy and histological examinations in our hospital. A total of 90% (9/10) and 66.7% (4/6) of patients, respectively, had a positive finding via wireless capsule endoscopy (CE) and double-balloon enteroscopy (DBE). The barium-swallow or small bowel follow-through (SBFT) was performed on 11 patients. Positive changes were observed under computer tomographic (CT) scanning in 89.5% (17/19) of patients. Reasonable treatment strategies were employed for all patients. Conclusions: Our data indicate that IBDU accounts for 5.7% of initial diagnoses of IBD. The definition of IBDU is valuable in clinical practice. For those who had no clear clinical, endoscopic, histological, or other features affording a diagnosis of either UC or CD,IBDU could be used parenthetically.

  20. The role of fecal calprotectin in investigating inflammatory bowel diseases

    OpenAIRE

    Mustafa Erbayrak; Cansel Turkay; Elife Eraslan; Hulya Cetinkaya; Benan Kasapoglu; Mehmet Bektas

    2009-01-01

    INTRODUCTION: Invasive and non-invasive tests can be used to evaluate the activity of inflammatory bowel diseases. OBJECTIVE: The aim of the present study was to investigate the role of fecal calprotectin in evaluating inflammatory bowel disease activity and the correlation of fecal calprotectin with the erythrocyte sedimentation rate and C reactive protein values in inflammatory bowel disease. METHOD: Sixty-five patients affected with inflammatory bowel disease were enrolled. Twenty outpatie...

  1. Stressful life events and psychosocial correlates of pediatric inflammatory bowel disease activity

    Science.gov (United States)

    Giannakopoulos, George; Chouliaras, George; Margoni, Daphne; Korlou, Sophia; Hantzara, Vassiliki; Panayotou, Ioanna; Roma, Eleftheria; Liakopoulou, Magda; Anagnostopoulos, Dimitris C

    2016-01-01

    AIM To investigate the association of psychiatric and psychosocial correlates with inflammatory bowel disease (IBD) activity in children and adolescents. METHODS A total of 85 pediatric IBD patients (in remission or active state of the disease) and their parents completed a series of questionnaires and semi-structured interviews measuring life events, depression, anxiety, family dysfunction, and parent mental health. Differences between the remission and the IBD active group and the association of any significant variable with the disease activity state were examined. RESULTS Parents of children being in active state of the disease reported more life events (P = 0.005) and stressful life events (P = 0.048) during the past year and more mental health symptoms (P < 0.001), while the children themselves reported higher levels of anxiety symptoms (P = 0.017) compared to the remission group. In the logistic regression multivariate analysis, the only predictor which had a significant positive effect on the probability of the patients being in active state was parent mental health symptoms (OR = 4.8; 95%CI: 1.2-25.8). CONCLUSION Life events, child anxiety and parent mental health symptoms may be important correlates of pediatric IBD activity and targets of thorough assessment and treatment. PMID:27679771

  2. Interleukin 27 is up-regulated in patients with active inflammatory bowel disease.

    Science.gov (United States)

    Furuzawa Carballeda, Janette; Fonseca Camarillo, Gabriela; Yamamoto-Furusho, Jesús K

    2016-08-01

    The aim of the study was to characterize and quantify tissue gene and protein expression of IL-27 in ulcerative colitis (UC) and Crohn's disease (CD) patients. This is an observational and cross-sectional study. Fifty-four patients with IBD were studied: 27 active UC, 12 inactive UC, 10 active CD, and 5 inactive CD. All patients belonged to the Inflammatory Bowel Disease Clinic at the Instituto Nacional de Ciencias Médicas y Nutrición. We found that IL-27 gene expression was significantly higher in active UC versus inactive UC group (P = 0.015). The IL-27 mRNA expression was increased in patients with active CD compared with inactive CD disease (P = 0.035). The percentage of IL-27 immunoreactive cells was higher in active UC versus active CD patients and non-inflamed tissue controls. The IL-27 was significantly elevated in active UC and CD patients, and it was associated with disease severity.

  3. Cutaneous manifestations of inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    Al Roujayee Abdulaziz

    2007-01-01

    Full Text Available Inflammatory bowel disease (IBD has many extraintestinal manifestations, and skin lesions are one of the most frequently described extraintestinal findings. Reports indicate an incidence of cutaneous manifestations ranging from 2 to 34%, Cutaneous manifestations are usually related to the activity of the bowel disease but may have an independent course. In this review we aim to address the various cutaneous manifestations associated with IBD, their impact on the disease course, and the treatment options available.

  4. Different Activation of TRAF4 and TRAF6 in Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Jun Shen

    2013-01-01

    Full Text Available In recent years, interests combining the exploration of tumor necrosis factor receptor-associated factor 4 (TRAF4 and TRAF6 in immune cells and transgenic mice are emerging. Although it has been found that TRAF4 and TRAF6 share the same TRAF binding sites, comprehensive study of TRAF4 and TRAF6 in inflammatory bowel disease (IBD is still lacking. This paper shows similar and different expression patterns of TRAF4 and TRAF6 in patients with IBD. The results indicate that TRAF4 and TRAF6 are overexpressed in IBD. TRAF4 and TRAF6 play different roles in the pathogenesis of IBD. Moreover, TRAF4 may be an indicator of endoscopic disease activity of UC and TRAF6 preactivation can be detected in noninflamed colonic segments.

  5. Increasing Patient Activation Could Improve Outcomes for Patients with Inflammatory Bowel Disease.

    Science.gov (United States)

    Shah, Shawn L; Siegel, Corey A

    2015-12-01

    Inflammatory bowel disease (IBD) is a complex disease process that often requires the integration of skills from various health care providers to adequately meet the needs of patients with IBD. The medical and surgical treatment options for IBD have become more complicated and are frequently a source of angst for both the patient and provider. However, it has become more important than ever to engage patients in navigating the treatment algorithm. Although novel in the IBD world, the concept of patients' becoming more active and effective managers of their care has been well studied in other disease processes such as diabetes mellitus and mental illness. This idea of patient activation refers to a patient understanding his or her role in the care process and having the skill sets and self-reliance necessary to manage his or her own health care. Over the past decade, evidence supporting the role of patient activation in chronic illness has grown, revealing improved health outcomes, enhanced patient experiences, and lower overall costs. Patient activation can be measured, and interventions have been shown to improve levels of activation over time and influence outcomes. A focus on patient activation is very appropriate for patients with IBD because this may potentially serve as a tool for IBD providers to not only improve patient outcomes and experience but also reduce health care costs.

  6. /sup 111/In-oxine-labelled autologous leucocytes in inflammatory bowel disease: New scintigraphic activity index

    Energy Technology Data Exchange (ETDEWEB)

    Ybern, A.; Martin-Comin, J.; Villa, R.; Gine, J.J.; Casanovas, T.; Gassull, M.A.

    1986-01-01

    The usefulness of scintigraphy with /sup 111/In-oxine-labelled autologous leucocytes was investigated in 27 patients with inflamatory bowel disease (IBD): 16 with ulcerative colitis and 11 with Crohn's disease. Scans were performed 2-4 h (early scan) and at 24 h (late scan) after leucocyte reinjection. No false-negative results occurred in the early scan; however, in the late scan, 2 patients with Crohn's disease had a normal scintigram. A new index of activity (Isub(l)) based on the number and relative activity of abnormal /sup 111/In-leucocyte zones was used for scan quantitation. All patients with clinically active IBD had Isub(l) >= 2. The scintigraphic index showed a significant correlation with the Harvey clinical index, especially in patients with ulcerative colitis. Our results suggest that an early scan (2-4 h) provides useful information in cases of IBD, and that Isub(l) >= 2 is indicative of the degree of disease activity in such patients. (orig.).

  7. [Inflammatory Bowel Disease Competence Network].

    Science.gov (United States)

    Schreiber, Stefan; Hartmann, Heinz; Kruis, Wolfgang; Kucharzik, Torsten; Mudter, Jonas; Siegmund, Britta; Stallmach, Andreas; Witte, Christine; Fitzke, Klaus; Bokemeyer, Bernd

    2016-04-01

    The Inflammatory Bowel Disease Competence Network is a network of more than 500 physicians and scientists from university clinics, hospitals and gastroenterology practices. The focus extends from the two major forms of inflammatory bowel diseases, Crohn's disease and ulcerative colitis, into other chronic inflammatory conditions affecting the intestine, including coeliac disease and microscopic colitis. The network translates basic science discoveries (in particular in the molecular epidemiology research) into innovative diagnostics and therapy. Through its strong networking structures it supports a continuous process to improve quality and standardisation in patient care that is implemented in close interaction with European networks addressing this disease group.Optimisation of patient care based on scientifically proven evidence is a main focus of the network. Therefore, it supports and coordinates translational research and infrastructure projects that investigate aetiology, improvement of diagnostic methods, and development of new or improved use of established therapies. Members participate in various training projects, thus ensuring the rapid transfer of research results into clinical practice.The competence network cooperates with the main patient organisations to engage patients in all levels of activities. The network and the patient organisations have interest in promoting public awareness about the disease entities, because their importance and burden is underestimated in non-specialised medical fields and among the general public.

  8. [Inflammatory Bowel Disease Competence Network].

    Science.gov (United States)

    Schreiber, Stefan; Hartmann, Heinz; Kruis, Wolfgang; Kucharzik, Torsten; Mudter, Jonas; Siegmund, Britta; Stallmach, Andreas; Witte, Christine; Fitzke, Klaus; Bokemeyer, Bernd

    2016-04-01

    The Inflammatory Bowel Disease Competence Network is a network of more than 500 physicians and scientists from university clinics, hospitals and gastroenterology practices. The focus extends from the two major forms of inflammatory bowel diseases, Crohn's disease and ulcerative colitis, into other chronic inflammatory conditions affecting the intestine, including coeliac disease and microscopic colitis. The network translates basic science discoveries (in particular in the molecular epidemiology research) into innovative diagnostics and therapy. Through its strong networking structures it supports a continuous process to improve quality and standardisation in patient care that is implemented in close interaction with European networks addressing this disease group.Optimisation of patient care based on scientifically proven evidence is a main focus of the network. Therefore, it supports and coordinates translational research and infrastructure projects that investigate aetiology, improvement of diagnostic methods, and development of new or improved use of established therapies. Members participate in various training projects, thus ensuring the rapid transfer of research results into clinical practice.The competence network cooperates with the main patient organisations to engage patients in all levels of activities. The network and the patient organisations have interest in promoting public awareness about the disease entities, because their importance and burden is underestimated in non-specialised medical fields and among the general public. PMID:26968556

  9. [Diagnosis of functional bowel diseases].

    Science.gov (United States)

    Kruis, W

    2007-02-28

    Functional bowel disorders cause frequent doctor visits. The term comprises various disease entities. Most frequent are the irritable bowel syndrome, functional constipation and functional diarrhea. An exact history plays an outstanding role for the diagnosis of all these entities. History either confirms a positive diagnosis or initiates some complementary investigations. Redundant and dangerous technical procedures should be avoided in the diagnostic work up.

  10. Self-reported disability in patients with inflammatory bowel disease largely determined by disease activity and illness perceptions

    NARCIS (Netherlands)

    van der Have, Mike; Fidder, Herma H; Leenders, Max; Kaptein, Ad A; van der Valk, Mirthe E; van Bodegraven, Ad A; Dijkstra, Gerard; de Jong, Dirk J; Pierik, Marieke; Ponsioen, Cyriel Y; van der Meulen-de Jong, Andrea E; van der Woude, C Janneke; van de Meeberg, Paul C; Romberg-Camps, Mariëlle J L; Clemens, Cees H M; Jansen, Jeroen M; Mahmmod, Nofel; Bolwerk, Clemens J M; Vermeijden, J Reinoud; Siersema, Peter D; Oldenburg, Bas

    2015-01-01

    BACKGROUND: The inflammatory bowel disease (IBD) disability index has recently been introduced to measure patients' physical, psychological, familial, and social limitations associated with IBD. We assessed factors related to self-reported disability and the relationship between disability and direc

  11. Fecal calprotectin in inflammatory bowel disease.

    Science.gov (United States)

    Walsham, Natalie E; Sherwood, Roy A

    2016-01-01

    Inflammatory bowel disease (IBD) and irritable bowel syndrome share many symptoms. While irritable bowel syndrome is a functional bowel disorder for which no specific treatment is available, the range of effective therapies for IBD is evolving rapidly. Accurate diagnosis of IBD is therefore essential. Clinical assessment, together with various imaging modalities and endoscopy, has been the mainstay of diagnosis for many years. Fecal biomarkers of gastrointestinal inflammation have appeared in the past decade, of which calprotectin, a neutrophil cytosolic protein, has been studied the most. Crohn's disease and ulcerative colitis are chronic remitting and relapsing diseases, and objective assessment of disease activity and response to treatment are important. This review focuses on the use of fecal calprotectin measurements in the diagnosis and monitoring of patients with IBD. PMID:26869808

  12. Elevated plasma cryofibrinogen in patients with active inflammatory bowel disease is morbigenous

    Institute of Scientific and Technical Information of China (English)

    Koji Sawada; Ryouki Takahashi; Abbi R Saniabadi; Maiko Ohdo; Takashi Shimoyama

    2006-01-01

    AIM: To investigate the role of cryofibrinogen (CF) in active inflammatory bowel disease (IBD).METHODS: CF was assayed in 284 subjects: 61 with active and 63 with inactive ulcerative colitis (UC), 45 who had proctocolectomy, 35 with active and 20 with inactive Crohn's disease (CD), 40 with other diseases and 20 healthy controls. Trypsin inhibitor (TI) and TI antibody (TI-Ab) were measured in plasma and CF complex by ELISA.RESULTS: CF in active UC was strikingly high compared with all other groups (χ2<0.001). Similarly, CF was significantly higher in active CD than in inactive CD or in controls (χ2<0.01). In UC, high CF and TI-Ab were associated with the need for operations. Further, high CF, CF/fibrinogen ratio, low TI and high TI-Ab in plasma were associated with disease activity or refractoriness to medication. Elevated CF was not associated with acute reactants like C-reactive protein and white blood cell counts except for erythrocyte sedimentation rate,suggesting that elevated CF was not a consequence of acute inflammation.CONCLUSION: Elevated CF in active IBD appears to be morbigenous. CF promotes IBD via two main mechanisms, quenching of TI (an anti-inflammatory substance)and impairing microvascular perfusion by forming protein aggregates. CF may also serve as a biomarker of chronic IBD. Additional studies are warranted to fully evaluate the role of CF in IBD and the outcome should contribute to a better understanding of the pathogenesis of IBD.

  13. PPARγ in Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Vito Annese

    2012-01-01

    Full Text Available Peroxisome proliferator-activated receptor gamma (PPARγ is member of a family of nuclear receptors that interacts with nuclear proteins acting as coactivators and corepressors. The colon is a major tissue which expresses PPARγ in epithelial cells and, to a lesser degree, in macrophages and lymphocytes and plays a role in the regulation of intestinal inflammation. Indeed, both natural and synthetic PPARγ ligands have beneficial effects in different models of experimental colitis, with possible implication in the therapy of inflammatory bowel disease (IBD. This paper will specifically focus on potential role of PPARγ in the predisposition and physiopathology of IBD and will analyze its possible role in medical therapy.

  14. Inflammatory Bowel Disease (For Teens)

    Science.gov (United States)

    ... Just like other organs in your body, the intestines can develop problems or diseases. IBD (which is not the same thing as irritable bowel syndrome, or IBS), can cause more serious problems than ...

  15. The Correlation of Serum IL-12B Expression With Disease Activity in Patients With Inflammatory Bowel Disease

    Science.gov (United States)

    Lee, Hye Won; Chung, Sook Hee; Moon, Chang Mo; Che, Xiumei; Kim, Seung Won; Park, Soo Jung; Hong, Sung Pil; Kim, Tae Il; Kim, Won Ho; Cheon, Jae Hee

    2016-01-01

    Abstract Genetic variants in IL12B, encoding the p40 subunit common in interleukin-12 (IL-12) and interleukin-23, were identified as the susceptibility loci for inflammatory bowel disease (IBD). This study aimed to identify the correlation of serum IL-12B expression with disease activity in patients with IBD and evaluate the possibility of IL-12B as a biomarker for assessing inflammatory status in IBD. A total of 102 patients with IBD, including 38, 32, and 32 patients with Crohn's disease (CD), ulcerative colitis (UC), and intestinal Behçet's disease (intestinal BD), respectively, were included. The clinical and laboratory data from the patients were collected at the time of serum IL-12B measurement. Serum IL-12B levels were measured using an enzyme-linked immunosorbent assay. The median IL-12B levels in patients with CD, UC, and intestinal BD were significantly higher than those in controls (1.87, 2.74, and 2.73 pg/mL, respectively, vs. 1.42 pg/mL, all P <0.05). IL-12B concentrations were associated with disease activity in patients with UC and intestinal BD but not in those with CD. IL-12B levels were increased with increasing disease activity in patients with UC (P <0.001). Likewise, patients with active intestinal BD had higher IL-12B levels than those without active disease (P = 0.008). IL-12B levels were correlated with the endoscopic disease activity of UC (P = 0.002) and intestinal BD (P = 0.001) but not that of CD. Serum IL-12B levels were significantly correlated with clinical and endoscopic disease activity in patients with UC and intestinal BD, suggesting its potential use as a biomarker for assessing disease activity in these patients. PMID:27281077

  16. Nutritional Strategies in the Management of Adult Patients with Inflammatory Bowel Disease: Dietary Considerations from Active Disease to Disease Remission.

    Science.gov (United States)

    Nguyen, Douglas L; Limketkai, Berkeley; Medici, Valentina; Saire Mendoza, Mardeli; Palmer, Lena; Bechtold, Matthew

    2016-10-01

    Inflammatory bowel disease (IBD) is a group of chronic, lifelong, and relapsing illnesses, such as ulcerative colitis and Crohn's disease, which involve the gastrointestinal tract. There is no cure for these diseases, but combined pharmacological and nutritional therapy can induce remission and maintain clinical remission. Malnutrition and nutritional deficiencies among IBD patients result in poor clinical outcomes such as growth failure, reduced response to pharmacotherapy, increased risk for sepsis, and mortality. The aim of this review is to highlight the consequences of malnutrition in the management of IBD and describe nutritional interventions to facilitate induction of remission as well as maintenance; we will also discuss alternative delivery methods to improve nutritional status preoperatively.

  17. Activated eosinophils in association with enteric nerves in inflammatory bowel disease.

    Directory of Open Access Journals (Sweden)

    Claire M Smyth

    Full Text Available Enteric neural dysfunction leads to increased mucous production and dysmotility in inflammatory bowel disease (IBD. Prior studies have shown that tissue eosinophilia is related to disease activity. We hypothesized that interactions between eosinophils and nerves contribute to neural dysfunction in IBD. Tissue from patients with intractable IBD, endoscopic biopsies from patients with steroid responsive IBD, both when active and quiescent, and control tissue were studied. Immunohistochemical studies showed that eosinophils localize to nerves in the mucosal layer of patients with Crohn's disease (CD (p<0.001 and ulcerative colitis (UC, (p<0.01. Eosinophils localized to substance P and choline acetyltransferase (ChAT immunostained nerves. Real time PCR of laser capture micro-dissected enteric ganglia demonstrated Intercellular Adhesion Molecule 1 (ICAM-1 mRNA was increased 7-fold in UC (n = 4, (p = 0.03, and 10-fold in CD (n = 3, (p = 0.05. Compared with controls, eotaxin-3 (CCL-26 mRNA was increased 9-fold in UC (p = 0.04 and 15-fold in CD (p = 0.06. Eosinophil numbers correlated with disease activity, while deposition of major basic protein (MBP and eosinophil Transforming Growth Factor β-1 (TGFβ-1 expression were seen in therapeutically responsive disease. These data indicate a significant localization of eosinophils to nerves in IBD, mediated through neurally expressed ICAM-1 and eotaxin-3. This cell/neural interaction may influence the function of nerves and contribute to symptoms in IBD.

  18. Health-related quality of life in adolescents with inflammatory bowel disease depends on disease activity and psychiatric comorbidity.

    Science.gov (United States)

    Engelmann, G; Erhard, D; Petersen, M; Parzer, P; Schlarb, A A; Resch, F; Brunner, R; Hoffmann, G F; Lenhartz, H; Richterich, A

    2015-04-01

    Adolescent patients with inflammatory bowel disease (IBD) show an increased risk for behavioral and emotional dysfunction. Health-related quality of life (HRQoL) is influenced by medical illnesses, as well as by psychiatric disorders, but for adolescents with IBD, the extent to which HRQoL is influenced by these two factors is unclear. For 47 adolescent IBD patients, we analyzed disease activity, HRQoL and whether or not a psychiatric disorder was present. Disease activity was estimated using pediatric Ulcerative Colitis Activity Index and pediatric Crohn's Disease Activity Index. The IMPACT-III and the EQ-5D were used to measure HRQoL and QoL, respectively. In addition, patient and parent diagnostic interviews were performed. 55.3 % patients fulfilled DSM-IV criteria for one or more psychiatric disorders. In all patients, psychiatric comorbidity together with disease activity contributed to a reduction in quality of life. Adolescents with IBD are at a high risk for clinically relevant emotional or behavioral problems resulting in significantly lower HRQoL. We conclude that accessible, optimally structured psychotherapeutic and/or psychiatric help is needed in adolescent patients with IBD. PMID:24838299

  19. Clinicians’ Guide to the Use of Fecal Calprotectin to Identify and Monitor Disease Activity in Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Brian Bressler

    2015-01-01

    Full Text Available BACKGROUND: Objective monitoring of the severity of inflammation in patients with inflammatory bowel disease (IBD is an essential part of disease management. However, repeat endoscopy to define extent and severity of inflammation is not practical. Fecal calprotectin (FC is a biomarker that can be used as a surrogate test to distinguish inflammatory from noninflammatory gastrointestinal disease.

  20. Serum YKL-40, a potential new marker of disease activity in patients with inflammatory bowel disease

    DEFF Research Database (Denmark)

    Vind, Ida; Johansen, J S; Price, P A;

    2003-01-01

    BACKGROUND: YKL-40 is secreted by macrophages and neutrophils and is a growth factor for vascular endothelial cells and fibroblasts. Elevated serum concentrations of YKL-40 are found in patients with diseases characterized by inflammation or ongoing fibrosis. The aim of this study was to seek...... association between serum YKL-40 in patients with ulcerative colitis (UC) and Crohn disease (CD) and clinical disease activity. METHODS: One-hundred-and-sixty-four patients with UC and 173 patients with CD were studied. The Simple Clinical Colitis Activity Index (SCCAI) and the Harvey-Bradshaw (H-B) score...

  1. Indium 111-granulocyte scanning in the assessment of disease extent and disease activity in inflammatory bowel disease. A comparison with colonoscopy, histology, and fecal indium 111-granulocyte excretion

    Energy Technology Data Exchange (ETDEWEB)

    Saverymuttu, S.H.; Camilleri, M.; Rees, H.; Lavender, J.P.; Hodgson, H.J.; Chadwick, V.S.

    1986-05-01

    Indium 111-leukocyte scanning has recently been introduced as a new method for imaging inflammatory bowel disease. The technique has recently been made more specific for acute inflammation by labeling a pure granulocyte fraction rather than the conventional mixed leukocyte preparation. We now report a prospective study comparing 111In-granulocyte scanning with endoscopy, histology, and fecal 111In-granulocyte excretion for the assessment of disease extent and severity in colonic inflammatory bowel disease. In 52 patients with Crohn's disease or ulcerative colitis, disease extent and severity were assessed macroscopically, histologically, or by scanning using a numerical grading system. Excellent correlations were found between both endoscopy and histology and 111In scans (r = 0.90 (endoscopy) and r = 0.90 (histology) for extent; r = 0.86 and r = 0.91 for disease activity). Severity graded by scanning also showed a close correlation with fecal 111In-granulocyte excretion (r = 0.90). Indium 111-granulocyte scans are a rapid, accurate, noninvasive means of assessing both disease extent and severity of colonic involvement in inflammatory bowel disease.

  2. Clinicians’ guide to the use of fecal calprotectin to identify and monitor disease activity in inflammatory bowel disease

    Science.gov (United States)

    Bressler, Brian; Panaccione, Remo; Fedorak, Richard N; Seidman, Ernest G

    2015-01-01

    BACKGROUND: Objective monitoring of the severity of inflammation in patients with inflammatory bowel disease (IBD) is an essential part of disease management. However, repeat endoscopy to define extent and severity of inflammation is not practical. Fecal calprotectin (FC) is a biomarker that can be used as a surrogate test to distinguish inflammatory from noninflammatory gastrointestinal disease. METHODS: A targeted search of the literature regarding FC, focusing primarily on the past three years, was conducted to develop practical clinical guidance on the current utility of FC in the routine management of IBD patients. RESULTS: It is recommended that samples for FC testing be obtained from the first bowel excretion of the day. FC testing should be used as standard of care to accurately confirm inflammation and ‘real-time’ disease activity when a clinician suspects an IBD flare. Although FC is a reliable marker of inflammation, its role in routine monitoring in improving long-term outcomes has not yet been fully assessed. Based on available evidence, the authors suggest the following cut-off values and management strategies: when FC levels are 100 μg/g to 250 μg/g, inflammation is possible and further testing (eg, colonoscopy) is required to confirm inflammation; and when FC levels are >250 μg/g, active inflammation is likely and strategies to control inflammation should be initiated (eg, optimizing current therapies or switching to an alternative therapy). DISCUSSION: FC is a useful biomarker to accurately assess the degree of inflammation and should be incorporated into the management of patients with IBD. PMID:26125109

  3. Farnesoid X receptor (FXR activation and FXR genetic variation in inflammatory bowel disease.

    Directory of Open Access Journals (Sweden)

    Rian M Nijmeijer

    Full Text Available BACKGROUND: We previously showed that activation of the bile salt nuclear receptor Farnesoid X Receptor (FXR protects against intestinal inflammation in mice. Reciprocally, these inflammatory mediators may decrease FXR activation. We investigated whether FXR activation is repressed in the ileum and colon of inflammatory bowel disease (IBD patients in remission. Additionally, we evaluated whether genetic variation in FXR is associated with IBD. METHODS: mRNA expression of FXR and FXR target gene SHP was determined in ileal and colonic biopsies of patients with Crohn's colitis (n = 15 and ulcerative colitis (UC; n = 12, all in clinical remission, and healthy controls (n = 17. Seven common tagging SNPs and two functional SNPs in FXR were genotyped in 2355 Dutch IBD patients (1162 Crohn's disease (CD and 1193 UC and in 853 healthy controls. RESULTS: mRNA expression of SHP in the ileum is reduced in patients with Crohn's colitis but not in patients with UC compared to controls. mRNA expression of villus marker Villin was correlated with FXR and SHP in healthy controls, a correlation that was weaker in UC patients and absent in CD patients. None of the SNPs was associated with IBD, UC or CD, nor with clinical subgroups of CD. CONCLUSIONS: FXR activation in the ileum is decreased in patients with Crohn's colitis. This may be secondary to altered enterohepatic circulation of bile salts or transrepression by inflammatory signals but does not seem to be caused by the studied SNPs in FXR. Increasing FXR activity by synthetic FXR agonists may have benefit in CD patients.

  4. Rapid fecal calprotectin testing to assess for endoscopic disease activity in inflammatory bowel disease: A diagnostic cohort study

    Directory of Open Access Journals (Sweden)

    Lukasz Kwapisz

    2015-01-01

    Full Text Available Background and Aim: With increasing numbers of patients diagnosed with inflammatory bowel disease (IBD, it is important to identify noninvasive methods of detecting disease activity. The aim of this study is to examine the diagnostic accuracy of fecal rapid calprotectin (FC testing in the detection of endoscopically active IBD. Patients and Methods: All consecutive patients presenting to outpatient clinics with lower gastrointestinal symptoms were prospectively recruited. Patients provided FC samples. Sensitivity (Sn, specificity (Sp, positive predictive value (PPV, and negative predictive value (NPV for FC were calculated. Receiver–operator characteristics (ROC curve was used to identify the ideal FC cutoff that predicts endoscopic disease activity. Correlation between FC and endoscopic disease activity, disease location, and C-reactive protein (CRP levels were measured. Results: One hundred and twenty-six patients, of whom 52% were females, were included in the final analysis with a mean age of 44.4 ± 16.7 years. Comparing FC to endoscopic findings, the following results were calculated: A cutoff point of 100 μg/g showed Sn = 83%, Sp = 67%, PPV = 65%, and NPV = 85%; and 200 μg/g showed Sn = 66%, Sp = 82%, PPV = 73%, and NPV = 77%. Based on ROC curve, the best FC cutoff point to predict endoscopic disease activity was 140 μg/g. Using this reference, FC levels strongly correlated with colorectal, ileocolonic, and ileal disease and predicted endoscopic activity. Conclusions: FC is an accurate test when used as an initial screening tool for patients suspected of having active IBD. Given its noninvasive nature, it may prove to reduce the need for colonoscopy and be an added tool in the management of IBD.

  5. Phosphotidylserine exposure and neutrophil extracellular traps enhance procoagulant activity in patients with inflammatory bowel disease.

    Science.gov (United States)

    He, Zhangxiu; Si, Yu; Jiang, Tao; Ma, Ruishuang; Zhang, Yan; Cao, Muhua; Li, Tao; Yao, Zhipeng; Zhao, Lu; Fang, Shaohong; Yu, Bo; Dong, Zengxiang; Thatte, Hemant S; Bi, Yayan; Kou, Junjie; Yang, Shufen; Piao, Daxun; Hao, Lirong; Zhou, Jin; Shi, Jialan

    2016-04-01

    Inflammatory bowel disease (IBD)-associated thromboembolic event often lacks precise aetiology. The aim of this study was to investigate the contribution of phosphatidylserine (PS) exposure and neutrophil extracellular traps (NETs) towards the hypercoagulable state in IBD. We demonstrated that the levels of PS exposed MPs and the sources of MP-origin, platelets, erythrocytes, leukocytes and cultured endothelial cells (ECs) were higher in IBD groups than in healthy controls using flow cytometry and confocal microscopy. Wright-Giemsa and immunofluorescence staining demonstrated that the elevated NETs were released by activated IBD neutrophils or by control neutrophils treated with IBD sera obtained from patients with the active disease. MPs and MP-origin cells in IBD groups, especially in active stage, markedly shortened coagulation time and had increased levels of fibrin, thrombin and FXa production as assessed by coagulation function assays. Importantly, we found that on stimulated ECs, PS rich membranes provided binding sites for FXa and FVa, promoting fibrin formation while TNF blockage or IgG depletion attenuated this effect. Treatment of control neutrophils with TNF and isolated IgG from PR3-ANCA-positive active IBD patients also resulted in the release of NETs. Blockade of PS with lactadherin prolonged coagulation time, decreased fibrin formation to control levels, and inhibited the procoagulant enzymes production in the MPs and MP-origin cells. NET cleavage by DNase I partly decreased PCA in IBD or stimulated neutrophils. Our study reveals a previously unrecognised link between hypercoagulable state and PS exposure or NETs, and may further explain the epidemiological association of thrombosis within IBD patients. PMID:26660948

  6. Fecal calprotectin in inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    Walsham NE

    2016-01-01

    Full Text Available Natalie E Walsham,1 Roy A Sherwood2 1Department of Clinical Biochemistry, University Hospital Lewisham, Lewisham, 2Department of Clinical Biochemistry, Viapath at King’s College Hospital NHS Foundation Trust, London, UK Abstract: Inflammatory bowel disease (IBD and irritable bowel syndrome share many symptoms. While irritable bowel syndrome is a functional bowel disorder for which no specific treatment is available, the range of effective therapies for IBD is evolving rapidly. Accurate diagnosis of IBD is therefore essential. Clinical assessment, together with various imaging modalities and endoscopy, has been the mainstay of diagnosis for many years. Fecal biomarkers of gastrointestinal inflammation have appeared in the past decade, of which calprotectin, a neutrophil cytosolic protein, has been studied the most. Crohn’s disease and ulcerative colitis are chronic remitting and relapsing diseases, and objective assessment of disease activity and response to treatment are important. This review focuses on the use of fecal calprotectin measurements in the diagnosis and monitoring of patients with IBD. Keywords: calprotectin, Crohn’s disease, ulcerative colitis, inflammatory bowel disease, inflammation 

  7. Inflammatory bowel disease in pregnancy

    Institute of Scientific and Technical Information of China (English)

    Dawn B Beaulieu; Sunanda Kane

    2011-01-01

    Crohn's disease and ulcerative colitis affect women in their child-bearing years. Family planning has come to be a common discussion between the gastroenterologist and the inflammatory bowel disease (IBD) patient.Disease control prior to desired conception and throughout pregnancy is the most important thing to keep in mind when caring for the IBD patient. Continued medical management during pregnancy is crucial in optimizing outcomes. Studies indicate that quiescent disease prior to conception infer the best pregnancy outcomes, similar to those in the general population.Active disease prior to and during pregnancy, can lead to complications such as pre-term labor, low birth weight, and small for gestational age infants. Although there are no definitive long term effects of pregnancy on IBD, there are some limited studies that suggest that it may alter the disease course. Understanding the literature and its limitations is important in the modern era of IBD care. Educating the patient and taking a team approach with the obstetrician will help achieve successful outcomes for mother and baby.

  8. Irritable bowel syndrome, inflammatory bowel disease and the microbiome

    OpenAIRE

    Major, Giles; Robin C. Spiller

    2014-01-01

    Purpose of review The review aims to update the reader on current developments in our understanding of how the gut microbiota impact on inflammatory bowel disease and the irritable bowel syndrome. It will also consider current efforts to modulate the microbiota for therapeutic effect. Recent findings Gene polymorphisms associated with inflammatory bowel disease increasingly suggest that interaction with the microbiota drives pathogenesis. This may be through modulation of the immune response,...

  9. Beyond endoscopic assessment in inflammatory bowel disease: real-time histology of disease activity by non-linear multimodal imaging

    Science.gov (United States)

    Chernavskaia, Olga; Heuke, Sandro; Vieth, Michael; Friedrich, Oliver; Schürmann, Sebastian; Atreya, Raja; Stallmach, Andreas; Neurath, Markus F.; Waldner, Maximilian; Petersen, Iver; Schmitt, Michael; Bocklitz, Thomas; Popp, Jürgen

    2016-07-01

    Assessing disease activity is a prerequisite for an adequate treatment of inflammatory bowel diseases (IBD) such as Crohn’s disease and ulcerative colitis. In addition to endoscopic mucosal healing, histologic remission poses a promising end-point of IBD therapy. However, evaluating histological remission harbors the risk for complications due to the acquisition of biopsies and results in a delay of diagnosis because of tissue processing procedures. In this regard, non-linear multimodal imaging techniques might serve as an unparalleled technique that allows the real-time evaluation of microscopic IBD activity in the endoscopy unit. In this study, tissue sections were investigated using the non-linear multimodal microscopy combination of coherent anti-Stokes Raman scattering (CARS), two-photon excited auto fluorescence (TPEF) and second-harmonic generation (SHG). After the measurement a gold-standard assessment of histological indexes was carried out based on a conventional H&E stain. Subsequently, various geometry and intensity related features were extracted from the multimodal images. An optimized feature set was utilized to predict histological index levels based on a linear classifier. Based on the automated prediction, the diagnosis time interval is decreased. Therefore, non-linear multimodal imaging may provide a real-time diagnosis of IBD activity suited to assist clinical decision making within the endoscopy unit.

  10. Beyond endoscopic assessment in inflammatory bowel disease: real-time histology of disease activity by non-linear multimodal imaging.

    Science.gov (United States)

    Chernavskaia, Olga; Heuke, Sandro; Vieth, Michael; Friedrich, Oliver; Schürmann, Sebastian; Atreya, Raja; Stallmach, Andreas; Neurath, Markus F; Waldner, Maximilian; Petersen, Iver; Schmitt, Michael; Bocklitz, Thomas; Popp, Jürgen

    2016-01-01

    Assessing disease activity is a prerequisite for an adequate treatment of inflammatory bowel diseases (IBD) such as Crohn's disease and ulcerative colitis. In addition to endoscopic mucosal healing, histologic remission poses a promising end-point of IBD therapy. However, evaluating histological remission harbors the risk for complications due to the acquisition of biopsies and results in a delay of diagnosis because of tissue processing procedures. In this regard, non-linear multimodal imaging techniques might serve as an unparalleled technique that allows the real-time evaluation of microscopic IBD activity in the endoscopy unit. In this study, tissue sections were investigated using the non-linear multimodal microscopy combination of coherent anti-Stokes Raman scattering (CARS), two-photon excited auto fluorescence (TPEF) and second-harmonic generation (SHG). After the measurement a gold-standard assessment of histological indexes was carried out based on a conventional H&E stain. Subsequently, various geometry and intensity related features were extracted from the multimodal images. An optimized feature set was utilized to predict histological index levels based on a linear classifier. Based on the automated prediction, the diagnosis time interval is decreased. Therefore, non-linear multimodal imaging may provide a real-time diagnosis of IBD activity suited to assist clinical decision making within the endoscopy unit. PMID:27406831

  11. Toll-like receptor activation by helminths or helminth products to alleviate inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    Song YanXia

    2011-09-01

    Full Text Available Abstract Helminth infection may modulate the expression of Toll like receptors (TLR in dendritic cells (DCs and modify the responsiveness of DCs to TLR ligands. This may regulate aberrant intestinal inflammation in humans with helminthes and may thus help alleviate inflammation associated with human inflammatory bowel disease (IBD. Epidemiological and experimental data provide further evidence that reducing helminth infections increases the incidence rate of such autoimmune diseases. Fine control of inflammation in the TLR pathway is highly desirable for effective host defense. Thus, the use of antagonists of TLR-signaling and agonists of their negative regulators from helminths or helminth products should be considered for the treatment of IBD.

  12. Small bowel imaging of inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Emanuele; Casciani; Chiara; De; Vincentiis; Gianfranco; Gualdi

    2015-01-01

    The study of the small bowel(SB) has always beenchallenging both for clinicians and radiologist. It is a long and tortuous tube that can be affected by various pathologies whose signs and symptoms are usually non specific and can mimic other acute abdominal disorders. For these reasons, imaging plays a central role in the diagnosis of the different pathological conditions that can occur. They are important also in the management and follow up of chronic diseases. We expose and evaluate all the radiological methods that are now available for the study of the SB with particular emphasis on the technological improvement of cross-sectional imaging, such as computed tomography(CT) and magnetic resonance imaging(MRI). These techniques have, infact, highly improved in terms of execution times(fast acquisitions images), patients discomfort and radiation dose, for CT, with consequent reduced biological risks. Moreover, the new post-processing options with multiplanar reconstruction and isotropic images have made significant changes in the evaluation of the exams. Especially MRI scans have been improved by the advent of new sequences, such as diffusion weighted imaging and cine-MRI, parallel imaging and breath-hold sequences and can provide excellent soft-tissue contrast without the use of ionizing radiations.

  13. Danish cohort of monozygotic inflammatory bowel disease twins: Clinical characteristics and inflammatory activity

    Science.gov (United States)

    Moller, Frederik Trier; Knudsen, Lina; Harbord, Marcus; Satsangi, Jack; Gordon, Hannah; Christiansen, Lene; Christensen, Kaare; Jess, Tine; Andersen, Vibeke

    2016-01-01

    AIM: To describe the establishment of a Danish inflammatory bowel diseases (IBD) twin cohort with focus on concordance of treatment and inflammatory markers. METHODS: We identified MZ twins, likely to be discordant or concordant for IBD, by merging information from the Danish Twin Register and the National Patient Register. The twins were asked to provide biological samples, questionnaires, and data access to patient files and public registries. Biological samples were collected via a mobile laboratory, which allowed for immediate centrifugation, fractionation, and storage of samples. The mean time from collection of samples to storage in the -80 °C mobile freezer was less than one hour. The diagnoses where validated using the Copenhagen diagnostic criteria. RESULTS: We identified 159 MZ IBD twin pairs, in a total of 62 (39%) pairs both twins agreed to participate. Of the supposed 62 IBD pairs, the IBD diagnosis could be confirmed in 54 pairs. The cohort included 10 concordant pairs, whereof some were discordant for either treatment or surgery. The 10 concordant pairs, where both pairs suffered from IBD, included eight CD/CD pairs, one UC/UC pair and one UC/IBDU pair. The discordant pairs comprised 31 UC, 5 IBDU (IBD unclassified), and 8 CD discordant pairs. In the co-twins not affected by IBD, calprotectin was above 100 μg/g in 2 participants, and above 50 μg/g in a further 5 participants. CONCLUSION: The presented IBD twin cohorts are an excellent resource for bioinformatics studies with proper adjustment for disease-associated exposures including medication and inflammatory activity in the co-twins. PMID:27275097

  14. Clinicians’ guide to the use of fecal calprotectin to identify and monitor disease activity in inflammatory bowel disease

    OpenAIRE

    Brian Bressler; Remo Panaccione; Richard N Fedorak; Seidman, Ernest G.

    2015-01-01

    BACKGROUND: Objective monitoring of the severity of inflammation in patients with inflammatory bowel disease (IBD) is an essential part of disease management. However, repeat endoscopy to define extent and severity of inflammation is not practical. Fecal calprotectin (FC) is a biomarker that can be used as a surrogate test to distinguish inflammatory from noninflammatory gastrointestinal disease.METHODS: A targeted search of the literature regarding FC, focusing primarily on the past three ye...

  15. Self-reported Disability in Patients with Inflammatory Bowel Disease Largely Determined by Disease Activity and Illness Perceptions

    NARCIS (Netherlands)

    van der Have, Mike; Fidder, Herma H.; Leenders, Max; Kaptein, Ad A.; van der Valk, Mirthe E.; van Bodegraven, Ad A.; Dijkstra, Gerard; de Jong, Dirk J.; Pierik, Marieke; Ponsioen, Cyriel Y.; van der Meulen-de Jong, Andrea E.; van der Woude, C. Janneke; van de Meeberg, Paul C.; Romberg-Camps, Marielle J. L.; Clemens, Cees H. M.; Jansen, Jeroen M.; Mahmmod, Nofel; Bolwerk, Clemens J. M.; Vermeijden, J. Reinoud; Siersema, Peter D.; Oldenburg, Bas

    2015-01-01

    Background:The inflammatory bowel disease (IBD) disability index has recently been introduced to measure patients' physical, psychological, familial, and social limitations associated with IBD. We assessed factors related to self-reported disability and the relationship between disability and direct

  16. Comorbidity in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Antonio López San Román; Fernando Mu(n)oz

    2011-01-01

    Patients with inflammatory bowel disease (IBD) can be affected by other unrelated diseases. These are called comorbid conditions, and can include any secondary health problem that affects a person suffering from a primary or main disease, and which is neither linked physiopathologically to the primary condition, nor is it due to the treatments used for the primary condition or to its long-term anatomical or physiological consequences.Different comorbid conditions, as well as their influence on IBD, are discussed.

  17. Inflammatory bowel disease activity assessed by fecal calprotectin and lactoferrin: correlation with laboratory parameters, clinical, endoscopic and histological indexes

    Science.gov (United States)

    2009-01-01

    Background Research has shown that fecal biomarkers are useful to assess the activity of inflammatory bowel disease (IBD). The aim of the study is: to evaluate the efficacy of the fecal lactoferrin and calprotectin as indicators of inflammatory activity. Findings A total of 78 patients presenting inflammatory bowel disease were evaluated. Blood tests, the Crohn's Disease Activity Index (CDAI), Mayo Disease Activity Index (MDAI), and Crohn's Disease Endoscopic Index of Severity (CDEIS) were used for the clinical and endoscopic evaluation. Two tests were performed on the fecal samples, to check the levels of calprotectin and lactoferrin. The performance of these fecal markers for detection of inflammation with reference to endoscopic and histological inflammatory activity was assessed and calculated sensitivity, specificity, accuracy. A total of 52 patient's samples whose histological evaluations showed inflammation, 49 were lactoferrin-positive, and 40 were calprotectin-positive (p = 0.000). Lactoferrin and calprotectin findings correlated with C-reactive protein in both the CD and UC groups (p = 0.006; p = 0.000), with CDAI values (p = 0.043; 0.010), CDEIS values in DC cases (p = 0,000; 0.000), and with MDAI values in UC cases (p = 0.000). Conclusion Fecal lactoferrin and calprotectin are highly sensitive and specific markers for detecting intestinal inflammation. Levels of fecal calprotectin have a proportional correlation to the degree of inflammation of the intestinal mucosa. PMID:19874614

  18. Inflammatory bowel disease activity assessed by fecal calprotectin and lactoferrin: correlation with laboratory parameters, clinical, endoscopic and histological indexes

    Directory of Open Access Journals (Sweden)

    Rossini Lucio

    2009-10-01

    Full Text Available Abstract Background Research has shown that fecal biomarkers are useful to assess the activity of inflammatory bowel disease (IBD. The aim of the study is: to evaluate the efficacy of the fecal lactoferrin and calprotectin as indicators of inflammatory activity. Findings A total of 78 patients presenting inflammatory bowel disease were evaluated. Blood tests, the Crohn's Disease Activity Index (CDAI, Mayo Disease Activity Index (MDAI, and Crohn's Disease Endoscopic Index of Severity (CDEIS were used for the clinical and endoscopic evaluation. Two tests were performed on the fecal samples, to check the levels of calprotectin and lactoferrin. The performance of these fecal markers for detection of inflammation with reference to endoscopic and histological inflammatory activity was assessed and calculated sensitivity, specificity, accuracy. A total of 52 patient's samples whose histological evaluations showed inflammation, 49 were lactoferrin-positive, and 40 were calprotectin-positive (p = 0.000. Lactoferrin and calprotectin findings correlated with C-reactive protein in both the CD and UC groups (p = 0.006; p = 0.000, with CDAI values (p = 0.043; 0.010, CDEIS values in DC cases (p = 0,000; 0.000, and with MDAI values in UC cases (p = 0.000. Conclusion Fecal lactoferrin and calprotectin are highly sensitive and specific markers for detecting intestinal inflammation. Levels of fecal calprotectin have a proportional correlation to the degree of inflammation of the intestinal mucosa.

  19. Surgery for inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    John M Hwang; Madhulika G Varma

    2008-01-01

    Despite the new and ever expanding array of medications for the treatment of inflammatory bowel disease (IBD),there are still clear indications for operative management of IBD and its complications.We present an overview of indications,procedures,considerations,and controversies in the surgical therapy of IBD.

  20. Clostridium difficile and inflammatory bowel disease.

    OpenAIRE

    Greenfield, C.; Aguilar Ramirez, J R; Pounder, R E; Williams, T.; Danvers, M; Marper, S R; Noone, P

    1983-01-01

    Stools from 109 patients with inflammatory bowel disease (13.4%) contained Clostridium difficile or its toxin, an incidence similar to the stools of 99 control patients with diarrhoea (11.9%), but significantly higher than the stools of 77 control patients with a normal bowel habit (1.4%). Sixty-six per cent of the diarrhoea controls, but only 11% of the inflammatory bowel disease patients, reported recent antibiotic use: however, 67% of inflammatory bowel disease patients were taking sulphas...

  1. Cancer in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Jianlin Xie; Steven H Itzkowitz

    2008-01-01

    Patients with long-standing inflammatory bowel disease (IBD) have an increased risk of developing colorectal cancer (CRC). Many of the molecular alterations responsible for sporadic colorectal cancer, namely chromosomal instability, microsatellite instability, and hypermethylation, also play a role in colitis-associated colon carcinogenesis. Colon cancer risk in inflammatory bowel disease increases with longer duration of colitis, greater anatomic extent of colitis, the presence of primary sclerosing cholangitis, family history of CRC and degree of inflammation of the bowel. Chemoprevention includes aminosalicylates, ursodeoxycholic acid, and possibly folic acid and statins. To reduce CRC mortality in IBD, colonoscopic surveillance with random biopsies remains the major way to detect early mucosal dysplasia. When dysplasia is confirmed, proctocolectomy is considered for these patients. Patients with small intestinal Crohn's disease are at increased risk of small bowel adenocarcinoma. Ulcerative colitis patients with total proctocolectomy and ileal pouch anal- anastomosis have a rather low risk of dysplasia in the ileal pouch, but the anal transition zone should be monitored periodically. Other extra intestinal cancers, such as hepatobiliary and hematopoietic cancer, have shown variable incidence rates. New endoscopic and molecular screening approaches may further refine our current surveillance guidelines and our understanding of the natural history of dysplasia.

  2. Heritability in inflammatory bowel disease

    DEFF Research Database (Denmark)

    Gordon, Hannah; Trier Moller, Frederik; Andersen, Vibeke;

    2015-01-01

    Since Tysk et al's pioneering analysis of the Swedish twin registry, twin and family studies continue to support a strong genetic basis of the inflammatory bowel diseases. The coefficient of heritability for siblings of inflammatory bowel disease probands is 25 to 42 for Crohn's disease and 4 to 15...... for ulcerative colitis. Heritability estimates for Crohn's disease and ulcerative colitis from pooled twin studies are 0.75 and 0.67, respectively. However, this is at odds with the much lower heritability estimates from Genome-Wide Association Studies (GWAS). This "missing heritability" is likely due...... underestimate heritability due to incomplete linkage disequilibrium, and because some single nucleotide polypeptides (SNPs) do not reach a level of significance to allow detection. SNPs missed by GWAS include common SNPs with low penetrance and rare SNPs with high penetrance. All methods of heritability...

  3. Selenium and inflammatory bowel disease.

    Science.gov (United States)

    Kudva, Avinash K; Shay, Ashley E; Prabhu, K Sandeep

    2015-07-15

    Dietary intake of the micronutrient selenium is essential for normal immune functions. Selenium is cotranslationally incorporated as the 21st amino acid, selenocysteine, into selenoproteins that function to modulate pathways involved in inflammation. Epidemiological studies have suggested an inverse association between selenium levels and inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis that can potentially progress to colon cancer. However, the underlying mechanisms are not well understood. Here we summarize the current literature on the pathophysiology of IBD, which is multifactorial in origin with unknown etiology. We have focused on a few selenoproteins that mediate gastrointestinal inflammation and activate the host immune response, wherein macrophages play a pivotal role. Changes in cellular oxidative state coupled with altered expression of selenoproteins in macrophages drive the switch from a proinflammatory phenotype to an anti-inflammatory phenotype to efficiently resolve inflammation in the gut and restore epithelial barrier integrity. Such a phenotypic plasticity is accompanied by changes in cytokines, chemokines, and bioactive metabolites, including eicosanoids that not only mitigate inflammation but also partake in restoring gut homeostasis through diverse pathways involving differential regulation of transcription factors such as nuclear factor-κB and peroxisome proliferator-activated receptor-γ. The role of the intestinal microbiome in modulating inflammation and aiding in selenium-dependent resolution of gut injury is highlighted to provide novel insights into the beneficial effects of selenium in IBD.

  4. Diet and Inflammatory Bowel Disease

    OpenAIRE

    Knight-Sepulveda, Karina; Kais, Susan; Santaolalla, Rebeca; Abreu, Maria T.

    2015-01-01

    Patients with inflammatory bowel disease (IBD) are increasingly becoming interested in nonpharmacologic approaches to managing their disease. One of the most frequently asked questions of IBD patients is what they should eat. The role of diet has become very important in the prevention and treatment of IBD. Although there is a general lack of rigorous scientific evidence that demonstrates which diet is best for certain patients, several diets—such as the low-fermentable oligosaccharide, disac...

  5. Up-regulation and Pre-activation of TRAF3 and TRAF5 in Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Jun Shen, Yu-qi Qiao, Zhi-hua Ran, Tian-rong Wang

    2013-01-01

    Full Text Available Objective: TRAF3 and TRAF5 share a common ancestral gene, and interact as essential components of signaling pathways in immunity. TRAF3 and TRAF5 are overexpressed in the colon of rat/mouse models with colitis. However, the expressions of TRAF3 and TRAF5 in patients with inflammatory bowel disease have not been elucidated. The aim of the present study is to explore the potential roles of TRAF3 and TRAF5 in patients with inflammatory bowel disease.Methods: Plasma levels of TRAF3 and TRAF5 proteins were detected by Enzyme-linked Immunosorbent Assay (ELISA. Colonic expression of TRAF3 and TRAF5 proteins was detected by western blot analysis. Quantitative Real-time PCR (qRT-PCR was applied for gene expression. Inflamed intestinal mucosa and non-inflamed intestinal mucosa in patients with inflammatory bowel disease and normal mucosa was analyzed from healthy controls.Results: The plasma levels of TRAF3 and TRAF5 were significantly higher both in patients with Crohn's disease and ulcerative colitis than in healthy controls. Only soluble TRAF5 showed a weak correlation with endoscopic disease activity index (Baron score in patients with ulcerative colitis (spearman's r=0.358, P=0.022. Gene expressions of TRAF3 and TRAF5 in peripheral blood mononuclear cells were significantly higher both in patients with Crohn's disease and ulcerative colitis than in healthy controls (all P<0.0001. Gene and protein expressions of TRAF3 and TRAF5 were significantly higher in inflamed colonic mucosa of patients with Crohn's disease and ulcerative colitis than in non-inflamed colonic mucosa and normal mucosa of healthy controls (all P<0.0001. Furthermore, gene and protein expressions of TRAF3 and TRAF5 were also significantly higher in non-inflamed colonic mucosa of patients with Crohn's disease and ulcerative colitis than in normal mucosa of healthy controls.Conclusions: TRAF3 and TRAF5 are overexpressed in inflammatory bowel disease. Although the endoscopic appearance

  6. Prognosis after first-time myocardial infarction in patients with inflammatory bowel disease according to disease activity

    DEFF Research Database (Denmark)

    Kristensen, Søren Lund; Ahlehoff, Ole; Lindhardsen, Jesper;

    2014-01-01

    , 0.95-2.77) for persistent activity, and 0.97 (95% CI, 0.78-1.19) for remission when compared with the non-IBD group. Among 73 451 patients, including 863 with IBD, alive 30 days after discharge, IBD was associated with hazard ratios of 1.21 (95% CI, 0.99-1.49) for recurrent MI, 1.14 (95% CI, 1.......01-1.28) for all-cause mortality, and 1.17 (95% CI, 1.03-1.34) for the composite end point. When compared with the non-IBD group, IBD flares, in particular, were associated with increased risks of recurrent MI (hazard ratio, 3.09; 95% CI, 1.79-5.32), all-cause mortality (hazard ratio, 2.25; 95% CI, 1.......61-3.15), and the composite end point (hazard ratio, 2.04; 95% CI, 1.35-3.06), whereas no increased risk was identified in remission. CONCLUSIONS: Active inflammatory bowel disease worsens prognosis after MI, in particular, in relation with flares....

  7. Cannabis for inflammatory bowel disease.

    Science.gov (United States)

    Naftali, Timna; Mechulam, Raphael; Lev, Lihi Bar; Konikoff, Fred M

    2014-01-01

    The marijuana plant Cannabis sativa has been used for centuries as a treatment for a variety of ailments. It contains over 60 different cannabinoid compounds. Studies have revealed that the endocannabinoid system is involved in almost all major immune events. Cannabinoids may, therefore, be beneficial in inflammatory disorders. In murine colitis, cannabinoids decrease histologic and microscopic inflammation. In humans, cannabis has been used to treat a plethora of gastrointestinal problems, including anorexia, emesis, abdominal pain, diarrhea, and diabetic gastroparesis. Despite anecdotal reports on medical cannabis in inflammatory bowel disease (IBD), there are few controlled studies. In an observational study in 30 patients with Crohn's disease (CD), we found that medical cannabis was associated with improvement in disease activity and reduction in the use of other medications. In a more recent placebo-controlled study in 21 chronic CD patients, we showed a decrease in the CD activity index >100 in 10 of 11 subjects on cannabis compared to 4 of 10 on placebo. Complete remission was achieved in 5 of 11 subjects in the cannabis group and 1 of 10 in the placebo group. Yet, in an additional study, low-dose cannabidiol did not have an effect on CD activity. In summary, evidence is gathering that manipulating the endocannabinoid system can have beneficial effects in IBD, but further research is required to declare cannabinoids a medicine. We need to establish the specific cannabinoids, as well as appropriate medical conditions, optimal dose, and mode of administration, to maximize the beneficial effects while avoiding any potential harmful effects of cannabinoid use. PMID:24969296

  8. Use of thiopurines in inflammatory bowel disease

    OpenAIRE

    Frei, Pascal; Biedermann, Luc; Nielsen, Ole Haagen; Rogler, Gerhard

    2013-01-01

    The use of thiopurines as immunosuppression for the treatment of refractory or chronic active inflammatory bowel disease is established for both Crohn's disease and ulcerative colitis. Nevertheless, many questions remain concerning the optimal treatment regimens of azathioprine, 6-mercaptopurine and thioguanine. We will briefly summarize dose recommendations, indications for thiopurine therapy and side effects which are relevant in clinical practice. We discuss some currently debated topics, ...

  9. MAP kinases in inflammatory bowel disease

    DEFF Research Database (Denmark)

    Coskun, Mehmet; Olsen, Jørgen; Seidelin, Jakob Benedict;

    2011-01-01

    of cellular activities and have been implicated in the pathogenesis of several diseases, including inflammatory bowel disease (IBD). This review summarizes recent findings on the regulatory mechanism of MAPK signaling pathways, focusing on nuclear targets and their role in IBD. Finally, it summarizes how...... these signaling pathways have been exploited for the development of therapeutics and discuss the current knowledge of potential MAPK inhibitors and their anti-inflammatory effects in clinical trials related to IBD....

  10. [Blastocystis hominis and bowel diseases].

    Science.gov (United States)

    Ustün, Sebnem; Turgay, Nevin

    2006-01-01

    Blastocystis hominis (B. hominis) is a parasite of uncertain role in human disease. It may be identified during a workup for gastrointestinal symptoms, usually in stools. The clinical consequences of B. hominis infection are mainly diarrhea and abdominal pain as well as nonspecific gastrointestinal symptoms such as nausea, anorexia, vomiting, weight loss, lassitude, dizziness, and flatulence. Case reports and series have suggested a pathogenic role of B. hominis in causing intestinal inflammation. Also some studies have suggested that inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are associated with B. hominis infection. The investigators indicate that the stools of all patients presenting with IBD or IBS should be examined, and culture methods for B. hominis carried out. Invasion and mucosal inflammation of the intestine with B. hominis have been observed in studies of gnotobiotic guinea pigs. The transmission, pathogenicity, culture characteristics, taxonomy, life cycle, biochemistry and molecular biology of B. hominis remain unclear. More studies are necessary for this parasite. PMID:17106862

  11. Biomarkers in inflammatory bowel diseases

    DEFF Research Database (Denmark)

    Bennike, Tue; Birkelund, Svend; Stensballe, Allan;

    2014-01-01

    Unambiguous diagnosis of the two main forms of inflammatory bowel diseases (IBD): Ulcerative colitis (UC) and Crohn's disease (CD), represents a challenge in the early stages of the diseases. The diagnosis may be established several years after the debut of symptoms. Hence, protein biomarkers...... for early and accurate diagnostic could help clinicians improve treatment of the individual patients. Moreover, the biomarkers could aid physicians to predict disease courses and in this way, identify patients in need of intensive treatment. Patients with low risk of disease flares may avoid treatment...... with medications with the concomitant risk of adverse events. In addition, identification of disease and course specific biomarker profiles can be used to identify biological pathways involved in the disease development and treatment. Knowledge of disease mechanisms in general can lead to improved future...

  12. Immunopathogenesis of inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    David Q Shih; Stephan R Targan

    2008-01-01

    Crohn's disease and ulcerative colitis are chronic relapsing immune mediated disorders that results from an aberrant response to gut luminal antigen in genetically susceptible host. The adaptive immune response that is then triggered was widely considered to be a T-helper-1 mediated condition in Crohn's disease and T-helper-2 mediated condition in ulcerative colitis. Recent studies in animal models, genome wide association, and basic science has provided important insights in in the immunopathogenesis of inflammatory bowel disease, one of which was the characterization of the interleukin-23/Th-17 axis.

  13. Iron therapy in inflammatory bowel disease : effects on oxidative stress and disease activity

    OpenAIRE

    Erichsen, Kari

    2005-01-01

    This thesis is based on the following papers, referred to in the text by their roman numerals: I Erichsen K, Hausken T, Ulvik RJ, Svardal A, Berstad A, Berge RK. Ferrous fumarate deteriorated plasma antioxidant status in patients with Crohn disease. Scand J Gastroenterol 2003;38:543-548. - II Erichsen K, Milde AM, Arslan G, Helgeland L, Gudbrandsen OA, Ulvik RJ, Berge RK, Hausken T, Berstad A. Low-dose oral ferrous fumarate aggravated intestinal inflammation in rats with DSS-in...

  14. The role of nuclear medicine in inflammatory bowel disease. A review with experiences of aspecific bowel activity using immunoscintigraphy with {sup 99m}Tc anti-granulocyte antibodies

    Energy Technology Data Exchange (ETDEWEB)

    Gyoerke, Tamas E-mail: gyorke@radi.sote.hu; Duffek, Laszlo; Bartfai, Katalin; Mako, Erno; Karlinger, Kinga; Mester, Adam; Tarjan, Zsolt

    2000-09-01

    The diagnosis of inflammatory bowel disease (IBD) needs a complex diagnostic work-up. Beside verifying the disease itself, it is fundamental to assess disease extent and activity and to detect associated complications, to find the most effective treatment and for follow up. Scintigraphy with radiolabelled leukocytes is able to provide a complete survey of the whole intestinal tract, both the small and large bowel, and detects septic complications successfully with negligible risk. Radionuclide procedures are useful in establishing or ruling out IBD in patients with intestinal complaints, in assessing disease severity, and in the evaluation of extraintestinal septic complications. Widely available radionuclide procedures are discussed, i.e. scintigraphy by {sup 111}Indium oxime or {sup 99m}Technetium HMPAO labelled white blood cells and immunoscintigraphy with {sup 99m}Tc anti-granulocyte antibodies. Advantages and disadvantages of all three methods are stressed out. Patients and methods: The immunoscintigraphies with {sup 99m}Tc anti-granulocyte antibodies (ANTI-GRANULOCYTE[reg] BW 250/183) of 27 patients with suspicion of IBD were retrospectively analysed. Planar anterior and posterior images were obtained 4 and 24 h postinjection, respectively. The bowel was divided into six segments and the activity was visually graded with reference to bone marrow in each segments. The scans were compared with the results of radiological and endoscopical investigations. The diagnosis of IBD was proved or ruled out by means of enteroclysis, large bowel enema or endoscopy. Results: In the 27 patients, 74 bowel segments with increased activity were detected. In the case of 30 segments in 16 patients, bowel inflammation was revealed by the other methods (true positives). In the case of 44 bowel segments, no underlying bowel inflammation could be verified, and these activities were regarded as aspecific activity. We could not differentiate between true positive and aspecific

  15. Fecal calprotectin in inflammatory bowel disease

    OpenAIRE

    Walsham NE; Sherwood RA

    2016-01-01

    Natalie E Walsham,1 Roy A Sherwood2 1Department of Clinical Biochemistry, University Hospital Lewisham, Lewisham, 2Department of Clinical Biochemistry, Viapath at King’s College Hospital NHS Foundation Trust, London, UK Abstract: Inflammatory bowel disease (IBD) and irritable bowel syndrome share many symptoms. While irritable bowel syndrome is a functional bowel disorder for which no specific treatment is available, the range of effective therapies for IBD is evolving rapidly. Acc...

  16. Video capsule endoscopy in inflammatory bowel disease

    Science.gov (United States)

    Collins, Paul D

    2016-01-01

    Video capsule endoscopy (VCE) has evolved to become an important tool for the non-invasive examination of the small bowel, which hitherto had been relatively inaccessible to direct visualisation. VCE has been shown to play a role in monitoring the activity of small bowel Crohn’s disease and can be used to assess the response to anti-inflammatory treatment in Crohn’s disease. For those patients with Crohn’s disease who have undergone an intestinal resection, VCE has been assessed as a tool to detect post-operative recurrence. VCE may also aid in the reclassification of patients with a diagnosis of Inflammatory Bowel Disease Unclassified to Crohn’s disease. The evolution of colon capsule endoscopy (CCE) has expanded the application of this technology further. The use of CCE to assess the activity of ulcerative colitis has been described. This advance in capsule technology has also fuelled interest in its potential role as a minimally invasive tool to assess the whole of GI tract opening the possibility of its use for the panenteric assessment of Crohn’s disease. VCE is a safe procedure. However, the risk of a retained capsule is higher in patients with suspected or confirmed Crohn’s disease compared with patients having VCE examination for other indications. A retained video capsule is rare after successful passage of a patency capsule which may be utilised to pre-screen patients undergoing VCE. This paper describes the use of VCE in the assessment of inflammatory bowel disease. PMID:27499830

  17. NATURAL AGENTS FOR INFLAMMATORY BOWEL DISEASE

    Directory of Open Access Journals (Sweden)

    Darji Vinay Chhanalal

    2011-02-01

    Full Text Available Inflammatory bowel disease (IBD is a chronic inflammatory disease of gastrointestinal tract. It comprises the two conditions, Crohn’s disease and ulcerative colitis, characterized by chronic recurrent ulceration of the bowel. Conventional drugs for colitis treatment include aminosalicylate, corticosteroids,antibiotics & immunomodulators. 5- Amino salicylic acid having side effects in 30% of the patients. Systemic corticosteroids producing incidence of complication is 4.3%. Antibiotic therapy is beneficial in 70% of the patients & Immunomodulators having 50 to 70% beneficial effects. This report shows that there is no any appropriate treatment available to treat IBD without side effects. A natural agent with reduced or no toxicity is therefore essential. In nature there are so many types of natural agents which are used as protective agents in IBD. This article emphasizes many natural products obtained from plant & other sources, which possess potent activity against experimentally induced IBD.

  18. Anorexia nervosa complicating inflammatory bowel disease.

    OpenAIRE

    Mallett, P; MURCH, S.

    1990-01-01

    Two cases of inflammatory bowel disease, occurring in adolescence and complicated by anorexia nervosa, are presented. The management of the bowel disease with corticosteroids appeared to precipitate the eating disorder in one case whereas covert withdrawal of steroid treatment led to life threatening complications of inflammatory bowel disease in the other. The difficulties of managing two serious conditions, each ideally treated in a specialist centre, are discussed and the dangers of treati...

  19. Inflammatory bowel disease and airway diseases

    Science.gov (United States)

    Vutcovici, Maria; Brassard, Paul; Bitton, Alain

    2016-01-01

    Airway diseases are the most commonly described lung manifestations of inflammatory bowel disease (IBD). However, the similarities in disease pathogenesis and the sharing of important environmental risk factors and genetic susceptibility suggest that there is a complex interplay between IBD and airway diseases. Recent evidence of IBD occurrence among patients with airway diseases and the higher than estimated prevalence of subclinical airway injuries among IBD patients support the hypothesis of a two-way association. Future research efforts should be directed toward further exploration of this association, as airway diseases are highly prevalent conditions with a substantial public health impact. PMID:27678355

  20. Zinc absorption in inflammatory bowel disease

    Energy Technology Data Exchange (ETDEWEB)

    Valberg, L.S.; Flanagan, P.R.; Kertesz, A.; Bondy, D.C.

    1986-07-01

    Zinc absorption was measured in 29 patients with inflammatory bowel disease and a wide spectrum of disease activity to determine its relationship to disease activity, general nutritional state, and zinc status. Patients with severe disease requiring either supplementary oral or parenteral nutrition were excluded. The mean 65ZnCl2 absorption, in the patients, determined using a 65Zn and 51Cr stool-counting test, 45 +/- 17% (SD), was significantly lower than the values, 54 +/- 16%, in 30 healthy controls, P less than 0.05. Low 65ZnCl2 absorption was related to undernutrition, but not to disease activity in the absence of undernutrition or to zinc status estimated by leukocyte zinc measurements. Mean plasma zinc or leukocyte zinc concentrations in patients did not differ significantly from controls, and only two patients with moderate disease had leukocyte zinc values below the 5th percentile of normal. In another group of nine patients with inflammatory bowel disease of mild-to-moderate severity and minimal nutritional impairment, 65Zn absorption from an extrinsically labeled turkey test meal was 31 +/- 10% compared to 33 +/- 7% in 17 healthy controls, P greater than 0.1. Thus, impairment in 65ZnCl2 absorption in the patients selected for this study was only evident in undernourished persons with moderate or severe disease activity, but biochemical evidence of zinc deficiency was uncommon, and clinical features of zinc depletion were not encountered.

  1. Intestinal epithelium in inflammatory bowel disease

    DEFF Research Database (Denmark)

    Coskun, Mehmet

    2014-01-01

    The intestinal epithelium has a strategic position as a protective physical barrier to luminal microbiota and actively contributes to the mucosal immune system. This barrier is mainly formed by a monolayer of specialized intestinal epithelial cells (IECs) that are crucial in maintaining intestina...... of inflammatory bowel disease (IBD). Understanding the role of the intestinal epithelium in IBD pathogenesis might contribute to an improved knowledge of the inflammatory processes and the identification of potential therapeutic targets....

  2. Intestinal epithelial cells in inflammatory bowel diseases

    Institute of Scientific and Technical Information of China (English)

    Giulia; Roda; Alessandro; Sartini; Elisabetta; Zambon; Andrea; Calafiore; Margherita; Marocchi; Alessandra; Caponi; Andrea; Belluzzi; Enrico; Roda

    2010-01-01

    The pathogenesis of inflammatory bowel diseases (IBDs) seems to involve a primary defect in one or more of the elements responsible for the maintenance of intestinal homeostasis and oral tolerance. The most important element is represented by the intestinal barrier, a complex system formed mostly by intestinal epithelial cells (IECs). IECs have an active role in producing mucus and regulating its composition; they provide a physical barrier capable of controlling antigen traff ic through the intestinal muco...

  3. Hypertrophic osteoarthropathy of chronic inflammatory bowel disease

    Energy Technology Data Exchange (ETDEWEB)

    Oppenheimer, D.A.; Jones, H.H.

    1982-12-01

    The case of a 14-year old girl with painful periostitis and ulcerative colitis is reported. The association of chronic inflammatory bowel disease with osteoarthropathy is rare and has previously been reported in eight patients. The periosteal reaction found in association with inflammatory bowel disease is apparently related to a chronic disease course and may cause extreme localized pain.

  4. Inflammatory Bowel Disease and Thrombosis

    Directory of Open Access Journals (Sweden)

    Ahmet Tezel

    2012-06-01

    Full Text Available Inflammatory Bowel Disease (IBD is a group of chronic and relapsing inflammatory disorders of the gastrointestinal system. In these cases, findings are detected in extraintestinal systems also. There is a tendency for thrombotic events in IBD, as in the other inflammatory processes. The pathogenesis of this thrombotic tendency is multidimensional, including lack of natural anticoagulants, prothrombotic media induced via the inflammatory process, long-term sedentary life style, steroid use, surgery, and catheter placement. The aim of this review was to highlight the positive relationship between IBD and thrombotic events, and the proper treatment of at-risk patients.

  5. Treatment of active steroid-refractory inflammatory bowel diseases with granulocytapheresis: Our experience with a prospective study

    Institute of Scientific and Technical Information of China (English)

    Bresci Giampaolo; Parisi Giuseppe; Bertoni Michele; Mazzoni Alessandro; Scatena Fabrizio; Copria Alfonso

    2006-01-01

    AIM: To report our experience with the use of granulocytapheresis (GCAP) in 14 patients with active steroidrefractory inflammatory bowel disease (IBD) in order to evaluate its efficacy in achieving remission and maintaining a long lasting symptom-free period.METHODS: The activity of the disease was evaluated by clinical activity index (CAI) and endoscopic index (EI)in ulcerative colitis (UC), while by Crohn's disease activity index (CDAI) in Crohn's disease (CD). The patients were treated using the AdacolumnTM system, an adsorption column which selectively binds to granulocytes and monocytes. One session/week of GCAP was performed for 5 wk. Steroids were stopped during apheresis.RESULTS: All the patients completed the five-week course showing no complications. At the end of the last session, 93% of patients showed a clinical remission of the disease that persisted for 6 mo. Nine months after the end of the treatment, 60% of the cases maintained remission, while 23% of the patients were still in clinical remission after 12 mo.CONCLUSION: Even if the number of our patients with steroid-refractory IBDs was not big, we can assert that GCAP is well tolerated and effective, especially in the first six months after the treatment, in a significant percentage of cases. The rate of sustained response drops slightly after 6 mo and significantly after 12 mo, however the absence of severe side effects can be a stimulus for further evaluating new schedules of treatment.

  6. Familial occurrence of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Orholm, M; Munkholm, P; Langholz, E;

    1991-01-01

    BACKGROUND AND METHODS: We assessed the familial occurrence of inflammatory bowel disease in Copenhagen County, where there has been a long-term interest in the epidemiology of such disorders. In 1987 we interviewed 662 patients in whom inflammatory bowel disease had been diagnosed before 1979...

  7. Pregnancy outcome in inflammatory bowel disease

    DEFF Research Database (Denmark)

    Bortoli, A; Pedersen, N; Duricova, D;

    2011-01-01

    Inflammatory bowel disease (IBD) frequently affects women during their reproductive years. Pregnancy outcome in women with IBD is well described, particularly in retrospective studies.......Inflammatory bowel disease (IBD) frequently affects women during their reproductive years. Pregnancy outcome in women with IBD is well described, particularly in retrospective studies....

  8. Diet and Inflammatory Bowel Disease.

    Science.gov (United States)

    Knight-Sepulveda, Karina; Kais, Susan; Santaolalla, Rebeca; Abreu, Maria T

    2015-08-01

    Patients with inflammatory bowel disease (IBD) are increasingly becoming interested in nonpharmacologic approaches to managing their disease. One of the most frequently asked questions of IBD patients is what they should eat. The role of diet has become very important in the prevention and treatment of IBD. Although there is a general lack of rigorous scientific evidence that demonstrates which diet is best for certain patients, several diets-such as the low-fermentable oligosaccharide, disaccharide, monosaccharide, and polyol diet; the specific carbohydrate diet; the anti-inflammatory diet; and the Paleolithic diet-have become popular. This article discusses the diets commonly recommended to IBD patients and reviews the supporting data. PMID:27118948

  9. Novel susceptibility genes in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Colin Noble; Elaine Nimmo; Daniel Gaya; Richard K Russell; Jack Satsangi

    2006-01-01

    The inflammatory bowel disease, Crohn's disease and ulcerative colitis, are polygenic disorders with important environmental interactions. To date, the most widely adopted approach to identifying susceptibility genes in complex diseases has involved genome wide linkage studies followed by studies of positional candidate genes in loci of interest. This review encompasses data from studies into novel candidate genes implicated in the pathogenesis of inflammatory bowel disease. Novel techniques to identify candidate genes-genome wide association studies, yeast-two hybrid screening, microarray gene expression studies and proteomic profiling,are also reviewed and their potential role in unravelling the pathogenesis of inflammatory bowel disease are discussed.

  10. The relationship of mucosal bacteria to duodenal histopathology, cytokine mRNA, and clinical disease activity in cats with inflammatory bowel disease.

    Science.gov (United States)

    Janeczko, S; Atwater, D; Bogel, E; Greiter-Wilke, A; Gerold, A; Baumgart, M; Bender, H; McDonough, P L; McDonough, S P; Goldstein, R E; Simpson, K W

    2008-04-01

    Feline inflammatory bowel disease (IBD) is the term applied to a group of poorly understood enteropathies that are considered a consequence of uncontrolled intestinal inflammation in response to a combination of elusive environmental, enteric microbial, and immunoregulatory factors in genetically susceptible cats. The present study sought to examine the relationship of mucosal bacteria to intestinal inflammation and clinical disease activity in cats with inflammatory bowel disease. Duodenal biopsies were collected from 27 cats: 17 undergoing diagnostic investigation of signs of gastrointestinal disease, and 10 healthy controls. Subjective duodenal histopathology ranged from normal (10), through mild (6), moderate (8), and severe (3) IBD. The number and spatial distribution of mucosal bacteria was determined by fluorescence in situ hybridization with probes to 16S rDNA. Mucosal inflammation was evaluated by objective histopathology and cytokine profiles of duodenal biopsies. The number of mucosa-associated Enterobacteriaceae was higher in cats with signs of gastrointestinal disease than healthy cats (Pcats. These data establish that the density and composition of the mucosal flora is related to the presence and severity of intestinal inflammation in cats and suggest that mucosal bacteria are involved in the etiopathogenesis of feline IBD.

  11. Reduction in diversity of the colonic mucosa associated bacterial microflora in patients with active inflammatory bowel disease

    OpenAIRE

    Ott, S.J.; Musfeldt, M; Wenderoth, D F; Hampe, J; Brant, O; Fölsch, U R; Timmis, K N; Schreiber, S

    2004-01-01

    Background and aims: The intestinal bacterial microflora plays an important role in the aetiology of inflammatory bowel disease (IBD). As most of the colonic bacteria cannot be identified by culture techniques, genomic technology can be used for analysis of the composition of the microflora.

  12. OMOM capsule endoscopy in diagnosis of small bowel disease

    Institute of Scientific and Technical Information of China (English)

    Chen-yi LI; Bing-ling ZHANG; Chun-xiao CHEN; You-ming LI

    2008-01-01

    Objective: To assess the diagnostic efficiency of OMOM capsule endoscopy (CE) in a group of patients with different indications. Methods: Data from 89 consecutive patients (49 males, 40 females) with suspected small bowel disease who under-went OMOM CE (Jinshan Science and Technology Company, Chongqing, China) examination were obtained by retrospective review. The patients' indications of the disease consisted of the following: obscure gastrointestinal bleeding (OGIB), abdominal pain or diarrhea, partial intestinal obstruction, suspected inflammatory bowel disease, tumor of unknown origin, hypoproteinemia, constipation, weight loss, and elevated tumor markers. Results: CE failed in one patient. Visualization of the entire small bowel was achieved in 75.0%. Capsules were naturally excreted by all patients. The detection rate of abnormalities was 70.5% for pa-tients with suspected small bowel disease, and the diagnostic yield for patients with OGIB was higher than that for patients with abdominal pain or diarrhea (85.7% vs 53.3%, P<0.005). Angiodysplasia was the most common small bowel finding. Active bleeding sites were noted in the small intestine in 11 cases. Conclusion: OMOM CE is a useful diagnostic tool for the diagnosis of variably suspected small bowel disease, whose diagnostic efficiency is similar to that of the Pillcam SB (small bowel) CE (Given Imaging, Yoqneam, Israel).

  13. Etiopathogenesis of inflammatory bowel diseases

    Institute of Scientific and Technical Information of China (English)

    Silvio Danese; Claudio Fiocchi

    2006-01-01

    Theories explaining the etiopathogenesis of inflammatory bowel disease (IBD) have been proposed ever since Crohn's disease (CD) and ulcerative colitis (UC) were recognized as the two major forms of the disease. Although the exact cause(s) and mechanisms of tissue damage in CD and UC have yet to be completely understood, enough progress has occurred to accept the following hypothesis as valid: IBD is an inappropriate immune response that occurs in genetically susceptible individuals as the result of a complex interaction among environmental factors, microbial factors, and the intestinal immune system. Among an almost endless list of environmental factors, smoking has been identified as a risk factor for CD and a protective factor for UC. Among microbial factors, no convincing evidence indicates that classical infectious agents cause IBD, while mounting evidence points to an abnormal immune response against the normal enteric flora as being of central importance. Gut inflammation is mediated by cells of the innate as well as adaptive immune systems, with the additional contribution of non-immune cells, such as epithelial, mesenchymal and endothelial cells, and platelets.

  14. NATURAL AGENTS FOR INFLAMMATORY BOWEL DISEASE

    OpenAIRE

    Darji Vinay Chhanalal; Bariya Aditi Hemrajbhai; Deshpande Shrikalp Shrikant

    2011-01-01

    Inflammatory bowel disease (IBD) is a chronic inflammatory disease of gastrointestinal tract. It comprises the two conditions, Crohn’s disease and ulcerative colitis, characterized by chronic recurrent ulceration of the bowel. Conventional drugs for colitis treatment include aminosalicylate, corticosteroids,antibiotics & immunomodulators. 5- Amino salicylic acid having side effects in 30% of the patients. Systemic corticosteroids producing incidence of complication is 4.3%. Antibiotic therapy...

  15. The Role of Fecal Calprotectin in Investigating Inflammatory Bowel Diseases

    Science.gov (United States)

    Erbayrak, Mustafa; Turkay, Cansel; Eraslan, Elife; Cetinkaya, Hulya; Kasapoglu, Benan; Bektas, Mehmet

    2009-01-01

    INTRODUCTION: Invasive and non-invasive tests can be used to evaluate the activity of inflammatory bowel diseases. OBJECTIVE: The aim of the present study was to investigate the role of fecal calprotectin in evaluating inflammatory bowel disease activity and the correlation of fecal calprotectin with the erythrocyte sedimentation rate and C reactive protein values in inflammatory bowel disease. METHOD: Sixty-five patients affected with inflammatory bowel disease were enrolled. Twenty outpatients diagnosed with inflammatory bowel disease comprised the control group. RESULTS: In the present study, all patients in the control group had an fecal calprotectin value lower than the cut-off point (50 mg/kg). CONCLUSION: In conclusion, fecal calprotectin was found to be strongly associated with colorectal inflammation indicating organic disease. Fecal calprotectin is a simple and non-invasive method for assessing excretion of macrophages into the gut lumen. Fecal calprotectin values can be used to evaluate the response to treatment, to screen asymptomatic patients, and to predict inflammatory bowel disease relapses. PMID:19488608

  16. The role of fecal calprotectin in investigating inflammatory bowel diseases

    Directory of Open Access Journals (Sweden)

    Mustafa Erbayrak

    2009-05-01

    Full Text Available INTRODUCTION: Invasive and non-invasive tests can be used to evaluate the activity of inflammatory bowel diseases. OBJECTIVE: The aim of the present study was to investigate the role of fecal calprotectin in evaluating inflammatory bowel disease activity and the correlation of fecal calprotectin with the erythrocyte sedimentation rate and C reactive protein values in inflammatory bowel disease. METHOD: Sixty-five patients affected with inflammatory bowel disease were enrolled. Twenty outpatients diagnosed with inflammatory bowel disease comprised the control group. RESULTS: In the present study, all patients in the control group had an fecal calprotectin value lower than the cut-off point (50 mg/kg. CONCLUSION: In conclusion, fecal calprotectin was found to be strongly associated with colorectal inflammation indicating organic disease. Fecal calprotectin is a simple and non-invasive method for assessing excretion of macrophages into the gut lumen. Fecal calprotectin values can be used to evaluate the response to treatment, to screen asymptomatic patients, and to predict inflammatory bowel disease relapses.

  17. Human Blood and Mucosal Regulatory T Cells Express Activation Markers and Inhibitory Receptors in Inflammatory Bowel Disease.

    Directory of Open Access Journals (Sweden)

    James D Lord

    Full Text Available FOXP3+ regulatory T cells (Tregs are critical for preventing intestinal inflammation. However, FOXP3+ T cells are paradoxically increased in the intestines of patients with the inflammatory bowel disease (IBD ulcerative colitis (UC or Crohn's disease (CD. We determined whether these FOXP3+ cells in IBD patients share or lack the phenotype of such cells from patients without IBD.We quantified and characterized FOXP3+ Treg populations, as well as FOXP3- CD4+ T cells, in the lamina propria lymphocytes (LPL of intestine surgically resected from patients with and without IBD, and in the blood of controls or Crohn's patients with or without disease activity.In all samples, a similar fraction of FOXP3+ cells expressed the "natural" Treg (nTreg marker Helios, suggesting that, in IBD, these cells are not entirely "induced" Tregs (iTregs derived from activated effector T cells. Helios+ and Helios- FOXP3+ T cells demonstrated similar expression of maturation markers, activation markers, and inhibitory molecules between IBD patients and controls, while FOXP3- cells paradoxically expressed more of the inhibitory receptors CD39, CTLA4, and PD-1 in inflamed mucosa. Greater expression of activation markers was also seen in both Helios+ and Helios- Tregs, relative to FOXP3- cells, in both IBD patients and controls, indicating that Tregs are effectively activated by antigen in IBD.Extensive immunophenotyping revealed that Helios+ and Helios- mucosal Tregs exist at a similar frequency, and have a similar expression of inhibitory molecules and activation markers in patients with IBD as in healthy controls.

  18. Occult spondyloarthritis in inflammatory bowel disease.

    Science.gov (United States)

    Bandinelli, Francesca; Manetti, Mirko; Ibba-Manneschi, Lidia

    2016-02-01

    Spondyloarthritis (SpA) is a frequent extra-intestinal manifestation in patients with inflammatory bowel disease (IBD), although its real diffusion is commonly considered underestimated. Abnormalities in the microbioma and genetic predisposition have been implicated in the link between bowel and joint inflammation. Otherwise, up to date, pathogenetic mechanisms are still largely unknown and the exact influence of the bowel activity on rheumatic manifestations is not clearly explained. Due to evidence-based results of clinical studies, the interest on clinically asymptomatic SpA in IBD patients increased in the last few years. Actually, occult enthesitis and sacroiliitis are discovered in high percentages of IBD patients by different imaging techniques, mainly enthesis ultrasound (US) and sacroiliac joint X-ray examinations. Several diagnostic approaches and biomarkers have been proposed in an attempt to correctly classify and diagnose clinically occult joint manifestations and to define clusters of risk for patient screening, although definitive results are still lacking. The correct recognition of occult SpA in IBD requires an integrated multidisciplinary approach in order to identify common diagnostic and therapeutic strategies. The use of inexpensive and rapid imaging techniques, such as US and X-ray, should be routinely included in daily clinical practice and trials to correctly evaluate occult SpA, thus preventing future disability and worsening of quality of life in IBD patients.

  19. Diet and risk of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Andersen, Vibeke; Olsen, Anja; Carbonnel, Franck;

    2012-01-01

    Background: A better understanding of the environmental factors leading to inflammatory bowel disease should help to prevent occurrence of the disease and its relapses. Aim: To review current knowledge on dietary risk factors for inflammatory bowel disease. Methods: The PubMed, Medline and Cochrane...... Library were searched for studies on diet and risk of inflammatory bowel disease. Results: Established non-diet risk factors include family predisposition, smoking, appendectomy, and antibiotics. Retrospective case–control studies are encumbered with methodological problems. Prospective studies...... on European cohorts, mainly including middle-aged adults, suggest that a diet high in protein from meat and fish is associated with a higher risk of inflammatory bowel disease. Intake of the n-6 polyunsaturated fatty acid linoleic acid may confer risk of ulcerative colitis, whereas n-3 polyunsaturated fatty...

  20. Scintigraphic assessment of indium-111-labeled granulocyte splenic pooling: A new approach to inflammatory bowel disease activity

    Energy Technology Data Exchange (ETDEWEB)

    Loreal, O.; Moisan, A.; Bretagne, J.F.; LeCloirec, J.; Raoul, J.L.; Gastard, J.; Herry, J.Y. (CHU, Pontchaillou, Rennes (France))

    1990-09-01

    We have conducted a prospective study into the sensitivity and the specificity of the fall in splenic activity (FSA) as an index of activity in inflammatory bowel disease (IBD). FSA was measured on scintiscans obtained at 3 and 24 hr postinjection of indium-111-labeled granulocytes. One hundred and twenty-two scans were acquired in 96 patients who were divided into six groups: Gr. I = normal volunteers (n = 10); Gr. II = inflammatory rheumatism (n = 10); Gr. III = abscesses (n = 17); Gr. IV = ulcerative colitis (UC: n = 23); Gr. V = colonic Crohn's disease (CCD: n = 22); and Gr. VI = ileal Crohn's disease (ICD: n = 14). FSA for Groups I and II was constantly below 10%, but it was increased in the other four groups (abscesses: 39% +/- 12%; UC: 35% +/- 13.5%; CCD: 23.7% +/- 14.7%; ICD: 21.5% +/- 11.7%). There was a significant correlation between fecal excretion of 111In (FEI) and FSA in patients with IBD (UC: r = 0.71, p less than 0.001; CCD: r = 0.74, p less than 0.001; ICD: r = 0.43, p less than 0.001). FSA was followed in 16 patients with IBD after medical treatment and there was a significant correlation between variations in FSA and in FEI (r = 0.879, p less than 0.001). FSA is a very sensitive although nonspecific index of disease activity in IBD and may replace FEI in the assessment of IBD activity.

  1. Pharmacogenetics in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Marie Pierik; Paul Rutgeerts; Robert Vlietinck; Severine Vermeire

    2006-01-01

    Pharmacogenetics is the study of the association between variability in drug response and (or) drug toxicity and polymorphisms in genes. The goal of this field of science is to adapt drugs to a patient's specific genetic background and therefore make them more efficacious and safe. In this article we describe the variants in genes that influence either the efficacy or toxicity of common drugs used in the treatment of inflammatory bowel diseases (IBD), ulcerative colitis (UC),and Crohn's disease (CD) including sulfasalazine and mesalazine, azathioprine (AZA) and 6-mercaptopurine (6-MP), methotrexate (MTX), glucocorticosteroids (CSs) and infliximab. Furthermore, difficulties with pharmacogenetic studies in general and more specifically in IBD are described. Although pharmacogenetics is a promising field that already contributed to a better understanding of some of the underlying mechanisms of action of drugs used in IBD, the only discovery translated until now into daily practice is the relation between thiopurine S-methyltransferase (TPMT) gene polymorphisms and hematological toxicity of thiopurine treatment. In the future it is necessary to organize studies in well characterized patient cohorts who have been uniformly treated and systematically evaluated in order to quantitate drug response more objectively. An effort should be made to collect genomic DNA from all patients enrolled in clinical drug trials after appropriate informed consent for pharmacogenetic studies.

  2. Human Blood and Mucosal Regulatory T Cells Express Activation Markers and Inhibitory Receptors in Inflammatory Bowel Disease

    OpenAIRE

    Lord, James D.; Shows, Donna M.; Chen, Janice; Thirlby, Richard C.

    2015-01-01

    Background FOXP3+ regulatory T cells (Tregs) are critical for preventing intestinal inflammation. However, FOXP3+ T cells are paradoxically increased in the intestines of patients with the inflammatory bowel disease (IBD) ulcerative colitis (UC) or Crohn’s disease (CD). We determined whether these FOXP3+ cells in IBD patients share or lack the phenotype of such cells from patients without IBD. Methods We quantified and characterized FOXP3+ Treg populations, as well as FOXP3- CD4+ T cells, in ...

  3. PYODERMA GANGRENOSUM WITH INFLAMATORY BOWEL DISEASE

    Directory of Open Access Journals (Sweden)

    Guru Prasad

    2015-01-01

    Full Text Available Pyoderma gangrenosum (PG is a chronic , painful ulcerated skin disease of unknown etiology. Its association with inflammatory bowel disease like ulcerative colitis is common . The lesions generally appear dur ing the course of active bowel disease , frequently concur with exacerbations of colitis , sometimes with inactive ulcerative colitis. 15 to 20 % of patients with Pyoderma gangrenosum have ulcerative colitis and 0.5 to 5 % of patients with ulcerative colitis have Pyoderma gangrenosum . occasionally skin lesions may preceed active inflammation of colon . Here we report a case of 50 year old female presenting with large ulcerated lesion over the anterior aspect of the middle 1/3 rd of left leg associated with sev ere pain and bloody discharge. skin biopsy shows epidermis with necrosis and diffuse dense neutrophilic infiltrate in superficial epidermis extending into the deep dermis. Colonoscopy shows features of ulcerative colitis . Patient showed rapid response with systemic steroids and specific treatment with 5 - amino salicylic acid (mesalamine. ulcer healed within 6 weeks and followed for 3months with no recurrence.

  4. Small Bowel Crohn's disease MRI pictorial essay

    International Nuclear Information System (INIS)

    The focus of this article includes revision of normal small bowel anatomy on sequences performed at our institution, with advantages and disadvantages; brief summary of the disease; appearance of acute active disease; usefulness of ancillary findings of active disease; appearance of chronic disease both active and inactive; complications of Crohn's disease; pitfalls and limitations of interpretation; and clinically relevant reporting through clinician feedback.

  5. Microbiota biodiversity in inflammatory bowel disease

    OpenAIRE

    Comito, Donatella; Cascio, Antonio; Romano, Claudio

    2014-01-01

    Gut microbiota plays a significant role in human health and energy balance, and provides protection against disease states. An altered balance between microbiota and its host (dysbiosis) would appear to contribute to the development of Inflammatory Bowel Disease (IBD), Crohn’s Disease (CD) and Ulcerative Colitis (UC). CD and UC are chronic inflammatory diseases of the gastrointestinal tes.

  6. Role of scintigraphy in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Maria I Stathaki; Sophia I Koukouraki; Nikolaos S Karkavitsas; Ioannis E Koutroubakis

    2009-01-01

    The diagnosis of inflammatory bowel disease (IBD) depends on direct endoscopic visualization of the colonic and ileal mucosa and the histological study of the obtained samples.Radiological and scintigraphic methods are mainly used as an adjunct to endoscopy.In this review,we focus on the diagnostic potential of nuclear medicine procedures.The value of all radiotracers is described with special reference to those with greater experience and more satisfactory results.Tc-99m hexamethylpropylene amine oxime white blood cells remain a widely acceptable scintigraphic method for the diagnosis of IBD,as well as for the evaluation of disease extension and severity.Recently,pentavalent Tc-99m dimercaptosuccinic acid has been recommended as an accurate variant and a complementary technique to endoscopy for the follow-up and assessment of disease activity.Positron emission tomography alone or with computed tomography using fluorine-18 fluorodeoxyglucose appears to be a promising method of measuring inflammation in IBD patients.

  7. Importance of nutrition in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Alfredo José Lucendo; Livia Cristina De Rezende

    2009-01-01

    Inflammatory bowel disease (IBD) results from the interaction between an individual's immune response and precipitant environmental factors, which generate an anomalous chronic inflammatory response in those who are genetically predisposed. Various feeding practices have been implicated in the origin of IBD based on epidemiological observations in developed countries, but we do not have solid evidence for the etiological role played by specific food types. IBD is associated with frequent nutritional deficiencies, the pattern and severity of which depends on the extent, duration and activity of the inflammation. Nutritional support allows these deficiencies in calories, macro and micronutrients to be rectified. Enteral nutrition is also a primary therapy for IBD, especially for Crohn's disease, as it allows the inflammatory activity to be controlled, kept in remission, and prevents or delays the need for surgery. Nutritional support is especially important in childhood IBD as an alternative to pharmacological t reatment . This repor t discusses the complex relationship between diet and IBD.

  8. Dietary fortificant iron intake is negatively associated with quality of life in patients with mildly active inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    Powell Jonathan J

    2013-01-01

    Full Text Available Abstract Background Iron deficiency anaemia and oral iron supplementation have been associated negatively with quality of life, and with adverse effects, respectively, in subjects with inflammatory bowel disease (IBD. Hence, the risk-benefit ratio of oral iron is not understood in this patient group. The present case–control study investigated whether dietary iron intake impacts on quality of life in IBD patients. Methods Quality of life, habitual dietary iron intakes and iron requirements were assessed in 29 patients with inactive or mildly active IBD as well as in 28 healthy control subjects. Results As expected, quality of life was worse in IBD patients as a whole in comparison to healthy controls according to EuroQol score and EuroQol VAS percentage (6.9 ± 1.6 vs 5.3 ± 0.6; pvs 88 ± 12%; p=0.004 respectively. For IBD subjects, 21/29 were iron deplete based upon serum iron responses to oral iron but, overall, were non-anaemic with mean haemoglobin of 13.3 ± 1.5 g/dL, and there was no difference in their quality of life compared to 8/29 iron replete subjects (Hb 14.0 ± 0.8 g/dL. Interestingly, total dietary iron intake was significantly negatively associated with quality of life in IBD patients, specifically for non-haem iron and, more specifically, for fortificant iron. Moreover, for total non-haem iron the negative association disappeared when fortificant iron values were subtracted. Finally, further sub-analysis indicated that the negative association between (fortificant dietary iron intake and quality of life in IBD patients is driven by findings in patients with mildly active disease rather than in patients with quiescent disease. Conclusions Iron deficiency per se (i.e. without concomitant anaemia does not appear to further affect quality of life in IBD patients with inactive or mildly active disease. However, in this preliminary study, dietary iron intake, particularly fortificant iron, appears to be significantly negatively

  9. Biologic concentration testing in inflammatory bowel disease.

    Science.gov (United States)

    Vaughn, Byron P; Sandborn, William J; Cheifetz, Adam S

    2015-06-01

    Anti-TNF medications have revolutionized the care of patients with inflammatory bowel disease. However, despite an initial robust effect, loss of response is common and long-term results are disappointing. Much of this lack of durability may be due to inadequate dose optimization, and recent studies suggest a correlation between serum drug concentrations and clinical outcomes. Currently, in clinical practice, measurement of drug concentrations and antibodies to drug are typically performed only when a patient presents with active inflammatory bowel disease symptoms or during a potential immune-mediated reaction to anti-TNF ("reactive" setting). However, proactive monitoring of anti-TNF concentrations with titration to a therapeutic window (i.e., therapeutic concentration monitoring) represents a new strategy with many potential clinical benefits including prevention of immunogenicity, less need for IFX rescue therapy, and greater durability of IFX treatment. This review will cover the salient features of anti-TNF pharmacokinetics and pharmacodynamics and provide a rational approach for the use of anti-TNF concentration testing in both the reactive and proactive settings. PMID:25590953

  10. Management of Inflammatory Bowel Disease During Pregnancy.

    Science.gov (United States)

    Bar-Gil Shitrit, Ariella; Grisaru-Granovsky, Sorina; Ben Ya'acov, Ami; Goldin, Eran

    2016-08-01

    Inflammatory bowel disease (IBD) usually affects women during their reproductive years and many concerns arise among these young patients. Pre-pregnancy consultation with a multi-disciplinary team is very important. The team should make patients aware of the critical importance of ensuring that conception occurs during a period of disease remission. Conception during an IBD flare-up results in disease activity or even exacerbates disease in two-thirds of women. Exacerbation of the disease is associated with increased frequency of maternal and fetal complications. Drug therapy constitutes a considerable source of patient anxiety but most drugs used for treating IBD are considered safe. Therefore, continuing pharmacological therapy during pregnancy is necessary to maintain disease control. Optimization of pre-conception nutritional status and smoking cessation are also emphasized. The general guideline for most patients, except for active perianal disease patients, is to aim for vaginal delivery in the absence of obstetric contraindications. Consistent, ongoing follow-up, as detailed in this review, should allay the anxieties and fears surrounding continuing immunosuppressive drugs during pregnancy, allowing each patient to attain the optimal conditions for achieving her goal of holding a healthy baby. PMID:27068171

  11. Inflammatory Bowel Disease. Medical and psychological aspects

    NARCIS (Netherlands)

    Albersnagel, Frans; Dijkstra, Gerard

    2007-01-01

    A review is presented in which the state of the art of behavioural-scientific research on inflammatory bowel disease (BID) is sorted out. After a short introduction on medical aspects of the two diseases that constitute IBD, i.e. Crohn's disease and ulcerative colitis, the factors that may have an i

  12. Clostridium difficile and pediatric inflammatory bowel disease

    DEFF Research Database (Denmark)

    Martinelli, Massimo; Strisciuglio, Caterina; Veres, Gabor;

    2014-01-01

    BACKGROUND: Clostridium difficile infection is associated with pediatric inflammatory bowel disease (IBD) in several ways. We sought to investigate C. difficile infection in pediatric patients with IBD in comparison with a group of children with celiac disease and to evaluate IBD disease course...

  13. Nuclear medicine imaging of inflammatory bowel disease

    Energy Technology Data Exchange (ETDEWEB)

    Froelich, J.W.

    1987-01-01

    With the availability of indium-labeled white blood cells, radionuclide imaging studies have a definite role in the diagnosis and staging of patients with inflammatory bowel disease. The In-/sup 111/ white blood cell study is particularly helpful in evaluating recurrent disease in patients with severe intercurrent diseases and in screening patients without the need for barium examinations.

  14. [Fecal Calprotectin in Inflammatory Bowel Disease].

    Science.gov (United States)

    Lee, Jun

    2016-05-25

    Inflammatory bowel disease (IBD), Crohn's disease and ulcerative colitis comprise conditions characterized by chronic, relapsing immune activation and inflammation within the gastrointestinal tract. Objective estimation of intestinal inflammation is the mainstay in the diagnosis and observation of IBD, but is primarily dependent on expensive and invasive procedures such as endoscopy. Therefore, a simple, noninvasive, inexpensive, and accurate test would be extremely important in clinical practice. Fecal calprotectin is a calcium-containing protein released into the lumen that is excreted in feces during acute and chronic inflammation. It is well-researched, noninvasive, and has high sensitivity and specificity for identification of inflammation in IBD. This review will focus on the use of fecal calprotectin to help diagnose, monitor, and determine treatment in IBD. PMID:27206433

  15. Use of thiopurines in inflammatory bowel disease.

    Science.gov (United States)

    Frei, Pascal; Biedermann, Luc; Nielsen, Ole Haagen; Rogler, Gerhard

    2013-02-21

    The use of thiopurines as immunosuppression for the treatment of refractory or chronic active inflammatory bowel disease is established for both Crohn's disease and ulcerative colitis. Nevertheless, many questions remain concerning the optimal treatment regimens of azathioprine, 6-mercaptopurine and thioguanine. We will briefly summarize dose recommendations, indications for thiopurine therapy and side effects which are relevant in clinical practice. We discuss some currently debated topics, including the combination of azathioprine and allopurinol, switching of thiopurine therapy in case of side effects, the use of azathioprine in pregnancy, the infection risk using thiopurines and the evidence when to stop thiopurines. Excellent reviews have been published on the thiopurine metabolic pathway which will not be discussed here in detail. PMID:23467510

  16. Intestinal epithelium in inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    Mehmet eCoskun

    2014-08-01

    Full Text Available The intestinal epithelium has a strategic position as a protective physical barrier to luminal microbiota and actively contributes to the mucosal immune system. This barrier is mainly formed by a monolayer of specialized intestinal epithelial cells (IECs that are crucial in maintaining intestinal homeostasis. Therefore, dysregulation within the epithelial layer can increase intestinal permeability, lead to abnormalities in interactions between IECs and immune cells in underlying lamina propria, and disturb the intestinal immune homeostasis, all of which are linked to the clinical disease course of inflammatory bowel disease (IBD. Understanding the role of the intestinal epithelium in IBD pathogenesis might contribute to an improved knowledge of the inflammatory processes and the identification of potential therapeutic targets.

  17. Confocal Laser Endomicroscopy in Inflammatory Bowel Disease

    DEFF Research Database (Denmark)

    Rasmussen, Ditlev Nytoft; Karstensen, John Gásdal; Riis, Lene Buhl;

    2015-01-01

    of confocal laser endomicroscopy for inflammatory bowel disease. METHODS: Available literature was searched systematically for studies applying confocal laser endomicroscopy in Crohn's disease or ulcerative colitis. Relevant literature was reviewed and only studies reporting original clinical data were...... included. Next, eligible studies were analysed with respect to several parameters, such as technique and clinical aim and definitions of outcomes. RESULTS: Confocal laser endomicroscopy has been used for a wide range of purposes in inflammatory bowel disease, covering assessment of inflammatory severity...... of histological features such as colonic crypts, epithelial gaps and epithelial leakiness to fluorescein. CONCLUSIONS: Confocal laser endomicroscopy remains an experimental but emerging tool for assessment of inflammatory bowel disease. It is the only method that enables in vivo functional assessment...

  18. Environmental Triggers for Inflammatory Bowel Disease

    OpenAIRE

    Ananthakrishnan, Ashwin N

    2013-01-01

    Inflammatory bowel diseases [IBD; Crohn’s disease (CD), ulcerative colitis (UC)] are chronic immunologically mediated diseases that are due to a dysregulated immune response to intestinal flora in a genetically susceptible host. Despite advances in genetics, the likelihood of occurrence of disease remains incompletely explained and there appears to be a strong role for the environment in mediating risk of disease. Smoking remains the most widely studied and replicated risk factor, contributin...

  19. The evolving epidemiology of inflammatory bowel disease.

    LENUS (Irish Health Repository)

    Shanahan, Fergus

    2009-07-01

    Epidemiologic studies in inflammatory bowel disease (IBD) include assessments of disease burden and evolving patterns of disease presentation. Although it is hoped that sound epidemiologic studies provide aetiological clues, traditional risk factor-based epidemiology has provided limited insights into either Crohn\\'s disease or ulcerative colitis etiopathogenesis. In this update, we will summarize how the changing epidemiology of IBD associated with modernization can be reconciled with current concepts of disease mechanisms and will discuss studies of clinically significant comorbidity in IBD.

  20. Role of indium-111 white blood cells in inflammatory bowel disease

    Energy Technology Data Exchange (ETDEWEB)

    Froelich, J.W.; Field, S.A.

    1988-10-01

    Inflammatory bowel disease in patients may be difficult to diagnose because of the complex problems associated with this disease. Radionuclides are able to provide a rapid and effective method of imaging the bowel in patients with active inflammatory bowel disease. In the past, clinical work-ups have included barium x-ray studies and endoscopy. Scarring and fistula formation have made it difficult to determine between the active disease and abscesses that may occur. Gallium-67 (67Ga) has been very useful in imaging patients with inflammatory bowel disease, but the multiple-day imaging procedure has been a limitation for the clinicians when achieving a diagnosis. Recent results with Indium-111 (111In)--labeled WBCs have provided excellent correlation between clinical symptoms and colonoscopy findings in patients with inflammatory bowel disease. This technique has also allowed the differentiation between reoccurring inflammatory bowel disease and abscesses that accompany the disease within a 24-hour time period. The use of intravenous (IV) glucagon has increased the clarity of the images in the small bowel. Technetium 99m (99mTc) diethylenetriaminepentaacetic acid (DTPA) has been used in patients with inflammatory bowel disease demonstrating promising results. Investigators feel labelling 99mTc with WBCs will be improved, therefore yielding a greater efficiency, which will have a major impact on imaging patients with inflammatory bowel disease. Imaging patients with inflammatory bowel disease using radionuclides has yielded promising results. This is a significant advancement over barium radiography and endoscopy exams.24 references.

  1. New pharmaceuticals in inflammatory bowel disease

    OpenAIRE

    Łodyga, Michał; Eder, Piotr; Bartnik, Witold; Gonciarz, Maciej; Kłopocka, Maria; Linke, Krzysztof; Małecka-Panas, Ewa; Radwan, Piotr; Rydzewska, Grażyna

    2015-01-01

    This paper complements the previously published Guidelines of the Working Group of the Polish Society of Gastroenterology and former National Consultant in Gastroenterology regarding the management of patients with Crohn's disease and ulcerative colitis. Attention was focused on the new pharmaceutical recently registered for inflammatory bowel disease treatment.

  2. Management of inflammatory bowel disease in pregnancy

    NARCIS (Netherlands)

    S. Vermeire (Silvio); F. Carbonnel (Franck); P.G. Coulie (Pierre); V. Geenen (Vincent); J.M.W. Hazes (Mieke); P.L. Masson (Pierre); F. de Keyser (Filip); E. Louis (Edouard)

    2012-01-01

    textabstractBackground and Aims: Inflammatory bowel disease (IBD) is a chronic disease affecting mainly young people in their reproductive years. IBD therefore has a major impact on patients' family planning decisions. Management of IBD in pregnancy requires a challenging balance between optimal dis

  3. Neuropeptide receptor expression in inflammatory bowel disease

    NARCIS (Netherlands)

    Beek, Willy Pascale ter

    2008-01-01

    Inflammatory bowel disease (IBD), i.e. Crohn’s disease and ulcerative colitis are characterized by a chronic inflammation of the gastrointestinal tract. Neuropeptides are involved in the regulation of intestinal motility, chloride secretion and inflammatory response, three processes that are disturb

  4. Inflammatory Bowel Disease and Cervical Neoplasia

    DEFF Research Database (Denmark)

    Rungoe, Christine; Simonsen, Jacob; Riis, Lene;

    2015-01-01

    BACKGROUND & AIMS: We examined the risk of cervical neoplasia (dysplasia or cancer) in women with ulcerative colitis (UC) or Crohn's disease (CD). We also calculated the reverse, the risk for diagnosis with cervical neoplasia before development of inflammatory bowel disease (IBD). METHODS: We...

  5. Familial risk of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Trier Møller, Frederik; Andersen, Vibeke; Jess, Tine;

    2014-01-01

    Background The inflammatory bowel diseases (IBD) – ulcerative colitis (UC) and Crohn’s disease (CD) - are caused by complex gene-environment interactions. This study provides updated familial aggregation patterns in a large population-based Danish IBD cohort. Methods: Our cohort study was based...

  6. Current treatment for inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Chang-tai Xu; Xiue-gan Guo; Bo-rong Pan

    2003-01-01

    @@Introduction Idiopathic inflammatory bowel disease consists of Crohn's disease (CD) and ulcerative colitis (UC). CD can affect any part of the gastrointestinal tract, from the mouth to the anus, and is also known as regional enteritis, terminal ileitis, or granulomatous……

  7. Short bowel syndrom as a complication of Crohn's disease

    OpenAIRE

    Skok, Pavel; Ocepek, Andreja

    2015-01-01

    During the course of Crohn's disease, some patients require surgical bowel resection due to intestinal stenosis. Attention is drawn to a possible complication of such surgical procedures: in a patients with Crohn's disease, short bowel syndrome developed following several small and large intestine resections that were necessary in the treatment of recidiving acute bowel obstructions. When the remnant small bowel is shorter than 200 cm, characteristic symptoms of short bowel syndrome develop i...

  8. Iron deficiency anemia in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Sindhu; Kaitha; Muhammad; Bashir; Tauseef; Ali

    2015-01-01

    Anemia is a common extraintestinal manifestation of inflammatory bowel disease(IBD) and is frequently overlooked as a complication. Patients with IBD are commonly found to have iron deficiency anemia(IDA) secondary to chronic blood loss, and impaired iron absorption due to tissue inflammation. Patients with iron deficiency may not always manifest with signs and symptoms; so, hemoglobin levels in patients with IBD must be regularly monitored for earlier detection of anemia. IDA in IBD is associated with poor quality of life, necessitating prompt diagnosis and appropriate treatment. IDA is often associated with inflammation in patients with IBD. Thus, commonly used labora-tory parameters are inadequate to diagnose IDA, and newer iron indices, such as reticulocyte hemoglobin content or percentage of hypochromic red cells or zinc protoporphyrin, are required to differentiate IDA from anemia of chronic disease. Oral iron preparations are available and are used in patients with mild disease activity. These preparations are inexpensive and con-venient, but can produce gastrointestinal side effects, such as abdominal pain and diarrhea, that limit their use and patient compliance. These preparations are partly absorbed due to inflammation. Non-absorbed iron can be toxic and worsen IBD disease activity. Although cost-effective intravenous iron formulations are widely available and have improved safety profiles, physicians are reluctant to use them. We present a review of the pathophysiologic mechanisms of IDA in IBD, improved diagnostic and therapeutic strategies, efficacy, and safety of iron replacement in IBD.

  9. Diagnostics in inflammatory bowel disease: Ultrasound

    Institute of Scientific and Technical Information of China (English)

    Deike Strobel; Ruediger S Goertz; Thomas Bernatik

    2011-01-01

    Diagnosis of chronic inflammatory bowel diseases (IBD) is based on a combination of clinical symptoms, laboratory tests and imaging data. Imaging of the morphological characteristics of IBD includes the assessment of mucosal alterations, transmural involvement and extraintestinal manifestations. No single imaging technique serves as a diagnostic gold standard to encompass all disease manifestations. Ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) allow cross-sectional imaging of the transmural alterations and extraintestinal manifestations. While in the USA the technique of choice is CT, in Europe the focus is more on MRI and ultrasound (US). Most patients with chronic IBD are diagnosed at a young age. After baseline diagnosis many of these young patients have to undergo repetitive imaging procedures during the variable clinical course of the disease, characterized by alternate periods of remission and active disease, and in monitoring the response to treatment. US has the advantage of being noninvasive, less costly, and easily repeatable, and thus can be very useful in following up patients with IBD. In addition, rising concern about radiation exposure in young adults indicates the demand for radiation-sparing techniques like US and MRI. This article focuses on the current clinical practice of US in IBD, describing the current technologies used in transabdominal intestinal US and the characteristic sonographic findings in Crohn′s disease and ulcerative colitis.

  10. Pulse cyclophosphamide therapy for inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Zsolt Barta; László Tóth; Margit Zeher

    2006-01-01

    AIM: To assess the efficacy of intravenous cyclophosphamide pulse therapy for refractory inflammatory bowel disease (IBD).METHODS: We included in our cohort eight patients with (moderate/severe) steroid refractory IBD (4 with ulcerative colitis and 4 with Crohn's disease). They all received 6 cycles of intravenous cyclophosphamide (800mg) per month.RESULTS: Patients entered into remission after the second/third cyclophosphamide pulse. Disease activity decreased. There were no side effects and toxicity. All the patients went into long lasting remission. All Crohn's disease patients and 3 of 4 ulcerative colitis patients achieved complete remission. One patient with ulcerative colitis showed an impressive clinical response but did not enter into remission. For the maintenance, patients with Crohn's disease were treated with methotrexate (15 mg/wk) and patients with ulcerative colitis were treated with azathioprine (2.5 mg/kg body weight/d).CONCLUSION: Remission was maintained in all patients for 6 mo on the average. The drug was well tolerated. These findings suggest that aggressive immunosuppressive therapy may be useful in some refractory patients and further controlled study should be considered in order to fully evaluate this type of treatment as a potential therapy for IBD.

  11. The Social Toll of Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Richard G Farmer

    1994-01-01

    Full Text Available Inflammatory bowel disease (IBD – ulcerative colitis and Crohn’s disease – has become one the most important chronic digestive disorders found in the younger population. As a result of the nature of the illness, with remission and exacerbation of the inflammatory process, there has been increasing concern regarding the costs, both financial and social, of IBD. There have been attempts to quantify disease activity and to assess the results of treatment and the ability of the patient to function in society. As a result, there has been an increased interest in the ‘social toll’ of IBD. Begi1ming in 1988, and using a direct interview technique, ambulatory patients with IBD were evaluated for quality of life at the Cleveland Clinic Foundation. Included were patients whose disease had been present for about 10 years, and both surgical and nonsurgical patients. The interview questionnaire consisted of 47 items in four categories: functional/economic, social/recreational, affect/life in general and medical/symptoms. Patients with ulcerative colitis had better quality of life than those with Crohn’s disease and patients without surgery had better quality of life than those who had undergone surgery. Over the ensuing five-year period, it was shown that quality of life measures are of value in assessing the results of medical and surgical therapy, and the measures frequently give information not usually obtained by physicians and have implications for quality assurance and outcome measurement.

  12. Coping with Stress in Patients with Inflammatory Bowel Disease and Its Relationship with Disease Activity, Psychological Disorders, and Quality of Life

    Directory of Open Access Journals (Sweden)

    Manizheh Danesh

    2015-09-01

    Full Text Available Background: Inflammatory bowel diseases (IBD are chronic diseases with significant impact on patients’ well-being. The aim of this study was the determination of stress coping strategies in IBD patients and their correlation with disease activity, psychological health, and quality of life (QOL. Methods: This cross-sectional study was conducted on IBD patients referred to a gastroenterology clinic in Isfahan city (Iran. Disease activity, severity of anxiety and depression symptoms, stress coping strategies, and QOL were assessed using standard questionnaires. Coping strategies in IBD patients were compared to an unaffected control group. Results: 80 patients with mean age of 52.9 years (57.5% female and mean disease duration of 6.5 years were studied. Compared to the controls, IBD patients had higher scores in the maladaptive coping styles (evasive and palliative (P < 0.05. Association between coping strategies and disease activity was not significant. Severity of anxiety and depression was directly correlated with the maladaptive strategies (fatalistic and emotional (r = 0.283 to 0.468 and inversely correlated with the adaptive strategies (confrontive, optimistic, and self-reliant (r = -0.320 to -0.534. In addition, QOL was inversely correlated with the maladaptive strategies (fatalistic and emotional (r = -0.278 to -0.327 and directly correlated with the adaptive strategies (confrontive and optimistic (r = 0.262 to 0.355. Conclusion: Patients with IBD use more maladaptive and less adaptive stress coping strategies which are associated with their psychological health and QOL. Larger and prospective studies on the dynamic and interactive network of biopsychosocial factors in IBD patients are required.

  13. Signal transducer and activator of transcription 6 gene G2964A polymorphism and inflammatory bowel disease.

    NARCIS (Netherlands)

    Xia, B; Crusius, J.B.A.; Wu, J; Zwiers, A.; Bodegraven, van A.A.; Pena, A.S.

    2003-01-01

    Signal transducer and activator of transcription 6 (STAT6) is a key transcription factor involved in interleukin 4 (IL-4) and IL-13-mediated Th2 response. The STAT6 gene is located on chromosome 12q13.3-14.1 (IBD2 region) and is therefore a positional and functional candidate gene for study in infla

  14. Inflammatory bowel disease in pediatric patients

    Energy Technology Data Exchange (ETDEWEB)

    Charron, M. [Children`s Hospital of Pittsburgh, Pittsburgh (United States). Dept. of Radiology

    1997-12-01

    Optimal management of chronic idiopathic inflammatory bowel disease requires determination of disease localization and intensity. Scintigraphy with the use of {sup 99m}Tc - HMPAO- White Bloods Cells ({sup 99m}Tc - HMPAO-WBC) is a relatively new noninvasive nuclear medicine procedure. They have evaluated more than 230 children and have found a high correspondence between the disease distribution shown by the {sup 99m}Tc - HMPAO- WBC scan and that shown by endoscopic, radiologic, or surgical methods. Additionally the {sup 99m}Tc - HMPAO-WBC scan has the ability of identifying extra intestinal site of inflammation, such as appendicitis and others. The {sup 99m}Tc - HMPAO-WBC scan is reliable in differentiating Crohn`s disease from ulcerative colitis. Some patients because of unequivocal demonstrable small bowel uptake are reclassified from ulcerative colitis to Crohn`s disease. The medication regimen is frequently altered because of the intensity of uptake displayed by the {sup 99m}Tc - HMPAO-WBC scan. It is a practical and safe study even in an acutely ill patient who may not tolerate endoscopic or radiological study. At their institution, the {sup 99m}Tc - HMPAO-WBC scan is now part of the initial evaluation, and follow-up of patients with inflammatory bowel disease. In conclusion the {sup 99m}Tc - HMPAO-WBC is excellent for the detection, localization and characterization of inflammatory bowel disease in children. Compared with the other methods of investigation this study requires no bowel preparation, is noninvasive and has excellent diagnostic accuracy.

  15. Minimally Invasive Surgery for Inflammatory Bowel Disease

    OpenAIRE

    Holder-Murray, Jennifer; Marsicovetere, Priscilla; Holubar, Stefan D

    2015-01-01

    Abstract: Surgical management of inflammatory bowel disease is a challenging endeavor given infectious and inflammatory complications, such as fistula, and abscess, complex often postoperative anatomy, including adhesive disease from previous open operations. Patients with Crohn's disease and ulcerative colitis also bring to the table the burden of their chronic illness with anemia, malnutrition, and immunosuppression, all common and contributing independently as risk factors for increased su...

  16. Inflammatory bowel disease: Genetic and epidemiologic considerations

    Institute of Scientific and Technical Information of China (English)

    Judy H Cho

    2008-01-01

    Genome-wide association studies have firmly established that many genomic loci contribute to inflammatory bowel disease, especially in Crohn's disease. These studies have newly-established the importance of the interleukin 23 and autophagy pathways in disease pathogenesis. Future challenges include: (1) the establishment of precisely causal alleles, (2) definition of altered functional outcomes of associated and causal alleles and (3) integration of genetic findings with environmental factors.

  17. Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE)

    DEFF Research Database (Denmark)

    Peyrin-Biroulet, L; Sandborn, W; Sands, B E;

    2015-01-01

    OBJECTIVES: The Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) program was initiated by the International Organization for the Study of Inflammatory Bowel Diseases (IOIBD). It examined potential treatment targets for inflammatory bowel disease (IBD) to be used for a "treat-t...

  18. Inflammatory Bowel Disease: School Nurse Management

    Science.gov (United States)

    Kitto, Lisa

    2010-01-01

    Initial symptoms and diagnosis of inflammatory bowel disease (IBD) usually occur between 10 and 20 years of age, although younger cases are reported. The complicated nature of IBD diagnosis and treatment can interfere with physical and emotional development that normally occurs in school-age children and adolescents. The school nurse should be…

  19. Stem cell therapy for inflammatory bowel disease

    NARCIS (Netherlands)

    Duijvestein, Marjolijn

    2012-01-01

    Hematopoietic stem cell transplantation (HSCT) and mesenchymal stromal (MSC) cell therapy are currently under investigation as novel therapies for inflammatory bowel diseases (IBD). Hematopoietic stem cells are thought to repopulate the immune system and reset the immunological response to luminal a

  20. Environmental factors in inflammatory bowel disease

    DEFF Research Database (Denmark)

    Hansen, Tanja Stenbaek; Jess, Tine; Vind, Ida;

    2011-01-01

    The role of environmental factors in development of inflammatory bowel disease (IBD) remains uncertain. The aim of the present study was to assess a number of formerly suggested environmental factors in a case-control study of an unselected and recently diagnosed group of patients with IBD...

  1. Accuracy of 99mTc (V)-Dimercaptosuccinic Acid Scintigraphy and Fecal Calprotectin Compared with Colonoscopy in Localizing Active Lesions in Inflammatory Bowel Disease

    Science.gov (United States)

    Basirat, Vahid; Azizi, Zahra; Javid Anbardan, Sanam; Taghizadeh Asl, Mina; Farbod, Yasaman; Teimouri, Azam; Ebrahimi Daryani, Nasser

    2016-01-01

    INTRODUCTION Due to limitation of colonoscopy in assessing the entire bowel and patients’ intolerance in inflammatory bowel disease (IBD), in the current study, we aimed to prospectively compare the accuracy of 99mTc(V)-dimercaptosuccinic acid (DMSA) and fecal calprotectin with ileocolonoscopy as new methods for localizing inflammations. METHODS Current prospective study conducted between 2012 and 2014 on 30 patients with IBD attending Gastroenterology Clinic of Tehran University of Medical Sciences. Fecal calprotectin and disease activity were measured for all participants and all of them underwent 99mTc (V)-DMSA scintigraphy and colonoscopy. The accuracy of 99mTc (V)-DMSA scintigraphy and calprotectin in localizing bowel lesions were calculated. RESULTS A total of 22 patients with ulcerative colitis (UC) and 8 patients with Crohn’s disease (CD) were evaluated in our study. Sensitivity, positive likelihood ratio (PLR), and positive predictive value (PPV) of scintigraphy and calprotectin over colonoscopy in localization of UC lesions were 86.36%, 0.86%, 100.00% and 90.91%, 0.91, and 100.00%, respectively. Meanwhile, it showed 66.67% sensitivity and 81.25% specificity with PLR=3.56, negative likelihood ratio (NLR)=0.41, PPV=84.21%, and negative predictive value (NPV)= 61.90% in localizing lesions in patients with CD. The calprotectin level had sensitivity, PLR, and PPV of 90.00%, 0.90, and 100.00% in detecting active disease over colonoscopy, respectively. CONCLUSION The 99mTc (V)-DMSA scintigraphy would be an accurate method for detecting active inflammation in follow-up of patients with IBD and assessing response to treatment as a non-invasive and complementary method beside colonoscopy for more accurate diagnosis of CD or UC. PMID:27698971

  2. Novel genetic markers in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Genetic factors play a significant role in determining inflammatory bowel disease (IBD) susceptibility. Epidemiologic data support genetic contribution to the pathogenesis of IBD, which include familial aggregation, twin studies, racial and ethnic differences in disease prevalence. Linkage studies have identified several susceptibility genes contained in different genomic regions named IBD1 to IBD9. Nucleotide oligomerization domain (NOD2) and human leukocyte antigen (HLA) genes are the most extensively studied genetic regions (IBD1 and IBD3 respectively) in IBD. Mutations of the NOD2 gene are associated with Crohn's disease (CD) and several HLA genes are associated with ulcerative colitis (UC) and CD. Toll like receptors (TLRs) have an important role in the innate immune response against infections by mediating recognition of pathogen-associated microbial patterns. Studying single-nucleotide polymorphisms (SNPs) in molecules involved in bacterial recognition seems to be essential to define genetic backgrounds at risk of IBD. Recently, numerous new genes have been identified to be involved in the genetic susceptibility to IBD: NOD1/Caspase-activation recruitment domains 4 (CARD4), Chemokine ligand 20 (CCL20), IL-11, and IL-18 among others. The characterization of these novel genes potentially will lead to the identification of therapeutic agents and clinical assessment of phenotype and prognosis in patients with IBD.

  3. Interaction of obesity and inflammatory bowel disease

    Science.gov (United States)

    Harper, Jason W; Zisman, Timothy L

    2016-01-01

    Inflammatory bowel disease (IBD) is a chronic inflammatory condition of unknown etiology that is thought to result from a combination of genetic, immunologic and environmental factors. The incidence of IBD has been increasing in recent decades, especially in developing and developed nations, and this is hypothesized to be in part related to the change in dietary and lifestyle factors associated with modernization. The prevalence of obesity has risen in parallel with the rise in IBD, suggesting a possible shared environmental link between these two conditions. Studies have shown that obesity impacts disease development and response to therapy in patients with IBD and other autoimmune conditions. The observation that adipose tissue produces pro-inflammatory adipokines provides a potential mechanism for the observed epidemiologic links between obesity and IBD, and this has developed into an active area of investigative inquiry. Additionally, emerging evidence highlights a role for the intestinal microbiota in the development of both obesity and IBD, representing another potential mechanistic connection between the two conditions. In this review we discuss the epidemiology of obesity and IBD, possible pathophysiologic links, and the clinical impact of obesity on IBD disease course and implications for management. PMID:27672284

  4. Current medical therapy of inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Kiron M. Das; Sherif A. Farag

    2000-01-01

    The current established drugs used to treat inflammatory bowel disease include glucocorticoids includingnewer agent budesonide, sulfasalazine and 5-ASA compounds such as Asacol, Pentasa, Dipentum andBalsalazide and immunomodulatory agents such as azathioprine, and 6-mercaptopurine. Additional drugswhich have been found to be useful, particularly in refractory cases of Crohn's disease including fistulizingtype of Crohn's disease, include cyclosporine A, methotrexate, humanized antibody against TNFa(cA2),FK506, IL-10, IL-11 and Probiotics. Various agents, whether used alone or in combination, have to betailored for each patient and none is ideal. Exciting new developments directed against proinflammatorypathways, cytokines, free oxygen radicals and cell surface related immune targets are areas of intense recentinvestigations and many novel therapeutic agents are expected to be available in the near future for medicaltreatment of inflammatory bowel disease.

  5. Role of cytokines in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis (UC), rep- resents a group of chronic disorders characterized by inflammation of the gastrointestinal tract, typically with a relapsing and remitting clinical course. Mucosal mac- rophages play an important role in the mucosal im- mune system, and an increase in the number of newly recruited monocytes and activated macrophages has been noted in the inflamed gut of patients with IBD. Activated macrophages are thought to be major con- tributors to the production of inflammatory cytokines in the gut, and imbalance of cytokines is contributing to the pathogenesis of IBD. The intestinal inflammation in IBD is controlled by a complex interplay of innate and adaptive immune mechanisms. Cytokines play a key role in IBD that determine T cell differentiation of Th1, Th2, T regulatory and newly described Th17 cells. Cytokines levels in time and space orchestrate the development, recurrence and exacerbation of theinflammatory process in IBD. Therefore, several cyto- kine therapies have been developed and tested for the treatment of IBD patients.

  6. Non-invasive investigation of inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    JA Tibble; I Bjarnason

    2001-01-01

    The assessment of inflammatory activity in intestinal disease in man can be done using a variety of different techniques. These range from the use of non - invasive acute phase inflammatory markers measured in plasma such as C reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) (both of which give an indirect assessment of disease activity) to the direct assessment of disease activity by intestinal biopsy performed during endoscopy in association with endoscopic scoring systems. Both radiology and endoscopy are conventional for the diagnosis of inflammatory bowel disease (IBD).However these techniques have severe limitations when it comes to assessing functional components of the disease such as activity and prognosis. Here we briefly review the value of two emerging intestinal function tests. Intestinal permeability, although ideally suited for diagnostic screening for small bowel Crohns disease, appears to give reliable predictive data for imminent relapse of small bowel Crohns disease and it can be used to assess responses to treatment. More significantly it is now clear that single stool assay of neutrophil specific proteins (calprotectin, lactoferrin) give the same quantitative data on intestinal inflammation as the 4 - day faecal excretion of 111lndium labelled white cells. Faecal calprotectin is shown to be increased in over 95% of patients with IBD and correlates with clinical disease activity. It reliably differentiates between patients with IBD and irritable bowel syndrome. More importantly, at a given faecal calprotectin concentration in patients with quiescent IBD,the test has a specificity and sensitivity in excess of 85% in predicting clinical relapse of disease. This suggests that relapse of IBD is closely related to the degree of intestinal inflammation and suggests that targeted treatment at an asymptomatic stage of the disease may be indicated.

  7. Environmental Risk Factors for Inflammatory Bowel Disease

    OpenAIRE

    Natalie A Molodecky; Gilaad G. Kaplan

    2010-01-01

    Inflammatory bowel disease (IBD) is characterized by chronic inflammation of the gastrointestinal tract and is associated with significant morbidity. The etiology of IBD has been extensively studied during the last several decades; however, causative factors in disease pathology are not yet fully understood. IBD is thought to result from the interaction between genetic and environmental factors that influence the normal intestinal commensal flora to trigger an inappropriate mucosal immune res...

  8. Arthritic manifestations of inflammatory bowel disease.

    OpenAIRE

    Suh, C. H.; Lee, C H; Lee, J.; Song, C. H.; Lee, C.W.; Kim, W. H.; S.K. Lee

    1998-01-01

    Inflammatory bowel disease (IBD) is commonly associated with arthritic manifestations. They are divided into three clinical categories; peripheral arthritis, spondylitis, and sacroiliitis. To evaluate the incidence of arthritis associated with IBD in Korea, we retrospectively reviewed one hundred and twenty-nine patients with IBD, 77 with ulcerative colitis (UC) and 52 with Crohn's disease (CD). Arthritis occurred in twenty-two patients (17.1%); 15 with UC(19.6%), 7 with CD (13.5%). Patients ...

  9. Review of Inflammatory Bowel Disease in China

    Directory of Open Access Journals (Sweden)

    Lingna Ye

    2013-01-01

    Full Text Available Inflammatory bowel disease mainly consisting of ulcerative colitis and Crohn’s disease has been rising gradually during the last two decades in China. In this review article, we provide the latest epidemiological trends in incidence, prevalence, and mortality of IBD patients in China and summarize the risk factors and genetic susceptibility of Chinese IBD patients. We also compare these characteristics to those of IBD patients in Western countries.

  10. Environment and the Inflammatory Bowel Diseases

    OpenAIRE

    Frolkis, Alexandra; Dieleman, Levinus A.; Barkema, Herman W.; Panaccione, Remo; Ghosh, Subrata; Richard N Fedorak; Madsen, Karen; Kaplan, Gilaad G; on behalf of the Alberta IBD Consortium

    2013-01-01

    Inflammatory bowel diseases (IBD), which consists of Crohn disease and ulcerative colitis, are chronic inflammatory conditions of the gas-trointestinal tract. In genetically susceptible individuals, the interaction between environmental factors and normal intestinal commensal flora is believed to lead to an inappropriate immune response that results in chronic inflammation. The incidence of IBD have increased in the past century in developed and developing countries. The purpose of the presen...

  11. Environment and the inflammatory bowel diseases

    OpenAIRE

    Frolkis, Alexandra; Dieleman, Levinus A.; Barkema, Herman W.; Panaccione, Remo; Ghosh, Subrata; Richard N Fedorak; Madsen, Karen; Kaplan, Gilaad G

    2013-01-01

    Inflammatory bowel diseases (IBD), which consists of Crohn disease and ulcerative colitis, are chronic inflammatory conditions of the gas-trointestinal tract. In genetically susceptible individuals, the interaction between environmental factors and normal intestinal commensal flora is believed to lead to an inappropriate immune response that results in chronic inflammation. The incidence of IBD have increased in the past century in developed and developing countries. The purpose of the presen...

  12. Inflammatory bowel disease: potential therapeutic strategies

    DEFF Research Database (Denmark)

    Nielsen, O H; Vainer, B; Bregenholt, S;

    1997-01-01

    This review deals with potential and possibly primary therapeutics that, through insight into the inflammatory cascade, result in more rational treatment principles replacing the classical therapy of inflammatory bowel disease (IBD), i.e. Crohn's disease (CD) and ulcerative colitis (UC). These new...... therapies might be useful for IBD patients, especially since the 'classical therapy' with agents like glucocorticoids, sulfasalazine, mesalazine, azathioprine, 6-mercaptopurine, cyclosporin and methotrexate is often only moderately effective and may have important side-effects. Controlled trials...

  13. Leukocyte migration in experimental inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    E. P. Van Rees

    1997-01-01

    Full Text Available Emigration of leukocytes from the circulation into tissue by transendothelial migration, is mediated subsequently by adhesion molecules such as selectins, chemokines and integrins. This multistep paradigm, with multiple molecular choices at each step, provides a diversity in signals. The influx of neutrophils, monocytes and lymphocytes into inflamed tissue is important in the pathogenesis of chronic inflammatory bowel disease. The importance of each of these groups of adhesion molecules in chronic inflammatory bowel disease, either in human disease or in animal models, will be discussed below. Furthermore, the possibilities of blocking these different steps in the process of leukocyte extravasation in an attempt to prevent further tissue damage, will be taken into account.

  14. Inflammatory bowel diseases and reproductive health.

    Science.gov (United States)

    Kokoszko-Bilska, Agnieszka; Sobkiewicz, Slawomir; Fichna, Jakub

    2016-08-01

    Inflammatory bowel diseases (IBD) constitute a group of chronic intestinal diseases, including Crohn's disease and ulcerative colitis, which typically involve patients of reproductive age and may influence several features of human reproduction. There are many concerns regarding the interactions between the course of IBD, applied treatment (pharmacological or surgical), and fertility, reproductive outcomes, and also neonatal outcomes. To review the literature describing fertility in IBD patients (separately for female and male), and possible infertility treatment in this group of patients, a PubMed search for English only publications (articles and/or abstracts) was conducted. Initially, the titles of publications and their abstracts were screened, and the most appropriate articles were selected and reviewed. Overall, in patients with quiescent IBD, fertility is almost identical to the general population, but particular subgroups of patients (with active disease, on pharmacological treatment, and after pelvic or abdominal surgery) may be affected by reduced fertility. Additionally, patients with IBD have fewer children than the general population, mainly as a result of voluntary childlessness. The main objectives for successful reproductive outcomes in IBD patients are proper guidance and also optimal treatment for achieving and maintaining disease remission. Recently, the European Evidence-Based Consensus on Reproduction and Pregnancy in IBD (the European Crohn's and Colitis Organization Guidelines) has been established to optimize preconceptional counseling and to promote an appropriate clinical management for patients planning to conceive. However, further studies are needed regarding the preservation of fertility in IBD patients and introduction of optimal infertility treatment in this group of patients. PMID:27117378

  15. Noninvasive Testing for Mucosal Inflammation in Inflammatory Bowel Disease.

    Science.gov (United States)

    Iborra, Marisa; Beltrán, Belén; Nos, Pilar

    2016-10-01

    Biomarkers have gained increasing attention for the diagnosis and follow-up of inflammatory bowel disease (IBD). Endoscopy remains the gold standard for assessing disease activity. Biomarkers are rapid, inexpensive, and noninvasive, and can be used in different stages of the disease with high sensitivity and specificity. Calprotectin and tests for C-reactive protein are used to assess the disease activity, predict relapse, and monitor treatment response. New noninvasive tests are being studied. This review discusses current evidence for these surrogate markers, their potential clinical applications, and limitations in disease management. We highlight recent advances in IBD biomarkers and future uses.

  16. Infertility in men with inflammatory bowel disease.

    Science.gov (United States)

    Shin, Takeshi; Okada, Hiroshi

    2016-08-01

    Inflammatory bowel disease (IBD) predominantly affects young adults. Fertility-related issues are therefore important in the management of patients with IBD. However, relatively modest attention has been paid to reproductive issues faced by men with IBD. To investigate the effects of IBD and its treatment on male fertility, we reviewed the current literature using a systematic search for published studies. A PubMed search were performed using the main search terms "IBD AND male infertility", "Crohn's disease AND male infertility", "ulcerative colitis AND male infertility". References in review articles were used if relevant. We noted that active inflammation, poor nutrition, alcohol use, smoking, medications, and surgery may cause infertility in men with IBD. In surgery such as proctocolectomy with ileal pouch-anal anastomosis, rectal incision seems to be associated with sexual dysfunction. Of the medications used for IBD, sulfasalazine reversibly reduces male fertility. No other medications appear to affect male fertility significantly, although small studies suggested some adverse effects. There are limited data on the effects of drugs for IBD on male fertility and pregnancy outcomes; however, patients should be informed of the possible effects of paternal drug exposure. This review provides information on fertility-related issues in men with IBD and discusses treatment options. PMID:27602237

  17. Faecal calprotectin: Management in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    José; Manuel; Benítez; Valle; García-Sánchez

    2015-01-01

    Inflammatory bowel disease(IBD) is a chronic and relapsing disorder which leads to an inflammation of the gastrointestinal tract. A tailored therapy to achieve mucosal healing with the less adverse events has become a key issue in the management of IBD. In the past, the clinical remission was the most important factor to consider for adapting diagnostic procedures and therapeutic strategies. However, there is no a good correlation between symptoms and intestinal lesions, so currently the goals of treatment are to achieve not only the control of symptoms, but deep remission, which is related with a favourable prognosis. Thus, the determination of biological markers or biomarkers of intestinal inflammation play a crucial role. Many biomarkers have been extensively evaluated in IBD showing significant correlation with endoscopic lesions, risk of recurrence and response to treatment. One of the most important markers is faecal calprotectin(FC). Despite calprotectin limitations, this biomarker represents a reliable and noninvasive alternative to reduce the need for endoscopic procedures. FC has demonstrated its performance for regular monitoring of IBD patients, not only to the diagnosis for discriminating IBD from non-IBD diagnosis, but for assessing disease activity, relapse prediction and response to therapy. Although, FC provides better results than other biomarkers such as C-reactive protein and erythrocyte sedimentation rate, these surrogate markers of intestinal inflammation should not be used isolation but in combination with other clinical, endoscopic, radiological or/and histological parameters enabling a comprehensive assessment of IBD patients.

  18. Infertility in men with inflammatory bowel disease

    Science.gov (United States)

    Shin, Takeshi; Okada, Hiroshi

    2016-01-01

    Inflammatory bowel disease (IBD) predominantly affects young adults. Fertility-related issues are therefore important in the management of patients with IBD. However, relatively modest attention has been paid to reproductive issues faced by men with IBD. To investigate the effects of IBD and its treatment on male fertility, we reviewed the current literature using a systematic search for published studies. A PubMed search were performed using the main search terms “IBD AND male infertility”, “Crohn’s disease AND male infertility”, “ulcerative colitis AND male infertility”. References in review articles were used if relevant. We noted that active inflammation, poor nutrition, alcohol use, smoking, medications, and surgery may cause infertility in men with IBD. In surgery such as proctocolectomy with ileal pouch-anal anastomosis, rectal incision seems to be associated with sexual dysfunction. Of the medications used for IBD, sulfasalazine reversibly reduces male fertility. No other medications appear to affect male fertility significantly, although small studies suggested some adverse effects. There are limited data on the effects of drugs for IBD on male fertility and pregnancy outcomes; however, patients should be informed of the possible effects of paternal drug exposure. This review provides information on fertility-related issues in men with IBD and discusses treatment options. PMID:27602237

  19. Factors affecting poor nutritional status after small bowel resection in patients with Crohn disease.

    Science.gov (United States)

    Jang, Ki Ung; Yu, Chang Sik; Lim, Seok-Byung; Park, In Ja; Yoon, Yong Sik; Kim, Chan Wook; Lee, Jong Lyul; Yang, Suk-Kyun; Ye, Byong Duk; Kim, Jin Cheon

    2016-07-01

    In Crohn disease, bowel-preserving surgery is necessary to prevent short bowel syndrome due to repeated operations. This study aimed to determine the remnant small bowel length cut-off and to evaluate the clinical factors related to nutritional status after small bowel resection in Crohn disease.We included 394 patients (69.3% male) who underwent small bowel resection for Crohn disease between 1991 and 2012. Patients who were classified as underweight (body mass index bowel length cut-offs were determined using receiver operating characteristic curves. Variables associated with poor nutritional status were assessed retrospectively using Student t tests, chi-squared tests, Fisher exact tests, and logistic regression analyses.The mean follow-up period was 52.9 months and the mean patient ages at the time of the last bowel surgery and last follow-up were 31.2 and 35.7 years, respectively. The mean remnant small bowel length was 331.8 cm. Forty-three patients (10.9%) underwent ileostomy, 309 (78.4%) underwent combined small bowel and colon resection, 111 (28.2%) had currently active disease, and 105 (26.6%) underwent at least 2 operations for recurrent disease. The mean body mass index and modified nutritional risk index were 20.6 and 100.8, respectively. The independent factors affecting underweight status were remnant small bowel length ≤240 cm (odds ratio: 4.84, P bowel length ≤230 cm (odds ratio: 2.84, P = 0.012), presence of ileostomy (odds ratio: 3.36, P = 0.025), and currently active disease (odds ratio: 4.90, P bowel length ≤230 cm are risk factors affecting the poor nutritional status of patients with Crohn disease after small bowel resection. PMID:27472702

  20. Pancreatic disorders in inflammatory bowel disease

    Science.gov (United States)

    Antonini, Filippo; Pezzilli, Raffaele; Angelelli, Lucia; Macarri, Giampiero

    2016-01-01

    An increased incidence of pancreatic disorders either acute pancreatitis or chronic pancreatitis has been recorded in patients with inflammatory bowel disease (IBD) compared to the general population. Although most of the pancreatitis in patients with IBD seem to be related to biliary lithiasis or drug induced, in some cases pancreatitis were defined as idiopathic, suggesting a direct pancreatic damage in IBD. Pancreatitis and IBD may have similar presentation therefore a pancreatic disease could not be recognized in patients with Crohn’s disease and ulcerative colitis. This review will discuss the most common pancreatic diseases seen in patients with IBD. PMID:27574565

  1. Neurological Manifestations In Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    youssef HNACH

    2015-06-01

    Full Text Available IntroductionThe purpose of this retrospective study was to report neurological manifestations noted in patients who were monitored for inflammatory bowel disease, in order to document the pathophysiological, clinical, progressive, and therapeutic characteristics of this entity.Material and methodsWe conducted a retrospective study on patients monitored -in the gastroenterology service in Ibn Sina Hospital in Rabat, Morocco- for inflammatory bowel disease from 1992 till 2013 and who developed neurological manifestations during its course. Patients with iatrogenic complications were excluded, as well as patients with cerebrovascular risk factors.ResultsThere were 6 patients, 4 of whom have developed peripheral manifestations. Electromyography enabled the diagnosis to be made and the outcome was favorable with disappearance of clinical manifestations and normalization of the electromyography.The other 2 patients, monitored for Crohn’s disease, developed ischemic stroke. Cerebral computed tomography angiography provided positive and topographic diagnosis. Two patients were admitted to specialized facilities.ConclusionNeurological manifestations in inflammatory bowel disease are rarely reported.  Peripheral neuropathies and stroke remain the most common manifestations. The mechanisms of these manifestations are not clearly defined yet. Currently, we hypothesize the interaction of immune mediators.

  2. Liver Disorders in Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Victor Uko

    2012-01-01

    Full Text Available Disorders of the hepatobiliary system are relatively common extraintestinal manifestations of inflammatory bowel disease (IBD. These disorders are sometimes due to a shared pathogenesis with IBD as seen in primary sclerosing cholangitis (PSC and small-duct primary sclerosing cholangitis (small-duct PSC. There are also hepatobiliary manifestations such as cholelithiasis and portal vein thrombosis that occur due to the effects of chronic inflammation and the severity of bowel disease. Lastly, medications used in IBD such as sulfasalazine, thiopurines, and methotrexate can adversely affect the liver. It is important to be cognizant of these disorders as some do have serious long-term consequences. The management of these disorders often requires the expertise of multidisciplinary teams to achieve the best outcomes.

  3. Biologic therapy for inflammatory bowel disease.

    Science.gov (United States)

    Ardizzone, Sandro; Bianchi Porro, Gabriele

    2005-01-01

    Despite all of the advances in our understanding of the pathophysiology of inflammatory bowel disease (IBD), we still do not know its cause. Some of the most recently available data are discussed in this review; however, this field is changing rapidly and it is increasingly becoming accepted that immunogenetics play an important role in the predisposition, modulation and perpetuation of IBD. The role of intestinal milieu, and enteric flora in particular, appears to be of greater significance than previously thought. This complex interplay of genetic, microbial and environmental factors culminates in a sustained activation of the mucosal immune and non-immune response, probably facilitated by defects in the intestinal epithelial barrier and mucosal immune system, resulting in active inflammation and tissue destruction. Under normal situations, the intestinal mucosa is in a state of 'controlled' inflammation regulated by a delicate balance of proinflammatory (tumour necrosis factor [TNF]-alpha, interferon [IFN]-gamma, interleukin [IL]-1, IL-6, IL-12) and anti-inflammatory cytokines (IL-4, IL-10, IL-11). The mucosal immune system is the central effector of intestinal inflammation and injury, with cytokines playing a central role in modulating inflammation. Cytokines may, therefore, be a logical target for IBD therapy using specific cytokine inhibitors. Biotechnology agents targeted against TNF, leukocyte adhesion, T-helper cell (T(h))-1 polarisation, T-cell activation or nuclear factor (NF)-kappaB, and other miscellaneous therapies are being evaluated as potential therapies for IBD. In this context, infliximab is currently the only biologic agent approved for the treatment of inflammatory and fistulising Crohn's disease. Other anti-TNF biologic agents have emerged, including CDP 571, certolizumab pegol (CDP 870), etanercept, onercept and adalimumab. However, ongoing research continues to generate new biologic agents targeted at specific pathogenic mechanisms involved

  4. Recent advances in small bowel diseases: PartⅡ

    Institute of Scientific and Technical Information of China (English)

    Alan BR Thomson; Angeli Chopra; Michael Tom Clandinin; Hugh Freeman

    2012-01-01

    As is the case in all areas of gastroenterology and hepatology,in 2009 and 2010 there were many advances in our knowledge and understanding of small intestinal diseases.Over 1000 publications were reviewed,and the important advances in basic science as well as clinical applications were considered.In Part Ⅱ we review six topics:absorption,short bowel syndrome,smooth muscle function and intestinal motility,tumors,diagnostic imaging,and cystic fibrosis.

  5. [Chronic inflammatory bowel diseases in cats].

    Science.gov (United States)

    Ghermai, A K

    1989-01-01

    The aetiology of chronic idiopathic intestinal inflammation is unknown. It is characterized by a diffuse infiltration with inflammatory cells into the intestinal mucosa and sometimes submucosa. Cats with chronic intermittent vomiting and diarrhoea, later on accompanied by anorexia and weight loss, are presented. Definitive diagnosis can be obtained by intestinal biopsy only. An immune pathogenesis is suspected, which is supported by the fact, that chronic inflammatory bowel disease responds to steroid therapy.

  6. Inflammatory bowel disease-associated spondyloarthropathies

    Institute of Scientific and Technical Information of China (English)

    Walter Fries

    2009-01-01

    This issue presents a symposium held in Messina talking about inflammatory bowel disease (IBD) and associated spondyloarthropathies. The topic covers epidemiology and clinical manifestations of IBD-related arthropathies,common genetic and immunologic features, combined therapies for gut and joint inflammation, and future biologic therapies etc. I believe this series of articles will deeply facilitate understanding of and the approach to IBD and associated arthropathies.

  7. Nutritional concerns in pediatric inflammatory bowel disease

    Science.gov (United States)

    2016-01-01

    The pathophysiology and fundamental etiologic mechanism of inflammatory bowel disease (IBD) is not well understood even though therapeutic regimens and drugs are rapidly evolutionary. IBD has complicated connections with genetic, immunologic, gut microbial, environmental, and nutritional factors. It is not clearly well known to the physicians how to feed, what nutrients are more helpful, and what food to be avoided. This review discusses the issues of growth and important nutritional concerns in the management of IBD in childhood. PMID:27462352

  8. Immunogenetic Susceptibilities in Inflammatory Bowel Disease

    OpenAIRE

    Rotter, Jerome I

    1990-01-01

    It is now clear that the major identified risk factor for the inflammatory bowel diseases (IBDs) is a positive family history. Furthermore, the available data in spouses and twins indicate that the genetic susceptibility is due in large measure to shared familial predisposition. This emphasizes the importance of identifying the actual familial susceptibilities. Given the data for immunopathogenetic etiologies in the genesis of IBD, the logical candidate genes are those that involve the immune...

  9. Biologic Concentration Testing in Inflammatory Bowel Disease

    OpenAIRE

    Vaughn, Byron P; Sandborn, William J; Cheifetz, Adam S.

    2015-01-01

    Abstract: Anti-TNF medications have revolutionized the care of patients with inflammatory bowel disease. However, despite an initial robust effect, loss of response is common and long-term results are disappointing. Much of this lack of durability may be due to inadequate dose optimization, and recent studies suggest a correlation between serum drug concentrations and clinical outcomes. Currently, in clinical practice, measurement of drug concentrations and antibodies to drug are typically pe...

  10. Use of biosimilars in inflammatory bowel disease: Statements of the Italian Group for Inflammatory Bowel Disease.

    Science.gov (United States)

    Annese, Vito; Vecchi, Maurizio

    2014-11-01

    The introduction of biological therapies, particularly anti-TNFα agents, has revolutionized the management of inflammatory bowel disease in those cases which are refractory to conventional treatment; however these drugs are not risk-free and their use has substantially increased the cost of treatment. As marketing protection expires for original, first-generation biopharmaceuticals, lower-cost "copies" of these drugs produced by competitor companies-referred to as biosimilars-are already entering the market. In September 2013, the European Medicines Agency approved two infliximab biosimilars for treatment of adult and paediatric inflammatory bowel disease patients, a decision based largely on efficacy and safety data generated in studies of patients with ankylosing spondylitis and rheumatoid arthritis. For many clinicians, extrapolation practices and the general question of interchangeability between biosimilars and reference biologics are cause for concern. In the present paper, the Italian Group for inflammatory bowel disease presents its statements on these issues, with emphasis on the peculiar clinical characteristics of inflammatory bowel disease and the importance of providing physicians and patients with adequate information and guarantees on the safety and efficacy of these new drugs in the specific setting of inflammatory bowel disease.

  11. Use of biosimilars in inflammatory bowel disease: Statements of the Italian Group for Inflammatory Bowel Disease.

    Science.gov (United States)

    Annese, Vito; Vecchi, Maurizio

    2014-11-01

    The introduction of biological therapies, particularly anti-TNFα agents, has revolutionized the management of inflammatory bowel disease in those cases which are refractory to conventional treatment; however these drugs are not risk-free and their use has substantially increased the cost of treatment. As marketing protection expires for original, first-generation biopharmaceuticals, lower-cost "copies" of these drugs produced by competitor companies-referred to as biosimilars-are already entering the market. In September 2013, the European Medicines Agency approved two infliximab biosimilars for treatment of adult and paediatric inflammatory bowel disease patients, a decision based largely on efficacy and safety data generated in studies of patients with ankylosing spondylitis and rheumatoid arthritis. For many clinicians, extrapolation practices and the general question of interchangeability between biosimilars and reference biologics are cause for concern. In the present paper, the Italian Group for inflammatory bowel disease presents its statements on these issues, with emphasis on the peculiar clinical characteristics of inflammatory bowel disease and the importance of providing physicians and patients with adequate information and guarantees on the safety and efficacy of these new drugs in the specific setting of inflammatory bowel disease. PMID:25139379

  12. Immunogenetic phenotypes in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Marla C Dubinsky; Kent Taylor; Stephan R Targan; Jerome I Rotter

    2006-01-01

    The currently accepted etiopathogenic hypothesis suggests that the chronic intestinal inflammation and related systemic manifestations characteristic of inflammatory bowel disease (IBD) are due to an overly aggressive or pathologic immune response to resident luminal bacterial constituents. Predisposing factors are genetic dysregulation of mucosal immune responses and/or barrier function, with onset triggered by environmental stimuli. These factors and their interactions may also be important determinants of disease phenotype and disease progression. The emergence of immunogenetic phenotypes lends support to the proposed hypothesis that susceptibility genes regulate distinct immune processes, driven by luminal antigens, expressed as specific immune phenotypes which in turn influence clinical phenotypes in IBD patient

  13. Colonic ornithine decarboxylase in inflammatory bowel disease: ileorectal activity gradient, guanosine triphosphate stimulation, and association with epithelial regeneration but not the degree of inflammation and clinical features.

    Science.gov (United States)

    Allgayer, Hubert; Roisch, Ulla; Zehnter, Elmar; Ziegenhagen, Dieter J; Dienes, Hans P; Kruis, Wolfgang

    2007-01-01

    The role of colonic mucosal ornithine decarboxylase (ODC) in inflammatory bowel disease (IBD) remains controversial. This study assessed mucosal ODC activity in IBD patients segment by segment with regard to patient characteristics, disease activity/duration, medication, degree of mucosal inflammation, and presence/absence of epithelial regeneration and guanosine triphosphate (GTP) stimulation. Mucosal ODC activity was determined in biopsy specimens from the terminal ileum, cecum/ascending, transverse, and descending colon, and the sigmoid/rectum of 35 patients with IBD (18 with Crohn's disease, 17 with ulcerative colitis) and 29 controls, using the amount of 14CO2 liberated from (carboxyl-14C)ornithine hydrochloride. GTP-stimulatable activity was expressed as the ratio of ODC activity in the presence and absence of GTP (70 micromol/L). Mucosal inflammation was assessed endoscopically/microscopically with previously described criteria. Presence/absence of mucosal regeneration also was determined by predefined criteria. Mucosal ODC-activity did not significantly differ in IBD patients and controls. There was a 4.4-fold activity gradient from the ileum to the rectum. Mucosal ODC activity was significantly higher in areas with epithelial regeneration compared to those without regeneration, and was stimulated by GTP by a factor of 1.42 in Crohn's disease and 1.19 in ulcerative colitis patients compared to controls (p < 0.004). On the other hand, there was no significant association/relationship of mucosal ODC activity with disease activity/duration and the endoscopic/histologic degree of mucosal inflammation. The observation of unchanged mucosal ODC activity in patients with IBD and the absence of a significant relationship with clinical and endoscopic/histologic disease characteristics speaks against a major role of ODC in IBD as a major disease marker. The role of the ileorectal gradient, the enhanced activity in areas with epithelial regeneration, and the GTP

  14. Microbiome, Metabolome and Inflammatory Bowel Disease.

    Science.gov (United States)

    Ahmed, Ishfaq; Roy, Badal C; Khan, Salman A; Septer, Seth; Umar, Shahid

    2016-01-01

    Inflammatory Bowel Disease (IBD) is a multifactorial disorder that conceptually occurs as a result of altered immune responses to commensal and/or pathogenic gut microbes in individuals most susceptible to the disease. During Crohn's Disease (CD) or Ulcerative Colitis (UC), two components of the human IBD, distinct stages define the disease onset, severity, progression and remission. Epigenetic, environmental (microbiome, metabolome) and nutritional factors are important in IBD pathogenesis. While the dysbiotic microbiota has been proposed to play a role in disease pathogenesis, the data on IBD and diet are still less convincing. Nonetheless, studies are ongoing to examine the effect of pre/probiotics and/or FODMAP reduced diets on both the gut microbiome and its metabolome in an effort to define the healthy diet in patients with IBD. Knowledge of a unique metabolomic fingerprint in IBD could be useful for diagnosis, treatment and detection of disease pathogenesis. PMID:27681914

  15. Microbiome, Metabolome and Inflammatory Bowel Disease

    Science.gov (United States)

    Ahmed, Ishfaq; Roy, Badal C.; Khan, Salman A.; Septer, Seth; Umar, Shahid

    2016-01-01

    Inflammatory Bowel Disease (IBD) is a multifactorial disorder that conceptually occurs as a result of altered immune responses to commensal and/or pathogenic gut microbes in individuals most susceptible to the disease. During Crohn’s Disease (CD) or Ulcerative Colitis (UC), two components of the human IBD, distinct stages define the disease onset, severity, progression and remission. Epigenetic, environmental (microbiome, metabolome) and nutritional factors are important in IBD pathogenesis. While the dysbiotic microbiota has been proposed to play a role in disease pathogenesis, the data on IBD and diet are still less convincing. Nonetheless, studies are ongoing to examine the effect of pre/probiotics and/or FODMAP reduced diets on both the gut microbiome and its metabolome in an effort to define the healthy diet in patients with IBD. Knowledge of a unique metabolomic fingerprint in IBD could be useful for diagnosis, treatment and detection of disease pathogenesis. PMID:27681914

  16. Microbiome, Metabolome and Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Ishfaq Ahmed

    2016-06-01

    Full Text Available Inflammatory Bowel Disease (IBD is a multifactorial disorder that conceptually occurs as a result of altered immune responses to commensal and/or pathogenic gut microbes in individuals most susceptible to the disease. During Crohn’s Disease (CD or Ulcerative Colitis (UC, two components of the human IBD, distinct stages define the disease onset, severity, progression and remission. Epigenetic, environmental (microbiome, metabolome and nutritional factors are important in IBD pathogenesis. While the dysbiotic microbiota has been proposed to play a role in disease pathogenesis, the data on IBD and diet are still less convincing. Nonetheless, studies are ongoing to examine the effect of pre/probiotics and/or FODMAP reduced diets on both the gut microbiome and its metabolome in an effort to define the healthy diet in patients with IBD. Knowledge of a unique metabolomic fingerprint in IBD could be useful for diagnosis, treatment and detection of disease pathogenesis.

  17. Intestinal protease-activated receptor-2 and fecal serine protease activity are increased in canine inflammatory bowel disease and may contribute to intestinal cytokine expression.

    Science.gov (United States)

    Maeda, Shingo; Ohno, Koichi; Uchida, Kazuyuki; Igarashi, Hirotaka; Goto-Koshino, Yuko; Fujino, Yasuhito; Tsujimoto, Hajime

    2014-08-01

    Serine proteases elicit cellular responses via protease-activated receptor-2 (PAR-2) which is known to regulate inflammation and the immune response. Although the gastrointestinal tract is exposed to large amounts of proteolytic enzymes, the role of PAR-2 in canine inflammatory bowel disease (IBD) remains unclear. The objective of this study was to investigate the effects of PAR-2 activation on inflammatory cytokine/chemokine gene expression in canine intestine and the expression of intestinal PAR-2 and fecal serine protease activity in dogs with IBD. Duodenal biopsies from healthy dogs were cultured and treated ex vivo with trypsin or PAR-2 agonist peptide, and inflammatory cytokine/chemokine gene expression in the tissues was then quantified by real-time PCR. PAR-2 mRNA and protein expression levels in the duodenal mucosa were examined by real-time PCR and immunohistochemistry, respectively. Fecal serine protease activity was determined by azocasein assay. In ex vivo-cultured duodenum, trypsin and PAR-2 agonist peptide induced significant up-regulation of mRNA expression levels of interleukin-1 β (IL-1β), IL-8, mucosae-associated epithelial chemokine (MEC) and fractalkine, and this up-regulation was inhibited by a serine protease inhibitor. Duodenal PAR-2 mRNA and protein expression levels were higher in dogs with IBD than in healthy control dogs. Fecal serine protease activity was significantly elevated in dogs with IBD, and the level of activity correlated positively with the clinical severity score. These results suggest that PAR-2 may contribute to the pathogenesis of canine IBD by inducing expression of inflammatory mediators in response to luminal serine proteases.

  18. The epidemiology of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Burisch, Johan; Munkholm, Pia

    2015-01-01

    BACKGROUND AND AIMS: The inflammatory bowel diseases (IBD), Crohn's disease (CD) and ulcerative colitis (UC), are chronic relapsing disorders of unknown aetiology. The aim of this review is to present the latest epidemiology data on occurrence, disease course, risk for surgery, as well as mortality...... overall in Europe from 6.0 per 100,000 person-years in UC and 1.0 per 100,000 person-years in CD in 1962 to 9.8 per 100,000 person-years and 6.3 per 100,000 person-years in 2010, respectively. The highest incidence of IBD is found on the Faroe Islands. Overall, surgery rates have been declining over...... and cancer risks. MATERIAL AND METHODS: Gold standard epidemiology data on the disease course and prognosis of patients with inflammatory bowel disease (IBD) are based on unselected population-based cohort studies. RESULTS: The incidence of ulcerative colitis (UC) and Crohn's disease (CD) has increased...

  19. Inflammatory Bowel Disease: Changing Associations to Mechanisms.

    Science.gov (United States)

    Click, Benjamin; Whitcomb, David C

    2016-01-01

    Managing the health of individual patients suffering from complex disorders is a challenge and is costly. Inflammatory bowel disease (IBD) is a prototypic complex disorder of the small and large intestines. Susceptibility is complex, severity is variable, and response to treatment is unpredictable. Di Narzo et al. (Clin Transl Gastroenterol 7: e177; doi:10.1038/ctg.2016.34) bring diverse teams of physicians and scientists together to break down the mechanisms of IBD by linking pathogenic genetic variants with altered gene expression in specific cell types causing IBD. Framing new findings in the context of other complex diseases provides a roadmap for predictive medicine. PMID:27607898

  20. New serological biomarkers of inflammatory bowel disease.

    Science.gov (United States)

    Li, Xuhang; Conklin, Laurie; Alex, Philip

    2008-09-01

    Serological biomarkers in inflammatory bowel disease (IBD) are a rapidly expanding list of non-invasive tests for objective assessments of disease activity, early diagnosis, prognosis evaluation and surveillance. This review summarizes both old and new biomarkers in IBD, but focuses on the development and characterization of new serological biomarkers (identified since 2007). These include five new anti-glycan antibodies, anti-chitobioside IgA (ACCA), anti-laminaribioside IgG (ALCA), anti-manobioside IgG (AMCA), and antibodies against chemically synthesized (Sigma) two major oligomannose epitopes, Man alpha-1,3 Man alpha-1,2 Man (SigmaMan3) and Man alpha-1,3 Man alpha-1,2 Man alpha-1,2 Man (SigmaMan4). These new biomarkers serve as valuable complementary tools to existing biomarkers not only in differentiating Crohn's disease (CD), ulcerative colitis (UC), normal and other non-IBD gut diseases, but also in predicting disease involvement (ileum vs colon), IBD risk (as subclinical biomarkers), and disease course (risk of complication and surgery). Interestingly, the prevalence of the antiglycan antibodies, including anti-Saccharomyces cerevisiae antibodies (ASCA), ALCA and AMCA, was found to be associated with single nucleotide polymorphisms (SNPs) of IBD susceptible genes such as NOD2/CARD15, NOD1/CARD4, toll-like receptors (TLR) 2 and 4, and beta-defensin-1. Furthermore, a gene dosage effect was observed: anti-glycan positivity became more frequent as the number of NOD2/CARD15 SNPS increased. Other new serum/plasma IBD biomarkers reviewed include ubiquitination factor E4A (UBE4A), CXCL16 (a chemokine), resistin, and apolipoprotein A-IV. This review also discusses the most recent studies in IBD biomarker discovery by the application of new technologies such as proteomics, fourier transform near-infrared spectroscopy, and multiplex enzyme-linked immunosorbent assay (ELISA)'s (with an emphasis on cytokine/chemokine profiling). Finally, the prospects of developing more

  1. New serological biomarkers of inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Xuhang Li; Laurie Conldin; Philip Alex

    2008-01-01

    Serological biomarkers in inflammatory bowel disease(IBD)are a rapidty expanding list of non-invasive tests for objective assessments of disease activity,early diagnosis,prognosis evaluation and surveillance.This review summarizes both old and new biomarkers in IBD,but focuses on the development and characterization of new serological iomarkers(identified since 2007).These include five new anti-glycan antibodies,anti-chitobioside IgA(ACCA),anti-laminaribioside IgG(ALCA),anti-manobioside IgG(AMCA),and antibodies against chemically synthesized(∑)two major oligomannose epitopes,Man α-1,3 Man α-1,2 Man(∑Man3)and Man α-1,3 Man α-1,2 Man α-1,2 Man(∑Man4).These new biomarkers erve as valuable complementary tools to existing biomarkers not only in differentiating Crohn's disease(CD),ulcerative colitis(UC),normal and other non-IBD gut diseases,but also in predicting disease involvement(ileum vs colon),IBD risk(as subclinical biomarkers),and disease course(risk of complication and surgery).Interestingly,the prevalence of he antiglycan antibodies,including anti-Saccharomyces cerevisiae antibodies(ASCA),ALCA and AMCA,was found to be associated with single nucleotide polymorphisms(SNPs)of IBD susceptible genes such as NOD2/CARDl5,NOD1/CARD4,toll-like receptors(TLR)2 and 4,and β-defensin-1.Further more,a gene dosage effect was observed:anti-glycan positivity became more requent as the number of NOD2/CARDl5 SNPS increased.Other new serum/plasma IBD biomarkers reviewed include ubiquitination factor E4A(UBE4A),CXCL16(a chemokine),resistin,and apolipoprotein A-Ⅳ.This review also discusses the most recent studies in IBD biomarker discovery by the application of new technologies such as proteomics,fourier transform near-infrared spectroscopy,and multiplex enzyme-linked immunosorbent assay(ELISA)'s(with an emphasis on cytokine/chemokine profiling).Finally,the prospects of developing more clinically useful novel diagnostic algorithms by incorporating new technologies in

  2. Inflammatory bowel disease in Turkish children

    Institute of Scientific and Technical Information of China (English)

    Murat Cakir; Fatih Unal; Gonul Dinler; Masallah Baran; Hasan Ali Yuksekkaya; Gokhan Tumgor; Erhun Kasirga; Ayhan Gazi Kalayci; Sema Aydogdu

    2015-01-01

    Background: This study was undertaken to evaluate demographics, clinical manifestations, laboratoryfi ndings and outcomes of children with inflammatory bowel disease (IBD) in Turkey. Methods: We analyzed the medical records of 127 children diagnosed with IBD (under 18 years old) between January 2004 and January 2012 in 8 pediatric gastroenterology centers. Results: Of the 127 patients, 90 (70.9%) suffered from ulcerative colitis (UC), 29 (22.8%) from Crohn's disease (CD), and 8 (6.3%) from IBD unclassified. The mean age of the 127 patients was 11.6±4.1 years, and 11.8% of the patients were below 5 years old. Of the patients, 49.6% were male, and males were more predominant in patients with CD than in those with UC (72.4%vs. 42.2%,P=0.008; a male/female ratio of 2.62 in CD, P=0.0016). Approximately one fifth of the patients had extra-intestinal manifestations and 13.3% of the patients had associated diseases. Extraintestinal manifestations and associated diseases were more common in early onset disease [P=0.017, odds ratio (OR)=4.02;P=0.03, OR=4.1]. Of the patients, 15% had normal laboratory parameters including anemia, high platelet count, hypoalbuminemia, hypoferritinemia, and high sedimentation rate. Area under receiver operation characteristics was used to predict pancolitis in patients with UC. The values of C-reactive protein, sedimentation rate and pediatric ulcerative colitis activity were 0.61 (P=0.06), 0.66 (P=0.01) and 0.76 (P=0.0001), respectively. Four (4.4%) patients with UC underwent colectomy, andfi nally two (1.5%, 95% confidence interval: 0-3.7%) patients died from primary disease or complications. Conclusions: IBD is an increasing clinical entity in Turkey. Features of IBD are similar to those in other populations, but prospective multicenter studies are needed to analyze the true incidence of IBD in Turkish children.

  3. Role of Diet in Inflammatory Bowel Disease.

    Science.gov (United States)

    Ruemmele, Frank M

    2016-01-01

    The incidence of inflammatory bowel disease (IBD) is steadily in the rise in Western as well as in developing countries paralleling the increase of westernized diets, characterized by high protein and fat as well as excessive sugar intake, with less vegetables and fiber. An interesting hypothesis is that environmental (food-) triggered changes of the intestinal microbiome might cause a proinflammatory state preceding the development of IBD. Indeed, an intact intestinal epithelial barrier assuring a normal bacterial clearance of the intestinal surface is crucial to guarantee intestinal homeostasis. Any factors affecting the epithelial barrier function directly or indirectly may impact on this homeostasis, as well as any changes of the intestinal microbial composition. It is intriguing to learn that some frequently used food components impact on the quality of the intestinal barrier, as well as on the composition of the intestinal microbiome. This highlights the close interaction between living conditions, hygiene, food habits and food quality with the bacterial composition of the intestinal microbiome and the activation status of the intestinal immune system. There is clear evidence that nutritional therapy is highly successful in the treatment of Crohn's disease (CD). Exclusive enteral nutrition is well established as induction therapy of CD. New diets, such as a CD exclusion diet or defined diets (specific carbohydrate diets, FODMAP diet, Paleolithic diet) are being discussed as treatment options for IBD. Well-designed clinical trials in IBD are urgently required to define the precise role of each of these diets in the prevention or management of IBD. Up to now, the role of diet in IBD is highly undermined by lay and anecdotal reports without sufficient scientific proof. PMID:27355913

  4. High morbidity after laparoscopic emergency colectomy for inflammatory bowel disease

    DEFF Research Database (Denmark)

    Qazi, S.M.; Skovdal, J.; Bisgaard, T.;

    2011-01-01

    INTRODUCTION: Only limited data are available on subtotal laparoscopic colectomy (STC) in patients with in inflammatory bowel disease. We present the first Danish experiences with intended laparoscopic STC for inflammatory bowel disease (IBD). The primary outcome was 30-day morbidity. MATERIAL...... AND METHODS: The present study is a retrospective single-centre study with consecutive enrolment of patients undergoing intended STC for IBD from 1 January 2005 to 31 July 2009. The results were analysed as either emergency or elective operations. Only the most severe complication was noted for each patient....... Data on medical treatment, blood tests and complications and death within 30 days were registered. RESULTS: A total of 32 patients underwent surgery (15 elective and 17 emergency procedures). Patients in the emergency group had significantly more severe disease activity than elective patients. Severe...

  5. Primary sclerosing cholangitis and disease distribution in inflammatory bowel disease.

    LENUS (Irish Health Repository)

    O'Toole, Aoibhlinn

    2012-04-01

    The relationship between site of intestinal inflammation and primary sclerosing cholangitis (PSC) development in inflammatory bowel disease (IBD) has not been studied extensively, but may be important in understanding the pathogenesis of PSC. We aimed to determine patterns of disease distribution in IBD patients with and without PSC.

  6. Pathophysiology of acute small bowel disease with CT correlation

    International Nuclear Information System (INIS)

    The objective of this article is to review the pathophysiology of acute small bowel diseases, and to correlate the mechanisms of disease with computed tomography (CT) findings. Disease entities will be classified into the following: immune mediated and infectious causes, vascular causes, mechanical causes, trauma, and others. Having an understanding of acute small bowel pathophysiology is a useful teaching tool, and can lead to imaging clues to the most likely diagnosis of acute small bowel disorders.

  7. Preventive health measures in inflammatory bowel disease

    Science.gov (United States)

    Abegunde, Ayokunle T; Muhammad, Bashir H; Ali, Tauseef

    2016-01-01

    We aim to review the literature and provide guidance on preventive health measures in inflammatory bowel disease (IBD). Structured searches were performed in PubMed, MEDLINE, EMBASE, Web of Science and Cochrane Library from January 1976 to June 2016 using the following keywords: (inflammatory bowel disease OR Crohn’s disease OR ulcerative colitis) AND (health maintenance OR preventive health OR health promotion). Abstracts of the articles selected from each of these multiple searches were reviewed, and those meeting the inclusion criteria (that is, providing data regarding preventive health or health maintenance in IBD patients) were recorded. Reference lists from the selected articles were manually reviewed to identify further relevant studies. Patients with IBD are at increased risk of developing adverse events related to the disease course, therapeutic interventions, or non-adherence to medication. Recent studies have suggested that IBD patients do not receive preventive services with the same thoroughness as patients with other chronic diseases. Preventive health measures can avert morbidity and improve the quality of life of patients with IBD. Gastroenterologists and primary care physicians (PCPs) should have an up to date working knowledge of preventive health measures for IBD patients. A holistic approach and better communication between gastroenterologists and PCPs with explicit clarification of roles will prevent duplication of services and streamline care. PMID:27678347

  8. Is the disease course predictable in inflammatory bowel diseases?

    OpenAIRE

    Lakatos, Peter Laszlo; Kiss, Lajos S

    2010-01-01

    During the course of the disease, most patients with Crohn’s disease (CD) may eventually develop a stricturing or a perforating complication, and a significant number of patients with both CD and ulcerative colitis will undergo surgery. In recent years, research has focused on the determination of factors important in the prediction of disease course in inflammatory bowel diseases to improve stratification of patients, identify individual patient profiles, including clinical, laboratory and m...

  9. Is the disease course predictable in inflammatory bowel diseases?

    Institute of Scientific and Technical Information of China (English)

    Peter; Laszlo; Lakatos; Lajos; S; Kiss

    2010-01-01

    During the course of the disease,most patients with Crohn's disease(CD) may eventually develop a stricturing or a perforating complication,and a significant number of patients with both CD and ulcerative colitis will undergo surgery.In recent years,research has focused on the determination of factors important in the prediction of disease course in inflammatory bowel diseases to improve stratification of patients,identify individual patient profiles,including clinical,laboratory and molecular markers,which ...

  10. Structural brain lesions in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Can; Dolapcioglu; Hatice; Dolapcioglu

    2015-01-01

    Central nervous system(CNS) complications or manifes-tations of inflammatory bowel disease deserve particular attention because symptomatic conditions can require early diagnosis and treatment, whereas unexplained manifestations might be linked with pathogenic me-chanisms. This review focuses on both symptomatic and asymptomatic brain lesions detectable on imaging studies, as well as their frequency and potential mecha-nisms. A direct causal relationship between inflammatory bowel disease(IBD) and asymptomatic structural brain changes has not been demonstrated, but several possible explanations, including vasculitis, thromboembolism and malnutrition, have been proposed. IBD is associated with a tendency for thromboembolisms; therefore, cerebro-vascular thromboembolism represents the most frequent and grave CNS complication. Vasculitis, demyelinating conditions and CNS infections are among the other CNS manifestations of the disease. Biological agents also represent a risk factor, particularly for demyelination. Identification of the nature and potential mechanisms of brain lesions detectable on imaging studies would shed further light on the disease process and could improve patient care through early diagnosis and treatment.

  11. Oral pathology in inflammatory bowel disease

    Science.gov (United States)

    Muhvić-Urek, Miranda; Tomac-Stojmenović, Marija; Mijandrušić-Sinčić, Brankica

    2016-01-01

    The incidence of inflammatory bowel diseases (IBD) - Crohn’s disease (CD) and ulcerative colitis (UC) - has been increasing on a global scale, and progressively, more gastroenterologists will be included in the diagnosis and treatment of IBD. Although IBD primarily affects the intestinal tract, extraintestinal manifestations of the disease are often apparent, including in the oral cavity, especially in CD. Specific oral manifestations in patients with CD are as follows: indurate mucosal tags, cobblestoning and mucogingivitis, deep linear ulcerations and lip swelling with vertical fissures. The most common non-specific manifestations, such as aphthous stomatitis and angular cheilitis, occur in both diseases, while pyostomatitis vegetans is more pronounced in patients with UC. Non-specific lesions in the oral cavity can also be the result of malnutrition and drugs. Malnutrition, followed by anemia and mineral and vitamin deficiency, affects the oral cavity and teeth. Furthermore, all of the drug classes that are applied to the treatment of inflammatory bowel diseases can lead to alterations in the oral cavity due to the direct toxic effects of the drugs on oral tissues, as well as indirect immunosuppressive effects with a risk of developing opportunistic infections or bone marrow suppression. There is a higher occurrence of malignant diseases in patients with IBD, which is related to the disease itself and to the IBD-related therapy with a possible oral pathology. Treatment of oral lesions includes treatment of the alterations in the oral cavity according to the etiology together with treatment of the primary intestinal disease, which requires adequate knowledge and a strong cooperation between gastroenterologists and specialists in oral medicine. PMID:27433081

  12. Oral pathology in inflammatory bowel disease.

    Science.gov (United States)

    Muhvić-Urek, Miranda; Tomac-Stojmenović, Marija; Mijandrušić-Sinčić, Brankica

    2016-07-01

    The incidence of inflammatory bowel diseases (IBD) - Crohn's disease (CD) and ulcerative colitis (UC) - has been increasing on a global scale, and progressively, more gastroenterologists will be included in the diagnosis and treatment of IBD. Although IBD primarily affects the intestinal tract, extraintestinal manifestations of the disease are often apparent, including in the oral cavity, especially in CD. Specific oral manifestations in patients with CD are as follows: indurate mucosal tags, cobblestoning and mucogingivitis, deep linear ulcerations and lip swelling with vertical fissures. The most common non-specific manifestations, such as aphthous stomatitis and angular cheilitis, occur in both diseases, while pyostomatitis vegetans is more pronounced in patients with UC. Non-specific lesions in the oral cavity can also be the result of malnutrition and drugs. Malnutrition, followed by anemia and mineral and vitamin deficiency, affects the oral cavity and teeth. Furthermore, all of the drug classes that are applied to the treatment of inflammatory bowel diseases can lead to alterations in the oral cavity due to the direct toxic effects of the drugs on oral tissues, as well as indirect immunosuppressive effects with a risk of developing opportunistic infections or bone marrow suppression. There is a higher occurrence of malignant diseases in patients with IBD, which is related to the disease itself and to the IBD-related therapy with a possible oral pathology. Treatment of oral lesions includes treatment of the alterations in the oral cavity according to the etiology together with treatment of the primary intestinal disease, which requires adequate knowledge and a strong cooperation between gastroenterologists and specialists in oral medicine. PMID:27433081

  13. Current medical therapy of inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Kiron M. Das; Sherif A. Farag

    2000-01-01

    The 1990's have brought a significant promise and the hope for a better and brighter future in the new millennium for patients with inflammatory bowel disease (I3D). A better understanding of the pathophysiology of IBD symptoms has led to newer treatnent modalities and streamlining of therapy for specific subsets of patients. ULCERATIVE COUTISThe treatnent for ulcerative colitis (UC) is aimed at modulating the inflammatory response. The drugs which are found to be effective are sulfasalazine (Azulfidine, Salazopyrin) and its 5ASA derivatives, glucocorticosteroids, immunomodulators/immunosuppressants, and other new potential drugs (Table 1).

  14. Nephrolithiasis in patients with inflammatory bowel disease in the community

    Directory of Open Access Journals (Sweden)

    Cury DB

    2013-07-01

    Full Text Available Dídia Bismara Cury,1,2 Alan C Moss,2 Nestor Schor3 1Scope Clinic, Campo Grande, Brazil; 2Center for Inflammatory Bowel Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; 3Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil Background: Inflammatory bowel disease (IBD has been associated with renal stone formation. The objective of this study was to determine prospectively the prevalence of nephrolithiasis in a community-based population of patients with IBD and to analyze factors associated with renal calculus formation. Methods: Screening renal ultrasound was performed in a well characterized cohort of patients seen between 2009 and 2012 at an IBD clinic. We enrolled 168 patients, including 93 with Crohn’s disease and 75 with ulcerative colitis. Clinical and phenotypic variables associated with asymptomatic nephrolithiasis were determined. Results: Nephrolithiasis was detected in 36 patients with Crohn’s disease and in 28 patients with ulcerative colitis (38% for both. Although none of the patients had been previously hospitalized for symptomatic nephrolithiasis, nine with Crohn’s disease and five with ulcerative colitis had recurrent urinary tract infections or hydronephrosis. In patients with Crohn’s disease, ileocolonic (L3 disease was associated with a greater risk of nephrolithiasis than was ileal (L1 or colonic (L2 disease (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.8–7. Active ulcerative colitis (regardless of severity represented a significant risk factor for formation of renal calculi (OR 4.2, 95% CI 1.1–15, P = 0.02. Conclusion: In surgery-naïve patients with IBD in the community, asymptomatic nephrolithiasis is common and should be considered when renal dysfunction or infection is detected. Keywords: clinical activity indices, Crohn’s disease, inflammatory bowel disease, nephrolithiasis, ulcerative colitis

  15. Management of Musculoskeletal Manifestations in Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Tejas Sheth

    2015-01-01

    Full Text Available Musculoskeletal manifestations are the most common extraintestinal manifestations in inflammatory bowel diseases. Some appendicular manifestations are independent of gut inflammation and are treated with standard anti-inflammatory strategies. On the other hand, axial involvement is linked to gut inflammatory activity; hence, there is a considerable amount of treatment overlap. Biological therapies have revolutionized management of inflammatory bowel diseases as well as of associated articular manifestations. Newer mechanisms driving gut associated arthropathy have surfaced in the past decade and have enhanced our interests in novel treatment targets. Introduction of biosimilar molecules is expected in the US market in the near future and will provide an opportunity for considerable cost savings on healthcare. A multidisciplinary approach involving a gastroenterologist, rheumatologist, and physical therapist is ideal for these patients.

  16. Management of Musculoskeletal Manifestations in Inflammatory Bowel Disease.

    Science.gov (United States)

    Sheth, Tejas; Pitchumoni, C S; Das, Kiron M

    2015-01-01

    Musculoskeletal manifestations are the most common extraintestinal manifestations in inflammatory bowel diseases. Some appendicular manifestations are independent of gut inflammation and are treated with standard anti-inflammatory strategies. On the other hand, axial involvement is linked to gut inflammatory activity; hence, there is a considerable amount of treatment overlap. Biological therapies have revolutionized management of inflammatory bowel diseases as well as of associated articular manifestations. Newer mechanisms driving gut associated arthropathy have surfaced in the past decade and have enhanced our interests in novel treatment targets. Introduction of biosimilar molecules is expected in the US market in the near future and will provide an opportunity for considerable cost savings on healthcare. A multidisciplinary approach involving a gastroenterologist, rheumatologist, and physical therapist is ideal for these patients.

  17. Therapeutic innovations in inflammatory bowel diseases.

    Science.gov (United States)

    Vanhove, W; Nys, K; Vermeire, S

    2016-01-01

    Inflammatory bowel disease (IBD) is a spectrum of complex multifactorial immune disorders characterized by chronic inflammation of the gut. Significant advances have been made in unraveling the pathogenesis of this disease spectrum, which have spurred the discovery of new therapeutic targets and strategies. In this review, we highlight the emerging new classes of IBD therapeutics under clinical evaluation and their method of action, including JAK inhibitors, anti-SMAD7 oligonucleotides, and cell-based therapies. Moreover, we discuss how an approach based on unique molecular insights in a given patient will, in the future, lead to a truly individualized/tailored disease management, starting at diagnosis, aiding in prognosis, and resulting in a personalized therapeutic approach. PMID:26509246

  18. Extraintestinal manifestations in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Silvio Danese; Stefano Semeraro; Alfredo Papa; Italia Roberto; Franco Scaldaferri; Giuseppe Fedeli; Giovanni Gasbarrini; Antonio Gasbarrini

    2005-01-01

    Inflammatory bowel diseases (IBD) can be really considered to be systemic diseases since they are often associated with extraintestinal manifestations,complications, and other autoimmune disorders. Indeed,physicians who care for patients with ulcerative colitis and Crohn's disease, the two major forms of IBD, face a new clinical challenge every day, worsened by the very frequent rate of extraintestinal complications. The goal of this review is to provide an overview and an update on the extraintestinal complications occurring in IBD.Indeed, this paper highlights how virtually almost every organ system can be involved, principally eyes, skin,joints, kidneys, liver and biliary tracts, and vasculature (or vascular system) are the most common sites of systemic IBD and their involvement is dependent on different mechanisms.

  19. Biologic targeting in the treatment of inflammatory bowel diseases.

    Science.gov (United States)

    Bosani, Matteo; Ardizzone, Sandro; Porro, Gabriele Bianchi

    2009-01-01

    The etiology of inflammatory bowel disease (IBD) has not yet been clarified and immunosuppressive agents which nonspecifically reduce inflammation and immunity have been used in the conventional therapies for IBD. Evidence indicates that a dysregulation of mucosal immunity in the gut of IBD causes an overproduction of inflammatory cytokines and trafficking of effector leukocytes into the bowel, thus leading to an uncontrolled intestinal inflammation. Under normal situations, the intestinal mucosa is in a state of "controlled" inflammation regulated by a delicate balance of proinflammatory (tumor necrosis factor [TNF-alpha], interferon-gamma [IFN-gamma], interleukin-1 [IL-1], IL-6, IL-12 and anti-inflammatory cytokines IL-4, IL-10, IL-11). The mucosal immune system is the central effector of intestinal inflammation and injury, with cytokines playing a central role in modulating inflammation. Cytokines may therefore be a logical target for inflammatory bowel disease therapy using specific cytokine inhibitors. Biotechnology agents targeted against TNF, leukocyte adhesion, Th1 polarization, T cell activation, nuclear factor-kappaB (NF-kappaB), and other miscellaneous therapies are being evaluated as potential therapies for the treatment of inflammatory bowel disease. In this context, infliximab and adalimumab are currently the only biologic agents approved in Europe for the treatment of inflammatory Crohn's disease. Other anti-TNF biologic agents have emerged, including CDP571, certolizumab pegol, etanercept, onercept. However, ongoing research continues to generate new biologic agents targeted at specific pathogenic mechanism involved in the inflammatory process. Lymphocyte-endothelial interactions mediated by adhesion molecules are important in leukocyte migration and recruitment to sites of inflammation, and selective blockade of these adhesion molecules is a novel and promising strategy to treat Crohn's disease. Therapeutics agents to inhibit leukocyte trafficking

  20. Environmental triggers for inflammatory bowel disease.

    Science.gov (United States)

    Ananthakrishnan, Ashwin N

    2013-01-01

    Inflammatory bowel diseases [IBD; Crohn's disease (CD), ulcerative colitis (UC)] are chronic immunologically mediated diseases that are due to a dysregulated immune response to intestinal flora in a genetically susceptible host. Despite advances in genetics, the likelihood of occurrence of disease remains incompletely explained and there appears to be a strong role for the environment in mediating risk of disease. Smoking remains the most widely studied and replicated risk factor, contributing to increased risk and severity of CD while conferring protection against UC. Recent data has suggested novel risk factors. Lower plasma vitamin D is associated with an increased risk of Crohn's disease, and vitamin D supplementation may prevent relapse of disease. Several medications including oral contraceptives, post-menopausal hormone replacement, aspirin, NSAIDs, and antibiotics may increase risk of CD or UC with the mechanisms of effect remaining inadequately defined. There is continuing evidence that depression and psychosocial stress may play a role in the pathogenesis of both CD and UC, while at the same time also increasing risk for disease flares. There is also a growing understanding of the role of diet on IBD, in particular through its effect on the microbiome. Animal protein intake and n-6 fatty acids may increase risk of UC while n-3 fatty acids and dietary fiber may confer protection. The effect of diet on established disease remains poorly studied. There is need for routine measurement of a spectrum of environmental exposures in prospective studies to further our understanding. PMID:23250702

  1. Endoscopic Evaluation of Surgically Altered Bowel in Patients with Inflammatory Bowel Diseases

    OpenAIRE

    Sinh, Preetika; Shen, Bo

    2015-01-01

    Abstract: Patients with inflammatory bowel diseases often undergo surgical procedures for medically refractory disease or colitis associated dysplasia. Endoscopic evaluation of the surgically altered bowel is often needed to assess for disease recurrence, its severity, and for therapy. It is important to obtain and review the operative report and abdominal imaging before performing the endoscopy. Diagnostic and therapeutic endoscopy can be safely performed in most patients with inflammatory b...

  2. INVASIVE AMOEBIASIS COMPLICATING IFLAMMATORY BOWEL DISEASE

    Directory of Open Access Journals (Sweden)

    Ziglam H

    2007-01-01

    Full Text Available INTRODUCTIONAmoebiasis, which is caused by the intestinal protozoan Entamoeba histolytica, is a ubiquitous parasitic infection affecting approximately 10% of the world’s population and causing more deaths every year (100,000 deaths than any other parasitic infection, with the exception of malaria and schistosomiasis [1–3]. Most individuals with an E. histolytica infection are asymptomatic, but some develop severe invasive disease, such as amoebic colitis. Other manifestations, such as pulmonary, cardiac or brain involvement, are rare. Intestinal amoebiasis can probably also present as a chronic, non-dysenteric syndrome of diarrhoea, weight loss, and abdominal pain that can last for years and mimic inflammatory bowel disease. Fulminant colitis with bowel necrosis leading to perforation and peritonitis occurs in only about 0.5% of cases, but it is associated with a mortality rate of more than 40%. Patients with invasive amoebiasis living in the United Kingdom and other developed countries generally acquire the infection in another country in which the pathogenic species is endemic. Areas that have high rates of amoebic infection include India, Africa, Mexico and parts of Central and South America. Infection with pathogenic E. histolytica is not a common cause of travelers’ diarrhoea, and gastrointestinal infection is uncommon in travelers who have spent less than one month in endemic areas.

  3. Disease Course and Surgery Rates in Inflammatory Bowel Disease

    DEFF Research Database (Denmark)

    Vester-Andersen, Marianne K; Prosberg, Michelle V; Jess, Tine;

    2014-01-01

    . METHODS: From 1 January 2003 to 31 December 2004, all incident cases (562) of patients diagnosed with UC, CD, or inflammatory bowel disease unclassified in a well-defined Copenhagen area were registered. Medical records were reviewed from 1 November 2011 to 30 November 2012, and clinical data were...

  4. Early cervical cancer coexistent with idiopathic inflammatory bowel disease

    Energy Technology Data Exchange (ETDEWEB)

    Hoffman, M.; Kalter, C.; Roberts, W.S.; Cavanagh, D.

    1989-07-01

    Early invasive carcinoma of the cervix may be treated by surgery or radiation therapy. Two patients with early cervical cancer are presented whose concomitant inflammatory bowel disease figured significantly in the selection of surgery as treatment. The use of radiotherapy in the face of inflammatory bowel disease, however, is not clearly addressed in the literature.

  5. Extraluminal factors contributing to inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Arvind Batra; Thorsten Stroh; Britta Siegmund

    2011-01-01

    Many identified and yet unknown factors contribute to the pathogenesis of inflammatory bowel disease (IBD).The genome-wide association studies clearly support the earlier developed concept that IBD occurs in genetically predisposed individuals who are exposed to distinct environmental factors, which together result in dysregulation of the mucosal immune system. Thus, the majority of previous studies have focused on the immune response within the intestinal wall. The present review aims to emphasize the contribution of three extraluminal structures to this inflammatory process, namely the mesenteric fat tissue, the lymphatics and the microvasculature.Broadening our view across the intestinal wall will not only facilitate our understanding of the disease,but will also us to identify future therapeutic targets.

  6. Fertility and pregnancy in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Elspeth Alstead

    2001-01-01

    @@ INTRODUCTION Inflammatory bowel disease(IBD)is a chronic disorder affecting young adults in the reproductive years.It is comon for both female and male patients with IBD to ask questions about IBD's effect on their relationships,sexual and reproductive function,in particular fertility,the outcome of pregnancy and its possible effets on the disease.An open discussion of the social situation and education targeted at these issues therefore forms an essential part of the management of any young person with IBD.the questions that are most commonly asked are summarised in Table 1.In order to answer these questions we need evidence.There are few large prospective case controlled studies to provide the information which is required but the available data,some of it from small observational studies,will be summarised in this chapter.

  7. Special issues in pediatric inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Maria Dubinsky

    2008-01-01

    The incidence of pediatric inflammatory bowel disease (IBD) is rising and recent advances in diagnostics and therapeutics have improved the care provided to these children. There are distinguishing features worth noting between early onset and adult onset IBD. Physical and psychosocial development remains a critical target for the comprehensive management of pediatric IBD. Children are not just little adults and consideration must be given to the stages of development and how these stages impact disease presentation and management. The final stage will be the transition from pediatric care to that of adult oriented care and special consideration must be given to make this a successful process. This review highlights special considerations in the management of the child with IBD.

  8. Familial risk of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Moller, Frederik Trier; Andersen, Vibeke; Wohlfahrt, Jan;

    2015-01-01

    OBJECTIVES: Estimates of familial risk of inflammatory bowel diseases (IBDs), Crohn's disease (CD), and ulcerative colitis (UC) are needed for counseling of patients and could be used to target future prevention. We aimed to provide comprehensive population-based estimates of familial risk of IBD....... METHODS: The study encompassed the entire Danish population during 1977-2011 (N=8,295,773; 200 million person-years). From national registries, we obtained information on diagnosis date of IBD (N=45,780) and family ties. Using Poisson regression, we estimated incidence rate ratios (IRRs) of IBD...... in relatives of IBD cases compared with individuals with relatives of the same type without IBD. RESULTS: The risk of CD was significantly increased in first-degree (IRR, 7.77; 95% confidence interval (CI), 7.05-8.56), second-degree (IRR, 2.44; 95% CI, 2.01-2.96), and third-degree relatives (IRR, 1.88; 95% CI...

  9. Environmental risk factors for inflammatory bowel disease.

    Science.gov (United States)

    Molodecky, Natalie A; Kaplan, Gilaad G

    2010-05-01

    Inflammatory bowel disease (IBD) is characterized by chronic inflammation of the gastrointestinal tract and is associated with significant morbidity. The etiology of IBD has been extensively studied during the last several decades; however, causative factors in disease pathology are not yet fully understood. IBD is thought to result from the interaction between genetic and environmental factors that influence the normal intestinal commensal flora to trigger an inappropriate mucosal immune response. Although many IBD susceptibility genes have been discovered, similar advances in defining environmental risk factors have lagged. A number of environmental risk factors have been explored, including smoking, appendectomy, oral contraceptives, diet, breastfeeding, infections/ vaccinations, antibiotics, and childhood hygiene. However, most of these factors have demonstrated inconsistent findings, thus making additional studies necessary to better understand the etiology of IBD. PMID:20567592

  10. Environment and the inflammatory bowel diseases.

    Science.gov (United States)

    Frolkis, Alexandra; Dieleman, Levinus A; Barkema, Herman W; Panaccione, Remo; Ghosh, Subrata; Fedorak, Richard N; Madsen, Karen; Kaplan, Gilaad G

    2013-03-01

    Inflammatory bowel diseases (IBD), which consists of Crohn disease and ulcerative colitis, are chronic inflammatory conditions of the gastrointestinal tract. In genetically susceptible individuals, the interaction between environmental factors and normal intestinal commensal flora is believed to lead to an inappropriate immune response that results in chronic inflammation. The incidence of IBD have increased in the past century in developed and developing countries. The purpose of the present review is to summarize the current knowledge of the association between environmental risk factors and IBD. A number of environmental risk factors were investigated including smoking, hygiene, microorganisms, oral contraceptives, antibiotics, diet, breastfeeding, geographical factors, pollution and stress. Inconsistent findings among the studies highlight the complex pathogenesis of IBD. Additional studies are necessary to identify and elucidate the role of environmental factors in IBD etiology. PMID:23516681

  11. Innovative therapeutics for inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Jesus K Yamamoto-Furusho

    2007-01-01

    Inflammatory bowel diseases (IBD) are chronic inflammatory conditions of the gastrointestinal tract,which clinically present as one of two disorders, Crohn's disease or ulcerative colitis. Mainstays of drug treatments for IBD include aminosalicylates, corticosteroids and immunosuppressants such as azathioprine, methotrexate and cyclosporin. Advances in basic research of the pathophysiological process in IBD have been applied to generate a variety of new therapeutics targeting at different levels of the inflammatory processes. New therapies are classified as: (1) Anti-TNFα antibodies; (2) Recombinant cytokines; (3) Selective adhesion blockade;(4) Growth factors; (5) Innate immunostimulation; (6) Nucleic acid based therapies; (7) Gene therapy; (8) Autologous bone-marrow transplantation; (9) Helminths and (10) Extracorporeal immunomodulation. All treatments have the potential to provide more effective and safe treatment for IBD.

  12. Targeting intestinal microflora in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Mario Guslandi

    2006-01-01

    @@ TO THE EDITOR In their recent review article[1], Andoh and Fujiyama examined the various therapeutic approaches targeting intestinal microflora in patients with inflammatory bowel disease (IBD). I would like to provide some additional data to complete and update their comments. First of all, when considering the role of probiotics in 1BD treatment it must be emphasized that, in addition to Bifidobacteria, the Nissle 1917 E. coli strain and cocktails of microorganisms such as VSL # 3 mentioned in the article, other probiotic agents have been tested in the short- and long-term treatment of either ulcerative colitis and Crohn's disease, the results of those studies being reported in major international scientific journals.

  13. Role of endoscopy in predicting the disease course in inflammatory bowel disease

    OpenAIRE

    Allez, Matthieu; Lémann, Marc

    2010-01-01

    Endoscopy provides a direct evaluation of mucosal lesions in inflammatory bowel disease (IBD), permitting the description of elementary lesions, their surface extent and severity. The severity of mucosal lesions directly reflects disease activity and may help to identify an aggressive behavior of the disease. Several studies have recently pointed out the potential role of endoscopy in the prediction of IBD outcome. Indeed, severe endoscopic lesions in Crohn’s disease (CD) patients, defined by...

  14. Role of endoscopy in predicting the disease course in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Matthieu; Allez; Marc; Lémann

    2010-01-01

    Endoscopy provides a direct evaluation of mucosal lesions in inflammatory bowel disease(IBD),permitting the description of elementary lesions,their surface extent and severity.The severity of mucosal lesions directly reflects disease activity and may help to identify an aggressive behavior of the disease.Several studies have recently pointed out the potential role of endoscopy in the prediction of IBD outcome.Indeed,severe endoscopic lesions in Crohn's disease(CD) patients,defined by deep and extensive ulce...

  15. CT of complicated inflammatory bowel disease in children

    Energy Technology Data Exchange (ETDEWEB)

    Riddlesberger, M.M. Jr.

    1985-09-01

    Most children with inflammatory bowel disease do not need a CT scan. However, when the course becomes complicated if often is necessary to evaluate what is happening outside the bowel lumen. CT is the examination of choice for that evaluation. With CT, the presence and extent of an abscess can be diagnosed and followed; fistulae can be detected; bowel wall and mesenteric thickening can generally be differentiated from an abscess.

  16. Influenza vaccination coverage in children with inflammatory bowel disease

    OpenAIRE

    Banaszkiewicz, Aleksandra; Klincewicz, Beata; Łazowska-Przeorek, Izabella; Grzybowska-Chlebowczyk, Urszula; Kąkol, Paulina; Mytyk, Aleksandra; Kofla, Anna; Radzikowski, Andrzej

    2014-01-01

    The aim of this study was to evaluate the influenza vaccination status among paediatric patients with inflammatory bowel disease (IBD) in Poland. This was a questionnaire-based study. 242 patients with IBD and 142 controls were enrolled in the study. Of patients with IBD, 7·8% received an influenza vaccine, compared to 18·3% of controls (P = 0·0013). There were no statistically significant differences in time from IBD diagnosis, disease activity and in drugs, between vaccinated and non-vaccin...

  17. Treatment of the Pregnant Patient with Inflammatory Bowel Disease

    DEFF Research Database (Denmark)

    Winter, Rachel; Nørgård, Bente M; Friedman, Sonia

    2016-01-01

    and on the rates of pregnancy loss and ectopic pregnancies. We do not know how to reliably measure disease activity during pregnancy or the effect of pregnancy on the microbiome. Although immunomodulators and anti-tumor necrosis factor medications are relatively safe during pregnancy, the long-term effects......Research regarding fertility, medication safety, and pregnancy outcomes is increasing, but there are still many knowledge gaps in these areas. Women with ulcerative colitis and Crohn's disease may have decreased fertility because of voluntary childlessness and inflammatory bowel disease (IBD......) surgery, and women with Crohn's disease may also have decreased ovarian reserve. Initial studies show that in vitro fertilization is a viable option, and laparoscopic ileoanal pouch anastomosis surgery improves fertility rates. Additional research is needed on the effect of disease activity on fertility...

  18. Pethidine-augmented white cell scintigraphy in inflammatory bowel disease

    Energy Technology Data Exchange (ETDEWEB)

    Davidson, J.; Poon, F.W.; Bessent, R.G.; Neilly, J.B.; Gray, H.W. [Dept. of Nuclear Medicine, Glasgow Royal Infirmary, Alexander Parade, Glasgow (United Kingdom)

    2000-06-01

    Technetium-99m hexamethylpropylene amine oxime ({sup 99m}Tc-HMPAO) white cell scintigraphy is invaluable for assessing the presence and extent of disease activity in patients with inflammatory bowel disease. Interpretation of images can be compromised by physiological excretion of tracer into the bowel via the biliary tree. This study assesses the effect of intravenous pethidine administered with the labelled white cells in an attempt to reduce the enterohepatic circulation of the tracer. Ninety-one subjects with proven or suspected inflammatory bowel disease were included in this study, all of whom underwent {sup 99m}Tc-HMPAO white cell scintigraphy. The control group of 50 subjects underwent the standard protocol for this study performed in our department. The other 41 subjects received an intravenous injection of 0.3 mg/kg of pethidine at the same time as re-injection of the labelled white cells. Images were graded using a five-point scale at both 1 and 2.5 h and categorised as positive, negative or non-diagnostic. Each scan was also assessed for the presence of a visible gall-bladder. The pethidine group had significantly fewer non-diagnostic scans than the control group (P=0.003), and significantly (P=0.001) more studies in which the gall-bladder was visualised. It is concluded that the use of pethidine appears to reduce biliary excretion of tracer during {sup 99m}Tc-HMPAO white cell scintigraphy. This may allow the delayed images, and early images with low-grade tracer uptake in the bowel, to be interpreted with greater confidence and thereby reduce the number of scans classified as non-diagnostic. (orig.)

  19. Urinary Metabolic Phenotyping Reveals Differences in the Metabolic Status of Healthy and Inflammatory Bowel Disease (IBD) Children in Relation to Growth and Disease Activity

    Science.gov (United States)

    Martin, Francois-Pierre; Ezri, Jessica; Cominetti, Ornella; Da Silva, Laeticia; Kussmann, Martin; Godin, Jean-Philippe; Nydegger, Andreas

    2016-01-01

    Background: Growth failure and delayed puberty are well known features of children and adolescents with inflammatory bowel disease (IBD), in addition to the chronic course of the disease. Urinary metabonomics was applied in order to better understand metabolic changes between healthy and IBD children. Methods: 21 Pediatric patients with IBD (mean age 14.8 years, 8 males) were enrolled from the Pediatric Gastroenterology Outpatient Clinic over two years. Clinical and biological data were collected at baseline, 6, and 12 months. 27 healthy children (mean age 12.9 years, 16 males) were assessed at baseline. Urine samples were collected at each visit and subjected to 1H Nuclear Magnetic Resonance (NMR) spectroscopy. Results: Using 1H NMR metabonomics, we determined that urine metabolic profiles of IBD children differ significantly from healthy controls. Metabolic differences include central energy metabolism, amino acid, and gut microbial metabolic pathways. The analysis described that combined urinary urea and phenylacetylglutamine—two readouts of nitrogen metabolism—may be relevant to monitor metabolic status in the course of disease. Conclusion: Non-invasive sampling of urine followed by metabonomic profiling can elucidate and monitor the metabolic status of children in relation to disease status. Further developments of omic-approaches in pediatric research might deliver novel nutritional and metabolic hypotheses. PMID:27529220

  20. Urinary Metabolic Phenotyping Reveals Differences in the Metabolic Status of Healthy and Inflammatory Bowel Disease (IBD Children in Relation to Growth and Disease Activity

    Directory of Open Access Journals (Sweden)

    Francois-Pierre Martin

    2016-08-01

    Full Text Available Background: Growth failure and delayed puberty are well known features of children and adolescents with inflammatory bowel disease (IBD, in addition to the chronic course of the disease. Urinary metabonomics was applied in order to better understand metabolic changes between healthy and IBD children. Methods: 21 Pediatric patients with IBD (mean age 14.8 years, 8 males were enrolled from the Pediatric Gastroenterology Outpatient Clinic over two years. Clinical and biological data were collected at baseline, 6, and 12 months. 27 healthy children (mean age 12.9 years, 16 males were assessed at baseline. Urine samples were collected at each visit and subjected to 1H Nuclear Magnetic Resonance (NMR spectroscopy. Results: Using 1H NMR metabonomics, we determined that urine metabolic profiles of IBD children differ significantly from healthy controls. Metabolic differences include central energy metabolism, amino acid, and gut microbial metabolic pathways. The analysis described that combined urinary urea and phenylacetylglutamine—two readouts of nitrogen metabolism—may be relevant to monitor metabolic status in the course of disease. Conclusion: Non-invasive sampling of urine followed by metabonomic profiling can elucidate and monitor the metabolic status of children in relation to disease status. Further developments of omic-approaches in pediatric research might deliver novel nutritional and metabolic hypotheses.

  1. Maternal inflammatory bowel disease and offspring body size

    DEFF Research Database (Denmark)

    Ajslev, Teresa Adeltoft; Sorensen, Thorkild I A; Jess, Tine

    2012-01-01

    Maternal inflammatory bowel disease (IBD) may influence intrauterine growth and hence size at birth, but the consequences for offspring in later life remain uncertain. This study investigated the growth of children of mothers with Crohn's disease (CD) or ulcerative colitis (UC).......Maternal inflammatory bowel disease (IBD) may influence intrauterine growth and hence size at birth, but the consequences for offspring in later life remain uncertain. This study investigated the growth of children of mothers with Crohn's disease (CD) or ulcerative colitis (UC)....

  2. Case Report: Inflammatory Bowel Disease and Thrombosis.

    Science.gov (United States)

    Maneval, Rhonda E; Clemence, Bonnie J

    2016-01-01

    Patients with inflammatory bowel disease (IBD) have a greater risk for developing venous thromboembolism (VTE). Patients admitted to the hospital with IBD flares often require insertion of long-term venous access devices, such as peripherally inserted central catheters (PICCs), to provide access for medications, blood draws, fluid management, and nutrition. PICCs have been associated with an increased risk for upper extremity deep vein thrombosis. In this case study analysis, 2 patients with IBD and PICCs who developed VTE are examined. The case report includes a thorough discussion of medical history, symptomology, PICC insertion, and events leading to VTE development. A review of acquired risk factors for IBD patients and a comparison of risk factors that predisposed each to VTE are explored. These cases highlight the need for nurses and physicians to heighten surveillance and engage in proactive strategies to prevent VTE in this population of patients. PMID:27074991

  3. Flavonoids in Inflammatory Bowel Disease: A Review

    Directory of Open Access Journals (Sweden)

    Teresa Vezza

    2016-04-01

    Full Text Available Inflammatory bowel disease (IBD is characterized by chronic inflammation of the intestine that compromises the patients’ life quality and requires sustained pharmacological and surgical treatments. Since their etiology is not completely understood, non-fully-efficient drugs have been developed and those that have shown effectiveness are not devoid of quite important adverse effects that impair their long-term use. In this regard, a growing body of evidence confirms the health benefits of flavonoids. Flavonoids are compounds with low molecular weight that are widely distributed throughout the vegetable kingdom, including in edible plants. They may be of great utility in conditions of acute or chronic intestinal inflammation through different mechanisms including protection against oxidative stress, and preservation of epithelial barrier function and immunomodulatory properties in the gut. In this review we have revised the main flavonoid classes that have been assessed in different experimental models of colitis as well as the proposed mechanisms that support their beneficial effects.

  4. Flavonoids in Inflammatory Bowel Disease: A Review

    Science.gov (United States)

    Vezza, Teresa; Rodríguez-Nogales, Alba; Algieri, Francesca; Utrilla, Maria Pilar; Rodriguez-Cabezas, Maria Elena; Galvez, Julio

    2016-01-01

    Inflammatory bowel disease (IBD) is characterized by chronic inflammation of the intestine that compromises the patients’ life quality and requires sustained pharmacological and surgical treatments. Since their etiology is not completely understood, non-fully-efficient drugs have been developed and those that have shown effectiveness are not devoid of quite important adverse effects that impair their long-term use. In this regard, a growing body of evidence confirms the health benefits of flavonoids. Flavonoids are compounds with low molecular weight that are widely distributed throughout the vegetable kingdom, including in edible plants. They may be of great utility in conditions of acute or chronic intestinal inflammation through different mechanisms including protection against oxidative stress, and preservation of epithelial barrier function and immunomodulatory properties in the gut. In this review we have revised the main flavonoid classes that have been assessed in different experimental models of colitis as well as the proposed mechanisms that support their beneficial effects. PMID:27070642

  5. Innate immunity in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    The human intestinal tract is home to an enormous bacterial flora. The host defense against microorganisms can be divided into innate and adaptive immunity. The former is the most immediate line of response to immunologic challenges presented by bacteria, viruses, and fungi. The mucosal immune system has evolved to balance the need to respond to pathogens while co-existing with commensal bacteria and food antigens. In inflammatory bowel disease (IBD), this hyporesponsiveness or tolerance breaks-down and inflammation supervenes driven by the intestinal microbial flora. Bacteria contain compounds and are recognized by a variety of receptors, including Toll-like receptors (TLRs) and NODs (a family of intracellular bacterial sensors) and are potent stimuli of innate immune responses. Several mutations in these receptors have been associated with development of IBD.

  6. Extraintestinal manifestations and complications in inflammatory bowel diseases

    Institute of Scientific and Technical Information of China (English)

    Katja S Rothfuss; Eduard F Stange; Klaus R Herrlinger

    2006-01-01

    Crohn's disease (CD) and ulcerative colitis (UC) are chronic inflammatory bowel diseases (IBD) that often involve organs other than those of the gastrointestinal tract. These nonintestinal affections are termed extraintestinal symptoms. Differentiating the true extraintestinal manifestations of inflammatory bowel diseases from secondary extraintestinal complications, caused by malnutrition, chronic inflammation or side effects of therapy, may be difficult. This review concentrates on frequency, clinical presentation and therapeutic implications of extraintestinal symptoms in inflammatory bowel diseases. If possible, extraintestinal manifestations are differentiated from extraintestinal complications. Special attention is given to the more recently described sites of involvement; I.e. Thromboembolic events, osteoporosis, pulmonary involvement and affection of the central nervous system.

  7. Metabolic inflammation in inflammatory bowel disease: crosstalk between adipose tissue and bowel.

    Science.gov (United States)

    Gonçalves, Pedro; Magro, Fernando; Martel, Fátima

    2015-02-01

    Epidemiological studies show that both the incidence of inflammatory bowel disease (IBD) and the proportion of people with obesity and/or obesity-associated metabolic syndrome increased markedly in developed countries during the past half century. Obesity is also associated with the development of more active IBD and requirement for hospitalization and with a decrease in the time span between diagnosis and surgery. Patients with IBD, especially Crohn's disease, present fat-wrapping or "creeping fat," which corresponds to ectopic adipose tissue extending from the mesenteric attachment and covering the majority of the small and large intestinal surface. Mesenteric adipose tissue in patients with IBD presents several morphological and functional alterations, e.g., it is more infiltrated with immune cells such as macrophages and T cells. All these lines of evidence clearly show an association between obesity, adipose tissue, and functional bowel disorders. In this review, we will show that the mesenteric adipose tissue and creeping fat are not innocent by standers but actively contribute to the intestinal and systemic inflammatory responses in patients with IBD. More specifically, we will review evidence showing that adipose tissue in IBD is associated with major alterations in the secretion of cytokines and adipokines involved in inflammatory process, in adipose tissue mesenchymal stem cells and adipogenesis, and in the interaction between adipose tissue and other intestinal components (immune, lymphatic, neuroendocrine, and intestinal epithelial systems). Collectively, these studies underline the importance of adipose tissue for the identification of novel therapeutic approaches for IBD.

  8. Intestinal microbiota, probiotics and prebiotics in inflammatory bowel disease.

    Science.gov (United States)

    Orel, Rok; Kamhi Trop, Tina

    2014-09-01

    It has been presumed that aberrant immune response to intestinal microorganisms in genetically predisposed individuals may play a major role in the pathogenesis of the inflammatory bowel disease, and there is a good deal of evidence supporting this hypothesis. Commensal enteric bacteria probably play a central role in pathogenesis, providing continuous antigenic stimulation that causes chronic intestinal injury. A strong biologic rationale supports the use of probiotics and prebiotics for inflammatory bowel disease therapy. Many probiotic strains exhibit anti-inflammatory properties through their effects on different immune cells, pro-inflammatory cytokine secretion depression, and the induction of anti-inflammatory cytokines. There is very strong evidence supporting the use of multispecies probiotic VSL#3 for the prevention or recurrence of postoperative pouchitis in patients. For treatment of active ulcerative colitis, as well as for maintenance therapy, the clinical evidence of efficacy is strongest for VSL#3 and Escherichia coli Nissle 1917. Moreover, some prebiotics, such as germinated barley foodstuff, Psyllium or oligofructose-enriched inulin, might provide some benefit in patients with active ulcerative colitis or ulcerative colitis in remission. The results of clinical trials in the treatment of active Crohn's disease or the maintenance of its remission with probiotics and prebiotics are disappointing and do not support their use in this disease. The only exception is weak evidence of advantageous use of Saccharomyces boulardii concomitantly with medical therapy in maintenance treatment.

  9. Neutrophilic dermatoses and inflammatory bowel diseases.

    Science.gov (United States)

    Marzano, A V; Menicanti, C; Crosti, C; Trevisan, V

    2013-04-01

    Pyoderma gangrenosum (PG) and Sweet's Syndrome (SS) are inflammatory skin diseases caused by the accumulation of neutrophils in the skin and, rarely, in internal organs, which led to coining the term of neutrophilic dermatoses (ND) to define these conditions. Recently, ND have been included among the autoinflammatory diseases, which are forms due to mutations of genes regulating the innate immune responses. Both PG and SS are frequently associated with inflammatory bowel diseases (IBD), a group of chronic intestinal disorders which comprises ulcerative colitis and Crohn's disease and whose pathogenesis involves both the innate and adaptive immunity in genetically prone individuals. Patients with IBD develop PG in 1-3% of cases, while SS is rarer. PG presents with deep erythematous-to-violaceous painful ulcers with undermined borders, but bullous, pustular, and vegetative variants can also occur. SS, also known as acute febrile neutrophilic dermatosis, is characterized by the abrupt onset of fever, peripheral neutrophilia, tender erythematous skin lesions and a diffuse neutrophilic dermal infiltrate. In this review that will be focused on PG and SS, we will describe also the aseptic abscesses syndrome, a new entity within the spectrum of ND which frequently occurs in association with IBD and is characterized by deep abscesses mainly involving the spleen and skin and by polymorphic cutaneous manifestations including PG- and SS-like lesions. PMID:23588144

  10. Inflammatory bowel disease: immunodiagnostics, immunotherapeutics, and ecotherapeutics.

    LENUS (Irish Health Repository)

    Shanahan, F

    2012-02-03

    Treatment options for inflammatory bowel disease (IBD) reflect a continuing shift from empiricism to strategies based on improved understanding of the pathophysiology of disease. In susceptible individuals, IBD appears to be the result of defective regulation of mucosal immune interactions with the enteric microflora. This has prompted research directed at the interface of the traditional disciplines of immunology, microbiology, and epithelial cell biology. Whereas immunodiagnostics have been of limited clinical value in IBD, assessments of mucosal rather than systemic immune function are promising. Therapeutically, there is an increasing trend toward more aggressive and earlier use of immunomodulatory agents, particularly for prevention of relapse, with cytokine manipulation as a bridge therapy to achieve remission in patients with acute severe disease. Although most drug treatments are directed toward altering the host response, the rationale for manipulating the enteric flora appears sound and will be the basis of additional future therapeutic strategies. Notwithstanding the widening range of options for drug therapy in IBD, other outcome modifiers and well-established principles of managing chronic disease are as important as ever.

  11. Small bowel angiodysplasia and novel disease associations: a cohort study.

    LENUS (Irish Health Repository)

    Holleran, Grainne

    2013-04-01

    Gastrointestinal angiodysplasias recurrently bleed, accounting for 3-5% of obscure gastrointestinal bleeding. The advent of small bowel capsule endoscopy (SBCE) has led to an increased recognition of small bowel angiodysplasias (SBAs) but little is known about their etiology. Previous small cohorts and case reports suggest an equal gender incidence and associations with cardiovascular disease, renal impairment, and coagulopathies.

  12. Small Bowel Imaging in Managing Crohn’s Disease Patients

    Directory of Open Access Journals (Sweden)

    Jörg G. Albert

    2012-01-01

    bowel CD, and treatment control with imaging is increasingly used to optimize the patients outcome. Thereby, capsule endoscopy, Balloon-assisted enteroscopy, and Magnetic resonance imaging have become key players to manage CD patients. In this review, role of small bowel imaging is detailed discussed for use in diagnosing and managing Crohn's disease patients.

  13. Light and sound - emerging imaging techniques for inflammatory bowel disease.

    Science.gov (United States)

    Knieling, Ferdinand; Waldner, Maximilian J

    2016-07-01

    Patients with inflammatory bowel disease are known to have a high demand of recurrent evaluation for therapy and disease activity. Further, the risk of developing cancer during the disease progression is increasing from year to year. New, mostly non-radiant, quick to perform and quantitative methods are challenging, conventional endoscopy with biopsy as gold standard. Especially, new physical imaging approaches utilizing light and sound waves have facilitated the development of advanced functional and molecular modalities. Besides these advantages they hold the promise to predict personalized therapeutic responses and to spare frequent invasive procedures. Within this article we highlight their potential for initial diagnosis, assessment of disease activity and surveillance of cancer development in established techniques and recent advances such as wide-view full-spectrum endoscopy, chromoendoscopy, autofluorescence endoscopy, endocytoscopy, confocal laser endoscopy, multiphoton endoscopy, molecular imaging endoscopy, B-mode and Doppler ultrasound, contrast-enhanced ultrasound, ultrasound molecular imaging, and elastography. PMID:27433080

  14. Utility of faecal calprotectin analysis in adult inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Lyn A Smith; Daniel R Gaya

    2012-01-01

    The inflammatory bowel diseases (IBD),Crohn's disease and ulcerative colitis,are chronic relapsing,remitting disorders.Diagnosis,along with assessment of disease activity and prognosis present challenges to managing clinicians.Faecal biomarkers,such as faecal calprotectin,are a non-invasive method which can be used to aid these decisions.Calprotectin is a calcium and zinc binding protein found in the cytosol of human neutrophils and macrophages.It is released extracellularly in times of cell stress or damage and can be detected within faeces and thus can be used as a sensitive marker of intestinal inflammation.Faecal calprotectin has been shown to be useful in the diagnosis of IBD,correlates with mucosal disease activity and can help to predict response to treatment or relapse.With growing evidence supporting its use,over the last decade this faecal biomarker has significantly changed the way IBD is managed.

  15. Light and sound - emerging imaging techniques for inflammatory bowel disease

    Science.gov (United States)

    Knieling, Ferdinand; Waldner, Maximilian J

    2016-01-01

    Patients with inflammatory bowel disease are known to have a high demand of recurrent evaluation for therapy and disease activity. Further, the risk of developing cancer during the disease progression is increasing from year to year. New, mostly non-radiant, quick to perform and quantitative methods are challenging, conventional endoscopy with biopsy as gold standard. Especially, new physical imaging approaches utilizing light and sound waves have facilitated the development of advanced functional and molecular modalities. Besides these advantages they hold the promise to predict personalized therapeutic responses and to spare frequent invasive procedures. Within this article we highlight their potential for initial diagnosis, assessment of disease activity and surveillance of cancer development in established techniques and recent advances such as wide-view full-spectrum endoscopy, chromoendoscopy, autofluorescence endoscopy, endocytoscopy, confocal laser endoscopy, multiphoton endoscopy, molecular imaging endoscopy, B-mode and Doppler ultrasound, contrast-enhanced ultrasound, ultrasound molecular imaging, and elastography. PMID:27433080

  16. Evaluation of inflammatory bowel disease with /sup 99mTc-DTPA

    Energy Technology Data Exchange (ETDEWEB)

    Kadir, S.; Strauss, H.W.

    1979-02-01

    Technetium-99m-labelled DTPA was found to localize in segments of bowel with inflammation due to ulcerative colitis, regional enteritis, and other forms of enterocolitis. The concentration of tracer was apparently related to the clinical activity of the disease process. Imaging with /sup 99m/Tc-DTPA may offer an appealing, noninvasive alternative for identifying and following up patients with inflammatory bowel disease.

  17. Role of the endothelium in inflammatory bowel diseases

    Institute of Scientific and Technical Information of China (English)

    Walter E Cromer; J Michael Mathis; Daniel N Granger; Ganta V Chaitanya; J Steven Alexander

    2011-01-01

    Inflammatory bowel diseases (IBD) are a complex group of diseases involving alterations in mucosal immunity and gastrointestinal physiology during both initiation and progressive phases of the disease. At the core of these alterations are endothelial cells, whose continual adjustments in structure and function coordinate vascular supply, immune cell emigration, and regulation of the tissue environment. Expansion of the endothelium in IBD (angiogenesis), mediated by inflammatory growth factors, cytokines and chemokines, is a hallmark of active gut disease and is closely related to disease severity. The endothelium in newly formed or inflamed vessels differs from that in normal vessels in the production of and response to inflammatory cytokines,growth factors, and adhesion molecules, altering coagulant capacity, barrier function and blood cell recruitment in injury. This review examines the roles of the endothelium in the initiation and propagation of IBD pathology and distinctive features of the intestinal endothelium contributing to these conditions.

  18. Quantitative Risk-Benefit Analysis of Probiotic Use for Irritable Bowel Syndrome and Inflammatory Bowel Disease.

    Science.gov (United States)

    Bennett, William E

    2016-04-01

    Probiotics have seen widespread use for a variety of gastrointestinal problems, especially in two common disorders: irritable bowel syndrome and inflammatory bowel disease. Since a wide variety of probiotic preparations has been used, and despite a large number of studies performed, a great deal of heterogeneity exists among them. Straightforward evidence-based recommendations for the use of probiotics in irritable bowel syndrome and inflammatory bowel disease have thus been difficult to formulate. In an effort to improve understanding of the risk-benefit balance of probiotics in these conditions, this study (1) queried the US FDA Adverse Event Reporting System (FAERS) database for all reported adverse drug events related to probiotics in 2013, and (2) constructed risk-benefit planes for both irritable bowel syndrome and inflammatory bowel disease using a geometric approximation of the confidence region between risk and benefit. The results show that adverse events from probiotics vary widely by disease, and when they occur, they are mild and may be difficult to distinguish from the natural history of the underlying disorders they are used to treat. The risk-benefit plane for irritable bowel syndrome straddles the risk-benefit threshold, so patients can expect a balance between a low chance of risk and also a low chance of benefit. The risk-benefit plane for inflammatory bowel disease largely lies above the risk-benefit threshold, so patients may expect more benefit than risk in most cases. More standardized and high-quality research is needed to improve our understanding of risk and benefit for these complex biopharmaceuticals. PMID:26467550

  19. Role of fecal calprotectin testing to predict relapse in teenagers with inflammatory bowel disease who report full disease control

    NARCIS (Netherlands)

    van Rheenen, Patrick F.

    2012-01-01

    Background: Teenagers with inflammatory bowel disease undergo regular follow-up visits to watch for symptoms that may indicate relapse. Current disease activity is frequently estimated with the use of the Pediatric Ulcerative Colitis Activity Index (PUCAI) and the Pediatric Crohn's Disease Activity

  20. An unusual white blood cell scan in a child with inflammatory bowel disease: a case report.

    Science.gov (United States)

    Porn, U; Howman-Giles, R; O'Loughlin, E; Uren, R; Chaitow, J

    2000-10-01

    Technetium-99m-labeled leukocyte (WBC) imaging is a valuable screening method for inflammatory bowel disease, especially in children, because of its high rate of sensitivity, low cost, and ease of preparation. A 14-year-old girl is described who had juvenile arthritis and iritis complicated by inflammatory bowel disease. She was examined for recurrent abdominal pain. A Tc-99m stannous colloid WBC scan was performed, and tracer accumulation was seen in the small bowel in the region of the distal ileum on the initial 1-hour image. Delayed imaging at 3 hours also revealed tracer accumulation in the cecum and ascending colon, which was not seen on the early image. A biopsy of the colon during endoscopy showed no evidence of active inflammation in the colon. The small bowel was not seen. Computed tomography revealed changes suggestive of inflammatory bowel disease in the distal ileum. The appearance on the WBC study was most likely a result of inflammatory bowel disease involving the distal ileum, with transit of luminal activity into the large bowel.

  1. An unusual white blood cell scan in a child with inflammatory bowel disease: a case report.

    Science.gov (United States)

    Porn, U; Howman-Giles, R; O'Loughlin, E; Uren, R; Chaitow, J

    2000-10-01

    Technetium-99m-labeled leukocyte (WBC) imaging is a valuable screening method for inflammatory bowel disease, especially in children, because of its high rate of sensitivity, low cost, and ease of preparation. A 14-year-old girl is described who had juvenile arthritis and iritis complicated by inflammatory bowel disease. She was examined for recurrent abdominal pain. A Tc-99m stannous colloid WBC scan was performed, and tracer accumulation was seen in the small bowel in the region of the distal ileum on the initial 1-hour image. Delayed imaging at 3 hours also revealed tracer accumulation in the cecum and ascending colon, which was not seen on the early image. A biopsy of the colon during endoscopy showed no evidence of active inflammation in the colon. The small bowel was not seen. Computed tomography revealed changes suggestive of inflammatory bowel disease in the distal ileum. The appearance on the WBC study was most likely a result of inflammatory bowel disease involving the distal ileum, with transit of luminal activity into the large bowel. PMID:11043720

  2. The update of ultrasound techniques in diagnosis of inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    Mohamed A. Nassef

    2014-06-01

    Conclusion: Conventional ultrasound is a widely available non-invasive method for imaging the alimentary gastrointestinal tract. This can provide an important contribution for diagnosis and monitoring of disease activity. Color Doppler sonography has proved to be a valuable method for the assessment of disease activity in inflammatory bowel disease.

  3. Rheumatic manifestations of inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Tatiana Sofía Rodríguez-Reyna; Cynthia Martínez-Reyes; Jesús Kazúo Yamamoto-Furusho

    2009-01-01

    This article reviews the literature concerning rheumatic manifestations of inflammatory bowel disease(IBD), including common immune-mediated pathways,frequency, clinical course and therapy. Musculoskeletal complications are frequent and well-recognized manifestations in IBD, and affect up to 33% of patients with IBD. The strong link between the bowel and the osteo-articular system is suggested by many clinical and experimental observations, notably in HLA-B27 transgenic rats. The autoimmune pathogenic mechanisms shared by IBD and spondyloarthropathies include genetic susceptibility to abnormal antigen presentation,aberrant recognition of self, the presence of autoantibodies against specific antigens shared by the colon and other extra-colonic tissues, and increased intestinal permeability. The response against microorganisms may have an important role through molecular mimicry and other mechanisms. Rheumatic manifestations of IBD have been divided into peripheral arthritis, and axial involvement, including sacroiliitis,with or without spondylitis, similar to idiopathic ankylosing spondylitis. Other periarticular features can occur,including enthesopathy, tendonitis, clubbing, periostitis,and granulomatous lesions of joints and bones.Osteoporosis and osteomalacia secondary to IBD and iatrogenic complications can also occur. The management of the rheumatic manifestations of IBD consists of physical therapy in combination with local injection of corticosteroids and nonsteroidal anti-inflammatory drugs; caution is in order however, because of their possible harmful effects on intestinal integrity, permeability,and even on gut inflammation. Sulfasalazine,methotrexate, azathioprine, cyclosporine and leflunomide should be used for selected indications. In some cases, tumor necrosis factor-α blocking agents should be considered as first-line therapy.

  4. Inflammatory Bowel Disease: Progress Towards a Gene

    Directory of Open Access Journals (Sweden)

    David A van Heel

    2000-01-01

    Full Text Available The pathogenesis of ulcerative colitis (UC and Crohn’s disease (CD is still unknown, but the importance of genetic susceptibility has been clearly shown by epidemiological data from family and twin studies. Linkage studies have identified two susceptibility loci for inflammatory bowel disease (IBD on chromosomes 12 and 16. Importantly, these linkages have been replicated by independent investigators, and studies of positional candidates within these regions continue, together with fine mapping strategies. Regions of ’suggestive’ linkage on chromosomes 1, 3, 4, 6, 7, 10, 22 and X have also been reported in individual studies. Other important candidate genes investigated include the interleukin-1 receptor antagonist, MUC3 and genes of the human leukocyte antigen (HLA system. The apparently conflicting data in different studies from around the world may be explained by ethnic differences, case mix and genetic heterogeneity. Replicated class II HLA associations include HLA DRB1*0103 and DR2 (DRB1*1502, involved in UC susceptibility, and HLA DRB1*03 and DR4 as resistance alleles for CD and UC respectively. Animal studies have provided insights from targeted mutations and quantitative trait locus analysis. The goals of continuing research include narrowing the regions of linkages and analysis of candidate genes, and possibly the application of newly developed methods using single nucleotide polymorphisms. Advances in IBD genetics hold the potential to provide knowledge about the disease pathogenesis at the molecular level, with ensuing benefits for clinical practice.

  5. Fecal Microbiota Transplantation for Inflammatory Bowel Disease

    Science.gov (United States)

    Lopez, Joanna

    2016-01-01

    The gut bacterial microbiome, particularly its role in disease and inflammation, has gained international attention with the successful use of fecal microbiota transplantation (FMT) in the treatment of Clostridium difficile infection. This success has led to studies exploring the role of FMT in other conditions, including inflammatory bowel disease (IBD). Both Crohn’s disease and ulcerative colitis are chronic inflammatory conditions of the gastrointestinal system that have multifactorial etiologies. A shift in gut microbial composition in genetically susceptible individuals, an altered immune system, and environmental factors are all hypothesized to have a role in the pathogenesis of IBD. While numerous case reports and cohort studies have described the use of FMT in patients with IBD over the last 2 decades, the development of new sequencing techniques and results from 2 recent randomized, controlled trials have allowed for a better understanding of the relationship between the microbiome and the human host. However, despite these efforts, knowledge remains limited and the role of FMT in the management of IBD remains uncertain. Further investigation is necessary before FMT joins the current armamentarium of treatment options in clinical practice. PMID:27493597

  6. Complementary Practitioners’ View of Treatment for Inflammatory Bowel Disease

    OpenAIRE

    Verhoef, Marja J; Rapchuk, Ivan; Liew, Trina; Weir, Vanessa; Hilsden, Robert J

    2002-01-01

    A substantial number of patients with inflammatory bowel disease use complementary therapies to manage their disease, including chiropractic and herbal therapies. The objective of this study was to explore whether providers of these therapies see patients with inflammatory bowel disease and recommend therapies, and to determine their opinions about the treatments that they recommend. The study sample comprised 66 chiropractors, 19 pharmacists, 16 herbalists and 15 health food store employees ...

  7. Limitations in assessment of mucosal healing in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Hugh; James; Freeman

    2010-01-01

    An emerging parameter to define the effectiveness of new therapeutic agents in clinical trials,and by extension,for use in day-to-day clinical practice has been labeled mucosal healing.It has been hypothesized that complete healing of the intestinal mucosa in inflammatory bowel diseases should result in reduced disease complications,reduced hospitalization and reduced surgical treatment.By implication,the natural history of inflammatory bowel disease might then be altered. Measurement of mucosal healing,how...

  8. Skeletal demineralization and growth retardation in inflammatory bowel disease

    Energy Technology Data Exchange (ETDEWEB)

    Genant, H.K.; Mall, J.C.; Wagonfeld, J.B.; Vander Horst, J.; Lanzl, L.H.

    1976-01-01

    Skeletal growth and mineralization in 54 adolescent and adult patients with inflammatory bowel disease have been analyzed comprehensively. Quantitative and qualitative radiologic techniques consisted of conventional roentgenography, photon absorptiometry, and radiographic morphometry. The data are correlated with the type, duration, and severity of disease, and with several modes of therapy. The results indicate that osteopenia and retardation of growth are common in patients with inflammatory bowel disease, particularly in adolescents, in whom the effects of corticosteroids on the skeleton are most deleterious.

  9. Risk of inflammatory bowel disease following a diagnosis of irritable bowel syndrome

    Directory of Open Access Journals (Sweden)

    Porter Chad K

    2012-05-01

    Full Text Available Abstract Background Irritable bowel syndrome (IBS and inflammatory bowel disease (IBD symptoms often overlap. In some IBS cases there are subtle inflammatory changes similar to the immune-mediated pathophysiology of IBD, and the risk of both increases after infectious gastroenteritis (IGE. Methods To evaluate the effect of IBS and IGE on IBD risk utilizing US Department of Defense medical encounter data, active duty personnel with IBS were matched to subjects without IBS. Medical encounter history was analyzed to assess for incident IBD. IGE was identified from documented medical encounters and by self-report. Relative risks were calculated using Poisson regression models. Results We identified 9,341 incident IBS cases and 18,678 matched non-IBS subjects and found an 8.6-fold higher incidence (p p  Conclusions These data reflect a complex interaction between illness presentation and diagnosis of IBS and IBD and suggest intercurrent IGE may increase IBD risk in IBS patients. Additional studies are needed to determine whether IBS lies on the causal pathway for IBD or whether the two are on a pathophysiological spectrum of the same clinical illness. These data suggest consideration of risk reduction interventions for IGE among IBS patients at high disease risk.

  10. Sonography in the diagnosis of chronic inflammatory bowel disease

    International Nuclear Information System (INIS)

    The accuracy of ultrasonography (US) in diagnosing active inflammatory bowel disease (IBD) is assessed on the basis of a randomized prospective study of 61 patients. Twenty-six of the patients were affected with crohn's disease (CD) and 12 with ulcerative colitis, while the remaining 23 patients were control subjects with no specific chronic IBD. The US signs considered as a significant for active CD and UC were: -visualization of a typical target image, that is a hyperechoic center corresponding to luminal bowel content, surrounded by a hypoechoic ring corresponding to loop walls; -at least 2 of the following: solid abdominal mass, distended loops, luminal narrowing, reduced peristalsis, stiff loops, and accumulation of fluid between the loops. US sensitivity and specificity for CD were 77% and 95.6%, respectively. As for UC, no significant results were obtained. In our experiance, US is a reliable method for detecting alterations and, especially, comlpications typical of CD in its active phase. Considering the young age of patients affected with CD and the number of exams they must undergo, US is considered as a useful tool in disease follow-up

  11. Laparoscopic Techniques: What is the Role in Inflammatory Bowel Disease?

    Directory of Open Access Journals (Sweden)

    Tracy L Hull

    1995-01-01

    Full Text Available Laparoscopic cholecystectomy has quickly become the preferred technique for removing the gallbladder. Real advantages in the area of laparoscopic gallbladder removal have spurred interest towards other areas of laparoscopic surgery. There has been interest in laparoscopic bowel surgery but this approach has not gained popularity as quickly as gallbladder surgery. Reasons surround the fact that the bowel is a continuous organ (versus an end organ like the gallbladder laden with bacteria and it has a rich blood supply. These differences make laparoscopic bowel surgery more difficult and challenging. If inflammatory bowel disease (IBD is considered, the indications to approach surgery laparoscopically fall into two categories: current and future indications. The current indications are diagnostic laparoscopy, fecal diversion, limited bowel resections with extracorporeal anastomosis and stoma closures. Future indications include laparoscopic subtotal colectomy and laparoscopic assisted pelvic pouch procedures. As experience is gained and laparoscopic instruments are modified and refined for bowel surgery, intracorporeal anastomosis and more extensive bowel resections will be feasible. Currently laparoscopic bowel surgery can be done in select circumstances for problems associated with IBD. It has yet to be proven if doing the surgery laparoscopically provides advantages for bowel surgery as has been demonstrated with gallbladder surgery. Prospective studies are underway to answer these questions.

  12. Psychosocial factors in peptic ulcer and inflammatory bowel disease.

    Science.gov (United States)

    Levenstein, Susan

    2002-06-01

    Over the past decade, while gastroenterologists' interest in mind-body interactions in organic disorders dwindled, stronger evidence has linked psychosocial factors with the incidence and recurrence of peptic ulcer and with the course of inflammatory bowel disease. Psychological-behavioral approaches to treatment continue to be disappointing. Psychosocial factors may affect ulcer by increasing duodenal acid load, altering local circulation or motility, intensifying Helicobacter pylori infection, stimulating corticosteroid secretion, and affecting health risk behaviors; possible mechanisms for inflammatory bowel disease include immune deregulation, gut permeability changes, and poor medication adherence. Both belong to the growing category of diseases thought to have an infectious component: for peptic ulcer the bacterium Helicobacter pylori, for inflammatory bowel disease an exaggerated immune response to gut bacteria. Peptic ulcer and inflammatory bowel disease, which present unique interactions among psychological, immunologic, endocrine, infectious, and behavioral factors, are splendid paradigms of the biopsychosocial model.

  13. Endoscopic assessment of inflammatory bowel disease: colonoscopy/esophagogastroduodenoscopy.

    LENUS (Irish Health Repository)

    Chan, Grace

    2012-06-01

    Endoscopy plays an important role in the initial diagnosis of IBD, including the evaluation of disease severity, activity, and extent. The implications of complete mucosal healing further confirm the function of endoscopy in the follow-up of IBD patients. The use of therapeutic endoscopy, for example stricture dilatation, can avoid the need for bowel resection. Modalities such as capsule endoscopy, EUS, NBI, CE, and other emerging techniques are likely to have an increasing role in the management of IBD, particularly in the area of dysplasia surveillance and treatment.

  14. Vitamin D, Multiple Sclerosis and Inflammatory Bowel Disease

    OpenAIRE

    Cantorna, Margherita T.

    2011-01-01

    It has now been more than 20 years since the vitamin D receptor was identified in cells of the immune system. The immune system has now been established as an important target of vitamin D. Vitamin D receptor knockout and vitamin D deficient mice have a surplus of effector T cells that have been implicated in the pathology of multiple sclerosis (MS) and inflammatory bowel disease (IBD). The active form of vitamin D directly and indirectly suppresses the function of these pathogenic T cells wh...

  15. Practical guidelines for the treatment of inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    T Kuhbacher; UR F(o)lsch

    2007-01-01

    In recent years, great progress has been made regarding the treatment of inflammatory bowel disease (IBD), particularly in the field of biological therapies.Nevertheless, the ultimate treatment is not in sight.With the development of new medication, it has become clear that we need a new understanding of IBD. Therapy needs to fit the different subtypes of IBD; e.g. mild disease in comparison to severe chronic active disease or Crohn's disease with or without fistulation or stenosis.The following article gives a practical overview of actual treatments for IBD. The intention of this article is not to provide a complete review of all new scientific developments, but to give a practical guideline for therapy of IBD.

  16. ANEMIA IN INFLAMMATORY BOWEL DISEASE MORE THAN AN EXTRAINTESTINAL COMPLICATION.

    Science.gov (United States)

    Nemeş, Roxana Maria; Pop, Corina Silvia; Calagiu, Dorina; Dobrin, Denisa; Chetroiu, Diana; Jantea, Petruta; Postolache, Paraschiva

    2016-01-01

    The most common hematologic complication of inflammatory bowel disease (IBD)--ulcerative colitis and Crohn's Disease is anemia. Anemia in patients with IBD may be a result of iron, vitamin B12 or folate deficiency; anemia of chronic disease and hemolytic anemia are other causes in these patients. Factors contributing to the development of anemia include chronic gastrointestinal blood loss, vitamin B12 malabsorption secondary to terminal ileitis, folate deficiency as a result of sulfasalazine therapy. Approximately 30% of patients with IBD have hemoglobin levels below 12 g/dl. The risk of developing anemia relates to disease activity, given that blood loss and inflammatory anemia are triggered by intestinal inflammation. In the management strategy of IBD patients with anemia it is important to distinguish between the different types of anemia in order to decide an appropriate manner of treatment.

  17. Management of difficult inflammatory bowel disease: where are we now?

    Institute of Scientific and Technical Information of China (English)

    D.S. Rampton

    2000-01-01

    Management of inflammatory bowel disease includes not only drug, endoscopic and surgical therapy but alsopsychosocial support, dietary and specific nutritional measures: a multidisciplinary medical, surgical, nursingand dietetic approach is essential for all patients, particularly those with complex or refractory disease. Inthis paper, current treatment of acute severe ulcerative colitis and steroid-refractory or -dependent Crohn'sdisease is reviewed. Adjunctive intravenous cyclosporin is an alternative to urgent colectomy in steroid-refractory patients with acute severe ulcerative colitis, while the place of intravenous heparin for thisindication awaits clarification. Azathioprine or 6-mercaptopurine are useful options in chronically active,steroid-refractory or -dependent Crohn's disease, but may take up to 4 months to work. Methotrexate is amore recent immunomodulatory alternative. Of new therapies selectively aimed at specific pathophysiologicaltargets, the first to reach clinical application is anti-TNF-alpha antibody (infliximab) for refractory Crohn'sdisease: its benefits are promising, but experience with it is limited to date, its cost is high and there areuncertainties about long-term safety. In view of the increasing variety and complexity of management optionsin inflammatory bowel disease, whether apparently responsive or difficult to treat, patients must participatein decisions about which therapies they are to be given.

  18. Complementary Practitioners’ View of Treatment for Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Marja J Verhoef

    2002-01-01

    Full Text Available A substantial number of patients with inflammatory bowel disease use complementary therapies to manage their disease, including chiropractic and herbal therapies. The objective of this study was to explore whether providers of these therapies see patients with inflammatory bowel disease and recommend therapies, and to determine their opinions about the treatments that they recommend. The study sample comprised 66 chiropractors, 19 pharmacists, 16 herbalists and 15 health food store employees in Calgary, Alberta. A structured questionnaire containing two patient scenarios (a patient with active ulcerative colitis and a patient with inactive Crohn’s disease was completed either by an in-person interview or by a mailed questionnaire. Most respondents had seen patients with ulcerative colitis, and at least 80% of each group except pharmacists (only 10% would treat these patients or recommend treatment. Almost all chiropractors used spinal manipulation, whereas herbalists and health food store employees suggested a wide range of different treatments. Chiropractors rated their treatment as moderately effective; herbalists and health food store employees viewed their recommendations as very effective. The results with respect to the second scenario were very similar. The wide range of treatment recommendations by practitioners, who differ greatly in terms of skills, knowledge and experience, has important implications for physician-patient communication, information provision and education regarding complementary and alternative therapies.

  19. Managing inflammatory bowel disease in pregnancy: current perspectives

    Directory of Open Access Journals (Sweden)

    Pinder M

    2016-10-01

    Full Text Available Matthew Pinder,1 Katie Lummis,1 Christian P Selinger1,2 1Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, 2University of Leeds, Leeds, UK Abstract: Inflammatory bowel disease (IBD affects many women of childbearing age. The course of IBD is closely related to pregnancy outcomes with poorly controlled IBD increasing the risk of prematurity, low weight for gestation, and fetal loss. As such, women with IBD face complex decision making weighing the risks of active disease versus those of medical treatments. This review summarizes the current evidence regarding the safety and efficacy of IBD treatments during pregnancy and lactation aiming to provide up-to-date guidance for clinicians. Over 50% of women have poor IBD- and pregnancy-related knowledge, which is associated with views contrary to medical evidence and voluntary childlessness. This review highlights the effects of poor patient knowledge and critically evaluates interventions for improving patient knowledge and outcomes. Keywords: pregnancy, breast feeding, nursing, inflammatory bowel disease, Crohn’s disease, ulcerative colitis

  20. Steroid allergy in patients with inflammatory bowel disease.

    LENUS (Irish Health Repository)

    Malik, M

    2007-11-01

    Background: Contact allergy to a steroid enema leading to worsening of inflammatory bowel disease (IBD) has recently been reported. This study was designed to look for evidence of steroid allergy in patients with IBD.

  1. Nutritional impact of inflammatory bowel diseases on children and adolescents

    Directory of Open Access Journals (Sweden)

    Gilton Marques dos Santos

    2014-12-01

    Full Text Available OBJECTIVE: To perform a sistematiy review of the literature about the nutritional impact of inflammatory bowel diseases in children and adolescents.DATA SOURCES: A systematic review was performed using PubMed/MEDLINE, LILACS and SciELO databases, with inclusion of articles in Portuguese and in English with original data, that analyzed nutritional aspects of inflammatory bowel diseases in children and adolescents. The initial search used the terms "inflammatory bowel diseases" and "children" or "adolescents" and "nutritional evaluation" or "nutrition deficiency". The selection of studies was initially performed by reading the titles and abstracts. Review studies and those withouth data for pediatric patients were excluded. Subsequently, the full reading of the articles considered relevant was performed.RESULTS: 237 studies were identified, and 12 of them were selected according to the inclusion criteria. None of them was performed in South America. During the analysis of the studies, it was observed that nutritional characteristics of patients with inflammatory bowel disease may be altered; the main reports were related to malnutrition, growth stunting, delayed puberty and vitamin D deficiency.CONCLUSION: There are nutritional consequences of inflammatory bowel diseases in children and adolescents, mainly growth stunting, slower pubertal development, underweight and vitamin deficiencies. Nutritional impairments were more significant in patients with Crohn's disease; overweight and obesity were more common in patients with ulcerative rectocolitis. A detailed nutritional assessment should be performed periodically in children and adolescents with inflammatory bowel disease.

  2. Recent results of laparoscopic surgery in inflammatory bowel disease

    OpenAIRE

    Kessler, Hermann; Mudter, Jonas; Hohenberger, Werner

    2011-01-01

    Inflammatory bowel diseases are an ideal indication for the laparoscopic surgical approach as they are basically benign diseases not requiring lymphadenectomy and extended mesenteric excision; well-established surgical procedures are available for the conventional approach. Inflammatory alterations and fragility of the bowel and mesentery, however, may demand a high level of laparoscopic experience. A broad spectrum of operations from the rather easy enterostomy formation for anal Crohn’s dis...

  3. What's new in inflammatory bowel disease in 2008?

    Institute of Scientific and Technical Information of China (English)

    Daniel C Baumgart

    2008-01-01

    Ulcerative colitis and Crohn's disease represent the two major forms of inflammatory bowel disease. In this highlight topic series of articles we cover the latest developments in genetics and epiderniology, intestinal physiology, mucosal immunology, mechanisms of epithelial cell injury and restitution, current medical therapy, modern surgical management, important extraintestinal complications such as primary sclerosing cholangitis, cholangiocellular carcinoma and autoimmune hepatitis as well as endoscopic and molecular screening, detection and prevention of small bowel and colorectal cancer.

  4. Non-perforating small bowel Crohn's disease assessed by MRI enterography: Derivation and histopathological validation of an MR-based activity index

    Energy Technology Data Exchange (ETDEWEB)

    Steward, Michael J., E-mail: mikejsteward@gmail.com [Department of Specialist Imaging, University College Hospital London, 235 Euston Road, London NW1 2BU (United Kingdom); Punwani, Shonit, E-mail: shonit.punwani@uclh.nhs.net [Department of Specialist Imaging, University College Hospital London, 235 Euston Road, London NW1 2BU (United Kingdom); Centre for Medical Imaging, Division of Medicine, University College London, 235 Euston Road, London NW1 2BU (United Kingdom); Proctor, Ian, E-mail: ian.proctor@nhs.net [Department of Histopathology, University College London Hospital, London, 235 Euston Road, London NW1 2BU (United Kingdom); Adjei-Gyamfi, Yvette, E-mail: yvette.adjei-gyamfi@uclh.nhs.net [Department of Specialist Imaging, University College Hospital London, 235 Euston Road, London NW1 2BU (United Kingdom); Chatterjee, Fiona, E-mail: fiona.chaterjee@uclh.nhs.net [Department of Specialist Imaging, University College Hospital London, 235 Euston Road, London NW1 2BU (United Kingdom); Bloom, Stuart, E-mail: stuart.bloom@uclh.nhs.net [Department of Gastroenterology, University College London Hospital, London, 235 Euston Road, London NW1 2BU (United Kingdom); Novelli, Marco, E-mail: marco.novealli@uclh.nhs.net [Department of Histopathology, University College London Hospital, London, 235 Euston Road, London NW1 2BU (United Kingdom); Halligan, Steve, E-mail: S.halligan@ucl.ac.uk [Department of Specialist Imaging, University College Hospital London, 235 Euston Road, London NW1 2BU (United Kingdom); Centre for Medical Imaging, Division of Medicine, University College London, 235 Euston Road, London NW1 2BU (United Kingdom); Rodriguez-Justo, Manuel, E-mail: manuel.rodriguez-justo@uclh.nhs.uk [Department of Histopathology, University College London Hospital, London, 235 Euston Road, London NW1 2BU (United Kingdom); and others

    2012-09-15

    Objectives: To develop and validate a qualitative scoring system for enteric Crohn's disease activity using MR enterography (MRE). Methods: MRE was performed in 16 patients (mean age 33, 8 male) undergoing small bowel resection. Mural thickness, T2 signal, contrast enhancement, and perimural oedema were scored qualitatively (0–3) at 44 locations. Transmural histopathological scoring of acute inflammation (AIS) was performed at all locations (score 0–13). MRI parameters best predicting AIS were derived using multivariate analysis. The MRI activity index was applied to 26 Crohn's patients (mean age 32, range 13–69 years, 15 male) and correlated to terminal ileal biopsy scores of acute inflammation (“eAIS” score 1–6). Receiver operator characteristic curves were calculated. Results: Mural thickness (coefficient 1.34 (95% CI 0.36, 2.32)], p = 0.007) and T2 signal (coefficient 0.90 (95% CI −0.24, 2.04) p = 0.06) best predicted AIS (AIS = 1.79 + 1.34*mural thickness + 0.94*mural T2 score [R-squared 0.52]). There was a significant correlation between the MRI index and eAIS (Kendall's tau = 0.40, 95% CI 0.11–0.64, p = 0.02). The model achieved a sensitivity of 0.81 (95% CI 0.54–0.96), specificity of 0.70 (0.35–0.93) and AUC 0.77 for predicting acute inflammation (eAIS ≥2). Conclusions: A simple qualitative MRI Crohn's disease activity score appears predictive against a histopathological standard of reference.

  5. Current trends in inflammatory bowel disease: the natural history

    OpenAIRE

    Langholz, Ebbe

    2010-01-01

    The description of the prognosis of inflammatory bowel disease (IBD) is based on systematic follow-up of population-based cohorts. A steady increase in incidence of IBD has occurred. The distribution of ulcerative colitis (UC) is fairly uniform with a preponderance of left-sided disease. One-third of Crohn’s disease (CD) patients present with colonic disease, one-third with ileocolonic disease and one-third with small bowel disease. IBD is associated with extra-intestinal manifestations (EIMs...

  6. Serological markers of inflammatory bowel disease.

    Science.gov (United States)

    Kuna, Andrea Tesija

    2013-01-01

    Inflammatory bowel disease (IBD) is a heterogeneous group of chronic inflammatory disorders of the gastrointestinal tract with two main distinguishable entities, Crohn's disease (CD) and ulcerative colitis (UC). IBD-unclassified (IBD-U) is a diagnosis that covers the "grey" zone of diagnostic uncertainty between UC and CD. Current diagnosis of IBD relies on the clinical, endoscopic, radiological, histological and biochemical features, but this approach has shortcomings especially in cases of overlapping symptoms of CD and UC. The need for a diagnostic tool that would improve the conventional methods in IBD diagnosis directed the search towards potential immunological markers, since an aberrant immune response against microbial or endogenous antigens in a genetically susceptible host seems to be implicated in IBD pathogenesis. The spectrum of antibodies to different microbial antigens and autoantibodies associated with IBD is rapidly expanding. Most of these antibodies are associated with CD like anti-glycan antibodies: anti-Saccharomices cerevisiae (ASCA) and the recently described anti-laminaribioside (ALCA), anti-chitobioside (ACCA), anti-mannobioside (AMCA), anti-laminarin (anti-L) and anti-chitin (anti-C) antibodies; in addition to other antibodies that target microbial antigens: anti-outer membrane porin C (anti-OmpC), anti-Cbir1 flagellin and anti-12 antibody. Also, autoantibodies targeting the exocrine pancreas (PAB) were shown to be highly specific for CD. In contrast, UC has been associated with anti-neutrophil cytoplasmic autoantibodies (pANCA) and antibodies against goblet cells (GAB). Current evidence suggests that serologic panels of multiple antibodies are useful in differential diagnosis of CD versus UC and can be a valuable aid in stratifying patients according to disease phenotype and risk of complications.

  7. Mouth cancer in inflammatory bowel diseases.

    Science.gov (United States)

    Giagkou, E; Christodoulou, D K; Katsanos, K H

    2016-05-01

    Mouth cancer is a major health problem. Multiple risk factors for developing mouth cancer have been studied and include history of tobacco and alcohol abuse, age over 40, exposure to ultraviolet radiation, human papilloma virus infection (HPV), nutritional deficiencies, chronic irritation, and existence or oral potentially malignant lesions such as leukoplakia and lichen planus. An important risk factor for mouth cancer is chronic immunosuppression and has been extensively reported after solid organ transplantation as well as HIV-infected patients. Diagnosis of inflammatory bowel disease (IBD) is not yet considered as a risk factor for oral cancer development. However, a significant number of patients with IBD are receiving immunosuppressants and biological therapies which could represent potential oral oncogenic factors either by direct oncogenic effect or by continuous immunosuppression favoring carcinogenesis, especially in patients with HPV(+) IBD. Education on modifiable risk behaviors in patients with IBD is the cornerstone of prevention of mouth cancer. Oral screening should be performed for all patients with IBD, especially those who are about to start an immunosuppressant or a biologic. PMID:26671147

  8. Intestinal barrier homeostasis in inflammatory bowel disease.

    Science.gov (United States)

    Goll, Rasmus; van Beelen Granlund, Atle

    2015-01-01

    The single-cell thick intestinal epithelial cell (IEC) lining with its protective layer of mucus is the primary barrier protecting the organism from the harsh environment of the intestinal lumen. Today it is clear that the balancing act necessary to maintain intestinal homeostasis is dependent on the coordinated action of all cell types of the IEC, and that there are no passive bystanders to gut immunity solely acting as absorptive or regenerative cells: Mucin and antimicrobial peptides on the epithelial surface are continually being replenished by goblet and Paneth's cells. Luminal antigens are being sensed by pattern recognition receptors on the enterocytes. The enteroendocrine cells sense the environment and coordinate the intestinal function by releasing neuropeptides acting both on IEC and inflammatory cells. All this while cells are continuously and rapidly being regenerated from a limited number of stem cells close to the intestinal crypt base. This review seeks to describe the cell types and structures of the intestinal epithelial barrier supporting intestinal homeostasis, and how disturbance in these systems might relate to inflammatory bowel disease.

  9. Biologic targeting in the treatment of inflammatory bowel diseases

    Directory of Open Access Journals (Sweden)

    Matteo Bosani

    2009-02-01

    Full Text Available Matteo Bosani, Sandro Ardizzone, Gabriele Bianchi PorroChair of Gastroenterology, “L. Sacco” University Hospital, Milan, ItalyAbstract: The etiology of inflammatory bowel disease (IBD has not yet been clarified and immunosuppressive agents which nonspecifically reduce inflammation and immunity have been used in the conventional therapies for IBD. Evidence indicates that a dysregulation of mucosal immunity in the gut of IBD causes an overproduction of inflammatory cytokines and trafficking of effector leukocytes into the bowel, thus leading to an uncontrolled intestinal inflammation. Under normal situations, the intestinal mucosa is in a state of “controlled” inflammation regulated by a delicate balance of proinflammatory (tumor necrosis factor [TNF-α], interferon-gamma [IFN-γ], interleukin-1 [IL-1], IL-6, IL-12 and anti-inflammatory cytokines IL-4, IL-10, IL-11. The mucosal immune system is the central effector of intestinal inflammation and injury, with cytokines playing a central role in modulating inflammation. Cytokines may therefore be a logical target for inflammatory bowel disease therapy using specific cytokine inhibitors. Biotechnology agents targeted against TNF, leukocyte adhesion, Th1 polarization, T cell activation, nuclear factor-kappaB (NF-κB, and other miscellaneous therapies are being evaluated as potential therapies for the treatment of inflammatory bowel disease. In this context, infliximab and adalimumab are currently the only biologic agents approved in Europe for the treatment of inflammatory Crohn’s disease. Other anti-TNF biologic agents have emerged, including CDP571, certolizumab pegol, etanercept, onercept. However, ongoing research continues to generate new biologic agents targeted at specific pathogenic mechanism involved in the inflammatory process. Lymphocyte-endothelial interactions mediated by adhesion molecules are important in leukocyte migration and recruitment to sites of inflammation, and

  10. Inflammatory bowel diseases: from pathogenesis to laboratory testing.

    Science.gov (United States)

    Basso, Daniela; Zambon, Carlo-Federico; Plebani, Mario

    2014-04-01

    Inflammatory bowel diseases (IBDs), which comprise the two major clinical subtypes, Crohn's disease and ulcerative colitis, incur high morbidity and potential mortality. The present study reviews data on the pathogenesis and diagnosis of IBDs. The pathogenesis depends on complex interactions between susceptibility genes, environmental factors, and innate and adaptive immunity, the understanding of which is crucial to discovering novel laboratory biomarkers. Traditional laboratory tests for the diagnosis, prognosis and assessment of disease activity of IBDs are reported on, and the biochemical properties, pre-analytical and analytical aspects and clinical utility of the fecal markers lactoferrin and calprotectin are described. DNA testing and established (ASCA and pANCA) and emerging (ACCA, ALCA, AMCA, OmpC) serum markers are described; a further aspect to be addressed is the clinical use of pharmacogenetics for the treatment of IBDs.

  11. The clinical implications of thalidomide in inflammatory bowel diseases.

    Science.gov (United States)

    Diamanti, Antonella; Capriati, Teresa; Papadatou, Bronislava; Knafelz, Daniela; Bracci, Fiammetta; Corsetti, Tiziana; Elia, Domenica; Torre, Giuliano

    2015-06-01

    Thalidomide has anti-inflammatory and anti-angiogenetic activity that makes it suitable for treating inflammatory bowel diseases (IBD). The recent guidelines from the European Crohn's and Colitis Organization/European Society for Pediatric Gastroenterology Hepatology and Nutrition conclude that thalidomide cannot be recommended in refractory pediatric Crohn's disease but that it may be considered in selected cohorts of patients who are not anti-TNFα agent responders. The main adverse effect is the potential teratogenicity that renders the long-term use of thalidomide problematic in young adults due to the strict need for contraceptive use. In short-term use it is relatively safe; the most likely adverse effect is the neuropathy, which is highly reversible in children. So far the use of thalidomide is reported in 223 adult and pediatric IBD patients (206 with Crohn's disease). In the following sections, the authors will discuss efficacy and safety of thalidomide, in the short-term treatment of IBD.

  12. Adenosine: An immune modulator of inflammatory bowel diseases

    Institute of Scientific and Technical Information of China (English)

    Jeff Huaqing Ye; Vazhaikkurichi M Rajendran

    2009-01-01

    Inflammatory bowel disease (IBD) is a common and lifelong disabling gastrointestinal disease. Emerging treatments are being developed to target inflammatory cytokines which initiate and perpetuate the immune response. Adenosine is an important modulator of inflammation and its anti-inflammatory effects have been well established in humans as well as in animal models. High extracellular adenosine suppresses and resolves chronic inflammation in IBD models. High extracellular adenosine levels could be achieved by enhanced adenosine absorption and increased de novo synthesis. Increased adenosine concentration leads to activation of the A2a receptor on the cell surface of immune and epithelial cells that would be a potential therapeutic target for chronic intestinal inflammation. Adenosine is transported via concentrative nucleoside transporter and equilibrative nucleoside transporter transporters that are localized in apical and basolateral membranes of intestinal epithelial cells, respectively. Increased extracellular adenosine levels activate the A2a receptor, which would reduce cytokines responsible for chronic inflammation.

  13. Increased expression of IL-16 in inflammatory bowel disease

    Science.gov (United States)

    Seegert, D; Rosenstiel, P; Pfahler, H; Pfefferkorn, P; Nikolaus, S; Schreiber, S

    2001-01-01

    BACKGROUND—Inflammatory bowel disease (IBD) is characterised by infiltration of inflamed mucosal regions with CD4+ T lymphocytes and other mononuclear cells. Interleukin (IL)-16 exerts a strong chemoattractant activity on CD4+ cells. Moreover, IL-16 activates expression and production of proinflammatory cytokines such as IL-1β, IL-6, IL-15, and tumour necrosis factor α (TNF-α) in human monocytes.
AIM—To examine if IL-16 expression is increased in IBD patients compared with healthy controls.
METHODS—Twenty one patients with IBD (10 with ulcerative colitis (UC), 11 with Crohn's disease (CD)), seven disease specificity controls (DSC), and seven healthy controls were studied. Biopsies were taken during colonoscopies and IL-16 mRNA as well as protein expression were investigated by reverse transcriptase-polymerase chain reaction, ELISA, western blot, and immunohistochemistry.
RESULTS—IL-16 mRNA and protein expression in the colonic mucosa of IBD patients were increased twofold compared with healthy controls, DSC, or IBD patients under steroid treatment. Most of the detected IL-16 protein was in its bioactive 17 kDa form and was predominantly expressed in eosinophils. Increased IL-16 expression in UC patients appeared to be mainly restricted to the inflamed regions of the colonic mucosa. Levels of caspase 3, which processes the 68 kDa IL-16 precursor molecule into the biological active 17 kDa form, were not increased.
CONCLUSIONS—Our results provide evidence that IL-16 expression is significantly increased in the inflamed colonic mucosa of IBD patients but not in control individuals, DSC, or patients under steroid treatment. Therefore, upregulation of IL-16 expression seems to be specific for chronic intestinal inflammation and could lead to increased secretion of other proinflammatory cytokines in IBD.


Keywords: interleukin-16; T lymphocytes; eosinophils; Crohn's disease; ulcerative colitis; inflammatory bowel disease PMID:11171821

  14. Mucosal antibodies in inflammatory bowel disease are directed against intestinal bacteria.

    OpenAIRE

    Macpherson, A.; Khoo, U Y; Forgacs, I; Philpott-Howard, J.; Bjarnason, I

    1996-01-01

    In contrast with normal subjects where IgA is the main immunoglobulin in the intestine, patients with active inflammatory bowel disease (IBD) produce high concentrations of IgG from intestinal lymphocytes, but the antigens at which these antibodies are directed are unknown. To investigate the specificities of these antibodies mucosal immunoglobulins were isolated from washings taken at endoscopy from 21 control patients with irritable bowel syndrome, 10 control patients with intestinal inflam...

  15. Role of STAT3 in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Ken Sugimoto

    2008-01-01

    Signal transducers and activators of transcription 3(STAT3)play an important role in various autoimmune disorders including inflammatory bowel disease(IBD).Recent studies have revealed that STAT3 activation plays distinctly difierent roles between innate immune responses and acquired immune responses in colitis.STAT3-mediated activation of acquired immune re-sponses plays a pathogenic role in colitis by enhancing the survival of pathogenic T cells.In contrast,STAT3-mediated activation of innate responses contributes to the suppression of colitis.This review will summarize the current understanding of the roles of STAT3 in IBD and the potential of targeting STAT3 for the treatment of BD,emphasizing recent observations.(C)2008 The WJG Press.All rights reserved.

  16. Etiology and pathophysiology of inflammatory bowel disease--environmental factors.

    Science.gov (United States)

    Andus, T; Gross, V

    2000-01-01

    Environmental factors play an important role in the pathophysiology of inflammatory bowel disease. There is a strong and consistent association between smoking and Crohn's disease, and between nonsmoking and ulcerative colitis. Despite extensive research, the exact pathophysiological mechanisms for these associations remain unclear. In spite of this, some clinical trials with nicotine-patches showed beneficial effects for the treatment of ulcerative colitis. Associations of Crohn's disease and ulcerative colitis with other environmental factors are weaker like the association with use of oral contraceptives or those less well investigated such as the association with childhood hygiene. Most studies suggesting a potential pathogenetic role of Mycobacterium paratuberculosis or an effect of tuberculostatic therapy in Crohn's disease could not be reproduced by others. Perinatal or childhood infections by viruses like measles are heavily debated, but not proven to be causal for inflammatory bowel disease. Coagulation disorders have been described as protecting from inflammatory bowel disease, suggesting hypercoagulability to be a pathogenetic factor. Some studies described that appendectomy may prevent the onset of ulcerative colitis in man and mice. Other environmental factors such as hydrogen sulfide, tonsillectomy, diet, blood transfusions, and Listeria also require confirmation. There are, however, convincing data from genetic animal models and twin studies that environmental factors as the intestinal bacterial flora interact with susceptible hosts to cause inflammatory bowel disease. Inflammatory bowel diseases have multifactorial etiologies, which require a differentiated approach for treatment and prevention. PMID:10690583

  17. Fecal immunochemical test as a biomarker for inflammatory bowel diseases: can it rival fecal calprotectin?

    OpenAIRE

    Kato, Jun; Hiraoka, Sakiko; Nakarai, Asuka; Takashima, Shiho; Inokuchi, Toshihiro; Ichinose, Masao

    2016-01-01

    Accurate evaluation of disease activity is essential for choosing an appropriate treatment and follow-up plan for patients with inflammatory bowel disease (IBD). Endoscopy is required for accurately evaluating disease activity, but the procedures are sometimes invasive and burdensome to patients. Therefore, alternative non-invasive methods for evaluating or predicting disease activity including mucosal status are desirable. Fecal calprotectin (Fcal) is the most widely used fecal marker for IB...

  18. Impact of pain on health-related quality of life in patients with inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Anja; Schirbel; Anne; Reichert; Stephanie; Roll; Daniel; C; Baumgart; Carsten; Büning; Bianca; Wittig; Bertram; Wiedenmann; Axel; Dignass; Andreas; Sturm

    2010-01-01

    AIM: To evaluate intensity, localization and cofactors of pain in Crohn’s disease and ulcerative colitis patients in connection with health-related quality of life (HRQOL) and disease activity. METHODS: We reviewed and analyzed the responses of 334 patients to a specifically designed questionnairebased on the short inflammatory bowel disease questionnaire (SIBDQ) and the German pain questionnaire. Pain intensity, HRQOL, Crohn’s disease activity index (CDAI) and colitis activity index (CAI) were correlated a...

  19. Involvement of coagulation and hemostasis in inflammatory bowel diseases.

    Science.gov (United States)

    Stadnicki, Antoni

    2012-09-01

    Inflammatory bowel diseases (IBD), Crohn's disease and ulcerative colitis (UC) are idiopathic, intestinal and systemic inflammatory disorders which are immunologically mediated with the activation of plasma proteolytic cascades. The activation of coagulation in IBD is related to the activity and colonic extension of the disease, but may still be persistent in a quiescent stage. Factor XIII seems to be as much a coagulation factor as a connective tissue factor which may contribute to intestinal healing. Fibrinolytic capacity is reduced in systemic circulation of IBD patients. Platelets activation is a feature of IBD which contributes to a pathogenic inflammatory sequel. There is evidence that coagulation activation may in turn mediate and amplify inflammatory cascades in IBD, especially via activating PARs related pathways. The etiology of thromboembolism in IBD seems to be multifactorial but is largely attributable to the coagulation activation and platelet aggregation during systemic inflammation. Thromboembolic (TE) complications in both Crohn's disease and UC appear to have at least 3-4 fold increased risk of developing compared to control patients. Currently, no single TE laboratory marker has a predictive value, but a recently developed endogenous thrombin potential test may have a potentially predicative value in IBD. At present, no interaction between IBD and inherited factors of thrombophilia has been found. An efficacy of heparin treatment in UC is still controversial, although heparin is safe in UC flare. Prophylactic anticoagulation against TE is currently not fully defined, however, high - risk patients should be considered for using a moderate dose of heparin. PMID:22272910

  20. Predictive factors of small bowel patency in Crohn's disease patients

    Directory of Open Access Journals (Sweden)

    Andreia Albuquerque

    2016-02-01

    Full Text Available Background: Patency capsule was developed to avoid small bowel video capsule endoscopy retention, namely in patients with Crohn's disease. Aims: To evaluate the predictive factors of small bowel patency in Crohn's disease patients. Patients and methods: Retrospective analysis including 151 Crohn's disease patients submitted to patency capsule (Agile® Patency Capsule from 2011 to 2012. Patients that excreted the intact patency capsule were classified as having a patent small bowel (without patency capsule retention, other patients were considered to have negative patency of the small bowel (patency capsule retention. Results: Patients had a mean age of 41±14 years, 54% were female and 25% had been previously submitted to surgery. Stricturing disease was seen in 20% of cases and penetrating disease in 16% of cases. Left-sided colonic lesions and ileal strictures were observed at colonoscopy in 13% and 9% of patients, respectively. In our sample, 28% of patients had negative patency of the small bowel (patency capsule retention. In multivariate analysis, independent factors that were associated with negative patency of the small bowel in Crohn's disease patients were stricturing (OR 10.16, p < 0.001 and penetrating phenotypes (OR 11.73, p = 0.001, left-sided colonic lesions (OR 3.77, p = 0.038, ileal stricture (OR 9.76, p = 0.003; previous intestinal surgery was found to be protective (OR 0.16, p = 0.006. Conclusions: Stricturing or penetrating disease, ileal strictures, no previous surgery and left-sided colonic lesions were the factors associated with negative small bowel patency in Crohn's disease patients.

  1. Risk of ischaemic heart disease in patients with inflammatory bowel disease

    DEFF Research Database (Denmark)

    Rungoe, Christine; Basit, Saima; Ranthe, Mattis Flyvholm;

    2013-01-01

    Inflammatory bowel disease (IBD) is a chronic inflammatory disorder. Systemic inflammation increases the risk of atherosclerosis and ischaemic heart disease (IHD).......Inflammatory bowel disease (IBD) is a chronic inflammatory disorder. Systemic inflammation increases the risk of atherosclerosis and ischaemic heart disease (IHD)....

  2. Inflammatory Bowel Disease in Children of Middle Eastern Descent

    Directory of Open Access Journals (Sweden)

    Christina Mai Ying Naidoo

    2014-01-01

    Full Text Available Increasing rates of inflammatory bowel disease (IBD are now seen in populations where it was once uncommon. The pattern of IBD in children of Middle Eastern descent in Australia has never been reported. This study aimed to investigate the burden of IBD in children of Middle Eastern descent at the Sydney Children’s Hospital, Randwick (SCHR. The SCHR IBD database was used to identify patients of self-reported Middle Eastern ethnicity diagnosed between 1987 and 2011. Demographic, diagnosis, and management data was collected for all Middle Eastern children and an age and gender matched non-Middle Eastern IBD control group. Twenty-four patients of Middle Eastern descent were identified. Middle Eastern Crohn’s disease patients had higher disease activity at diagnosis, higher use of thiopurines, and less restricted colonic disease than controls. Although there were limitations with this dataset, we estimated a higher prevalence of IBD in Middle Eastern children and they had a different disease phenotype and behavior compared to the control group, with less disease restricted to the colon and likely a more active disease course.

  3. Complex host genetics influence the microbiome in inflammatory bowel disease

    NARCIS (Netherlands)

    Knights, Dan; Silverberg, Mark S.; Weersma, Rinse K.; Gevers, Dirk; Dijkstra, Gerard; Huang, Hailiang; Tyler, Andrea D.; van Sommeren, Suzanne; Imhann, Floris; Stempak, Joanne M.; Huang, Hu; Vangay, Pajau; Al-Ghalith, Gabriel A.; Russell, Caitlin; Sauk, Jenny; Knight, Jo; Daly, Mark J.; Huttenhower, Curtis; Xavier, Ramnik J.

    2014-01-01

    Background: Human genetics and host-associated microbial communities have been associated independently with a wide range of chronic diseases. One of the strongest associations in each case is inflammatory bowel disease (IBD), but disease risk cannot be explained fully by either factor individually.

  4. Transcriptomic landscape of lncRNAs in inflammatory bowel disease

    DEFF Research Database (Denmark)

    Mirza, Aashiq Hussain; Bang-Berthelsen, Claus Heiner; Seemann, Ernst Stefan;

    2015-01-01

    BACKGROUND: Inflammatory bowel disease (IBD) is a complex multi-factorial inflammatory disease with Crohn's disease (CD) and ulcerative colitis (UC) being the two most common forms. A number of transcriptional profiling studies have provided compelling evidence that describe the role of protein...

  5. Cordyceps pruinosa for the treatment of inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    Dejun Cui

    2009-05-01

    Full Text Available "nTo date, there have been no curative drugs for inflammatory bowel disease (IBD. Conventional drugs and biologic agents are not always effective and may cause serious side effects. Therefore, it is still challenging to develop effective and safe novel drugs for IBD. Although the exact etiology of IBD remains elusive, it is generally accepted that the immune system of the gut plays a central role in the pathogenesis of IBD. Recently, the nuclear transcription factor kappa B (NF-κB has been identified as the pivotal elements in the regulation of the increased inflammatory activity. Moreover, recent studies have shown that Cordyceps pruinosa extract is a inhibitor of NF- κB activation and can enhance weak immune functions. Based on these facts, I hypothesize that Cordyceps pruinosa extract may thus exert its therapeutic effect on IBD by regulating NF-κB activity and improving impaired immune functions.

  6. Recent advances in cytokines: Therapeutic implications for inflammatory bowel diseases

    Institute of Scientific and Technical Information of China (English)

    Guillaume Bouguen; Jean-Baptiste Chevaux; Laurent Peyrin-Biroulet

    2011-01-01

    Inflammatory bowel diseases (IBDs) are complex and chronic disabling conditions resulting from a dysregulated dialogue between intestinal microbiota and components of both the innate and adaptive immune systems. Cytokines are essential mediators between activated immune and non-immune cells, including epithelial and mesenchymal cells. They are immunomodulatory peptides released by numerous cells and these have significant effects on immune function leading to the differentiation and survival of T cells. The physiology of IBD is becoming a very attractive field of research for development of new therapeutic agents. These include cytokines involved in intestinal immune inflammation. This review will focus on mechanisms of action of cytokines involved in IBD and new therapeutic opportunities for these diseases.

  7. Matrix Metalloproteinases in Inflammatory Bowel Disease: An Update

    Directory of Open Access Journals (Sweden)

    Shane O’Sullivan

    2015-01-01

    Full Text Available Matrix metalloproteinases (MMPs are known to be upregulated in inflammatory bowel disease (IBD and other inflammatory conditions, but while their involvement is clear, their role in many settings has yet to be determined. Studies of the involvement of MMPs in IBD since 2006 have revealed an array of immune and stromal cells which release the proteases in response to inflammatory cytokines and growth factors. Through digestion of the extracellular matrix and cleavage of bioactive proteins, a huge diversity of roles have been revealed for the MMPs in IBD, where they have been shown to regulate epithelial barrier function, immune response, angiogenesis, fibrosis, and wound healing. For this reason, MMPs have been recognised as potential biomarkers for disease activity in IBD and inhibition remains a huge area of interest. This review describes new roles of MMPs in the pathophysiology of IBD and suggests future directions for the development of treatment strategies in this condition.

  8. Role of Antimicrobial Peptides in Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Stefan Vordenbäumen

    2011-11-01

    Full Text Available Inflammatory bowel diseases (IBD are characterized by a chronic relapsing inflammation of the gastrointestinal mucosa. The etiology and pathogenesis of these disorders such as Crohn’s disease and ulcerative colitis are incompletely understood. Recently, antimicrobial peptides, which are expressed by leukocytes and epithelia, have been implicated in the pathogenesis of IBD. Antimicrobial peptides are pivotal for intestinal defense, shaping the composition of the luminal flora and contributing thereby to the maintenance of intestinal homeostasis. Apart from their antimicrobial activity affecting commensal bacteria, immunomodulatory properties of antimicrobial peptides have been identified, which link innate and adaptive immune response. There is increasing evidence that alterations in mucosal levels of these peptides contribute to IBD pathogenensis.

  9. Rifaximin in the treatment of inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Mario Guslandi

    2011-01-01

    The gut microbiota plays a role in promoting and maintaining inflammation in inflammatory bowel diseases (IBD), hence the rationale for the use of antibiotics in the treatment of those disorders. Antibiotics, however, may induce untoward effects, especially during longterm therapy. Rifaximin a polymer is an antibacterial agent that is virtually unabsorbed after oral administration and is devoid of systemic side effects. Rifaximin has provided promising results in inducing remission of Crohn's disease (up to 69% in open studies and significantly higher rates than placebo in double blind trials) and ulcerative colitis (76% in open studies and significantly higher rates than placebo in controlled studies) and might also have a role in maintaining remission of ulcerative colitis and pouchitis. The potential therapeutic activity of rifaximin in IBD deserves to be further investigated and confirmed in larger, controlled studies. The optimal dosage still needs to be better defined.

  10. In vitro and in vivo inhibitory activity of 6-amino-2,4,5-trimethylpyridin-3-ols against inflammatory bowel disease.

    Science.gov (United States)

    Banskota, Suhrid; Kang, Han-Eol; Kim, Dong-Guk; Park, Sang Won; Jang, Hyeonjin; Karmacharya, Ujjwala; Jeong, Byeong-Seon; Kim, Jung-Ae; Nam, Tae-Gyu

    2016-10-01

    Although the pathogenesis of inflammatory bowel disease (IBD) is complex, attachment and infiltration of leukocytes to gut epithelium induced by pro-inflammatory cytokines such as tumor necrosis factor-α (TNF-α) represents the initial step of inflammation in IBD. Previously, we have reported that some 6-amino-2,4,5-trimethylpyridin-3-ols have significant levels of antiangiogenic activity via PI3K inhibition. Based on the reports that angiogenesis is involved in the aggravation of IBD and that PI3K is a potential target for IBD therapy, we investigated whether the scaffold has inhibitory activity against in vitro and in vivo models of colitis. Many analogues showed >80% inhibition against TNF-α-induced monocyte adhesion to colon epithelial cells at 1μM. Compound 8m showed IC50=0.19μM, which is about five orders of magnitude better than that of 5-aminosalicylic acid (5-ASA, IC50=18.1mM), a positive control. In a rat model of 2,4,6-trinitrobenzenesulfonic acid (TNBS)-induced colitis, orally administered 8m dramatically ameliorated TNBS-induced colon inflammation. It was demonstrated by a high level of suppression in myeloperoxidase (MPO), a surrogate marker of colitis, as well as almost perfect recovery of colon and body weights in a dose-dependent manner. Compared to sulfasalazine, a prodrug of 5-ASA, compound 8m showed >300-fold better efficacy in those parameters. Taken together, 6-amino-2,4,5-trimethylpyridin-3-ols can provide a novel platform for anti-IBD drug discovery. PMID:27597248

  11. /sup 111/In autologous leucocytes in the diagnosis and assessment of inflammatory bowel disease. [Tropolone

    Energy Technology Data Exchange (ETDEWEB)

    Saverymuttu, S.H.; Peters, A.M.; Chadwick, V.S.; Hodgson, H.J.; Lavender, J.P. (Hammersmith Hospital, London (UK))

    1982-01-01

    Indium-111 autologous leukocyte scanning is now established as an effective method of localising sepsis (Ascher and others, 1980). In view of the extensive leucocyte infiltration of the intestinal wall in inflammatory bowel disease, the authors have prospectively studied the use of indium-111 labelled white cells in a variety of inflammatory bowel disorders. Leukocytes were labelled in 68 patients using /sup 111/In acetylacetonate and in 18 patients /sup 111/In tropolone. Crude mixed leukocytes preparations were used in 74 patients and pure neutrophil preparation used in 12 patients. Gamma scans over the abdomen were performed from 40 min later after re-injection of the labelled cells and assessed. /sup 111/In-tropolone labelling appeared to offer the advantage over /sup 111/In-acac labelling in localising inflamed bowel earlier. The technique of /sup 111/In-leukocyte scanning offers several advantages over the alternative technique of imaging diseased bowel using gallium-67 citrate. Indium-111 leukocyte scanning provides a novel approach to the problem of diagnosis and assessment of inflammatory bowel disease. It is non-invasive, requires no bowel preparation and this is safe in the acutely sick patient where conventional radiological imaging methods may be hazardous. /sup 111/In faecal excretion provides an objective assessment of disease activity which should prove useful in evaluating treatment regimes.

  12. Review article: antibiotics and probiotics in inflammatory bowel disease.

    Science.gov (United States)

    Kruis, W

    2004-10-01

    Treatment with antibiotics in inflammatory bowel disease has a long tradition and is widely used. The indications for antibiotic therapy are wide ranging, from specific situations such as abscesses or fistulae, to patients with severe disease (as an unspecific 'protective' measure), and to address the hypothesis that the enteric flora as a whole, or specific microorganisms such as mycobacteria, are involved in the pathogenesis of inflammatory bowel disease. The best-studied single antibiotic compound is metronidazole. However, overall, the scientific basis for the use of antibiotics is limited, which may reflect a lack of interest from sponsors within the pharmaceutical industry. Despite this weak evidence base, antibiotics are a globally established therapeutic tool in inflammatory bowel disease. Growing evidence from human and animal studies points towards a pivotal pathogenetic role of intestinal bacteria in inflammatory bowel disease. In view of these experimental findings, clinical trials have been undertaken to elucidate the therapeutic effects of probiotics in inflammatory bowel disease. Probiotics are viable nonpathogenic microorganisms which confer health benefits to the host by improving the microbial balance of the indigenous microflora. So far, of the many candidates, one specific strain (Escherichia coli Nissle 1917) and a mixture of eight different bacteria have demonstrated convincing therapeutic efficacy in controlled studies. Maintenance therapy in ulcerative colitis and prevention therapy, as well as the treatment of pouchitis, have emerged as areas in which probiotic therapy offers a valid therapeutic alternative to current treatments. Further investigations may detect additional clinically effective probiotics and other clinical indications.

  13. Primary sclerosing cholangitis associated with inflammatory bowel disease: an update.

    Science.gov (United States)

    Rossi, Roberta E; Conte, Dario; Massironi, Sara

    2016-02-01

    Primary sclerosing cholangitis (PSC) is a chronic progressive disease, usually associated with underlying inflammatory bowel diseases (IBDs), with a prevalence of 60-80% in western countries. Herein, we review the current knowledge about the association between PSC and IBD in terms of clinical approach and long-term patient management. A PubMed search was conducted for English-language publications from 2000 through 2015 using the following keywords: primary sclerosing cholangitis, inflammatory bowel disease, ulcerative colitis, Crohn's disease, diagnosis, therapy, follow-up, and epidemiology. In terms of diagnosis, liver function tests and histology are currently used. The medical treatment options for PSC associated with IBD do not differ from the cases of PSC alone, and include ursodeoxycholic acid and immunosuppressive agents. These treatments do not seem to improve survival, even if ursodeoxycholic acid given at low doses may be chemopreventive against colorectal cancer (CRC). Liver transplantation is the only potential curative therapy for PSC with reported survival rates of 85 and 70% at 5 and 10 years after transplant; however, there is a risk for PSC recurrence, worsening of IBD activity, and de-novo IBD occurrence after liver transplantation. PSC-IBD represents an important public health concern, especially in view of the increased risk for malignancy, including CRC. Long-life annual surveillance colonoscopy is usually recommended, although the exact timescale is still unclear. Further studies are required both to clarify whether annual colonoscopy is cost-effective, especially in younger patients, and to identify potential pharmaceutical agents and genetic targets that may retard disease progression and protect against CRC.

  14. Circulating L-selectin levels and endothelial CD34 expression in inflammatory bowel disease

    DEFF Research Database (Denmark)

    Seidelin, J B; Vainer, B; Horn, T;

    1998-01-01

    Soluble L-selectin (sL-selectin) concentrations are positively correlated with disease activity in ulcerative colitis (UC) but not in Crohn's disease (CD). This difference in sL-selectin regulation could be due to a disease specific regulation of L-selectin ligands. The aim of this study was to c...... was to compare levels of circulating sL-selectin, expression of the L-selectin ligand CD34 in the affected colon, and inflammatory bowel disease activity....

  15. An immunoglobulin G-4 related sclerosing disease of the small bowel: CT and small bowel series findings

    Energy Technology Data Exchange (ETDEWEB)

    Ko, Young Hwan; Hwang, Dae Hyun; Min, Seon Jeong [Dept. of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong (Korea, Republic of); Woo, Ji Young; Kim, Jeong Won; Hong, Hye Sook; Yang, Ik; Lee, Yul [Hallym University Kangnam Sacred Heart Hospital, Seoul (Korea, Republic of)

    2013-10-15

    Immunoglobulin G4 (IgG4)-related sclerosing disease is rare and is known to involve various organs. We present a case of histologically proven IgG4-related sclerosing disease of the small bowel with imaging findings on computed tomography (CT) and small bowel series. CT showed irregular wall thickening, loss of mural stratification and aneurysmal dilatation of the distal ileum. Small bowel series showed aneurysmal dilatations, interloop adhesion with traction and abrupt angulation.

  16. Retrograde spreading of hydrocortisone enema in inflammatory bowel disease

    Energy Technology Data Exchange (ETDEWEB)

    Jay, M.; Digenis, G.A.; Foster, T.S.; Antonow, D.R.

    1986-02-01

    A hydrocortisone suspension enema was radiolabeled with (/sup 99m/Tc)technetium sulfur colloid and administered to four normal subjects and eight patients with varying degrees of inflammatory bowel disease. The extent of enema spreading was monitored using external scintigraphy for a period of up to 4 hr after administration. Pretreatment of normal subjects with an evacuation enema resulted in spreading of the radiolabeled enema throughout the entire colon. In seven of the eight patients studied, the enema migrated a distance equal to or greater than the extent of disease involvement. An in vivo stability study with an indium-111-labeled enema, using the perturbed angular correlation technique, revealed that the enema retains its stability for up to 90 min after administration. These results indicate that the use of hydrocortisone enemas may not be restricted to distal bowel disease, but may also be effective in inflammatory bowel diseases involving proximal regions of the colon.

  17. Practical Guideline for Fatigue Management in Inflammatory Bowel Disease.

    Science.gov (United States)

    Kreijne, J E; Lie, M R K L; Vogelaar, L; van der Woude, C J

    2016-01-01

    During active inflammatory bowel disease (IBD) fatigue is a common symptom, which seems related to active gut inflammation. However, even in remission many patients suffer from fatigue that negatively affects quality of life and work productivity. Currently, robust knowledge on the pathogenesis and treatment of IBD-related fatigue is lacking. In order to alleviate the burden of IBD-related fatigue, a systematic approach is mandatory. We propose a fatigue attention cycle to enhance identification, evaluation and management of fatigued IBD patients. The benefits of the cycle are twofold. Firstly, it allows the systematic and uniform identification of patients with severe fatigue, in turn allowing tailored non-pharmacological and pharmacological interventions. Secondly, uniform identification of such patients creates a well-defined patient base to investigate the underlying pathogenesis of fatigue, resulting in a greater understanding of this debilitating phenomenon and possibly resulting in the discovery of predictive factors and new treatment interventions.

  18. Motility Evaluation in the Patient with Inflammatory Bowel Disease.

    Science.gov (United States)

    Abdalla, Sherine M; Kalra, Gorav; Moshiree, Baha

    2016-10-01

    Patients with inflammatory bowel disease (IBD) suffer frequently from functional bowel diseases (FBD) and motility disorders. Management of FBD and motility disorders in IBD combined with continued treatment of a patient's IBD symptoms will likely lead to better clinical outcomes and improve the patient's quality of life. The goals of this review were to summarize the most recent literature on motility disturbances in patients with IBD and to give a brief overview of the ranges of motility disturbances, from reflux disease to anorectal disorders, and discuss their diagnosis and specific management.

  19. Effects of dermatan sulfate derivatives on platelet surface P-selectin expression and protein C activity in blood of inflammatory bowel disease patients

    Institute of Scientific and Technical Information of China (English)

    Sheng-Li Ji; Hai-Yan Du; Yan-Qing Chi; Hui-Fei Cui; Ji-Chao Cao; Mei-Yu Geng; Hua-Shi Guan

    2004-01-01

    AIM: To investigate the effect of dermatan sulfate (DS)derivatives on platelet surface P-selectin expression and blood activated protein C (APC) activity in patients with inflammatory bowel disease (IBD), and to clarity the antiinflammatory mechanism of DS derivatives.METHODS: Dermatan sulfate (DS) was sulfated with chlorosulfonic acid to prepare polysulfated dermatan sulfate (PSDS). The major disaccharides of DS and PSDS were determined by 1H nuclear magnetic resonance spectroscopy (1H-NMR) and 13C-NMR. Both DS and PSDS were depolymerized with hydrogen peroxide. The fragments were separated by gel filtration chromatography. The effects of DS derivatives on P-selectin expression were assayed by ELISA method,and blood APC activity was assayed by the synthetic chromogenic substrate method.RESULTS: The major disaccharides of DS and PSDS were IdoA-1→3-GalNAc-4-SO3 and IdoA-2SO3-1→3-GalNAc4, 6-diSO3, respectively. Compared with the adenosine diphosphate stimulated group and IBD control group, DS and its derivatives all had significant inhibitory effects on P-selectin expression (P<0.01), but there was no difference between DS-derived oligosaccharides (DSOSs) and PSDS-derived oligosaccharides (PSDSOSs). The experiments on APC activity showed that DS and its derivatives all enhanced APC activity. The most active DSOS was the one with a relative molecular weight (Mr) of 4 825, which enhanced the APC activity from 106.5±11.5% to 181.8±22.3% (P<0.01). With the decrease of Mr, the activity of DSOSs decreased gradually. The effect of PSDS on APC activity enhancement was more significant than that of DS, and the APC activity was raised to 205.2±22.1% (P<0.01). All the PSDSOSs were more active than DSOSs on the basis of comparable Mr. With the decrease of Mr, the activity of PSDSOSs increased gradually, and the most active PSDSOS was PSDSOS3 with Mr of 2 749, which enhanced the APC activity to 331.2±27.8% (P<0.01), then the activity of PSDSOSs decreased gradually

  20. Pediatric Inflammatory Bowel Disease: from a translational perspective

    NARCIS (Netherlands)

    G.M. Damen (Gerard)

    2010-01-01

    textabstractCrohn’s disease (CD) and ulcerative colitis (UC), the two main subtypes of inflammatory bowel disease (IBD), are chronic relapsing inflammatory disorders of the gastrointestinal tract that have a peak age of onset in the second decade of life in children. There is strong evidence to supp

  1. Pediatric Inflammatory Bowel Disease: from diagnosis to transition

    NARCIS (Netherlands)

    C.I. de Bie (Charlotte)

    2012-01-01

    textabstractThe inflammatory bowel diseases (IBD) are chronic relapsing inflammatory disorders of the gastrointestinal tract, comprising Crohn’s disease (CD), ulcerative colitis (UC), and IBD-unclassified (IBD-U). CD is characterized by a transmural and often granulomatous inflammation that can invo

  2. Performance of the Montreal classification for inflammatory bowel diseases

    NARCIS (Netherlands)

    Spekhorst, Lieke M.; Visschedijk, Marijn C.; Alberts, Rudi; Festen, Eleonora A.; van der Wouden, Egbert-Jan; Dijkstra, Gerard; Weersma, Rinse K.

    2014-01-01

    AIM: To validate the Montreal classification system for Crohn's disease (CD) and ulcerative colitis (UC) within the Netherlands. METHODS: A selection of 20 de-identified medical records with an appropriate representation of the inflammatory bowel disease (IBD) sub phenotypes were scored by 30 observ

  3. Small bowel ultrasound in patients with celiac disease

    Energy Technology Data Exchange (ETDEWEB)

    Bartusek, D. [Department of Radiology, Masaryk University hospital Brno (Czech Republic)], E-mail: dbartusek@fnbrno.cz; Valek, V. [Department of Radiology, Masaryk University hospital Brno (Czech Republic)], E-mail: v.valek@fnbrno.cz; Husty, J. [Department of Radiology, Masaryk University hospital Brno (Czech Republic)], E-mail: jhusty@fnbrno.cz; Uteseny, J. [Department of Pediatric Internal Medicine, Masaryk University hospital Brno (Czech Republic)], E-mail: juteseny@fnbrno.cz

    2007-08-15

    Objective: Celiac disease (CD) is a common, lifelong disease with small bowel malabsorption based on genetically conditioned gluten intolerance. The clinical manifestation could be very heterogeneous. The proof of celiac disease is now based mainly on clinical and laboratory (antibodies and enterobiopsy) signs, which are in some cases problematic and inconvenient. Materials and methods: In our study we have examined 250 patients with suspection or with proven celiac disease and we evaluated specific ultrasound small bowel changes in this group. In the next step, we chose 59 patients with laboratory proved celiac disease and we statistically compared ultrasound, other laboratory and clinical findings in different forms and stages of the disease. Results: Specific small bowel pathologies in patients with celiac disease (like changes of intestinal villi in different parts of small bowel, abnormal peristalsis and mesenterial lymphadenopathy) can be well visualized by ultrasound and in combination with clinical and laboratory signs ultrasound examination could have an important role in screening, determination of diagnosis and monitoring of patients with different forms of celiac disease.

  4. New strategies for treatment of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Nielsen, Ole Haagen

    2014-01-01

    The etiology of inflammatory bowel disease (IBD), of which ulcerative colitis (UC) and Crohn's disease (CD) are the two most prevailing entities, is unknown. However, IBD is characterized by an imbalanced synthesis of pro-inflammatory mediators of the inflamed intestine, and for more than a decade...

  5. Inflammatory pathways of importance for management of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Pedersen, Jannie; Coskun, Mehmet; Soendergaard, Christoffer;

    2014-01-01

    Inflammatory bowel disease (IBD) is a group of chronic disorders of the gastrointestinal tract comprising Crohn's disease (CD) and ulcerative colitis (UC). Their etiologies are unknown, but they are characterised by an imbalanced production of pro-inflammatory mediators, e.g., tumor necrosis factor...

  6. Solid Organ Transplantation in Patients with Inflammatory Bowel Diseases (IBD: Analysis of Transplantation Outcome and IBD Activity in a Large Single Center Cohort.

    Directory of Open Access Journals (Sweden)

    Fabian Schnitzler

    Full Text Available Currently, limited data of the outcome of inflammatory bowel disease (IBD in patients after solid organ transplantation (SOT are available. We aimed to analyze effects of SOT on the IBD course in a large IBD patient cohort.Clinical data from 1537 IBD patients were analyzed for patients who underwent SOT (n = 31 between July 2002 and May 2014. Sub-analyses included SOT outcome parameters, IBD activity before and after SOT, and efficacy of IBD treatment.4.74% of patients with ulcerative colitis (UC and 0.84% of patients with Crohn's disease (CD underwent SOT (p = 2.69 x 10(-6, UC vs. CD. 77.4% of patients with SOT underwent liver transplantation (LTx with tacrolimus-based immunosuppressive therapy after SOT. All LTx were due to primary sclerosing cholangitis (PSC or PSC overlap syndromes. Six patients (19.4% required renal transplantation and one patient (3.2% heart transplantation. A survival rate of 83.9% after a median follow-up period of 103 months was observed. Before SOT, 65.0% of patients were in clinical remission and 5 patients received immunosuppressive therapy (16.1%. After SOT, 61.0% of patients were in remission (p = 1.00 vs. before SOT and 29.0% required IBD-specific immunosuppressive or anti-TNF therapy (p = 0.54 vs. before SOT. 42.9% of patients with worsening of IBD after SOT were at higher risk of needing steroid therapy for increased IBD activity (p = 0.03; relative risk (RR: 10.29; 95% CI 1.26-84.06. Four patients (13.0% needed anti-TNF therapy after SOT (response rate 75%.SOT was more common in UC patients due to the higher prevalence of PSC-related liver cirrhosis in UC. Despite mainly tacrolimus-based immunosuppressive regimens, outcome of SOT and IBD was excellent in this cohort. In this SOT cohort, concomitant immunosuppressive therapy due to IBD was well tolerated.

  7. Fecal calprotectin use in inflammatory bowel disease and beyond: A mini-review.

    Science.gov (United States)

    Alibrahim, Bashaar; Aljasser, Mohammed I; Salh, Baljinder

    2015-04-01

    Given the number of inflammatory disorders affecting the gastrointestinal tract directly and indirectly, coupled with the considerable overlap with functional disorders, it is evident that more useful noninvasive diagnostic tests are required to aid with diagnosis. If these tests can also have some utility for individual patient follow-up in terms of disease activity and response to treatment, as well as providing forewarning of disease relapse, it would be extremely useful information for the clinician. One recently described test that may fulfill several of these attributes is based on leakage of a mononuclear cell cytoplasmic protein, calprotectin, along the intestinal tract, which can then be quantified in feces. This has been used to distinguish patients exhibiting symptoms of irritable bowel syndrome from patients with inflammatory bowel disease, with a measure of success greater than with currently used techniques. The present article summarizes the experience with this test used in inflammatory bowel disease, as well as a variety of gastrointestinal disorders. PMID:25855880

  8. Risk of cardiovascular disease in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Nynne; Nyboe; Andersen; Tine; Jess

    2014-01-01

    Abundant scientific evidence supporting an association between inflammatory bowel disease(IBD) and venous thromboembolic events, caused by an IBD related hypercoagulability, is acknowledged and thromboprophylactic treatment strategies are now implemented in the management of IBD patients. In contrary, the risk of arterial thromboembolic disease, as ischemic heart disease, cerebrovascular events, and mesenteric ischemia in patients with IBD remains uncertain and the magnitude of a potentially increased risk is continuously debated, with ambiguous risk estimates among studies. The evident role of inflammation in the pathogenesis of atherosclerosis forms the basis of a biological plausible link; the chronic systemic inflammation in IBD patients increases the risk of atherosclerosis and thereby the risk of thrombotic events. Further, studies have shown that the burden of traditional risk factors for atherosclerosis, such as obesity, diabetes mellitus, and dyslipidemia is lower in IBD populations, thus further strengthen the role of non-traditional risk factors, as chronic inflammation in the linking of the two disease entities. Likewise, mortality from cardiovascular disease in IBD remains questioned. The aim of the current review is to give an up-date on the existing evidence of the possible association between IBD and cardiovascular disease and to discuss traditional and non-traditional risk factors.

  9. Expanding role of capsule endoscopy in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Capsule endoscopy has been shown to detect small bowel inflammatory changes better than any other imaging modality. Selection criteria have been optimized to increase the yield of capsule endoscopy in patients suspected to have Crohn's disease. Capsule endoscopy allows for earlier diagnosis of Crohn's disease of the small bowel and improved diagnosis of colitis in patients where it is unclear if they suffer from Crohn's or ulcerative colitis. A test capsule is available to assess for small bowel strictures and thus avoid capsule retention. A common language has been developed and a new scoring index will be added to capsule software. It is envisioned that the manner in which we treat Crohn's disease in the future will change, based on earlier diagnosis and treatment aimed at mucosal healing rather than symptom improvement.

  10. Biologic therapy in inflammatory bowel disease

    DEFF Research Database (Denmark)

    Theede, Klaus; Dahlerup, Jens Frederik; Fallingborg, Jan;

    2013-01-01

    In luminal Crohn's disease with moderate to severe inflammatory activity, infliximab and adalimumab can be used in the case of treatment failure with conventional therapies, such as systemic steroids and immunosuppressive therapy or if this treatment is not tolerated. Further treatment strategy d...

  11. Fertility and Contraception in Women With Inflammatory Bowel Disease.

    Science.gov (United States)

    Martin, Jason; Kane, Sunanda V; Feagins, Linda A

    2016-02-01

    Inflammatory bowel disease (IBD) carries a high burden in women during their reproductive years, and family planning issues are often a significant cause of concern. Fertility is normal in women with nonsurgically treated ulcerative colitis and similar or slightly reduced in women with Crohn's disease. Women who undergo ileal pouch anastomosis have reduced fertility. Fertility is likely worsened by disease activity but unaffected by medications used to treat IBD. Infertile patients with IBD respond as well as non-IBD patients to in vitro fertilization (IVF). Despite normal fertility, patients with IBD have fewer children due to concerns regarding infertility, disease inheritance, congenital abnormalities, and disease-related sexual dysfunction. Patients rarely discuss these issues with a physician. When discussion does occur, it may lead to changes in decision-making. Contraceptives are an important part of family planning, particularly during times of high disease activity. All forms of contraceptives are acceptable in patients with IBD, although there are specific considerations. The risks of combined oral contraceptives outweigh the benefits in patients with active disease and patients with prior or high risk for thromboembolism. Oral contraceptives and IBD are independently associated with an increased risk for thromboembolism, although it is not known whether this effect is compounding. Depot medroxyprogesterone acetate injection should be avoided in patients with or at risk for osteopenia. Intrauterine devices and implants are the most effective form of contraception and should be a first-line recommendation. The use of oral contraceptives is associated with the development of IBD, although there is no increased risk of disease relapse with the use of any form of contraceptive. PMID:27182211

  12. Imaging of inflammatory bowel disease. How?

    Energy Technology Data Exchange (ETDEWEB)

    Hiorns, Melanie P. [Great Ormond Street Hospital for Children, Radiology Department, London (United Kingdom)

    2008-06-15

    Traditionally the small bowel (barium) follow through (SBFT) has been the investigation of choice for that otherwise inaccessible length of gut between the duodenum and the ileocaecal valve. Whilst it is still a widely practised examination by radiologists it is being largely overtaken by other imaging modalities with CT, MRI and capsule endoscopy (CE) all competing for the territory. At the end of the last century, proponents of enteroclysis were predicting the eventual decline of the SBFT (in adults) although at that stage, in a 'state of the art' article, they were still brave enough to say that 'only in the small bowel does barium radiography remain unchallenged'. The same authors now write of how radiological investigations complement other techniques but are no longer the mainstay. (orig.)

  13. The Multifaceted Role of the Inflammasome in Inflammatory Bowel Diseases

    Directory of Open Access Journals (Sweden)

    Donata Lissner

    2011-01-01

    Full Text Available Inflammasomes are intracellular multiprotein complexes that coordinate the maturation of interleukin (IL-1β and IL-18 in response to pathogens and metabolic danger. Both cytokines have been linked to intestinal inflammation. However, recently evolving concepts ascribe a major role to the inflammasome in maintaining intestinal homeostasis. This review recapitulates its position in the development of inflammatory bowel disease, thereby outlining a model in which hypo- as well as hyperfunctionality can lead to an imbalance of the system, depending on the specific cell population affected. In the epithelium, the inflammasome is essential for regulation of permeability and epithelial regeneration through sensing of commensal microbes, while excessive inflammasome activation within the lamina propria contributes to severe intestinal inflammation.

  14. Next-Generation Therapeutics for Inflammatory Bowel Disease.

    Science.gov (United States)

    Dulai, Parambir S; Sandborn, William J

    2016-09-01

    Tumor necrosis factor (TNF) antagonists are the cornerstone of therapy for moderately to severely active inflammatory bowel disease (IBD). Although our understanding of pharmacokinetics, pharmacodynamics, and treatment optimization for these agents has evolved considerably over the past decade, a substantial majority of individuals fail to respond or lose response to TNF-antagonists over time. A need therefore remains for efficacious treatment options in these patients. Alternative immunological targets have now been identified, and several novel therapeutic agents are in development for IBD. In this review article, we discuss these novel therapeutic agents, with a particular focus on those demonstrated to be efficacious in phase 2 and 3 clinical trials. We further discuss considerations to be made when integrating these agents into routine practice over the next decade. PMID:27461274

  15. Potential Benefits of Dietary Fibre Intervention in Inflammatory Bowel Disease

    OpenAIRE

    Celestine Wong; Harris, Philip J.; Ferguson, Lynnette R

    2016-01-01

    Intestinal dysbiosis is thought to be an important cause of disease progression and the gastrointestinal symptoms experienced in patients with inflammatory bowel disease (IBD). Inflammation appears to be a major contributor in perpetuating a dysregulated gut microbiota. Although current drug therapies can significantly induce and maintain disease remission, there is no cure for these diseases. Nevertheless, ongoing human studies investigating dietary fibre interventions may potentially prove ...

  16. Hepatic manifestations of non-steroidal inflammatory bowel disease therapy

    Institute of Scientific and Technical Information of China (English)

    Robert; Hirten; Keith; Sultan; Ashby; Thomas; David; E; Bernstein

    2015-01-01

    Inflammatory bowel disease(IBD) is composed of Crohn’s disease and ulcerative colitis and is manifested by both bowel-related and extraintestinal manifestations. Recently the number of therapeutic options available to treat IBD has dramatically increased, with each new medication having its own mechanism of action and side effect profile. A complete understanding of the hepatotoxicity of these medications is important in order to distinguish these complications from the hepatic manifestations of IBD. This review seeks to evaluate the hepatobiliary complications of non-steroid based IBD medications and aide providers in the recognition and management of these side-effects.

  17. A pilot study of transrectal endoscopic ultrasound elastography in inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    Opacic Milorad

    2011-10-01

    Full Text Available Abstract Background Using standard diagnostic algorithms it is not always possible to establish the correct phenotype of inflammatory bowel disease which is essential for therapeutical decisions. Endoscopic ultrasound elastography is a new endoscopic procedure which can differentiate the stiffness of normal and pathological tissue by ultrasound. Therefore, we aimed to investigate the role of transrectal ultrasound elastography in distiction between Crohn's disease and ulcerative colitis. Methods A total 30 Crohn's disease, 25 ulcerative colitis, and 28 non-inflammatory bowel disease controls were included. Transrectal ultrasound elastography was performed in all patients and controls. In all ulcerative coltis patients and 80% of Crohn's disease patients endoscopy was performed to assess disease activity in the rectum. Results Significant difference in rectal wall thickness and strain ratio was detected between patients with Crohn's disease and controls (p = 0.0001. CD patients with active disease had higher strain ratio than patients in remission (p = 0.02. In ulcerative colitis group a significant difference in rectal wall thickness was found between controls and patients with active disease (p = 0.03. A significant difference in rectal wall thickness (p = 0.02 and strain ratio (p = 0.0001 was detected between Crohn's disease and ulcerative colitis patient group. Crohn's disease patients with active disease had a significantly higher strain ratio compared to ulcerative colitis patients with active disease (p = 0.0001. Conclusion Transrectal ultrasound elastography seems to be a promising new diagnostic tool in the field of inflammatory bowel disease. Further study on a larger cohort of patients is needed to definitely assess the role of transrectal ultrasound elastography in inflammatory bowel disease.

  18. Changes of the cytokine profile in inflammatory bowel diseases

    Institute of Scientific and Technical Information of China (English)

    Gy(o)rgyi Müzes; Béla Molnár; Zsolt Tulassay; Ferenc Sipos

    2012-01-01

    Cytokines are indispensable signals of the mucosaassociated immune system for maintaining normal gut homeostasis.An imbalance of their profile in favour of inflammation initiation may lead to disease states,such as that is observed in inflammatory bowel diseases (IBD).Although Crohn's disease (CD) is often described as a prototype of T-helper 1-type diseases,and ulcerative colitis (UC) is traditionally viewed as a T-helper 2-mediated condition,the classic paradigm,which categorises cytokines into pro-and anti-inflammatory groups,has recently been changed.The inflammation regulatory pathways may not be mutually exclusive as individual cytokines can have diverse and even opposing functions in various clinical and immunological settings.None the less there are many common immunological responses in IBD that are mediated by cytokines.Although they regulate and influence the development,course and recurrence of the inflammatory process,the concrete pathogenic role of these small signaling molecules is sometimes not unambiguous in the subtypes of the disease.Our aim is to review the current information about pro-and anti-inflammatory effects of traditionally studied and recently discovered cytokines in the pathogenesis of UC and CD.The better understanding of their production and functional activity may lead to the development of new therapeutic modalities.

  19. MRI for chronic inflammatory bowel disease; MRT chronisch entzuendlicher Darmerkrankungen

    Energy Technology Data Exchange (ETDEWEB)

    Hansmann, H.J.; Hess, T.; Hahmann, M.; Erb, G.; Richter, G.M.; Duex, M. [Heidelberg Univ. (Germany). Abt. Roentgendiagnostik; Elsing, C. [Heidelberg Univ. (Germany). Abt. IV - Gastroenterologie

    2001-01-01

    Chronic inflammatory bowel disease is diagnosed and monitored by the combination of colonoscopy and small bowel enteroklysis. Magnetic resonance imaging has become the gold standard for the imaging of perirectal and pelvic fistulas. With the advent of ultrafast MRI small and large bowel imaging has become highly attractive and is being advocated more and more in the diagnostic work up of inflammatory bowel disease. Imaging protocols include fast T{sub 1}-weighted gradient echo and T{sub 2}-weighted TSE sequences and oral or rectal bowel distension. Furthermore, dedicated imaging protocols are based on breath-hold imaging under pharmacological bowel paralysis and gastrointestinal MR contrast agents (Hydro-MRI). High diagnostic accuracy can be achieved in Crohn's disease with special reference to the pattern of disease, depth of inflammation, mesenteric reaction, sinus tract depiction and formation of abscess. In ulcerative colitis, the mucosa-related inflammation causes significantly less bowel wall thickening compared to Crohn's disease. Therefore with MRI, the extent of inflammatory changes is always underestimated compared to colonoscopy. According to our experience in more than 200 patients as well as the results in other centers, Hydro-MRI possesses the potential to replace enteroklysis in the diagnosis of chronic inflammatory bowel disease and most of the follow-up colonoscopies in Crohn's disease. Further technical improvements in 3D imaging will allow interactive postprocessing of the MR data. (orig.) [German] Zusammenfassung: Die Standardverfahren in der Diagnostik und der Verlaufskontrolle chronisch entzuendlicher Darmerkrankungen, speziell des Morbus Crohn und der Colitis ulcerosa, sind die Koloskopie und das Enteroklysma. Die MRT hat sich dazu ihren festen Platz in der Diagnostik perirektaler Fisteln erobert. Mit schnellen, T{sub 1}-gewichteten Gradienten-Echo-Sequenzen und T{sub 2}-gewichteten Turbo-Spin-Echo-Sequenzen koennen auch Duenn

  20. Body Image Dissatisfaction in Patients with Inflammatory Bowel Disease

    Science.gov (United States)

    Saha, Sumona; Zhao, Ying-Qi; Shah, Samir A.; Esposti, Silvia Degli; Lidofsky, Sheldon; Shapiro, Jason; LeLeiko, Neil; Bright, Renee; Law, Meaghan; Moniz, Heather; Samad, Zahid; Merrick, Marjorie; Sands, Bruce E.

    2014-01-01

    Background Despite the fact that the inflammatory bowel diseases (IBD) and their treatments may affect physical appearance, the effect of IBD on body image is poorly understood. The aims of this study were to determine whether body image dissatisfaction (BID) changes over time in patients with IBD and to examine the demographic and disease-related variables associated with decreased body image. Methods Adults aged 18 and above in the Ocean State Crohn's and Colitis Area Registry with at least 2 years of follow-up were eligible for this study. All patients were enrolled within 6 months of IBD diagnosis and followed prospectively. BID was assessed using a modified version of the Adapted Satisfaction With Appearance (ASWAP) questionnaire. Total ASWAP scores and 2 sub-scores were calculated. To assess for changes over time, general linear models for correlated data were used for continuous outcomes and generalized estimating equations were used for discrete outcomes. Results Two hundred seventy-four patients were studied. BID was found to be stable over time among men and women with IBD despite overall improvements in disease activity. No differences were found in BID according to IBD subtype. Female gender, greater disease activity, higher symptom burden, longer duration of steroid use, dermatologic and musculoskeletal manifestations of IBD, and ileocolonic disease location among patients with Crohn's disease were associated with greater BID. Greater BID was associated with lower health-related quality of life (HRQOL). Conclusions BID remains stable in an incident cohort of IBD despite improved disease activity and is associated with lower HRQOL PMID:25569736

  1. Biologic therapy in inflammatory bowel disease

    DEFF Research Database (Denmark)

    Theede, Klaus; Dahlerup, Jens Frederik; Fallingborg, Jan;

    2013-01-01

    In luminal Crohn's disease with moderate to severe inflammatory activity, infliximab and adalimumab can be used in the case of treatment failure with conventional therapies, such as systemic steroids and immunosuppressive therapy or if this treatment is not tolerated. Further treatment strategy...... depends on the primary response to induction therapy. Effect of maintenance therapy should be evaluated clinically and paraclinically at least every 26-52 weeks, and maybe supplemented by endoscopy or MRI scan. Decision of treatment discontinuation is based on disease manifestation, treatment response...... and paraclinical parameters. In fistulising Crohn's disease, treatment with infliximab or adalimumab can be initiated in simple fistula with rectal inflammation or complex fistula when the initial treatment has insufficient effect. Further treatment strategy depends on the primary response to induction therapy...

  2. Smoking in inflammatory bowel diseases: Good, bad or ugly?

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Smoking is an important environmental factor in inflammatory bowel disease (IBD), having different effects in ulcerative colitis (UC) and Crohn's disease (CD). A recent meta-analysis partially confirmed previous findings that smoking was found to be protective against ulcerative colitis and, after onset of the disease, might improve its course,decreasing the need for colectomy. However,smoking increases the risk of developing Crohn's disease and worsens its course, increasing the need for steroids, immunosuppressants and re-operations.Smoking cessation aggravates ulcerative colitis and improves Crohn's disease. Data are however, largely conflictive as well as the potential mechanisms involved in this dual relationship are still unknown. In this review article, the authors review the role of smoking in inflammatory bowel diseases.

  3. Prognosis and prognostic factors in inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    Thompson Nicholas

    1995-01-01

    Full Text Available The chance of normal survival for patients with inflammatory bowel disease is generally good. There may be a small excess mortality for those with Crohn′s disease; however recent studies do not confirm this trend. For those with ulcerative colitis, there may be an excess mortality in the first two years after diagnosis, especially in those who undergo surgery. The necessity for an operation varies, but at least 50% of patients with Crohn′s disease will be an operation in the first 10 years; whereas only about 20% of patients with ulcerative colitis will require a colectomy. Most patients with inflammatory bowel disease are able to lead a normal life and are not disabled by their disease. The prognosis in the elderly is usually good; however there is an increased mortality over younger patients, which is probably due to the presence of coexistent disease. Children also have a slightly higher mortality; this may be due to the relative frequency of a particularly extensive disease and the development of colorectal cancer. Growth retardation occurs in up to one-third of children with Crohn′s disease, but it may be resol" d if remission can be obtained. Pregnancy has not been shown to have an impact on inflammatory bowel disease, but its onset during pregnancy confers a significant risk for both mother and child. Extensive involvement is a poor prognosis factor in both diseases; conversely, isolated small bowel Crohn′s disease and ulcerative proctitis carry particularly good prognoses. A short clinical history, fistulae or abscesses at presentation probably represent an aggressive form of Crohn′s disease. Hypoalbuminemia, anemia and raised inflammatory markers are laboratory markers which suggest a worse prognosis in the short and possibly long-term.

  4. Laparoscopic versus Open Bowel Resection for Crohn's Disease

    OpenAIRE

    Tabet, Jeanine; Hong, Dennis; Kim, Cei-Whan; Wong, Jason; Goodacre, Robert; Anvari, Mehran

    2001-01-01

    BACKGROUND: Laparoscopic bowel resection is an alternative to open surgery for patients with Crohn's disease requiring surgical resection. The present report describes a seven-year experience with the laparoscopic treatment of Crohn's disease compared with the open technique in a tertiary Canadian centre.PATIENTS AND METHODS: A retrospective analysis of 61 consecutive patients undergoing elective resection for Crohn's disease was carried out between October 1992 and June 1999. This analysis i...

  5. Prognosis and prognostic factors in inflammatory bowel disease

    OpenAIRE

    Thompson Nicholas; Wakefield Andrew; Pounder Roy

    1995-01-01

    The chance of normal survival for patients with inflammatory bowel disease is generally good. There may be a small excess mortality for those with Crohn′s disease; however recent studies do not confirm this trend. For those with ulcerative colitis, there may be an excess mortality in the first two years after diagnosis, especially in those who undergo surgery. The necessity for an operation varies, but at least 50% of patients with Crohn′s disease will be an operation in ...

  6. Minimally invasive approaches for the treatment of inflammatory bowel disease

    OpenAIRE

    Zoccali, Marco; Fichera, Alessandro

    2012-01-01

    Despite significant improvements in medical management of inflammatory bowel disease, many of these patients still require surgery at some point in the course of their disease. Their young age and poor general conditions, worsened by the aggressive medical treatments, make minimally invasive approaches particularly enticing to this patient population. However, the typical inflammatory changes that characterize these diseases have hindered wide diffusion of laparoscopy in this setting, current...

  7. Role of Rho kinase signal pathway in inflammatory bowel disease

    OpenAIRE

    Huang, Yuan; Xiao, Shiyu; Jiang, Quanhang

    2015-01-01

    Inflammatory Bowel Disease (IBD) is nonspecific inflammation in the intestinal track, including Ulcerative Colitis (UC) and Crohn’s disease (CD). The incidence of IBD has increased significantly, with its numerous rising up to five million globally, more than 1,700,000 in China. Pathological character of IBD is the inflammation of intestinal mucosa and intestinal fibrosis. Although the pathogenesis of the disease has not yet been fully clarified, some evidence suggests that excessive intestin...

  8. Single-Port Laparoscopic Surgery for Inflammatory Bowel Disease

    OpenAIRE

    Emile Rijcken; Rudolf Mennigen; Norbert Senninger; Matthias Bruewer

    2012-01-01

    Background. Single Port Laparoscopic Surgery (SPLS) is being increasingly employed in colorectal surgery for benign and malignant diseases. The particular role for SPLS in inflammatory bowel disease (IBD) has not been determined yet. In this review article we summarize technical aspects and short term results of SPLS resections in patients with Crohn's disease or ulcerative colitis. Methods. A systematic review of the literature until January 2012 was performed. Publications were assessed for...

  9. Probiotics: An overview and their role in inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    Almeghaiseeb Ebtissam

    2007-01-01

    Full Text Available In recent years, novel insights have been gained into the role of bacterial microflora in health and disease. Commensal flora manipulation by probiotic bacteria has been investigated in human and experimental inflammatory bowel disease. Various probiotic species have shown promise in the treatment of ulcerative colitis, Crohn′s disease and pouchitis in small studies, although a clear clinical benefit remains to be established.

  10. News and controversy in inflammatory bowel disease treatment

    Directory of Open Access Journals (Sweden)

    Giulia Straforini

    2013-04-01

    Full Text Available Background: The treatment of Inflammatory bowel disease comes from many years of esperience, clinical trials and mistakes. Discussion: In patients with active Crohn disease steroids are considerated the first choice, but recently, the introduction of anti-TNF alfa agents (infliximab and adalimumab has changed the protocols. Anti-TNF are also used for closing fistula after surgical curettage. An efficently preventive treatment of Crohn disease still has not been found but hight dose of oral salicylates, azatioprine or 6-MP and antibiotics might be useful. In severe attacks of ulcerative colitis, high dose iv treatment of steroids are required for a few days. Later on, a further treatment with anti- TNF might delay the need of surgery. In patients with mild to moderate attacks of ulcerative colitis, topical treatment is preferred, it consists of enemas, suppositories or foams containing 5-aminosalycilic acid, traditional steroids, topical active steroids. Topical treatment can be associated with oral steroids or oral salicylates. Oral salicylates or azatioprine are used for prevention of relaps.

  11. Experiences of healing therapy in patients with irritable bowel syndrome and inflammatory bowel disease

    OpenAIRE

    Soundy, Andrew; Lee, Rhonda T.; Kingstone, Tom; Singh, Sukhdev; Pankaj R Shah; Roberts, Lesley

    2015-01-01

    Background The use and value of different complementary therapies requires investigation. In particular, qualitative research is required to understand the perceptions and experiences of patients who undergo healing therapy as one type of complementary therapy. The aim of this research is to consider patients perceptions and experiences following a course of healing therapy. Methods Twenty two patients took part in this study. This included 13 patients with irritable bowel disease (3 male, 10...

  12. What's new about inflammatory bowel diseases in 2011

    Institute of Scientific and Technical Information of China (English)

    JonasMudter

    2011-01-01

    Inflammatory bowel diseases (IBD) are chronic disorders of the intestine with increasing incidence in Europe, Northern America and asiatic countries such as china. Thus, we have putted together these topic highlight articles to give insights into the current understanding of IBD pathogenesis, diagnostics and treatment.

  13. Neuroimmune regulation of inflammatory responses in inflammatory bowel disease

    NARCIS (Netherlands)

    Rijnierse, Anneke

    2006-01-01

    The term inflammatory bowel disease (IBD) is used to describe chronic inflammatory conditions of the gastro-intestinal tract. Patients suffer from abdominal pain, diarrhea, rectal bleeding and a substantial personal burden. The etiology of IBD is gradually being unraveled but remains a complex inter

  14. Biomarkers for inflammation and surveillance strategies in inflammatory bowel disease

    NARCIS (Netherlands)

    Mooiweer, E.

    2014-01-01

    Chronic inflammation of the colonic mucosa, as observed in patients with inflammatory bowel disease (IBD), is associated with an increased risk of colorectal cancer (CRC). Endoscopic surveillance aimed at the detection of dysplasia and asymptomatic CRC is therefore recommended in order to mitigate t

  15. The microbiome and its therapeutic potential in inflammatory bowel diseases

    NARCIS (Netherlands)

    N.G.M. Rossen

    2016-01-01

    While the etiology of inflammatory bowel diseases (IBD) remains unclear, there is substantial evidence for the link between the microbiota and the pathogenesis of IBD. Interest for the application of Fecal Microbiota Transplantation (FMT) increases, especially now the insight in the intestinal micro

  16. Labor participation among patients with inflammatory bowel disease.

    NARCIS (Netherlands)

    Netjes, J.E.; Rijken, M.

    2013-01-01

    Background: The aims of the present study are twofold. First, to describe labor participation rates of people with inflammatory bowel disease (IBD) in the Netherlands compared with the total Dutch population and to people with chronic illness in general. Second, to explore differences in labor parti

  17. Distinctive inflammatory bowel disease phenotype in primary sclerosing cholangitis

    NARCIS (Netherlands)

    de Vries, A. Boudewijn; Janse, Marcel; Blokzijl, Hans; Weersma, Rinse K.

    2015-01-01

    AIM: To review the current literature for the specific clinical characteristics of inflammatory bowel disease (IBD) associated with primary sclerosing cholangitis (PSC). METHODS: A systematical review for clinical characteristics of IBD in PSC was performed by conducting a broad search for "primary

  18. Immunoglobulin coating of faecal bacteria in inflammatory bowel disease

    NARCIS (Netherlands)

    van der Waaij, LA; Kroese, FGM; Visser, A; Nelis, FG; Westerveld, BD; Jansen, PLM; Hunter, JO

    2004-01-01

    Objective An inappropriate mucosal immune response to the commensal bacterial flora may play a role in the pathogenesis of inflammatory bowel disease (IBD). In this study we determined the percentage of immunoglobulin-coated bacteria in the stools of patients and controls. Methods Faecal samples wer

  19. Maintenance Therapy and Prospects for Inflammatory Bowel Disease

    Institute of Scientific and Technical Information of China (English)

    XU Chang-tai; PAN Bo-rong; GUO Xiue-gan

    2003-01-01

    @@ Introduction Medical therapy of inflammatory bowel disease (IBD) can be considered in several subcategories, and this review is designed to provide selective updates for some of the most important therapeutic entities currently marketed or soon to be available for the medical management of IBD [1-6].

  20. Lymphogranuloma venereum proctitis: A differential diagnose to inflammatory bowel disease

    DEFF Research Database (Denmark)

    Høie, Sverre; Knudsen, Lene Surland; Gerstoft, Jan

    2011-01-01

    manifestation of LGV is a proctitis, with a clinical presentation and endoscopic findings resembling those of inflammatory bowel diseases (IBDs). LGV is considered new in Scandinavia. This case report focuses on difficulties in differentiating LGV and IBD. Material and methods. This case report used...

  1. Management of Iron-Deficiency Anemia in Inflammatory Bowel Disease

    DEFF Research Database (Denmark)

    Nielsen, Ole Haagen; Ainsworth, Mark; Coskun, Mehmet;

    2015-01-01

    Anemia is the most frequent complication of inflammatory bowel disease (IBD), but anemia, mostly due to iron deficiency, has long been neglected in these patients. The aim was to briefly present the pathophysiology, followed by a balanced overview of the different forms of iron replacement...

  2. What's new about inflammatory bowel diseases in 2011

    Institute of Scientific and Technical Information of China (English)

    Jonas Mudter

    2011-01-01

    Inflammatory bowel diseases (IBD) are chronic disorders of the intestine with increasing incidence in Europe, Northern America and asiatic countries such as china. Thus, we have putted together these topic highlight articles to give insights into the current understanding of IBD pathogenesis, diagnostics and treatment.

  3. Dairy Products, Dietary Calcium, and Risk of Inflammatory Bowel Disease

    DEFF Research Database (Denmark)

    Opstelten, Jorrit L; Leenders, Max; Dik, Vincent K;

    2016-01-01

    BACKGROUND: Dairy products may be involved in the etiology of inflammatory bowel disease by modulating gut microbiota and immune responses, but data from epidemiological studies examining this relationship are limited. We investigated the association between prediagnostic intake of these foods an...

  4. Perceptions of medication safety among patients with inflammatory bowel disease.

    LENUS (Irish Health Repository)

    Cullen, Garret

    2010-09-01

    The aim of this study was to assess attitudes towards and knowledge of medication safety in inflammatory bowel disease (IBD). IBD patients frequently require long-term treatment with potentially toxic medications. Techniques are employed to improve patient awareness of medication safety, but there are sparse data on their effectiveness.

  5. Inflammatory Bowel Disease in a Child with Sickle Cell Anemia

    OpenAIRE

    Khaled Alqoaer; Ahmed, Mohammed M.; Efteraj S. Alhowaiti

    2014-01-01

    Sickle cell anemia (SCA) is a chronic haemoglobinopathy that can affect many organs in the body including gastrointestinal tract. However, colonic involvement is very rare and usually in the form of ischemic colitis. We are reporting an 11-year-old Saudi girl with SCA who presented with persistent diarrhea and was found to have inflammaftory bowel disease.

  6. Oats and bowel disease: a systematic literature review.

    Science.gov (United States)

    Thies, Frank; Masson, Lindsey F; Boffetta, Paolo; Kris-Etherton, Penny

    2014-10-01

    Whole-grain foods such as oats may protect against colorectal cancer and have benefits on inflammatory bowel disease and coeliac disease. The present study aimed to systematically review the literature describing intervention studies that investigated the effects of oats or oat bran on risk factors for bowel disease. A literature search was conducted using Embase, Medline and the Cochrane library, which identified 654 potential articles. Thirty-eight articles describing twenty-nine studies met the inclusion criteria. Two studies carried out in participants with a history of colorectal adenomas found no effects of increased oat-bran intake on indirect risk makers for colorectal cancer. One of two interventions with oat bran in patients with ulcerative colitis showed small improvements in the patients' conditions. Most of the eleven studies carried out in adults with coeliac disease showed no negative effects of uncontaminated oat consumption. The fourteen studies carried out in volunteers with no history of bowel disease suggest that oats or oat bran can significantly increase stool weight and decrease constipation, but there is a lack of evidence to support a specific effect of oats on bowel function compared with other cereals. A long-term dietary intake of oats or oat bran could benefit inflammatory bowel disorders, but this remains to be proven. A protective effect on colorectal adenoma and cancer incidence has not yet been convincingly shown. The majority of patients with coeliac disease could consume up to 100 g/d of uncontaminated oats, which would increase the acceptability of, and adherence to, a gluten-free diet.

  7. EPA- and DHA-derived resolvins' actions in inflammatory bowel disease.

    Science.gov (United States)

    Schwanke, Raquel Cristina; Marcon, Rodrigo; Bento, Allisson Freire; Calixto, João B

    2016-08-15

    Inflammatory bowel diseases are chronic diseases divided into two major forms, ulcerative colitis and Crohn's disease, which are both associated with a chronic inflammatory condition of the gastrointestinal tract. Recent studies have shown that the resolution of inflammatory conditions is a biosynthetically active process where new pro-resolution lipid mediators derived from omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), such as E- and D-series resolvins, protectins, and macrophage mediator in resolving inflammation (maresins), have potent anti-inflammatory activity and serve as specialised mediators that play an important role in the resolution of inflammation. Recent studies have also shown the role of resolvins in referred hyperalgesia associated with different inflammatory processes, such as the visceral pain caused by inflammatory bowel disease. There are many reports describing the principal effects of EPA- and DHA-derived mediators in experimental models of inflammatory bowel diseases. This review focuses on the recent studies on the important role played by pro-resolution lipid mediators in controlling the inflammatory process associated with inflammatory bowel diseases. PMID:26325092

  8. Advance in Application of Fecal Markers for Evaluating Disease Activity in Inflammatory Bowel Disease%粪便标记物在炎症性肠病活动性评价中的应用进展

    Institute of Scientific and Technical Information of China (English)

    孟丽丽; 吴战军

    2015-01-01

    Inflammatory bowel disease( IBD)is a group of chronic nonspecific intestinal diseases characterized by a clinical relapsing-remitting behavior. The evaluation of disease activity is concerned by clinicians all the time. With the evolving in recognition of the pathogenesis of IBD,many novel biomarkers are emerging in recent years. This article reviewed advances in the accepted and ongoing research fecal markers of IBD.%炎症性肠病( IBD)是一组慢性非特异性肠道疾病,具有复发与缓解交替的病程特点,其疾病活动性的判断一直是临床医师关注的焦点。近年随着对IBD发病机制研究的不断深入,一些新的生物学标记物被发现。本文就近年已认可的和正在初步研究的IBD粪便标记物作一综述。

  9. Prenatal ultrasonic diagnosis of obstructive bowel disease: A retrospective analysis

    OpenAIRE

    Heydanus, Rogier; Spaargaren, M.C.; Wladimiroff, Juriy

    1994-01-01

    textabstractFetal obstructive bowel disease was diagnosed in 29 patients at 22–37 weeks (median 32 weeks) of gestation, seven (24 per cent) of whom also displayed other anomalies. Polyhydramnios was present in 20/29 cases (69 per cent). An abnormal karyotype existed in 7/29 cases (24 per cent), of which six were diagnosed prenatally (trisomy 21, n = 5; 69, XXX, n = 1) and one postnatally (trisomy 21). There was always an association with the ultrasonic ‘double bubble’ sign. Obstructive bowel ...

  10. Polymorphisms in NF-kappa B, PXR, LXR, PPAR gamma and risk of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Andersen, Vibeke; Christensen, Jane; Ernst, Anja;

    2011-01-01

    AIM: To investigate the contribution of polymorphisms in nuclear receptors to risk of inflammatory bowel disease (IBD). METHODS: Genotypes of nuclear factor (NF)-kappa B (NFKB1) NF kappa B -94ins/del (rs28362491); peroxisome proliferator-activated receptor (PPAR)-gamma (PPAR gamma) PPAR gamma Pro...

  11. Usefulness of Measuring Serum Procalcitonin Levels in Patients with Inflammatory Bowel Disease

    OpenAIRE

    Chung, Sook Hee; Lee, Hye Won; Kim, Seung Won; Park, Soo Jung; Hong, Sung Pil; Kim, Tae Il; Kim, Won Ho; Cheon, Jae Hee

    2016-01-01

    Background/Aims The relationships between serum procalcitonin, inflammatory bowel disease (IBD) and intestinal Behçet’s disease (BD) have not been completely determined. We aimed to evaluate the usefulness of measuring serum procalcitonin levels to assess disease activity and infection stage in patients with IBD and intestinal BD. Methods We retrospectively analyzed clinical data from 129 patients with IBD and intestinal BD for whom serum procalcitonin and C-reactive protein (CRP) levels were...

  12. Ultrasound in Crohn’s Disease - bowel wall characteristics and perfusion estimates using microbubbles

    OpenAIRE

    Nylund, Kim

    2013-01-01

    Crohn’s disease (CD) is a chronic inflammatory bowel disease which often presents early in life and sometimes can be debilitating. The patients need frequent diagnostic work-up to assess disease activity, location, extent and if complications have occurred. This warrants diagnostic tools which are of little nuisance to the patient, available, affordable and objective. Diagnostic ultrasound imaging could potentially fulfil these criteria. A specific problem in patients with CD i...

  13. The Role of Physical Exercise in Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Jan Bilski

    2014-01-01

    Full Text Available We reviewed and analyzed the relationship between physical exercise and inflammatory bowel disease (IBD which covers a group of chronic, relapsing, and remitting intestinal disorders including Crohn’s disease (CD and ulcerative colitis. The etiology of IBD likely involves a combination of genetic predisposition and environmental risk factors. Physical training has been suggested to be protective against the onset of IBD, but there are inconsistencies in the findings of the published literature. Hypertrophy of the mesenteric white adipose tissue (mWAT is recognized as a characteristic feature of CD, but its importance for the perpetuation of onset of this intestinal disease is unknown. Adipocytes synthesize proinflammatory and anti-inflammatory cytokines. Hypertrophy of mWAT could play a role as a barrier to the inflammatory process, but recent data suggest that deregulation of adipokine secretion is involved in the pathogenesis of CD. Adipocytokines and macrophage mediators perpetuate the intestinal inflammatory process, leading to mucosal ulcerations along the mesenteric border, a typical feature of CD. Contracting skeletal muscles release biologically active myokines, known to exert the direct anti-inflammatory effects, and inhibit the release of proinflammatory mediators from visceral fat. Further research is required to confirm these observations and establish exercise regimes for IBD patients.

  14. Role of Smad7 in inflammatory bowel diseases

    Institute of Scientific and Technical Information of China (English)

    Giovanni Monteleone; Roberta Caruso; Francesco Pallone

    2012-01-01

    Crohn's disease and ulcerative colitis,the major forms of inflammatory bowel diseases (IBD) in man,are complex diseases in which genetic and environmental factors interact to promote an excessive mucosal immune response directed against normal components of the bacterial microflora.There is also evidence that the pathologic process is due to defects in counter-regulatory mechanisms,such as those involving the immunosuppressive cytokine transforming growth factor (TGF)-β1.Indeed,studies in human IBD tissues and murine models of colitis have documented a disruption of TGF-β1 signalling marked by a block in the phosphorylation of Smad3,a signalling molecule associated with the activated TGF-β receptor,due to up-regulation of Smad7,an intracellular inhibitor of Smad3 phosphorylation.Knock-down of Smad7 with a specific antisense oligonucleotide restores TGF-β1/Smad3 signalling,thus resulting in a marked suppression of inflammatory cytokine production and attenuation of mutine colitis.These findings together with the demonstration that Smad7 antisense oligonucleotide is not toxic when administered in mice have paved the way for the development of a Smad7 antisense oligonucleotide-based pharmaceutical compound that is now ready to enter the clinics.In this article we review the available data supporting the pathogenic role of Smad7 in IBD and discuss whether and how Smad7 antisense therapy could help dampen the ongoing inflammation in IBD.

  15. Common immunologic mechanisms in inflammatory bowel disease and spondylarthropathies

    Institute of Scientific and Technical Information of China (English)

    Massimo C Fantini; Francesco Pallone; Giovanni Monteleone

    2009-01-01

    Spondyloarthropathies (SpA) are commonly observed extra-intestinal manifestations of both Crohn's disease (CD) and ulcerative colitis (UC), the two major forms of inflammatory bowel diseases (IBD). However, the immunological link between these two clinical entities is still poorly understood. Several lines of evidence indicate that SpA may originate from the relocation to the joints of the immune process primarily induced in the gut. The transfer of the intestinal inflammatory process into the joints implicates that immune cells activated in the gut-draining lymph nodes can localize, at a certain point of the intestinal disease, either into the gut or into the joints. This is indicated by the overlapping expression of adhesion molecules observed on the surface of intestinal and synovial endothelial cells during inflammation. Moreover bacterial antigens and HLA-B27 expression may be implicated in the reactivation of T cells at the articular level. Finally, accumulating evidence indicates that a T helper 17 cell-mediated immune response may contribute to IBD and IBD-related SpA with a crucial role played by tumor necrosis factor-α in CD and to a lesser extent in UC.

  16. Vitamin D and the Pathogenesis of Inflammatory Bowel Disease.

    Science.gov (United States)

    Limketkai, Berkeley N; Bechtold, Matthew L; Nguyen, Douglas L

    2016-10-01

    Vitamin D has traditionally been known for its role in bone metabolism, but emerging evidence has suggested a broader role for vitamin D in immune regulation. Vitamin D deficiency has been associated with the pathogenesis of diverse autoimmune disorders and has similarly been implicated as a contributor to inflammatory bowel disease. In this review, we discuss animal, in vitro, genetic, and epidemiologic studies that have linked vitamin D deficiency with inflammatory bowel disease pathogenesis or severity. Nonetheless, we present the caveat in interpreting these studies in the context of reverse causation: Does vitamin D deficiency lead to gastrointestinal disease, or does gastrointestinal disease (with related changes in dietary choices, intestinal absorption, nutritional status, lifestyle) lead to vitamin D deficiency? PMID:27538982

  17. Plant flavonol isorhamnetin attenuates chemically induced inflammatory bowel disease via a PXR-dependent pathway

    OpenAIRE

    Dou, Wei; Zhang, Jingjing; Li, Hao; Kortagere, Sandhya; Sun, Katherine; Ding, Lili; Ren, Gaiyan; WANG Zhengtao; Mani, Sridhar

    2014-01-01

    Isorhamnetin is an O-methylated flavonol present in fruit and vegetables. We recently reported the identification of isorhamnetin as an activator of the human pregnane X receptor (PXR), a known target for abrogating inflammation in inflammatory bowel disease (IBD). The current study investigated the role of isorhamnetin as a putative mouse PXR activator in ameliorating chemically induced IBD. Using two different models (Ulcerative colitis-like and Crohn’s disease-like) of experimental IBD in ...

  18. Role of interleukin-22 in inflammatory bowel disease.

    Science.gov (United States)

    Li, Lin-Jing; Gong, Chen; Zhao, Mei-Hua; Feng, Bai-Sui

    2014-12-28

    Inflammatory bowel disease (IBD) is a chronic inflammatory disease thought to be mediated by the microbiota of the intestinal lumen and inappropriate immune responses. Aberrant immune responses can cause secretion of harmful cytokines that destroy the epithelium of the gastrointestinal tract, leading to further inflammation. Interleukin (IL)-22 is a member of the IL-10 family of cytokines that was recently discovered to be mainly produced by both adaptive and innate immune cells. Several cytokines and many of the transcriptional factors and T regulatory cells are known to regulate IL-22 expression through activation of signal transducer and activator of transcription 3 signaling cascades. This cytokine induces antimicrobial molecules and proliferative and antiapoptotic pathways, which help prevent tissue damage and aid in its repair. All of these processes play a beneficial role in IBD by enhancing intestinal barrier integrity and epithelial innate immunity. In this review, we discuss recent progress in the involvement of IL-22 in the pathogenesis of IBD, as well as its therapeutic potential.

  19. Inflammatory Bowel Disease in Children, an Evolving Problem in Kuwait

    OpenAIRE

    Wafa′a A Al-Qabandi; Eman K Buhamrah; Khaled A Hamadi; Al-Osaimi, Suad A.; Al-Ruwayeh, Ahlam A.; JohnPatrick Madda

    2011-01-01

    Background/Aims: Inflammatory bowel disease (IBD) was previously thought a rare disease among children in Kuwait since most diarrhea cases were attributed to infections. In the past few years we observed an increase in the number of patients presenting with IBD. In this study we aimed to determine the epidemiology of IBD among children in the State of Kuwait. Patients and Methods: The charts of all children with IBD who were referred to the pediatric gastroenterology unit during the period Fe...

  20. Surgery for inflammatory bowel disease in the era of laparoscopy

    OpenAIRE

    Sica, Giuseppe S.; Biancone, Livia

    2013-01-01

    During the course of inflammatory bowel disease (IBD), surgery may be needed. Approximately 20% of patients with ulcerative colitis (UC) will require surgery, whereas up to 80% of Crohn’s disease (CD) patients will undergo an operation during their lifetime. For UC patients requiring surgery, total proctocolectomy and ileoanal pouch anastomosis (IPAA) is the operation of choice as it provides a permanent cure and good quality of life. Nevertheless a permanent stoma is a good option in selecte...

  1. Inflammatory bowel disease: the role of inflammatory cytokine gene polymorphisms

    OpenAIRE

    Owen P. Smith; Nasir Mahmud; Weir, Donald G.; Lesley Mynett-Johnson; Judith Conroy; Livingstone, Wendy J; Joanna Balding

    2004-01-01

    The mechanisms responsible for development of inflammatory bowel disease (IBD) have not been fully elucidated, although the main cause of disease pathology is attributed to up-regulated inflammatory processes. The aim of this study was to investigate frequencies of polymorphisms in genes encoding pro-inflammatory and anti-inflammatory markers in IBD patients and controls. We determined genotypes of patients with IBD (n= 172) and healthy controls (n= 389) for polymorphisms in genes encoding va...

  2. Role of nutrition in inflammatory bowel disease: an overview.

    OpenAIRE

    Clark, M L

    1986-01-01

    Although many patients with inflammatory bowel disease are malnourished, the role of nutritional support is still controversial. It is universally accepted that with adequate nutritional support patients will put on weight and that their biochemical functions may improve; the question nevertheless remains: does this help the patient get over his or her disease more quickly and, more importantly, does this affect morbidity and mortality? There are several ways of providing nutritional support ...

  3. Neuro-glial crosstalk in inflammatory bowel disease.

    OpenAIRE

    Neunlist, Michel; Van Landeghem, Lien; Bourreille, Arnaud; Savidge, T.

    2008-01-01

    Inflammatory bowel disease (IBD) is a multifactorial disease in which environmental, immune and genetic factors are involved in the pathogenesis. Although biological therapies (antibodies anti-tumour necrosis factor-alpha or anti-integrin) have considerably improved the symptoms and quality of life of IBD patients, some drawbacks have emerged limiting their long-term use. In addition, prevention of relapses and treatment of resistant ulcers remains a clinical challenge. In this context, a bet...

  4. Management of inflammatory bowel disease in the pregnant patient

    Institute of Scientific and Technical Information of China (English)

    Flavio M Habal; Nikila C Ravindran

    2008-01-01

    Inflammatory bowel disease (IBD) is a chronic disorder affecting young adults in their reproductive years.Many young women with IBD express concern about the effect their disease will have on fertility,pregnancy course and fetal development This article presents an approach to management of IBD in the pregnant patient,including counseling and investigation,and summarizes existing data on the safety of medications used to treat IBD in pregnancy and breastfeeding.

  5. Protein kinases are potential targets to treat inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Lei; Yang; Yutao; Yan

    2014-01-01

    Protein kinases play a crucial role in the pathogenesis of inflammatory bowel disease(IBD), the two main forms of which are ulcerative colitis and Crohn’s dis-ease. In this article, we will review the mechanisms of involvement of protein kinases in the pathogenesis of and intervention against IBD, in terms of their effects on genetics, microbiota, mucous layer and tight junc-tion, and the potential of protein kinases as therapeutic targets against IBD.

  6. ENTERAL NUTRITION SUPPORT TO TREAT MALNUTRITION IN INFLAMMATORY BOWEL DISEASE

    OpenAIRE

    Roberta Altomare; Giuseppe Damiano; Alida Abruzzo; Vincenzo Davide Palumbo; Giovanni Tomasello; Salvatore Buscemi; Attilio Ignazio Lo Monte

    2015-01-01

    Malnutrition is a common consequence of inflammatory bowel disease (IBD). Diet has an important role in the management of IBD, as it prevents and corrects malnutrition. It is well known that diet may be implicated in the aetiology of IBD and that it plays a central role in the pathogenesis of gastrointestinal-tract disease. Often oral nutrition alone is not sufficient in the management of IBD patients, especially in children or the elderly, and must be combined with oral supplementation or r...

  7. Toward an antifibrotic therapy for inflammatory bowel disease

    Science.gov (United States)

    2016-01-01

    Fibrosis in inflammatory bowel disease (IBD) is a largely unresolved clinical problem. Despite recent advances in anti-inflammatory therapies over the last few decades, the occurrence of intestinal strictures in Crohn’s disease patients has not significantly changed. No antifibrotic therapies are available. This journal supplement will address novel mechanisms of intestinal fibrosis, biomarker and imaging techniques and is intended to provide a roadmap toward antifibrotic therapies in IBD. PMID:27536358

  8. Role of diet in the management of inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Nirooshun; Rajendran; Devinder; Kumar

    2010-01-01

    Many studies have looked at connections between diet,etiology,signs and symptoms associated with inflammatory bowel disease(IBD).Although these connections are apparent to clinicians,they are difficult to prove qualitatively or quantitatively.Enteral feeding and polymeric diets are equally effective at bringing about remission in Crohn's disease(CD).Parenteral feeding is also effective,although none of these methods is as effective as corticosteroid therapy.However,enteral feeding is preferred in the pediat...

  9. Extraintestinal manifestations of inflammatory bowel disease: Do they influence treatment and outcome?

    Institute of Scientific and Technical Information of China (English)

    Fernando Tavarela Veloso

    2011-01-01

    Crohn's disease and ulcerative colitis are chronic inflammatory bowel diseases that often involve organs other than those of the gastrointestinal tract. Immune-related extraintestinal manifestations (EIMs) are usually related to disease activity, but sometimes may take an independent course. Globally, about one third of patients develop these systemic manifestations. Phenotypic classification shows that certain subsets of patients are more susceptible to developing EIMs, which frequently occur simultaneously in the same patient overlapping joints, skin, mouth, and eyes. The clinical spectrum of these manifestations varies from mild transitory to very severe lesions, sometimes more incapacitating than the intestinal disease itself. The great majority of these EIMs accompany the activity of intestinal disease and patients run a higher risk of a severe clinical course. For most of the inflammatory EIMs, the primary therapeutic target remains the bowel. Early aggressive therapy can minimize severe complications and maintenance treatment has the potential to prevent some devastating consequences.

  10. Chronic fatigue is associated with increased disease-related worries and concerns in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Lars-Petter Jelsness-Jφrgensen; Tomm Bernklev; Magne Henriksen; Roald Torp; Bjφrn Mourn

    2012-01-01

    AIM: To investigate the impact of chronic fatigue on disease-related worries in inflammatory bowel disease (IBD) and the potential multicolinearity between subjective questionnaires. METHODS: Patients in remission or with mild-tomoderate disease activity completed the fatigue questionnaire (FQ), the rating form of IBD patient concerns (RFIPC), the Short-Form 36 (SF-36), and IBD questionnaire (N-IBDQ). In addition, clinical and epidemiological data were obtained. RESULTS: In total, 140 patients were included; of which 92 were diagnosed with ulcerative colitis and 48 with Crohn's disease. the mean age of patients with chronic fatigue was 44.2 years (SD =15.8) and for non-fatigued patients was 44.7 years (SD = 16.0). Chrnnic fatigued patients had clinically significantly increased levels of disease-related worries, as measured by Cohen's d effect size. Worries about having an ostomy bag, loss of bowel control, and energy levels were most prominent in both chronic fatigued and non-chronic fatigued IBD patients. Variance inflation factor (VIF) and tolerance indicated that there were no problematic multicolinearity among the FQ, RFIPC, SF-36 and N-IBDQ responses (VIF 2). CONCLUSION: Chronic fatigue is associated with increased levels of disease-related worries and concerns in IBD. Increased levels of worries were also associated with impaired health-related quality of life.

  11. Intestinal permeability to 99mTc-diethylenetriaminopentaacetic acid in inflammatory bowel disease

    Energy Technology Data Exchange (ETDEWEB)

    Casellas, F.; Aguade, S.; Soriano, B.; Accarino, A.; Molero, J.; Guarner, L.

    1986-09-01

    Intestinal permeability in inflammatory bowel disease and its relation to periods of disease activity has been investigated by measuring the urinary excretion of DTPA labeled with 99mTc. Urine excretion in 10 control subjects was 2.7 +/- 1% of the test dose. Twelve patients with ulcerative colitis excreted 5.08 +/- 1.6% in remission, 10.61 +/- 2% during periods of mild activity, 19.41 +/- 0.9% during moderate activity, and 15.41 +/- 6.3% with severe activity. Sixteen patients with Crohn's disease excreted 5.7 +/- 1.9% in remission, 8.47 +/- 2.8% during mild activity of the disease, and 14.29 +/- 5.8% during moderate activity. No differences were observed between ulcerative colitis and Crohn's disease, or between ileal and colonic forms of Crohn's disease. Excretion in remission was significantly greater than in control subjects and there was a correlation between excretion and disease activity. In serial determinations done in seven patients we found that urine excretion of the test substance correlated with disease activity. We also studied DTPA excretion in 10 cases with gastric or duodenal ulcer (2.28 +/- 1.4%), six cases of acute gastroenteritis (4.87 +/- 3.1%) and nine cases with other intestinal diseases (3.6 +/- 1.1%). In all these cases, DTPA excretion was lower than in inflammatory bowel disease. Our results show that the urinary excretion of DTPA is a simple test that measures accurately the degree of activity of inflammatory bowel disease. The test is useful in Crohn's disease as well as in ulcerative colitis, and detects intestinal permeability abnormalities even in clinical remission. Significantly lower excretions are found in other intestinal diseases. The test may be recommended as a screening test for use in clinical practice.

  12. Detection And Identification Of Inflammatory Bowel Disease Electronic Nose

    Science.gov (United States)

    Covington, J. A.; Ouaret, N.; Gardner, J. W.; Nwokolo, C.; Bardhan, K. D.; Arasaradnam, R. P.

    2011-11-01

    Inflammatory bowel disease (IBD) is an inflammation of the lining of the human bowel and a major health issue in Europe. IBD carries with it significant morbidity from toxic treatment, surgery and a risk of developing bowel cancer. Thus there is a need for early identification of the disease using non-invasive tests. Present diagnostic techniques are based around invasive tests (i.e. endoscopy) and laboratory culture; the latter is limited as only 50% of the gut bacteria can be identified. Here we explore the use of an e-nose as a tool to detect and identify two IBDs (i.e. Crohn's disease (CD) & Ulcerative Colitis (UC)) based on headspace analysis from urine samples. We believe that the gut bacterial flora is altered by disease (due to fermentation) that in-turn modulates the gas composition within urine samples. 24 samples (9 CD, 6 UC, 9 controls) were analysed with an in-house e-nose and an Owlstone IMS instrument. Data analysis was performed using linear discriminant analysis (LDA and principal components analysis (PCA). Using the e-nose, LDA separates both disease groups and control, whilst PCA shows a small overlap of classes. The IMS data are more complex but shows some disease/control separation. We are presently collecting further samples for a larger study using more advanced data processing methods.

  13. Central Endoscopy Reading in Inflammatory Bowel Diseases.

    Science.gov (United States)

    Panés, Julián; Feagan, Brian G; Hussain, Fez; Levesque, Barrett G; Travis, Simon P

    2016-09-01

    Endoscopic assessment of the presence and severity of endoscopic lesions has become an essential part of clinical trials in ulcerative colitis and Crohn's disease, for both patient eligibility and outcome measures. Variability in lesion interpretation between and within observers and the potential bias of local investigators in patient assessment have long been recognized. This variability can be reduced, although not completely removed, by independent evaluation of the examinations by experienced off-site (central) readers, properly trained in regard to lesion definition and identification, that should be removed from direct patient contact and blinded to any other clinical or study data. Adding endoscopic demonstration of active disease to eligibility criteria has the potential to reduce placebo response rates, whereas in outcome assessment it has the potential to provide a more precise estimation of the treatment effect, increasing the efficiency of the study. Central endoscopy reading is still at the beginning of its development, and the paradigms of central reading need refinement in terms of the number of readers, the process by which a final score is assigned, the selection and sequence of central readers, and the endoscopic indices of choice. PMID:27604978

  14. Probiotics in inflammatory bowel disease--therapeutic rationale and role.

    LENUS (Irish Health Repository)

    Shanahan, Fergus

    2012-02-03

    The intestinal flora has a conditioning effect on intestinal homeostasis, delivering regulatory signals to the epithelium, the mucosal immune system and to the neuromuscular activity of the gut. Beneficial metabolic activities of the enteric flora include nutrient production, metabolism of dietary carcinogens, conversion of prodrugs to active drugs. However, increasing evidence suggests that some components of the enteric flora are essential ingredients in the pathogenesis of inflammatory bowel disease (IBD); this has prompted interest in therapeutic manipulation of the flora with probiotics. Probiotics are biologic control agents-described as live microbial food supplements which confer a health benefit beyond inherent basic nutrition. Multiple potential beneficial effects have been attributed to the probiotic use of lactic acid bacteria, bifidobacteria and other non-pathogenic commensals. At present, much of the promise of probiotics remains outside the realm of evidence-based medicine and awaits the results of prospective trials, now underway. No reliable in vitro predictors of in vivo efficacy of putative probiotics have been identified. Rigorous comparisons of probiotic performance have not been performed and the suitability of a given probiotic for different individuals is largely unexplored. Notwithstanding, an improved understanding of the normal commensal flora and host-flora interactions has the potential to open up new therapeutic strategies for inflammatory disorders of the gut.

  15. Basic and clinical aspects of osteoporosis in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Low bone mineral density and the increased risk of fracture in gastrointestinal diseases have a multifactorial pathogenesis. Inflammatory bowel disease (IBD) has been associated with an increased risk of osteoporosis and osteopenia and epidemiologic studies have reported an increased prevalence of low bone mass in patients with IBD. Certainly, genetics play an important role,along with other factors such as systemic inflammation,malnutrition, hypogonadism, glucocorticoid therapy in IBD and other lifestyle factors. At a molecular level the proinflammatory cytokines that contribute to the intestinal immune response in IBD are known to enhance bone resorption. There are genes influencing osteoblast function and it is likely that LRP5 may be involved in the skeletal development. Also the identification of vitamin D receptors (VDRs) and some of its polymorphisms have led to consider the possible relationships between them and some autoimmune diseases and may be involved in the pathogenesis through the exertion of its immunomodulatory effects during inflammation. Trying to explain the physiopathology we have found that there is increasing evidence for the integration between systemic inflammation and bone loss likely mediated via receptor for activated nuclear factor kappa-B (RANK),RANK-ligand, and osteoprotegerin, proteins that can affect both osteoclastogenesis and T-cell activation.Although glucocorticoids can reduce mucosal and systemic inflammation, they have intrinsic qualities that negatively impact on bone mass. It is still controversial if all IBD patients should be screened, especially in patients with preexisting risk factors for bone disease. Available methods to measure BMD include single energy x-ray absorptiometry, DXA, quantitative computed tomography (QCT), radiographic absorptiometry, and ultrasound.DXA is the establish method to determine BMD, and routinely is measured in the hip and the lumbar spine.There are several treatments options that have

  16. The gut microbiota in mouse models of inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    Kalliopi eGkouskou

    2014-02-01

    Full Text Available The intestine and the intestinal immune system have evolved through a symbiotic homeostasis under which a highly diverse microbial flora is maintained in the gastrointestinal tract while pathogenic bacteria are recognized and eliminated. Disruption of the balance between the immune system and the gut microbiota results in the development of multiple pathologies in humans. Inflammatory bowel diseases have been associated with alterations in the composition of intestinal flora but whether these changes are causal or result of inflammation is still under dispute. Various chemical and genetic models of inflammatory bowel diseases have been developed and utilized to elucidate the complex relationship between intestinal epithelium, immune system and the gut microbiota. In this review we describe some of the most commonly used mouse models of colitis and Crohn’s disease and summarize the current knowledge of how changes in microbiota composition may affect intestinal disease pathogenesis. The pursuit of gut-microbiota interactions will no doubt continue to provide invaluable insight into the complex biology of inflammatory bowel diseases.

  17. Role of emerging Campylobacter species in inflammatory bowel diseases.

    Science.gov (United States)

    Kaakoush, Nadeem O; Mitchell, Hazel M; Man, Si Ming

    2014-11-01

    The gut microbiota is a central player in the etiology of inflammatory bowel diseases. As such, there is intense scientific interest in elucidating the specific group/s of bacteria responsible for driving barrier damage and perpetuating the chronic inflammation that results in disease. Because of their ability to colonize close to the surface of the host intestinal epithelium, mucosa-associated bacteria are considered key players in the initiation and development of both Crohn's disease and ulcerative colitis. The leading bacterial candidates include adherent and invasive Escherichia coli, Helicobacter, Fusobacteria, Mycobacteria, and Campylobacter species. Of these, a member of the Campylobacter genus, Campylobacter concisus, has recently emerged as a putative player in the pathogenesis of inflammatory bowel diseases. Current research indicates that this bacterium possesses extraordinarily diverse pathogenic capacities as well as unique genetic and functional signatures that are defined by their ability to adhere to and invade host cells, secrete toxins, and the presence of a virulence-associated restriction-modification system. These characteristics enable the potential classification of C. concisus into distinct pathotypes, which we have named adherent and invasive C. concisus and adherent and toxinogenic C. concisus. In this review, we evaluate evidence for the role of emerging Campylobacter species in the pathogenesis of inflammatory bowel diseases.

  18. Antidepressants and inflammatory bowel disease: a systematic review

    Directory of Open Access Journals (Sweden)

    Andrews Jane M

    2006-09-01

    Full Text Available Abstract Background A number of studies have suggested a link between the patient's psyche and the course of inflammatory bowel disease (IBD. Although pharmacotherapy with antidepressants has not been widely explored, some investigators have proposed that treating psychological co-morbidities with antidepressants may help to control disease activity. To date a systematic analysis of the available studies assessing the efficacy of antidepressants for the control of somatic symptoms in IBD patients has not been performed. Methods We searched electronic databases, without any language restriction. All relevant papers issued after 1990 were examined. Results 12 relevant publications were identified. All of them referred to non-randomised studies. Antidepressants reported in these publications included paroxetine, bupropion, amitriptyline, phenelzine, and mirtazapine. In 10 articles, paroxetine, bupropion, and phenelzine were suggested to be effective for treating both psychological and somatic symptoms in patients suffering from IBD. Amitriptyline was found ineffective for treating somatic symptoms of IBD. Mirtazapine was not recommended for IBD patients. Conclusion Although most of reviewed papers suggest a beneficial effect of treatment with antidepressants in patients with IBD, due to the lack of reliable data, it is impossible to judge the efficacy of antidepressants in IBD. Properly designed trials are justified and needed based upon the available uncontrolled data.

  19. Role of mucosal dendritic cells in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Jan Hendrik Niess

    2008-01-01

    The gastrointestinal innate and adaptive immune system continuously faces the challenge of potent stimuli from the commensal microflora and food constituents.These local immune responses require a tight control,the outcome of which is in most cases the induction of tolerance.Local T cell immunity is an important compartment of the specific intestinal immune system.T cell reactivity is programmed during the initial stage of its activation by professional presenting cells.Mucosal dendritic cells(DCs)are assumed to play key roles in regulating immune responses in the antigen-rich gastrointestinal environment.Mucosal DCs are a heterogeneous population that can either initiate(innate and adaptive)immune responses,or control intestinal inflammation and maintain tolerance.Defects in this regulation are supposed to lead to the two major forms of inflammatory bowel disease(IBD),Crohn's disease(CD)and ulcerative colitis(UC).This review will discuss the emerging role of mucosal DCs in regulating intestinal inflammation and immune responses.(C)2008 The WJG Press.All rights reserved.

  20. Family and twin studies in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Leena Halme; Paulina Paavola-Sakki; Ulla Turunen; Maarit Lappalainen; Martti F(a)rkkil(a); Kimmo Kontula

    2006-01-01

    Studies examining the inheritance of inflammatory bowel disease (IBD) within different family groups have been the basis for recent molecular advances in the genetics of IBD. The derived heritability in Crohn's disease (CD) is higher than in many other complex diseases. The risk of IBD is highest in first-degree relatives of a CD proband,but first-degree relatives of a proband suffering from ulcerative colitis (UC) and more distant relatives are also at increased risk. Disease concordance rates in IBD have been examined in multiplex families and in three large European twin studies.

  1. Bowel movement frequency, oxidative stress and disease prevention

    Science.gov (United States)

    Vermorken, Alphons J.M.; Andrès, Emmanuel; Cui, Yali

    2016-01-01

    The significance of diet for disease prevention has long been recognised. Dietary recommendations have therefore been integrated in health promotion messages. Gastrointestinal functioning is essential for the digestion of nutrients. Oxidative stress has been observed in patients with constipation, as well as in those with colorectal cancer, cardiovascular disease and other chronic illnesses associated with constipation. The coexistence of colorectal neoplasia and coronary artery disease has been incriminated for exposure to common risk factors associated with increased oxidative stress. It was recently demonstrated that bowel movement frequency is inversely associated with cardiovascular mortality. The aim of the present study was to review the relevant literature in light of these findings. It was concluded that suboptimal functioning of the large bowel may contribute to oxidative stress and, therefore, to increased mortality. Bowel movement frequency may represent a simple quantifiable indicator of adequate colonic function and it is dependent on diet, exercise and other lifestyle factors, but also on individual characteristics, including colonic microbiota. Future health promotion actions may improve the prevention of a number of diseases by advocating lifestyle personalisation for assuring optimal intestinal functioning. PMID:27703675

  2. New endoscopic imaging techniques in surveillance ofinflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Tommaso Gabbani; Natalia Manetti; Andrea Giovanni Bonanomi; Antonio Luca Annese; Vito Annese

    2015-01-01

    Endoscopy plays a crucial role in the managementof inflammatory bowel disease (IBD). Advancesimaging techniques allow visualization of mucosaldetails, tissue characteristics and cellular alteration. Inparticular chromoendoscopy, magnification endoscopy,confocal laser endomicroscopy and endocytoscopyseem to have the possibility to radically modify theapproach to surveillance and decision making. Dyebasedchromoendoscopy (DBC) and magnificationchromoendoscopy improve detection of dysplasia,and evaluation of inflammatory activity and extensionof ulcerative colitis and are thus considered thestandard of care. Dye-less chromoendoscopy couldprobably replace conventional DBC for surveillance.Narrow band imaging and i-scan have shown toimprove activity and extent assessment in comparisonto white-light endoscopy. Confocal laser endomicroscopy(CLE) can detect more dysplastic lesions insurveillance colonoscopy and predict neoplastic andinflammatory changes with high accuracy comparedto histology. This technology is best used in conjunctionwith chromoendoscopy, narrow-band imaging, orautofluorescence because of its minute scanning area.This combination is useful for appropriate tissueclassification of mucosal lesions already detectedby standard or optically enhanced endoscopy. Thebest combination for IBD surveillance appear tobe chromoendoscopy for identification of areas ofsuspicion, with further examination with CLE to detectintraepithelial neoplasia. However cost, availability, andexperience are still an issue.

  3. New insights into inflammatory bowel disease and colitis-associated neoplasia

    OpenAIRE

    van Schaik, F.D.M.

    2012-01-01

    This thesis describes new insights into the development of inflammatory bowel disease (IBD: ulcerative colitis (UC) or Crohn’s disease (CD)) and IBD-associated neoplasia. In the first part, the value of serological markers as predictors of IBD was investigated in a large European cohort of individuals.A combination of serological markers was found to predict the development of IBD in individuals from a low-risk population. Furthermore, the role of pharmacological activation of the nuclear far...

  4. Overview of 5-ASA in Therapy of Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    CN Williams

    1994-01-01

    Full Text Available There are two forms of 5-aminosalicylic acid (5-ASA drug delivery. First, a pro-drug form in which 5-ASA, the active principal, is attached to a c.arrier molecule and released in the intestine by bacterial cleavage. An example of this is sulfasalazine, originally developed in the 1940s and found to be effective, cheap, but limited by side effects due to the sulfapyridine component. The second drug delivery system depends on an enteric coating for delayed pH-dependent release or for a timed-released mechanism. 5-ASA inhibits 5-lipoxygenase, modulates leukocyte function and inhibits soluble mediator release, and is an effective scavenger action of free oxygen radicals, the relative importance of which is unknown. The multiplicity of action is probably its strength because drugs that have only one of these actions are relatively ineffective in inflammatory bowel disease. 5-ASA compounds are effective in treating mild to moderate acute ulcerative colitis and in maintaining remission, and are equivalent to sulfasalazine in this regard. 5-ASA used topically in enema or suppository form is highly efficient in both acute disease and in maintaining remission. 5-ASA is also effective in active Crohn’s disease, but not as effective as in maintenance therapy compared with ulcerative colitis. The pro-drugs tend to have more side effects. Slow release compounds are well tolerated with few side effects, allowing increases to effective dosage. In patients intolerant of sulfasalazine, switching to a 5-ASA preparation usually results in tolerance and therapeutic benefit, with an occasional allergic reaction to the 5-ASA molecule limiting its use.

  5. Inflammatory bowel disease support groups: a primer for gastroenterology nurses.

    Science.gov (United States)

    Leshem, Rachel Namdar

    2003-01-01

    This article discusses the importance of a support group for people living with inflammatory bowel disease. The support group provides these patients and their families with a social framework for promoting positive adjustment to the illness and seeks to improve the patients' quality of life. The use of a support group has been described in the literature as a method of helping patients and their families to face living with chronic illness, but relatively little has been written about support groups for people with inflammatory bowel disease and the role of the gastroenterology nurse. In this article, the benefit of support groups and the content of the intervention are discussed including health education, self-efficiency, coping skills, and ways to increase feelings of social acceptance. PMID:14676612

  6. Overcoming challenges of treating inflammatory bowel disease in pregnancy.

    Science.gov (United States)

    Gaidos, Jill K J; Kane, Sunanda V

    2016-08-01

    Inflammatory bowel disease (IBD) is frequently diagnosed before or during the peak reproductive years. Overall management of inflammatory bowel disease is becoming more complex given the nuances involved with multiple mechanisms of action of the current treatment and need for therapeutic monitoring for safety and efficacy; another layer of complexity is added in the setting of a pregnancy. In this review, we have identified several key challenges that health care providers face when caring for patients with IBD during pregnancy. The goal of this review is to provide the most up-to-date evidence and provide our expert recommendations so that providers can more comfortably address patients' questions about pregnancy in IBD and the associated risks as well as optimize their care to ensure the best outcomes possible. PMID:26981845

  7. Lymphogranuloma venereum proctosigmoiditis is a mimicker of inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Marlene Gallegos; Dawn Bradly; Shriram Jakate; Ali Keshavarzian

    2012-01-01

    There has been an increasing prevalence of lymphogranuloma venereum (LGV) or Chlamydia trachomatis (C.trachomatis) cases among the men who have sex with men (MSM) population,particularly in Europe and North America.These cases may present with an incomplete or undisclosed history and proctosigmoiditis without characteristic adenopathy syndrome.During the initial evaluation and colonoscopy,there is a strong clinical and endoscopic suspicion of inflammatory bowel disease (IBD) by virtue of presentation and endoscopic and histological findings.The diagnosis of IBD is subsequently modified to LGV proctosigmoiditis when one or more of the following transpire:(1) there is failure of response to IBD therapy; (2) additional components of history (MSM/travel) may be identified; (3) return of initially performed Chlamydia antibody test is positive;and (4) response to antibiotics effective against Chlamydia.We describe three such cases initially suspected to be an inflammatory bowel disease and subsequently identified as C.trachomatis proctosigmoiditis.

  8. Diagnostic Considerations in Pediatric Inflammatory Bowel Disease Management

    OpenAIRE

    Cuffari, Carmen

    2009-01-01

    Approximately 20% of all inflammatory bowel disease (IBD) first presents in childhood or adolescence, and approximately 10% of the estimated 1.4 million Americans with IBD are under age 17. Diagnosis in pediatric patients may be complicated at presentation due to atypical symptoms and/or extraintestinal manifestations (eg, short stature, chronic anemia, unexplained fever, arthritis, mouth ulcers). Pediatric IBD is traditionally diagnosed using endoscopic evaluations of the upper and lower gas...

  9. Pulmonary involvement and allergic disorders in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Nikolaos; E; Tzanakis; Ioanna; G; Tsiligianni; Nikolaos; M; Siafakas

    2010-01-01

    Inflammatory bowel disease (IBD) has been associated with either clinical or subclinical airway and parenchymal lung involvement and interstitial lung complications. Several studies have reported that atopy has a high prevalence in IBD patients. Overlapping allergic disorders seem to be present in both the respiratory and gastrointestinal systems. The purpose of this review is to update clinicians on recent available literature and to discuss the need for a highly suspicious approach by clinicians.

  10. Inflammatory bowel disease in adolescents: What problems does it pose?

    Institute of Scientific and Technical Information of China (English)

    Ying Lu; James Markowitz

    2011-01-01

    Adolescents with inflammatory bowel disease face daily and long-term challenges that may be difficult for teenagers to manage. The developmental and psychosocial changes unique to this age group include becoming more autonomous and being more vulnerable to peer influence. These changes may lead to problems in medical management such as poor medication adherence and risky behavior. Being aware of these issues will help the medical team provide anticipatory guidance to address these concerns.

  11. Intestinal microbiota in inflammatory bowel disease: Friend of foe?

    OpenAIRE

    Fava, Francesca; Danese, Silvio

    2011-01-01

    Inflammatory bowel disease (IBD) arises from disruption of immune tolerance to the gut commensal microbiota, leading to chronic intestinal inflammation and mucosal damage in genetically predisposed hosts. In healthy individuals the intestinal microbiota have a symbiotic relationship with the host organism and possess important and unique functions, including a metabolic function (i.e. digestion of dietary compounds and xenobiotics, fermentation of undigestible carbohydrates with production of...

  12. Understanding of chemoprophylaxis and concordance in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Adam; Low; Melanie; Love; Robert; Walt; Katherine; Kane; Bertus; Eksteen; Jason; Goh

    2010-01-01

    AIM:To assess patients' understanding for the reasons for taking 5-aminosalicylic acid or ursodeoxycholic acid as chemoprophylaxis against colorectal carcinoma associated with in? ammatory bowel disease (IBD). METHODS: A questionnaire-based study using a 5 point opinion scale was performed. One hundred and ninety-two patients with colitis only and 74 patients with primary sclerosing cholangitis and IBD were invited to take part. RESULTS: Overall response rate was 58%. Sixtyfour percent of patients claimed f...

  13. Epithelial restitution and wound healing in inflammatory bowel disease

    OpenAIRE

    Sturm, Andreas; Dignass, Axel U.

    2008-01-01

    Inflammatory bowel disease is characterized by a chronic inflammation of the intestinal mucosa. The mucosal epithelium of the alimentary tract constitutes a key element of the mucosal barrier to a broad spectrum of deleterious substances present within the intestinal lumen including bacterial microorganisms, various dietary factors, gastrointestinal secretory products and drugs. In addition, this mucosal barrier can be disturbed in the course of various intestinal disorders including inflamma...

  14. Interstitial Nephritis in a Patient with Inflammatory Bowel Disease

    Science.gov (United States)

    Vasanth, Payaswini; Parmley, Michelle; Torrealba, Jose

    2016-01-01

    Tubulointerstitial nephritis in patients with inflammatory bowel disease has been linked to the use of 5-ASA derivatives. Various aspects of this theory have been challenged with a potential role for the underlying autoimmune disorder. Steroids are the mainstay of treatment and mycophenolate mofetil might be an effective alternative. We report a patient who responded well to mycophenolate despite continuing mesalamine, the suspected offending agent. PMID:27703822

  15. Herbal and plant therapy in patients with inflammatory bowel disease

    OpenAIRE

    Triantafyllidi, Aikaterini; Xanthos, Theodoros; Papalois, Apostolos; Triantafillidis, John K.

    2015-01-01

    The use of herbal therapy in inflammatory bowel disease (IBD) is increasing worldwide. The aim of this study was to review the literature on the efficacy of herbal therapy in IBD patients. Studies on herbal therapy for IBD published in Medline and Embase were reviewed, and response to treatment and remission rates were recorded. Although the number of the relevant clinical studies is relatively small, it can be assumed that the efficacy of herbal therapies in IBD is promising. The most import...

  16. Probiotics in Inflammatory Bowel Diseases and Associated Conditions

    OpenAIRE

    Mack, David R.

    2011-01-01

    A complex set of interactions between the human genes encoding innate protective functions and immune defenses and the environment of the intestinal mucosa with its microbiota is currently considered key to the pathogenesis of the chronic inflammatory bowel diseases (IBD). Probiotics offer a method to potentially alter the intestinal microbiome exogenously or may provide an option to deliver microbial metabolic products to alter the chronicity of intestinal mucosal inflammation characterizing...

  17. Biologic targeting in the treatment of inflammatory bowel diseases

    OpenAIRE

    Matteo Bosani; Sandro Ardizzone; Gabriele Bianchi Porro

    2009-01-01

    Matteo Bosani, Sandro Ardizzone, Gabriele Bianchi PorroChair of Gastroenterology, “L. Sacco” University Hospital, Milan, ItalyAbstract: The etiology of inflammatory bowel disease (IBD) has not yet been clarified and immunosuppressive agents which nonspecifically reduce inflammation and immunity have been used in the conventional therapies for IBD. Evidence indicates that a dysregulation of mucosal immunity in the gut of IBD causes an overproduction of inflammatory cytokine...

  18. Biologic targeting in the treatment of inflammatory bowel diseases

    OpenAIRE

    Ardizzone, Sandro

    2009-01-01

    This paper has been retracted. Matteo Bosani, Sandro Ardizzone, Gabriele Bianchi PorroChair of Gastroenterology, “L. Sacco” University Hospital, Milan, ItalyAbstract: The etiology of inflammatory bowel disease (IBD) has not yet been clarified and immunosuppressive agents which nonspecifically reduce inflammation and immunity have been used in the conventional therapies for IBD. Evidence indicates that a dysregulation of mucosal immunity in the gut of IBD ...

  19. Self-Care Among Patients With Inflammatory Bowel Disease

    OpenAIRE

    Lovén Wickman, Ulrica; Yngman-Uhlin, Pia; Hjortswang, Henrik; Riegel, Barbara; Stjernman, Henrik; Hollman Frisman, Gunilla

    2016-01-01

    Inflammatory bowel disease (IBD) is a chronic disease of unknown etiology. The disease occurs early in life and the burden of symptoms is significant. Patients need to perform self-care to handle their symptoms, but knowledge about what kind of self-care patients do is limited and these individuals need to learn how to manage the symptoms that arise. The aim of this study was to explore self-care among patients with IBD. Twenty adult patients with IBD, 25–66 years of age, were interviewed. Da...

  20. Role of CT colonography in inflammatory bowel disease

    International Nuclear Information System (INIS)

    CT colonography (CTC), or virtual colonoscopy, is a non-invasive imaging method that uses CT data sets combined with specialized imaging software to examine the colon. CTC is not used routinely in patients with inflammatory bowel disease (IBD). However, investigating contemporarily the colon, other abdominal organs and the peritoneum with CTC is at times useful in patients with IBD, especially when other diagnostic tools fail. Furthermore, since symptoms of colorectal cancer sometimes superimpose to those of inflammatory disease, it may happen to image patients with IBD incidentally. If clinical signs are suggestive for inflammatory disease, exam technique should be modified accordingly and distinguishing radiological findings searched for.

  1. Role of CT colonography in inflammatory bowel disease

    Energy Technology Data Exchange (ETDEWEB)

    Regge, Daniele [Institute for Cancer Research and Treatment, Candiolo, Turin (Italy)], E-mail: dregge@mauriziano.it; Neri, Emanuele; Turini, Francesca [Diagnostic and Interventional Radiology, University of Pisa (Italy); Chiara, Gabriele [Institute for Cancer Research and Treatment, Candiolo, Turin (Italy)

    2009-03-15

    CT colonography (CTC), or virtual colonoscopy, is a non-invasive imaging method that uses CT data sets combined with specialized imaging software to examine the colon. CTC is not used routinely in patients with inflammatory bowel disease (IBD). However, investigating contemporarily the colon, other abdominal organs and the peritoneum with CTC is at times useful in patients with IBD, especially when other diagnostic tools fail. Furthermore, since symptoms of colorectal cancer sometimes superimpose to those of inflammatory disease, it may happen to image patients with IBD incidentally. If clinical signs are suggestive for inflammatory disease, exam technique should be modified accordingly and distinguishing radiological findings searched for.

  2. Clinical applications of radiolabeled blood elements in inflammatory bowel disease

    Energy Technology Data Exchange (ETDEWEB)

    Martin-Comin, J. (Hospital Princeps d' Espanya, Barcelona (Spain). S. Medicina Nuclear); Prats, E. (Hospital Cinico, Zaragoza (Spain). S.Medicina Nuclear)

    1999-03-01

    The work discusses the main clinical features of inflammatory bowel disease (IBD) and the methods to obtain an accurate diagnostic. Nuclear medicine procedures are deeply analysed, with special emphasis in those where clinical experience is larger and that are available for clinical practice in most countries. In the opinion of the authors [sup 99m]Tc-HMPAO is the first choice agent, while [sup 111]In-oxine could be considered as a gold standard for evaluation of new agents. In the context of IBD, the WBC scintigraphy is useful for its diagnosis and the evaluation of disease extension. The evaluation of disease severity deserves further experiences.

  3. Inflammatory bowel disease related innate immunity and adaptive immunity

    Science.gov (United States)

    Huang, Yuan; Chen, Zhonge

    2016-01-01

    Inflammatory bowel disease (IBD) is a chronic nonspecific intestinal inflammatory disease, including ulcerative colitis (UC) and Crohn’s disease (CD). Its pathogenesis remains not yet clear. Current researchers believe that after environmental factors act on individuals with genetic susceptibility, an abnormal intestinal immune response is launched under stimulation of intestinal flora. However, previous studies only focused on adaptive immunity in the pathogenesis of IBD. Currently, roles of innate immune response in the pathogenesis of intestinal inflammation have also drawn much attention. In this study, IBD related innate immunity and adaptive immunity were explained, especially the immune mechanisms in the pathogenesis of IBD. PMID:27398134

  4. Genetic factors associated with the development of inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Crohn's disease (CD) and ulcerative colitis (UC) are complex polygenic disorders, characterized by several genes together with environmental factors contributing to the development of inflammatory bowel disease (IBD). Recent advances in research on genetic susceptibility have allowed the identification of diverse genes at different levels: (1) Innate immunity; (2) Antigen presentation molecules; (3) Epithelial integrity; (4) Drug transporter; (5) Cell adhesion. The application of genetic testing into clinical practice is close and all genetic markers may have several clinical implications: prediction of disease phenotype, molecular classification, prevention of complications, and prognosis.

  5. Extraintestinal manifestations of inflammatory bowel disease: epidemiology, diagnosis, and management

    DEFF Research Database (Denmark)

    Larsen, Signe; Bendtzen, Klaus; Nielsen, Ole Haagen

    2010-01-01

    the European Agency for the Evaluation of Medicinal Products (EMEA) and the US Food and Drug Administration (FDA) (cut-off date October 2009). The search terms 'Crohn's disease', 'inflammatory bowel disease', or 'ulcerative colitis' were combined with the terms 'adalimumab', 'anemia', 'arthritis......', 'thromboembolism', and 'treatment'. The search was performed on English-language reviews, practical guidelines, letters, and editorials. Articles were selected based on their relevance, and additional papers were retrieved from their reference lists. Since some of the diseases discussed are uncommon, valid...

  6. Do we really understand what the immunological disturbances in inflammatory bowel disease mean?

    Institute of Scientific and Technical Information of China (English)

    Epameinondas V Tsianos; Konstantinos Katsanos

    2009-01-01

    The gastrointestinal tract uses a system of tolerance and controlled inflammation to limit the response to dietary or bacteria-derived antigens in the gut. When this complex system breaks down, either by a chemical or pathogenic insult in a genetically predisposed individual the resulting immune response may lead to inflammatory bowel disease. Although the aetiopathogenesis of inflammatory bowel disease remains unsolved current evidence indicates that defective T-cell apoptosis and impairment of intestinal epithelial barrier function play important roles. In inflammatory bowel disease, it has been reported that activation of macrophages seems to be as important as increased production of the macrophage-derived cytokines such as TNF-α, IL-1 and IL-6. The triggering factor for this cascade is still to be elucidated as to whether it represents an auto-antigen or a hetero-antigen. It has been also demonstrated that a serologic anti-microbial response exists. This response includes antibodies against saccharomyces cerevisiae (ASCA), E. coli outer membrane porin C (Omp-C), flagelin (cBir1) and pseudomonas aeroginosa (I2). Host response to microbial pathogens includes self-defense mechanisms including defensins, pattern recognition receptors and Toll-like receptors. Neuroimmunomodulation in inflammatory bowel disease (IBD) is another interesting approach with implications on the influence of brain-gut axis on intestinal inflammation and its perpetuation. It is probable that inflammatory bowel disease represents a heterogenic group of diseases that share similar mechanisms of tissue damage but have different initiating events and immunoregulatory abnormalities. A better understanding of all these events will hopefully provide new insights into the mechanisms of epithelial responses to microorganisms and ideas for therapies. . 2009 The WJG Press and Baishideng. All rights reserved.

  7. Plain abdominal radiographs in children with inflammatory bowel disease

    Energy Technology Data Exchange (ETDEWEB)

    Taylor, G.A.; Nancarrow, P.A.; Hernanz-Schulman, M.; Teele, R.L.

    1986-03-01

    The value of plain abdominal radiography in children with inflammatory bowel disease (IBD) has not been ascertained. We reviewed the scout radiographs prior to first barium examination in 100 children with IBD (53 Crohn, 47 ulcerative colitis (UC) and scout films prior to excretory urography in 50 patients who had no clinical evidence of intestinal disease (controls)). The films were reviewed without clinical information, and the abnormalities on each film scored according to severity and location. Criteria included: mural thickening, dilatation and mucosal abnormalities of the small bowel and colon, as well as abnormal quantity and/or distribution of feces in the colon. Eighty percent (40/50) of the films in the control group were interpreted as normal. Abnormalities suggestive of IBD were presented in 73% of the IBD group (76% Crohn and 72% UC). Thirty-one percent of the films in the IBD group had a moderately abnormal score (>=3) or markedly abnormal score (>=5) at presentation. The most reliable radiographic findings were: mucosal abnormality in the colon and small bowel and an abnormal stool pattern (feces completely absent or only present in one colonic segment). The clinical presentation of IBD in childhood is often vague and nonspecific. Abnormalities in plain films of the abdomen are common in these patients and may be helpful in suggesting the presence and, to a great degree, the severity of disease in these children.

  8. Mucosal biomarkers in inflammatory bowel disease:Key pathogenic players or disease predictors?

    Institute of Scientific and Technical Information of China (English)

    Franco; Scaldaferrii; Carmen; Correale; Antonio; Gasbarrini; Silvio; Danese

    2010-01-01

    Inflammatory bowel diseases(IBDs) are chronic inflammatory disorders of the bowel,including ulcerative colitis and Crohn's disease.A single etiology has not been identified,but rather the pathogenesis of IBD is very complex and involves several major and minor contributors,employing different inflammatory pathways which have different roles in different patients.Although new and powerful medical treatments are available,many are biological drugs or immunosuppressants,which are associated with significant si...

  9. Cogan's Syndrome in Patients With Inflammatory Bowel Disease--A Case Series

    DEFF Research Database (Denmark)

    Vavricka, Stephan R; Greuter, Thomas; Scharl, Michael;

    2015-01-01

    BACKGROUND: Cogan's syndrome (CSy) is a very rare autoimmune disorder, mainly affecting the inner ear and the eye, and is associated with inflammatory bowel disease (IBD). METHODS: This was a European Crohn's and Colitis Organisation (ECCO) retrospective observational study, performed as part...... duration of IBD until diagnosis of CSy was 8.7 years (range 0.0-38.0) and mean age at CSy diagnosis was 44.6 years (range 9.0-67.0). Six patients had underlying ulcerative colitis (UC) and 16 had Crohn's disease. Eleven patients (50%) had active disease at CSy diagnosis. Sixteen patients were under IBD...... of the CONFER project. A call to all ECCO members was made to report concomitant CSy and inflammatory bowel disease (IBD) cases. Clinical data were recorded in a standardized questionnaire. RESULTS: This international case series reports on 22 concomitant CSy-IBD cases from 14 large medical centres. Mean...

  10. Inflammatory Bowel Disease Associated with Virulence Factors in Escherichia coli

    DEFF Research Database (Denmark)

    Mirsepasi-Lauridsen, Hengameh

    Inflammatory Bowel Disease (IBD) is a chronic inflammatory disease of the gastrointestinal tract, traditionally divided into Crohn’s disease (CD) and ulcerative colitis (UC). UC is a relapsing non-transmural chronic inflammatory disease that is restricted to the colon and during flares the disease...... are often expressed by the Extra-intestinal Pathogenic E. coli (ExPEC). Faecal calprotectin is a marker of gastrointestinal inflammation and is used in order to determine mucosal healing and disease relapses/ remission in IBD patients. Our study showed that CALPRO faecal calprotectin kit is most optimal...... is characterised by bloody diarrhoea. CD is a chronic, segmental localised granulomatous disease that can affect any part of the entire gastrointestinal tract from the mouth to the anus. The aetiology of IBD is still unknown, but studies indicate several possible aetiologies such as the host immune system...

  11. Nutrition in adult patients with inflammatory bowel disease.

    Science.gov (United States)

    Hebuterne, Xavier; Filippi, Jerome; Schneider, Stephane M

    2014-01-01

    Seventy five percent of hospitalized patients with Crohn's disease suffer from malnutrition. One third of Crohn's disease patients have a body mass index below 20. Sixty percent of Crohn's disease patients have sarcopenia. However some inflammatory bowel disease (IBD) patients are obese or suffer from sarcopenic-obesity. IBD patients have many vitamin and nutrient deficiencies, which can lead to important consequences such as hyperhomocysteinemia, which is associated with a higher risk of thromboembolic disease. Nutritional deficiencies in IBD patients are the result of insufficient intake, malabsorption and protein-losing enteropathy as well as metabolic disturbances directly induced by the chronic disease and its treatments, in particular corticosteroids. Screening for nutritional deficiencies in chronic disease patients is warranted. Managing the deficiencies involves simple nutritional guidelines, vitamin supplements, and nutritional support in the worst cases. PMID:25266810

  12. Anti-Inflammatory Activity of Fruit Fractions in Vitro, Mediated through Toll-Like Receptor 4 and 2 in the Context of Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Noha Ahmed Nasef

    2014-11-01

    Full Text Available Pattern recognition receptors such as Toll-Like Receptor 2 (TLR2 and 4 (TLR4 are important in detecting and responding to stress and bacterial stimuli. Defect or damage in the TLR2 and TLR4 pathways can lead to sustained inflammation, characteristic of inflammatory bowel disease (IBD. The goal of this study was to identify fruit fractions that can be tested further to develop them as complementary therapies for IBD. In order to do this, we identified fruit fractions that mediate their anti-inflammatory response through the TLR4 and TLR2 pathway. Human Embryonic Kidney (HEK-hTLR4 and hTLR2 cells were stimulated with their respective ligands to induce inflammation. These cells were treated with one of the 12 fractionated fruits and the inflammatory effect measured. 10 of the fruits came up as anti-inflammatory in the hTLR4 assay and nine in the hTLR2 assays. Many of the fruit fractions mediated their anti-inflammatory actions either mainly in their hydrophobic fractions (such as elderberry or hydrophilic fractions (such as red raspberry, or both. The strongest anti-inflammatory effects were seen for feijoa and blackberry. This study shows that fruits can have multiple fractions eliciting anti-inflammatory effects in a pathway specific manner. This suggests that the compounds found in fruits can act together to produce health benefits by way of reducing inflammation. Exploiting this property of fruits can help develop complimentary therapies for inflammatory diseases.

  13. Passive Smoking and Inflammatory Bowel Disease: A Meta-analysis

    Science.gov (United States)

    Jones, Deborah T.; Osterman, Mark T.; Bewtra, Meenakshi; Lewis, James D.

    2009-01-01

    Objectives Active smoking has a well-documented role in the etiology of inflammatory bowel disease (IBD), but the role of passive smoking has been unclear. This meta-analysis examined the relationship between prenatal smoke exposure and childhood passive smoke exposure and the development of IBD. Methods We searched the MEDLINE and EMBASE databases to identify observational studies regarding the relationship between prenatal and/or childhood passive smoke exposure and the development of Crohn’s disease (CD) and/or ulcerative colitis (UC). Pooled odds ratios were calculated for each relationship. Results A total of 534 and 699 potential studies were identified from MEDLINE and EMBASE, respectively, of which 13 met all of our inclusion criteria. Overall we did not observe a positive relationship between childhood passive smoke exposure and CD (OR, 1.10; 95% CI, 0.92–1.30) or UC (OR, 1.01; 95% CI, 0.85–1.20). Likewise, we did not observe an association between prenatal smoke exposure and CD (OR, 1.10; 95% CI, 0.67–1.80), or prenatal smoke exposure and UC (OR, 1.11; 95% CI, 0.63–1.97). Conclusions Our meta-analysis suggests that there is not a strong association between childhood passive smoke exposure and the development of CD. We found no evidence that childhood passive smoke exposure exerts a protective effect against UC, as is the case in active smoke exposure. Heterogeneity among the small number of studies limited the ability to draw conclusions about prenatal smoke exposure. PMID:18844625

  14. Initial Disease Course and Treatment in an Inflammatory Bowel Disease Inception Cohort in Europe

    DEFF Research Database (Denmark)

    Burisch, Johan; Pedersen, Natalia; Cukovic-Cavka, Silvja;

    2014-01-01

    follow-up. In western Europe, 65 Crohn's disease (CD) (16%), 20 ulcerative colitis (UC) (4%), and 4 IBD unclassified (4%) patients underwent surgery, and in eastern Europe, 12 CD (12%) and 2 UC (1%) patients underwent surgery. Eighty-one CD (20%), 80 UC (14%), and 13 (9%) IBD unclassified patients were......BACKGROUND: The EpiCom cohort is a prospective, population-based, inception cohort of inflammatory bowel disease (IBD) patients from 31 European centers covering a background population of 10.1 million. The aim of this study was to assess the 1-year outcome in the EpiCom cohort. METHODS: Patients...... were followed-up every third month during the first 12 (±3) months, and clinical data, demographics, disease activity, medical therapy, surgery, cancers, and deaths were collected and entered in a Web-based database (www.epicom-ecco.eu). RESULTS: In total, 1367 patients were included in the 1-year...

  15. Quantification, validation, and follow-up of small bowel motility in Crohn's disease

    Science.gov (United States)

    Cerrolaza, Juan J.; Peng, Jennifer Q.; Safdar, Nabile M.; Conklin, Laurie; Sze, Raymond; Linguraru, Marius George

    2015-03-01

    The use of magnetic resonance enterography (MRE) has become a mainstay in the evaluation, assessment and follow up of inflammatory bowel diseases, such as Crohn's disease (CD), thanks to its high image quality and its non-ionizing nature. In particular, the advent of faster MRE sequences less sensitive to image-motion artifacts offers the possibility to obtain visual, structural and functional information of the patient's small bowel. However, the inherent subjectivity of the mere visual inspection of these images often hinders the accurate identification and monitoring of the pathological areas. In this paper, we present a framework that provides quantitative and objective motility information of the small bowel from free-breathing MRE dynamic sequences. After compensating for the breathing motion of the patient, we create personalized peristaltic activity maps via optical flow analysis. The result is the creation of a new set of images providing objective and precise functional information of the small bowel. The accuracy of the new method was also evaluated from two different perspectives: objective accuracy (1.1 ± 0.6 mm/s of error), i.e., the ability of the system to provide quantitative and accurate information about the motility of moving bowel landmarks, and subjective accuracy (avg. difference of 0.7 ± 0.7 in a range of 1 to 5), i.e., the degree of agreement with the subjective evaluation of an expert. Finally, the practical utility of the new method was successfully evaluated in a preliminary study with 32 studies of healthy and CD cases, showing its potential for the fast and accurate assessment and follow up of CD in the small bowel.

  16. Association between psoriasis and inflammatory bowel disease

    DEFF Research Database (Denmark)

    Egeberg, A; Mallbris, L; Warren, R B;

    2016-01-01

    BACKGROUND: Psoriasis, Crohn disease (CD) and ulcerative colitis (UC) are chronic inflammatory disorders with overlapping genetic architecture. However, data on the frequency and risk of CD and UC in psoriasis are scarce and poorly understood. OBJECTIVES: To investigate the association between CD...

  17. Spiral CT colonography in inflammatory bowel disease

    Energy Technology Data Exchange (ETDEWEB)

    Tarjan, Zsolt E-mail: tarjan@radi.sote.hu; Zagoni, Tamas; Gyoerke, Tamas; Mester, Adam; Karlinger, Kinga; Mako, Erno K

    2000-09-01

    Objective: Most of the studies on virtual colonoscopy are dealing with the role of detecting colorectal polyps or neoplasms. We have undertaken this study to evaluate the value of CT colonography in patients with colonic Crohn's disease. Methods and material: Five patients (three males, two females, 23-51 years, mean age 42 years) with known (4) or suspected (1) Crohn's disease of the colon underwent fiberoptic colonoscopy and CT colonography in the same day or during a 1-week period. The images were evaluated with the so called zoomed axial slice movie technique and in some regions intra- and extraluminal surface shaded and volume rendered images were generated on a separate workstation. The results were compared to those of a colonoscopy. Results: The final diagnosis was Crohn's disease in four patients and colitis ulcerosa in one. Total examination was possible by colonoscopy in two cases, and with CT colonography in all five cases. The wall of those segments severely affected by the disease were depicted by the axial CT scans to be thickened. The thick walled, segments with narrow lumen seen on CT colonography corresponded to the regions where colonoscopy was failed to pass. Air filled sinus tracts, thickening of the wall of the terminal ileum, loss of haustration pseudopolyps and deep ulcers were seen in CT colonography. Three dimensional (3D) endoluminal views demonstrated pseudopolyps similar to endoscopic images None of the colonoscopically reported shallow ulcerations or aphtoid ulcerations or granular mucosal surface were observed on 2- or 3D CT colonographic images. Conclusion: CT colonography by depicting colonic wall thickening seems to be a useful tool in the diagnosis of Crohn's colitis, which could be a single examination depicting the intraluminal, and transmural extent of the disease.

  18. Defining Disease Severity in Inflammatory Bowel Diseases: Current and Future Directions.

    Science.gov (United States)

    Peyrin-Biroulet, Laurent; Panés, Julián; Sandborn, William J; Vermeire, Séverine; Danese, Silvio; Feagan, Brian G; Colombel, Jean-Frédéric; Hanauer, Stephen B; Rycroft, Beth

    2016-03-01

    Although most treatment algorithms in inflammatory bowel disease (IBD) begin with classifying patients according to disease severity, no formal validated or consensus definitions of mild, moderate, or severe IBD currently exist. There are 3 main domains relevant to the evaluation of disease severity in IBD: impact of the disease on the patient, disease burden, and disease course. These measures are not mutually exclusive and the correlations and interactions between them are not necessarily proportionate. A comprehensive literature search was performed regarding current definitions of disease severity in both Crohn's disease and ulcerative colitis, and the ability to categorize disease severity in a particular patient. Although numerous assessment tools for symptoms, quality of life, patient-reported outcomes, fatigue, endoscopy, cross-sectional imaging, and histology (in ulcerative colitis) were identified, few have validated thresholds for categorizing disease activity or severity. Moving forward, we propose a preliminary set of criteria that could be used to classify IBD disease severity. These are grouped by the 3 domains of disease severity: impact of the disease on the patient (clinical symptoms, quality of life, fatigue, and disability); measurable inflammatory burden (C-reactive protein, mucosal lesions, upper gastrointestinal involvement, and disease extent), and disease course (including structural damage, history/extension of intestinal resection, perianal disease, number of flares, and extraintestinal manifestations). We further suggest that a disease severity classification should be developed and validated by an international group to develop a pragmatic means of identifying patients with severe disease. This is increasingly important to guide current therapeutic strategies for IBD and to develop treatment algorithms for clinical practice. PMID:26071941

  19. Microbiome Heterogeneity Characterizing Intestinal Tissue and Inflammatory Bowel Disease Phenotype.

    Science.gov (United States)

    Tyler, Andrea D; Kirsch, Richard; Milgrom, Raquel; Stempak, Joanne M; Kabakchiev, Boyko; Silverberg, Mark S

    2016-04-01

    Inflammatory bowel disease has been associated with differential abundance of numerous organisms when compared to healthy controls (HCs); however, few studies have investigated variability in the microbiome across intestinal locations and how this variability might be related to disease location and phenotype. In this study, we have analyzed the microbiome of a large cohort of individuals recruited at Mount Sinai Hospital in Toronto, Canada. Biopsies were taken from subjects with Crohn's disease, ulcerative colitis, and HC, and also individuals having undergone ileal pouch-anal anastomosis for treatment of ulcerative colitis or familial adenomatous polyposis. Microbial 16S rRNA was sequenced using the Illumina MiSeq platform. We observed a great deal of variability in the microbiome characterizing different sampling locations. Samples from pouch and afferent limb were comparable in microbial composition. When comparing sigmoid and terminal ileum samples, more differences were observed. The greatest number of differentially abundant microbes was observed when comparing either pouch or afferent limb samples to sigmoid or terminal ileum. Despite these differences, we were able to observe modest microbial variability between inflammatory bowel disease phenotypes and HCs, even when controlling for sampling location and additional experimental factors. Most detected associations were observed between HCs and Crohn's disease, with decreases in specific genera in the families Ruminococcaceae and Lachnospiraceae characterizing tissue samples from individuals with Crohn's disease. This study highlights important considerations when analyzing the composition of the microbiome and also provides useful insight into differences in the microbiome characterizing these seemingly related phenotypes. PMID:26954709

  20. What's hot in inflammatory bowel disease in 2011?

    Institute of Scientific and Technical Information of China (English)

    Silvio Danese

    2011-01-01

    Ulcerative colitis and Crohn's disease (CD) are the two major forms of inflammatory bowel disease (IBD). In this highlight topic series of articles, the most recent advances in the IBD field are reviewed, especially the newly described cytokines, including the therapeutic implications for their manipulation. In addition, the interplay between the intestinal microbiota and the host is reviewed, including the role of defensins and dysbiosis in CD pathogenesis. Finally, the importance of the non immune systems such as endothelial cells and the hemostatic system are highlighted as new players in IBD pathogenesis.

  1. Extraintestinal manifestations of inflammatory bowel disease: epidemiology, diagnosis, and management

    DEFF Research Database (Denmark)

    Larsen, Signe; Bendtzen, Klaus; Nielsen, Ole Haagen

    2010-01-01

    Abstract Extraintestinal manifestations occur rather frequently in inflammatory bowel disease (IBD), e.g. ulcerative colitis (UC) and Crohn's disease (CD). The present paper provides an overview of the epidemiology, clinical characteristics, diagnostic process, and management of rheumatic......, metabolic, dermatologic (mucocutaneous), ophthalmologic, hepatobiliary, hematologic, thromboembolic, urinary tract, pulmonary, and pancreatic extraintestinal manifestations related to IBD. Articles were identified through search of the PubMed and Embase databases, the Cochrane Library, and the web sites...... and randomized clinical trials, if any, within the field and makes an attempt to point out practical guidelines for the diagnosis and treatment of various extraintestinal manifestations related to IBD....

  2. Intestinal microbiota in inflammatory bowel disease: Friend of foe?

    Institute of Scientific and Technical Information of China (English)

    Francesca Fava; Silvio Danese

    2011-01-01

    Inflammatory bowel disease (IBD) arises from disruption of immune tolerance to the gut commensal microbiota,leading to chronic intestinal inflammation and mucosal damage in genetically predisposed hosts. In healthy individuals the intestinal microbiota have a symbiotic relationship with the host organism and possess important and unique functions, including a metabolic function (i.e.digestion of dietary compounds and xenobiotics, fermentation of undigestible carbohydrates with production of short chain fatty acids), a mucosal barrier function (i.e. by inhibiting pathogen invasion and strengthening epithelial barrier integrity), and an immune modulatory function (i.e. mucosal immune system priming and maintenance of intestinal epithelium homeostasis). A fine balance regulates the mechanism that allows coexistence of mammals with their commensal bacteria.In IBD this mechanism of immune tolerance is impaired because of several potential causative factors. The gut microbiota composition and activity of IBD patients are abnormal, with a decreased prevalence of dominant members of the human commensal microbiota (i.e.Clostridium Ⅸa and Ⅳ groups, Bacteroides , bifidobacteria)and a concomitant increase in detrimental bacteria (i.e. sulphate-reducing bacteria, Escherichia coli ).The observed dysbiosis is concomitant with defective innate immunity and bacterial killing (i.e. reduced mucosal defensins and IgA, malfunctioning phagocytosis)and overaggressive adaptive immune response (due to ineffective regulatory T cells and antigen presenting cells), which are considered the basis of IBD pathogenesis.However, we still do not know how the interplay between these parameters causes the disease. Studies looking at gut microbial composition, epithelial integrity and mucosal immune markers in genotyped IBD populations are therefore warranted to shed light on this obscure pathogenesis.

  3. Intestinal Behçet's Disease: A True Inflammatory Bowel Disease or Merely an Intestinal Complication of Systemic Vasculitis?

    Science.gov (United States)

    Kim, Duk Hwan; Cheon, Jae Hee

    2016-01-01

    Behçet's disease (BD) is a multi-systemic inflammatory disorder of an unknown etiology and shows a chronic recurrent clinical course. When the disease involves the alimentary tract, it is called intestinal BD because of its clinical importance. Intestinal BD is more frequently reported in East Asian countries than in Western or Middle Eastern countries. While any part of the gastrointestinal tract can be involved, the most common location of intestinal BD is the ileocecal area. A few, large, deep ulcerations with discrete border are characteristic endoscopic findings of intestinal BD. Currently, there is no single gold standard test or pathognomonic finding of intestinal BD. However, recently developed novel diagnostic criteria and a disease activity index have helped in assessing intestinal BD. As intestinal BD shares a lot of characteristics with inflammatory bowel disease, including genetic background, clinical manifestations, and therapeutic strategies, distinguishing between the two diseases in clinical practice is quite difficult. However, biologic agents such as anti-tumor necrosis factor α antibody shows a considerable efficacy similar to inflammatory bowel disease cases. It is important to distinguish and treat those two disease entities separately from the standpoint of precise medicine. Clinicians should require comprehensive knowledge regarding the similarities and differences between intestinal BD and inflammatory bowel disease for making an accurate clinical decision.

  4. Breastfeeding and genetic factors in the etiology of inflammatory bowel disease in children

    Institute of Scientific and Technical Information of China (English)

    Theresa A Mikhailov; Sylvia E Furner

    2009-01-01

    Inflammatory bowel disease is a chronic, debilitating disorder of the gastrointestinal tract. The etiology of inflammatory bowel disease has not been elucidated, but is thought to be multifactorial with both environmental and genetic influences. A large body of research has been conducted to elucidate the etiology of inflammatory bowel disease. This article reviews this literature, emphasizing the studies of breastfeeding and the studies of genetic factors, particularly NOD2 polymorphisms.

  5. Inflammatory bowel disease in children, an evolving problem in Kuwait

    Directory of Open Access Journals (Sweden)

    Wafa′a A Al-Qabandi

    2011-01-01

    Full Text Available Background/Aims: Inflammatory bowel disease (IBD was previously thought a rare disease among children in Kuwait since most diarrhea cases were attributed to infections. In the past few years we observed an increase in the number of patients presenting with IBD. In this study we aimed to determine the epidemiology of IBD among children in the State of Kuwait. Patients and Methods: The charts of all children with IBD who were referred to the pediatric gastroenterology unit during the period February 1998 to January 2008 were retrospectively reviewed. Results: Out of a total of 130 children with IBD, 92 (71% had Crohn′s disease, 36 (28% had ulcerative colitis and two (1% had indeterminate colitis. The estimated annual incidence for IBD was 2.16/10 5 /year. The age range was nine months-15 years (median: 11 years. Fifty-three percent of all patients were females and 77% were Kuwaiti nationals. Positive family history was found in 23%. The commonest presenting symptoms were abdominal pain (87% and diarrhea (82%. Failure to thrive was detected in 35% and short stature in 20% at presentation. The ileocolonic region was the most common presentation site affected in Crohn′s patients and pancolitis was the commonest in ulcerative colitis. Conclusion: Inflammatory bowel disease is not uncommon in our children. We found no differences regarding disease presentation and clinical features compared to the Western world.

  6. State-of-the-art of irritable bowel syndrome and inflammatory bowel disease research in 2008

    Institute of Scientific and Technical Information of China (English)

    Lynne V McFarland

    2008-01-01

    Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are two of the leading causes of chronic intestinal conditions in the world.This issue of World Journal of Gastroenterology (WJG) presents a series of papers from world experts who discuss the current knowledge and opinions on these important conditions.Although great strides have been made in the diagnosis,treatment and pathology of IBS and IBD;much has yet to be explained.The etiologies and risk factors of these multifactorial conditions remain elusive.Specific diagnostic biomarkers need to be developed and safer treatments developed.The burden of IBS and IBD on the healthcare system is felt with repeated medical care visits and high costs.IBS and IBD patients can account for 30%-50% of office visits at gastroenterology services/clinics.Over one million people have IBD in the United States,with 30000 new cases being diagnosed every year.One-quarter million people in the UK are afflicted with IBD.The cost of medical care in the United States for IBD is estimated to be $1.8 billion/year.

  7. Epithelial restitution and wound healing in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Andreas Sturm; Axel U Dignass

    2008-01-01

    Inflammatory bowel disease is characterized by a chronic inflammation of the intestinal mucosa. The mucosal epithelium of the alimentary tract constitutes a key element of the mucosal barrier to a broad spectrum of deleterious substances present within the intestinal lumen including bacterial microorganisms, various dietary factors, gastrointestinal secretory products and drugs. In addition, this mucosal barrier can be disturbed in the course of various intestinal disorders including inflammatory bowel diseases. Fortunately, the integrity of the gastrointestinal surface epithelium is rapidly reestablished even after extensive destruction. Rapid resealing of the epithelial barrier following injuries is accomplished by a process termed epithelial restitution, followed by more delayed mechanisms of epithelial wound healing including increased epithelial cell proliferation and epithelial cell differentiation. Restitution of the intestinal surface epithelium is modulated by a range of highly divergent factors among them a broad spectrum of structurally distinct regulatory peptides, variously described as growth factors or cytokines. Several regulatory peptide factors act from the basolateral site of the epithelial surface and enhance epithelial cell restitution through TGF-β-dependent pathways. In contrast, members of the trefoil factor family (TFF peptides) appear to stimulate epithelial restitution in conjunction with mucin glycoproteins through a TGF-β-independent mechanism from the apical site of the intestinal epithelium. In addition,a number of other peptide molecules like extracellular matrix factors and blood clotting factors and also nonpeptide molecules including phospholipids, short-chain fatty acids (SCFA), adenine nucleotides, trace elements and pharmacological agents modulate intestinal epithelial repair mechanisms. Repeated damage and injury of the intestinal surface are key features of various intestinal disorders including inflammatory bowel diseases

  8. Serologic and laboratory markers in prediction of the disease course in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Marla; Cindy; Dubinsky

    2010-01-01

    The search for biologic markers that can assess the natural history and perhaps predict the course of individual's disease including response to treatments over time has become an important focus of inflammatory bowel disease research.The knowledge of an individual's prognosis can help physicians and patients make important management decisions and aid communication on risk and benefits of disease and treatment.

  9. Colorectal cancer and dysplasia in inflammatory bowel disease.

    Science.gov (United States)

    Zisman, Timothy L; Rubin, David T

    2008-05-01

    Both ulcerative colitis and Crohn's disease carry an increased risk of developing colorectal cancer. Established risk factors for cancer among patients with inflammatory bowel disease (IBD) include the younger age at diagnosis, greater extent and duration of disease, increased severity of inflammation, family history of colorectal cancer and coexisting primary sclerosing cholangitis. Recent evidence suggests that current medical therapies and surgical techniques for inflammatory bowel disease may be reducing the incidence of this complication. Nonetheless heightened vigilance and a careful, comprehensive approach to prevent or minimize the complications of invasive cancer are warranted in this unique cohort of patients. Current guidelines for the prevention and early detection of cancer in this high risk population are grounded in the concept of an inflammation-dysplasia-carcinoma sequence. A thorough understanding of the definition and natural history of dysplasia in IBD, as well as the challenges associated with detection and interpretation of dysplasia are fundamental to developing an effective strategy for surveillance and prevention, and understanding the limitations of the current approach to prevention. This article reviews the current consensus guidelines for screening and surveillance of cancer in IBD, as well as presenting the evidence and rationale for chemoprevention of cancer and a discussion of emerging technologies for the detection of dysplasia. PMID:18461651

  10. Use of thiopurines in inflammatory bowel disease: Safety issues

    Institute of Scientific and Technical Information of China (English)

    Anastasia; Konidari; Wael; El; Matary

    2014-01-01

    Thiopurines are widely used for maintenance treatment of inflammatory bowel disease. Interindividual variability in clinical response to thiopurines may be attributed to several factors including genetic polymorphisms, severity and chronicity of disease, comorbidities, duration of administration, compliance issues and use of concomitant medication, environmental factors and clinician and patient preferences. The purpose of this review is to summarise the current evidence on thiopurine safety and toxicity, to describe adverse drug events and emphasise the significance of drug interactions, and to discuss the relative safety of thiopurine use in adults, elderly patients, children and pregnant women. Thiopurines are safe to use and well tolerated, however dose adjustment or discontinuation of treatment must be considered in cases of non-response, poor compliance or toxicity. Drug safety, clinical response to treatment and short to long term risks and benefits must be balanced throughout treatment duration for different categories of patients. Treatment should be individualised and stratified according to patient requirements. Enzymatic testing prior to treatment commencement is advised. Surveillance with regular clinic follow-up and monitoring of laboratory markers is important. Data on long term efficacy, safety of thiopurine use and interaction with other disease modifying drugs are lacking, especially in paediatric inflammatory bowel disease. High quality, collaborative clinical research is required so as to inform clinical practice in the future.

  11. Inflammatory bowel disease and anxiety: links, risks, and challenges faced

    Directory of Open Access Journals (Sweden)

    Bannaga AS

    2015-03-01

    Full Text Available Ayman S Bannaga,1 Christian P Selinger2 1Department of Gastroenterology, Doncaster Royal Infirmary, Doncaster, UK; 2Department of Gastroenterology, St James University Hospital, Leeds, UK Abstract: Inflammatory bowel disease (IBD causes severe physical symptoms and is also associated with psychological comorbidities. Abnormal anxiety levels are found in up to 40% of patients with IBD. Anxiety symptoms are often related to flares of IBD but may persist in times of remission. Detection of anxiety disorder (AD in patients with IBD can be challenging. Patients with anxiety may also exhibit symptoms in keeping with functional gastrointestinal disorders (FGID. Evidence for the effectiveness of pharmacological and psychological therapies for anxiety stems from patients without IBD. Studies in patients with IBD have either been small or shown negative results. In light of this, a combined approach involving IBD physicians to improve disease control and psychologists or psychiatrists to treat anxiety is advised. This review examines the evidence of anxiety issues in IBD with a focus on extent of the problem, risk factors for anxiety, and the effectiveness of interventions. Keywords: inflammatory bowel disease, Crohn's disease, ulcerative colitis, anxiety

  12. Colorectal cancer and dysplasia in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Timothy L Zisman; David T Rubin

    2008-01-01

    Both ulcerative colitis and Crohn's disease carry an increased risk of developing colorectal cancer.Established risk factors for cancer among patients with inflammatory bowel disease (IBD) include the younger age at diagnosis,greater extent and duration of disease,increased severity of inflammation,family history of colorectal cancer and coexisting primary sclerosing cholangitis.Recent evidence suggests that current medical therapies and surgical techniques for inflammatory bowel disease may be reducing the incidence of this complication.Nonetheless heightened vigilance and a careful,comprehensive approach to prevent or minimize the complications of invasive cancer are warranted in this unique cohort of patients.Current guidelines for the prevention and early detection of cancer in this high risk population are grounded in the concept of an inflammation-dysplasia-carcinoma sequence.A thorough understanding of the definition and natural history of dysplasia in IBD,as well as the challenges associated with detection and interpretation of dysplasia are fundamental to developing an effective strategy for surveillance and prevention,and understanding the limitations of the current approach to prevention.This article reviews the current consensus guidelines for screening and surveillance of cancer in IBD,as well as presenting the evidence and rationale for chemoprevention of cancer and a discussion of emerging technologies for the detection of dysplasia.

  13. RNA interference-based nanosystems for inflammatory bowel disease therapy

    Directory of Open Access Journals (Sweden)

    Guo J

    2016-10-01

    Full Text Available Jian Guo,1 Xiaojing Jiang,1 Shuangying Gui1,2 1Department of Pharmaceutics, College of Pharmacy, Anhui University of Chinese Medicine, 2Institute of Pharmaceutics, Anhui Academy of Chinese Medicine, Hefei, Anhui, People’s Republic of China Abstract: Inflammatory bowel disease (IBD, which includes ulcerative colitis and Crohn’s disease, is a chronic, recrudescent disease that invades the gastrointestinal tract, and it requires surgery or lifelong medicinal therapy. The conventional medicinal therapies for IBD, such as anti-inflammatories, glucocorticoids, and immunosuppressants, are limited because of their systemic adverse effects and toxicity during long-term treatment. RNA interference (RNAi precisely regulates susceptibility genes to decrease the expression of proinflammatory cytokines related to IBD, which effectively alleviates IBD progression and promotes intestinal mucosa recovery. RNAi molecules generally include short interfering RNA (siRNA and microRNA (miRNA. However, naked RNA tends to degrade in vivo as a consequence of endogenous ribonucleases and pH variations. Furthermore, RNAi treatment may cause unintended off-target effects and immunostimulation. Therefore, nanovectors of siRNA and miRNA were introduced to circumvent these obstacles. Herein, we introduce non-viral nanosystems of RNAi molecules and discuss these systems in detail. Additionally, the delivery barriers and challenges associated with RNAi molecules will be discussed from the perspectives of developing efficient delivery systems and potential clinical use. Keywords: RNA interference, siRNA, miRNA, nanoparticles, inflammatory bowel disease, target therapy

  14. Protein tyrosine phosphatase non-receptor type 2 and inflammatory bowel disease

    OpenAIRE

    Spalinger, Marianne R.; MCCOLE, DECLAN F.; Rogler, Gerhard; Scharl, Michael

    2016-01-01

    Genome wide association studies have associated single nucleotide polymorphisms within the gene locus encoding protein tyrosine phosphatase non-receptor type 2 (PTPN2) with the onset of inflammatory bowel disease (IBD) and other inflammatory disorders. Expression of PTPN2 is enhanced in actively inflamed intestinal tissue featuring a marked up-regulation in intestinal epithelial cells. PTPN2 deficient mice suffer from severe intestinal and systemic inflammation and display aberrant innate and...

  15. Controlled trial of bowel rest and nutritional support in the management of Crohn's disease.

    OpenAIRE

    Greenberg, G R; Fleming, C R; Jeejeebhoy, K N; Rosenberg, I H; Sales, D; Tremaine, W J

    1988-01-01

    To define the role of bowel rest as an independent variable from nutritional support a prospective, randomised controlled trial was undertaken in 51 patients with active Crohn's disease unresponsive to other medical management. Nutritional support for 21 days was randomised to total parenteral nutrition and nil by mouth (n = 17), defined formula diet administered through a nasogastric tube (n = 19), or partial parenteral nutrition and oral food (n = 15). Nutrient input in the first two groups...

  16. Job Strain and the Risk of Inflammatory Bowel Diseases

    DEFF Research Database (Denmark)

    Heikkilä, Katriina; Madsen, Ida E H; Nyberg, Solja T;

    2014-01-01

    -Work Consortium. Work-related psychosocial stress was operationalised as job strain (a combination of high demands and low control at work) and was self-reported at baseline. Crohn's disease and ulcerative colitis were ascertained from national hospitalisation and drug reimbursement registers. The associations......BACKGROUND AND AIMS: Many clinicians, patients and patient advocacy groups believe stress to have a causal role in inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis. However, this is not corroborated by clear epidemiological research evidence. We investigated...... the association between work-related stress and incident Crohn's disease and ulcerative colitis using individual-level data from 95,000 European adults. METHODS: We conducted individual-participant data meta-analyses in a set of pooled data from 11 prospective European studies. All studies are a part of the IPD...

  17. Endoscopic Diagnosis and Differentiation of Inflammatory Bowel Disease

    Science.gov (United States)

    Lee, Ji Min; Lee, Kang-Moon

    2016-01-01

    Patients with inflammatory bowel disease have significantly increased in recent decades in Korea. Intestinal tuberculosis (ITB) and intestinal Behcet’s disease (BD), which should be differentiated from Crohn’s disease (CD), are more frequent in Korea than in the West. Thus, the accurate diagnosis of these inflammatory diseases is problematic in Korea and clinicians should fully understand their clinical and endoscopic characteristics. Ulcerative colitis mostly presents with rectal inflammation and continuous lesions, while CD presents with discontinuous inflammatory lesions and frequently involves the ileocecal area. Involvement of fewer than four segments, a patulous ileocecal valve, transverse ulcers, and scars or pseudopolyps are more frequently seen in ITB than in CD. A few ulcers with discrete margins are a typical endoscopic finding of intestinal BD. However, the differential diagnosis is difficult in many clinical situations because typical endoscopic findings are not always observed. Therefore, clinicians should also consider symptoms and laboratory, pathological, and radiological findings, in addition to endoscopic findings. PMID:27484813

  18. The burden of inflammatory bowel disease in Europe

    DEFF Research Database (Denmark)

    Burisch, Johan; Jess, Tine; Martinato, Matteo;

    2013-01-01

    Inflammatory bowel diseases (IBD) are chronic disabling gastrointestinal disorders impacting every aspect of the affected individual's life and account for substantial costs to the health care system and society. New epidemiological data suggest that the incidence and prevalence of the diseases...... are increasing and medical therapy and disease management have changed significantly in the last decade. An estimated 2.5-3million people in Europe are affected by IBD, with a direct healthcare cost of 4.6-5.6bn Euros/year. Therefore, the aim of this review is to describe the burden of IBD in Europe...... by discussing the latest epidemiological data, the disease course and risk for surgery and hospitalization, mortality and cancer risks, as well as the economic aspects, patients' disability and work impairment....

  19. Clinical outcomes at 12 months and risk of inflammatory bowel disease in patients with an intermediate raised fecal calprotectin: a ‘real-world’ view

    OpenAIRE

    McFarlane, Michael; Chambers, Samantha; Malik, Ahmad; Lee, Bee; Sung, Edmond; Nwokolo, Chuka; Waugh, Norman; Arasaradnam, Ramesh

    2016-01-01

    Objectives A recent systematic review confirmed the usefulness of fecal calprotectin (FC) in distinguishing organic (inflammatory bowel disease (IBD)) from non-organic gastrointestinal disease (irritable bowel syndrome (IBS)). FC levels 92% to exclude organic gastrointestinal (GI) disease. Levels >250 μg/g correlate with endoscopic IBD disease activity; sensitivity 90%. We aimed to determine clinical outcomes in intermediate raised FC results (50–250 μg/g). Setting Primary care general practi...

  20. Prevalence of Irritable Bowel Syndrome–like Symptoms in Japanese Patients with Inactive Inflammatory Bowel Disease

    Science.gov (United States)

    Tomita, Toshihiko; Kato, Yu; Takimoto, Mayu; Yamasaki, Takahisa; Kondo, Takashi; Kono, Tomoaki; Tozawa, Katsuyuki; Yokoyama, Yoko; Ikehara, Hisatomo; Ohda, Yoshio; Oshima, Tadayuki; Fukui, Hirokazu; Tanaka, Shigemi; Shima, Masayuki; Watari, Jiro; Miwa, Hiroto

    2016-01-01

    Background/Aims Few studies are available that have investigated the risk factors for overlapping irritable bowel syndrome (IBS)-like symptoms in patients with inactive inflammatory bowel disease (IBD). The present study has 3 objectives: (1) to assess the prevalence of IBS-like symptoms in Japanese patients with inactive IBD using Rome III criteria, (2) to examine the relationship of IBS-like symptoms to health related quality of life (HR-QOL), and (3) to investigate associations for developing IBS-like symptoms in patients with inactive IBD. Methods IBS-like symptoms were evaluated using the Rome III questionnaire for functional gastrointestinal disorders. HR-QOL and hospital anxiety and depression scale were evaluated. Results IBS-like symptoms were found in 17.5% (7/40) of patients with inactive ulcerative colitis, 27.1% (29/107) of patients with inactive Crohn’s disease (CD), and 5.3% (23/438) of healthy control subjects. The QOL level was significantly lower and anxiety score was significantly higher in inactive CD patients with IBS-like symptoms than in those without such symptoms (P = 0.003, P = 0.009). Use of anti-anxiety drugs was associated with the presence of IBS symptoms (P = 0.045). HR-QOL score was lower and anxiety score was higher in patients with inactive ulcerative colitis, but the difference was not statistically significant. Conclusions The prevalence of IBS-like symptoms in inactive IBD patients was significantly higher than in healthy controls. Inactive CD patients with IBS-like symptoms has low QOL and anxiety; suggesting that anxiety may be associated with symptom development in such patients. PMID:27193973

  1. Prebiotics and probiotics in irritable bowel syndrome and inflammatory bowel disease in children.

    Science.gov (United States)

    Guandalini, S; Cernat, E; Moscoso, D

    2015-01-01

    Underlying pathophysiological mechanisms of irritable bowel syndrome (IBS), a common disorder characterized by abdominal pain associated to a change in stool consistency or frequency, include low-grade inflammation and intestinal microbiota changes. Few and disappointing data are available for prebiotics. A few controlled trials (RCTs) of probiotics are instead available with favourable effects, although most are limited by suboptimal design and small sample size. A recent report from the Rome foundation group included 32 RCTs of probiotics, most of which showed an overall modest improvement in symptoms, with the patients most benefitting from probiotics being those with predominant diarrhoea and those having a post-infectious IBS. A review focusing only on children with functional gastrointestinal disorders concluded that probiotics are more effective than placebo in the treatment of patients with abdominal pain-related functional gastrointestinal disorders, although no effect on constipation was evident. The role for probiotics in inflammatory bowel disease (IBD) appears logical: the endogenous intestinal microbiota plays a central role in their development, and various probiotics have been found effective in animal models of IBD. However, research in humans has been overall quite limited, and it would seem that after a phase of intense research in the first decade of this century, the pace has slowed down, with fewer clinical trials been published in the past 2-3 years. To summarize current evidence: no probiotic has proven successful in Crohn's disease. In ulcerative colitis, on the other hand, data are more promising, and a very recent meta-analysis, that included 23 randomized controlled trials, concluded that there is evidence of efficacy for the probiotic mixture VSL#3 in helping inducing and maintaining remission, as well as in maintaining remission in patients with pouchitis. It is fair to state that for both IBD and IBS, more well-designed, rigorous

  2. Endoscopic Delivery of Fecal Biotherapy in Inflammatory Bowel Disease.

    Science.gov (United States)

    Kerman, David H

    2016-10-01

    The intestinal microbiome plays an important role in the pathogenesis of inflammatory bowel disease (IBD). We are able to use the microbiome as a therapeutic target with use of fecal microbiota transplantation (FMT) for cure of recurrent Clostridium difficile infection. Given our ability to target the dysbiotic state with FMT, its use as therapy in IBD has tremendous potential. This overview discusses the practical considerations of FMT therapy with respect to our current understanding of safety and efficacy in IBD, screening for donors and recipients, specimen handling and storage, methods of delivery, and regulatory considerations. PMID:27633598

  3. Fluoride: a risk factor for inflammatory bowel disease?

    Science.gov (United States)

    Follin-Arbelet, Benoit; Moum, Bjørn

    2016-09-01

    Although the association between inflammatory bowel disease (IBD) and oral hygiene has been noticed before, there has been little research on prolonged fluoride exposure as a possible risk factor. In the presented cases, exposure to fluoride seems indirectly associated with higher incidence of IBD. Fluoride toxicology and epidemiology documents frequent unspecific chronic gastrointestinal symptoms and intestinal inflammation. Efflux genes that confer resistance to environmental fluoride may select for IBD associated gut microbiota and therefore be involved in the pathogenesis. Together these multidisciplinary results argue for further investigation on the hypothesis of fluoride as a risk factor for IBD. PMID:27199224

  4. The Vitamin D Status in Inflammatory Bowel Disease

    OpenAIRE

    Veit, Lauren Elizabeth; Maranda, Louise; Fong, Jay; Nwosu, Benjamin Udoka

    2014-01-01

    Context There is no consensus on the vitamin D status of children and adolescents with inflammatory bowel disease (IBD). Aim To determine the vitamin D status of patients with IBD by comparing their serum 25(OH)D concentration to that of healthy controls. Hypothesis Serum 25(OH)D concentration will be lower in patients with IBD compared to controls. Subjects and Methods A case-controlled retrospective study of subjects with IBD (n = 58) of 2–20 years (male n = 31, age 16.38±2.21 years; female...

  5. Biosimilars in the therapy of inflammatory bowel diseases.

    Science.gov (United States)

    Hlavaty, Tibor; Letkovsky, Juraj

    2014-06-01

    A biosimilar is a copy of an approved biological medicine whose patent protections have expired. Biosimilars of antibodies to tumour necrosis factor α (TNFα) are becoming important in the treatment of inflammatory bowel diseases (IBD). The first one introduced commercially is an infliximab biosimilar. The aim of this study was to provide an overview of anti-TNFα biosimilars. The literature on biosimilars of monoclonal anti-TNFα antibodies was reviewed, including their manufacture and approval pathways, concerns about efficacy, safety, immunogenicity, extrapolation, switching and labelling. Previous experience with biosimilars of epoetin and other growth factors was also reviewed. The infliximab biosimilar CT-P13 was the first biosimilar monoclonal antibody registered for the treatment of IBD. The major advantage of biosimilars is the reduced cost of therapy. Concerns have arisen, however, about the efficacy and safety of CT-P13 in IBD, the extrapolation of results from rheumatologic trials to IBD and the free interchangeability of CT-P13 with infliximab. Experience with simple peptide biosimilars, such as epoetins and growth factors, has generally been positive, with these biosimilars having similar efficacy and safety as the original products, although immunogenicity remains a major concern. Upcoming postregistration studies will address concerns on biosimilars in IBD, including their efficacy, safety, immunogenicity, switching and interchangeability. Biosimilars active against the same epitopes, but with improved pharmacokinetic properties that enhance their efficacy and/or safety, may be the next stage in the development of biosimilars. Anti-TNFα biosimilars represent promising new treatment options for patients with IBD. However, data on their efficacy and safety in IBD are needed. PMID:24722561

  6. DYSMICROBISM, INFLAMMATORY BOWEL DISEASE AND THYROIDITIS: ANALYSIS OF THE LITERATURE.

    Science.gov (United States)

    Tomasello, G; Tralongo, P; Amoroso, F; Damiani, P; Sinagra, E; Noto, M; Arculeo, V M; Jurjus Zein, R; Saad, W; Jurjus, A; Gerbino, A; Leone, A

    2015-01-01

    The human body is colonized by a large number of microbes that are collectively referred to as the microbiota. They interact with the hosting organism and some do contribute to the physiological maintenance of the general good health thru regulation of some metabolic processes while some others are essential for the synthesis of vitamins and short-chain fatty acids. The abnormal variation, in the quality and/or quantity of individual bacterial species residing in the gastro-intestinal tract, is called “dysmicrobism”. The immune system of the host will respond to these changes at the intestinal mucosa level which could lead to Inflammatory Bowel Diseases (IBD). This inflammatory immune response could subsequently extend to other organs and systems outside the digestive tract such as the thyroid, culminating in thyroiditis. The goal of the present study is to review and analyze data reported in the literature about thyroiditis associated with inflammatory bowel diseases such as Ulcerative Colitis (UC) and Crohn’s Disease (CD). It was reported that similarities of some molecular bacterial components with molecular components of the host are considered among the factors causing IBD through an autoimmune reaction which could involve other non-immune cell types. The axis dysmicrobism-IBD-autoimmune reaction will be investigated as a possible etiopathogenic mechanism to Autoimmune Thyroiditis. If such is the case, then the employment of specific probiotic strains may represent a useful approach to moderate the immune system. PMID:26122213

  7. Value-based health care for inflammatory bowel diseases.

    Science.gov (United States)

    van Deen, Welmoed K; Esrailian, Eric; Hommes, Daniel W

    2015-05-01

    Increasing healthcare costs worldwide put the current healthcare systems under pressure. Although many efforts have aimed to contain costs in medicine, only a few have achieved substantial changes. Inflammatory bowel diseases rank among the most costly of chronic diseases, and physicians nowadays are increasingly engaged in health economics discussions. Value-based health care [VBHC] has gained a lot of attention recently, and is thought to be the way forward to contain costs while maintaining quality. The key concept behind VBHC is to improve achieved outcomes per encountered costs, and evaluate performance accordingly. Four main components need to be in place for the system to be effective: [1] accurate measurement of health outcomes and costs; [2] reporting of these outcomes and benchmarking against other providers; [3] identification of areas in need of improvement based on these data and adjusting the care delivery processes accordingly; and [4] rewarding high-performing participants. In this article we will explore the key components of VBHC, we will review available evidence focussing on inflammatory bowel diseases, and we will present our own experience as a guide for other providers.

  8. Thromboembolism in inflammatory bowel diseases: a report from Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Hussain Issa

    2011-01-01

    Full Text Available Hussain Issa1, Sami Al-Momen1, Bahaa Bseiso1, Ghada Ali Al-Janobi1, Mohamad Al-Jama1, Fadel Ali Almousa1, Mahdi E Al-Jarodi1, Ahmed H Al-Salem21Department of Internal Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia; 2Department of Pediatric Surgery, Maternity and Children Hospital, Dammam, Saudi ArabiaAbstract: Thromboembolism (TE is a serious but under-recognized complication of inflammatory bowel disease (IBD. This is specially so in developing countries where the incidence of IBD is low. In Saudi Arabia, IBD is considered to be rare, but the incidence is increasing. Where the clinical manifestations resemble those of developed countries, TE as a complication of IBD is considered to be very rare. This report describes six IBD patients with TE. This importance of the complication of TE is stressed, and physicians caring for these patients should be aware of it in order to obviate potential morbidity and mortality.Keywords: thromboembolism, inflammatory bowel disease, Crohn's disease, ulcerative colitis

  9. Is inflammatory bowel disease in dogs and cats associated with a Th1 or Th2 polarization?

    Science.gov (United States)

    Heilmann, Romy M; Suchodolski, Jan S

    2015-12-15

    Mucosal immunity involves complex interactions to generate either immune tolerance or active immune responses. An imbalance of pro- and anti-inflammatory cytokines and chemokines that drive the recruitment of immune cells to the intestinal mucosa are a key characteristic of inflammatory bowel disease in humans, where distinctive helper-T-lymphocyte profiles help to discriminate between Crohn's disease and ulcerative colitis. This review evaluates the current veterinary literature to determine whether a Th1/Th2 (and possibly also Th17) polarization also exists in canine and feline inflammatory bowel disease.

  10. High-sensitivity C-reactive protein in paediatric inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Marianne; Sidoroff; Riitta; Karikoski; Taneli; Raivio; Erkki; Savilahti; Kaija-Leena; Kolho

    2010-01-01

    AIM:To study whether high-sensitivity C-reactive protein(hs-CRP) measurement can aid the assessment of disease activity and glucocorticoid treatment in paediatric inflammatory bowel disease(IBD).METHODS:CRP levels were measured in 39 children with IBD undergoing colonoscopy [median age 12.8 years,Crohn's disease(CD) n=20],in 22 other children with IBD followed for acute response to glucocorticoids,and in 33 paediatric non-IBD patients.When standard CRP level was below detection limit(<5mg/L),hs-CRP was anal...

  11. Current advantages in the application of proteomics in inflammatory bowel disease.

    Science.gov (United States)

    Vaiopoulou, Anna; Gazouli, Maria; Theodoropoulos, George; Zografos, George

    2012-11-01

    Since the formulation of the concept of proteomics, a plethora of proteomic technologies have been developed in order to study proteomes. In inflammatory bowel disease (IBD), several studies use proteomics to try to better understand the disease and discover molecules which can be used as biomarkers. Biomarkers should be able to be used for diagnosis, therapy and prognosis. Although several biomarkers have been discovered, few biomarkers have clinical value. In this review, we analyze and report the current use of proteomic techniques to highlight biomarkers characterizing IBD, and different stages of disease activity. We also report the biomarkers and their potential clinical value.

  12. ORAL MUCOSA LESIONS AND ORAL SYMPTOMS IN INFLAMMATORY BOWEL DISEASE PATIENTS

    Directory of Open Access Journals (Sweden)

    Nuno LARANJEIRA

    2015-06-01

    Full Text Available Background Inflammatory Bowel Disease is known for its extra intestinal manifestations, the oral cavity is no exception. Objectives The aim of this study was to evaluate the association between Inflammatory Bowel Disease and oral mucosa lesions and symptoms, and complementary to evaluate their possible relation with oral hygiene, smoking habits, drug therapy, duration and activity of the disease. Methods Patients were selected from the Gastroenterology Clinic of a Portuguese tertiary referral hospital. This sample consisted of 113 patients previously diagnosed with ulcerative colitis or Crohn’s disease along with a control group of 58 healthy individuals that were accompanying the study group patients to their appointments. Clinical interviews and clinical examinations were performed for data collection. Results The patients in the study group were more affected by oral symptoms (P=0.011, and showed a trend towards a higher incidence of oral mucosal lesions, even though statistical significance was not reached (8.8% versus 3.4% in the control group; P=0.159. Patients in active phase were the most affected. No differences were detected between Crohn’s disease and ulcerative colitis, or concerning smoking habits. The corticosteroid and immunosuppressant therapy seemed to increase the incidence of oral symptoms (P=0.052. The oral mucosa lesions increased and the oral symptoms decreased over the course of the disease, however without statistical significance. Conclusion Oral mucosa’s lesions and oral symptoms were positively associated with Inflammatory Bowel Disease, mainly during disease activity periods and conceivably, associated with corticosteroid and immunosuppressant therapy.

  13. Fecal Calprotectin Use in Inflammatory Bowel Disease and Beyond: A Mini-Review

    Directory of Open Access Journals (Sweden)

    Bashaar Alibrahim

    2015-01-01

    Full Text Available Given the number of inflammatory disorders affecting the gastrointestinal tract directly and indirectly, coupled with the considerable overlap with functional disorders, it is evident that more useful noninvasive diagnostic tests are required to aid with diagnosis. If these tests can also have some utility for individual patient follow-up in terms of disease activity and response to treatment, as well as providing forewarning of disease relapse, it would be extremely useful information for the clinician. One recently described test that may fulfill several of these attributes is based on leakage of a mononuclear cell cytoplasmic protein, calprotectin, along the intestinal tract, which can then be quantified in feces. This has been used to distinguish patients exhibiting symptoms of irritable bowel syndrome from patients with inflammatory bowel disease, with a measure of success greater than with currently used techniques. The present article summarizes the experience with this test used in inflammatory bowel disease, as well as a variety of gastrointestinal disorders.

  14. The Short Health Scale: a valid and reliable measure of health related quality of life in English speaking inflammatory bowel disease patients.

    LENUS (Irish Health Repository)

    McDermott, Edel

    2013-09-01

    Health related quality of life in inflammatory bowel disease is influenced both by disease activity as well as by the psychosocial characteristics of the individual patient. The Short Health Scale (SHS) is a four-part visual analogue scale questionnaire using open-ended questions that are designed to assess the impact of inflammatory bowel disease on a health related quality of life. The four dimensions include bowel symptoms, activities of daily life, worry and general wellbeing. It has previously been validated in Swedish and Norwegian speaking patients.

  15. [Epithelial cell in intestinal homeostasis and inflammatory bowel diseases].

    Science.gov (United States)

    Zouiten-Mekki, Lilia; Serghini, Meriem; Fekih, Monia; Kallel, Lamia; Matri, Samira; Ben Mustapha, Nadia; Boubaker, Jalel; Filali, Azza

    2013-12-01

    Crohn's disease (CD) and ulcerative colitis (UC) are the principal inflammatory bowel diseases (IBD) which physiopathology is currently poorly elucidated. During these diseases, the participation of the epithelial cell in the installation and the perpetuation of the intestinal inflammation is now clearly implicated. In fact, the intestinal epithelium located at the interface between the internal environment and the intestinal luminal, is key to the homeostatic regulation of the intestinal barrier. This barrier can schematically be regarded as being three barriers in one: a physical, chemical and immune barrier. The barrier function of epithelial cell can be altered by various mechanisms as occurs in IBD. The goal of this article is to review the literature on the role of the epithelial cell in intestinal homeostasis and its implication in the IBD. PMID:24356146

  16. Social Media Use in Patients with Inflammatory Bowel Disease.

    Science.gov (United States)

    Guo, Ling; Reich, Jason; Groshek, Jacob; Farraye, Francis A

    2016-05-01

    Patients with chronic illnesses such as Inflammatory Bowel Disease (IBD) have been more keen to utilize the Internet and in particular, social media to obtain patient educational information in recent years. It is important for the gastroenterologist to be aware of these modalities and how they might affect information exchange and ultimately, disease management. This article addresses the current prevalence of social media use, advent of mobile health applications, social media usage in patients with chronic conditions, usage amongst providers, and most notably, the usage and preferences in IBD patients. Over the last decade there has been an increasing desire from patients to receive educational material about their disease through social media. We reviewed the medical literature on the quality of IBD-related information on social media. Given the disparity of information available on the Internet, we remark on the quality of this information and stress the need for further research to assess the validity of IBD information posted on social media.

  17. Tools for primary care management of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Bennett, Alice L; Munkholm, Pia; Andrews, Jane M

    2015-01-01

    is conducted. Inflammatory bowel disease (IBD) is one such chronic disease. Despite specialist care being essential, much IBD care could and probably should be delivered in primary care with continued collaboration between all stakeholders. Whilst most primary care physicians only have few patients currently...... affected by IBD in their caseload, the proportion of patients with IBD-related healthcare issues cared for in the primary care setting appears to be widespread. Data suggests however, that primary care physician's IBD knowledge and comfort in management is suboptimal. Current treatment guidelines for IBD...... are helpful but they are not designed for the primary care setting. Few non-expert IBD management tools or guidelines exist compared with those used for other chronic diseases such as asthma and scant data have been published regarding the usefulness of such tools including IBD action plans and associated...

  18. Improving pediatric Inflammatory Bowel Disease (IBD) follow-up.

    Science.gov (United States)

    Dykes, Dana; Williams, Elizabeth; Margolis, Peter; Ruschman, Jennifer; Bick, Julianne; Saeed, Shehzad; Opipari, Lisa

    2016-01-01

    Standardization of Inflammatory Bowel Disease (IBD) care through participation in the ImproveCareNow (ICN) Network has improved outcomes for pediatric patients with IBD, but under the current care model, our improvements have plateaued. Current ICN model care guidelines recommend health supervision visits every six months. We identified a gap in our practice's ability to ensure either a routine six month follow-up or a rapid follow-up after a disease flare, and a significant number of patients with active disease status during a six month period lacked timely reassessment after interventions or medication changes. Telemedicine provides an alternative method of care delivery to address these gaps, but has had limited use in patients with IBD. A multi-step approach to offer alternative follow-up care options via telemedicine was developed with potential impact on remission rates and quality of life. Short term goals of the pilot were to improve telemedicine access for patients with IBD were to 1) increase the percent of patients with active disease with a follow-up completed within two months of a visit from 40% to 70%, 2) increase the percent of patients with a visit scheduled within two months of their last sick visit from 20% to 70% (interim measure), 3) increase the number of eVisits from zero visits per month to two visits per month during pilot phase, 4) increase electronic communication with patients from zero messages per month to 200 messages per month, 5) no change in complications or adverse events (defined as an unplanned visit or ED (emergency department) encounter within 30 days of an eVisit. The expected outcomes of the e-visit model were to: maintain baseline care standards and health screening capabilities, improve access to care, and provide equivalent care delivery (no increase in the number of unplanned clinical encounters). Using the IHI model for improvement (Plan-Do-Study-Act) we have seen a progressive increase in the rate of patient signups

  19. Improving pediatric Inflammatory Bowel Disease (IBD) follow-up

    Science.gov (United States)

    Dykes, Dana; Williams, Elizabeth; Margolis, Peter; Ruschman, Jennifer; Bick, Julianne; Saeed, Shehzad; Opipari, Lisa

    2016-01-01

    Standardization of Inflammatory Bowel Disease (IBD) care through participation in the ImproveCareNow (ICN) Network has improved outcomes for pediatric patients with IBD, but under the current care model, our improvements have plateaued. Current ICN model care guidelines recommend health supervision visits every six months. We identified a gap in our practice's ability to ensure either a routine six month follow-up or a rapid follow-up after a disease flare, and a significant number of patients with active disease status during a six month period lacked timely reassessment after interventions or medication changes. Telemedicine provides an alternative method of care delivery to address these gaps, but has had limited use in patients with IBD. A multi-step approach to offer alternative follow-up care options via telemedicine was developed with potential impact on remission rates and quality of life. Short term goals of the pilot were to improve telemedicine access for patients with IBD were to 1) increase the percent of patients with active disease with a follow-up completed within two months of a visit from 40% to 70%, 2) increase the percent of patients with a visit scheduled within two months of their last sick visit from 20% to 70% (interim measure), 3) increase the number of eVisits from zero visits per month to two visits per month during pilot phase, 4) increase electronic communication with patients from zero messages per month to 200 messages per month, 5) no change in complications or adverse events (defined as an unplanned visit or ED (emergency department) encounter within 30 days of an eVisit. The expected outcomes of the e-visit model were to: maintain baseline care standards and health screening capabilities, improve access to care, and provide equivalent care delivery (no increase in the number of unplanned clinical encounters). Using the IHI model for improvement (Plan-Do-Study-Act) we have seen a progressive increase in the rate of patient signups

  20. Relação entre estado nutricional e atividade inflamatória em pacientes com doença inflamatória intestinal Relationship between nutritional status and inflammatory activity in patients with inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    Alice Freitas da Silva

    2010-09-01

    Full Text Available RACIONAL: As doenças inflamatórias intestinais caracterizam-se por diversos sintomas que afetam o aparelho digestório e, consequentemente, podem interferir sobre o estado nutricional. OBJETIVO: Avaliar o estado nutricional de pacientes com doença inflamatória intestinal em diferentes estágios de atividade inflamatória. MÉTODOS: Foram avaliados 55 pacientes com doença inflamatória intestinal, por meio de dados antropométricos, com aferição de peso, altura, circunferência do braço e prega cutânea do tríceps e tiveram sua composição corporal determinada por impedância bioelétrica. Para determinação de atividade inflamatória da doença foram utilizados os níveis séricos de proteína C reativa e o índice de Harvey e Bradshaw. Para comparação de médias foi usado o teste t não pareado, e para as médias não paramétricas, o teste de Mann-Whitney, considerando nível de significância valor de pBACKGROUND: The inflammatory bowel diseases are characterized by multiple digestive tract symptoms and therefore may interfere with nutritional status. AIM: To assess the nutritional status of patients with inflammatory bowel disease in different stages of inflammatory activity. METHODS: Fifty five patients with inflammatory bowel disease were demographically evaluated with weight measurement, height, arm circumference and triceps skinfold and had their body composition determined by bioelectrical impedance. For determination of inflammatory activity of the disease were used serum C-reactive protein and the index of Harvey and Bradshaw. To compare means it was used the unpaired t test, and the average non-parametric, the Mann-Whitney test, level of significance p <0.05. RESULTS: Among the patients, 28 had Crohn's disease and 27 ulcerative colitis, aged between 19 and 63 years and time since diagnosis 1-22 years. There was no difference in anthropometric measurements and body composition of patients whose disease was inflammatory

  1. Environmental risk factors for inflammatory bowel diseases: a review.

    Science.gov (United States)

    Ananthakrishnan, Ashwin N

    2015-02-01

    Inflammatory bowel diseases comprising Crohn's disease (CD) and ulcerative colitis (UC) are chronic immunologically mediated diseases. The key mechanism underlying the pathogenesis of these diseases is a dysregulated immune response to commensal flora in a genetically susceptible host. Thus intestinal microbial dysbiosis, host genetics, and the external environment all play an important role in the development of incident disease and in determining subsequent disease behavior and outcomes. There are several well-defined or putative environmental risk factors including cigarette smoking, appendectomy, diet, stress and depression, vitamin D as well as hormonal influence. The effect of some of the risk factors appears to differ between CD and UC suggesting that despite shared genetic and immunologic mechanisms, distinct pathways of pathogenesis exist. There is a growing body of literature identifying risk factors for incident disease. There is less rigorous literature defining triggers of relapse, and few controlled clinical trials examining if modification of such risk factors results in an improvement in patient outcomes. This is an area of considerable patient, physician, and scientific interest, and there is an important unmet need for rigorous studies of the external environment in disease pathogenesis and subsequent course.

  2. Impact of medical therapies on inflammatory bowel disease complication rate

    Institute of Scientific and Technical Information of China (English)

    Catherine Reenaers; Jacques Belaiche; Edouard Louis

    2012-01-01

    Crohn's disease and ulcerative colitis are progressive diseases associated with a high risk of complications over time including strictures,fistulae,perianal complications,surgery,and colorectal cancer.Changing the natural history and avoiding evolution to a disabling disease should be the main goal of treatment.In recent studies,mucosal healing has been associated with longer-term remission and fewer complications.Conventional therapies with immunosuppressive drugs are able to induce mucosal healing in a minority of cases but their impact on disease progression appears modest.Higher rates of mucosal healing can be achieved with anti-tumor necrosis factor therapies that reduce the risk of relapse,surgery and hospitalization,and are associated with perianal fistulae closure.These drugs might be able to change the natural history of the disease mainly when introduced early in the course of the disease.Treatment strategy in inflammatory bowel diseases should thus be tailored according to the risk that each patient could develop disabling disease.

  3. Prevalence of cholelithiasis in patients with chronic inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Wolfgang Kratzer; Mark M Haenle; Richard A Mason; Christian von Tirpitz; Volker Kaechele

    2005-01-01

    AIM: To investigate the effect of chronic inflammatory bowel disease (CIBD) specific risk factors for cholecystolithiasis,as duration and involvement pattern of the disease and prior surgery in patients with Crohn's disease (CD) and ulcerative colitis (UC).METHODS: A total of 222 patients with CD (135 females,87 males; average age, 35.8±11.8 years; range 17-81 years)and 88 patients with UC (39 females, 49 males; average age, 37.2±13.6 years; range 16-81 years) underwent clinical and ultrasound examinations. Besides age, sex and degree of obesity, patients' CIBD specific parameters, including duration and extent of disease and prior operations were documented and evaluated statistically using logistic regression.RESULTS: The overall prevalence of gallbladder stone disease in patients with CD was 13% (n = 30). Only age could be shown to be an independent risk factor (P = 0.014).Compared to a collective representative for the general population in the same geographic region, the prevalence of cholecystolithiasis was higher in all corresponding age groups. Patients with UC showed an overall prevalence of gallbladder stone disease of only 4.6%.CONCLUSION:Only age but not disease-specific factors such as duration and extent of disease, and prior surgery are independent risk factors for the development of cholecystolithiasis in patients with CIBD.

  4. Osteoporosis y enfermedad inflamatoria intestinal Osteoporosis and inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    L. Menchén

    2005-02-01

    Full Text Available La enfermedad inflamatoria intestinal es una entidad crónica de etiología desconocida en cuyo desarrollo influyen múltiples variables, como son la susceptibilidad individual, genética e inmunológica, así como diferentes factores ambientales. Sus manifestaciones clínicas son muy variadas y pueden afectar a otros órganos diferentes del tracto digestivo, convirtiéndose por tanto en una enfermedad multisistémica. En los últimos años existe un interés creciente por una de estas manifestaciones, la osteoporosis y la osteopenia, que puede afectar hasta al 42% de los pacientes y condiciona un importante aumento de la morbilidad. La inactividad, el tratamiento corticoideo prolongado, las deficiencias nutricionales y la propia enfermedad pueden favorecer el desarrollo de esta complicación. En esta revisión se repasan aspectos clínicos y etiológicos de la osteoporosis asociada a la enfermedad inflamatoria intestinal y se ofrecen pautas para su diagnóstico y tratamiento.Inflammatory bowel disease is a chronic disease with an unknown ethiology although multiple factors intervene such as individual, genetic and immunologic susceptibility, as well as different environmental factors. Like other multisystemic diseases, its clinical manifestations are diverse and it may affect other organs besides the gastrointestinal tract. In the last few years there is a growing interest for one of these extraintestinal manifestations, osteoporosis and osteopenia that may affect up to 42% of patients and can condition an important increase in morbility. Inactivity, prolonged corticosteroid treatment, nutritional deficiencies and the disease per se have an important role in the development of this complication. This article reviews clinical and ethiological aspects of inflammatory bowel disease associated osteoporosis and offers a strategy for diagnosis and treatment.

  5. Tc-99m labeled leukocyte scintigraphy and CT for the evaluation of patients with inflammatory bowel disease

    Energy Technology Data Exchange (ETDEWEB)

    Miyazaki, Chihoko; Kubo, Kohzoh; Aoyama, Hidefumi; Endoh, Hideho; Odashima, Yae; Saitoh, Eri [Sapporo City General Hospital (Japan)

    1997-06-01

    Seventeen cases of inflammatory bowel disease (IBD) were studied to define the intensity and extent of disease by {sup 99m}Tc-HMPAO-labeled leukocytes scintigraphy (TLLS), and 10 cases underwent CT examination to evaluate the bowel wall, lymph-nodes, and mesenteric surroundings. Serial TLLS were obtained up to 4 hours and CT was carried out within one week before or after TLLS. The sensitivities to early and delayed TLLS were 91% and 100%, respectively. The respective specificities were 100% and 33%. However, it appeared that mild IBD may yield false negative results in early TLLS while nonspecific bowel activity and migration of white cells may cause false positive results in delayed imaging. By setting the diagnostic criteria for labeled leukocyte accumulation on visualization of the small bowel regardless of uptake or activity of the large bowel similar to or greater than lumbar bone marrow, the sensitivity and specificity of delayed TLLS changed to 91% and 83%, respectively. On CT examination, mesenteric lymph-node swelling, periintestinal blurring and dilatation of mesenteric vasa recta were observed in all five patients with active Crohn`s disease, while wall thickening and enhancement were seen in four of them. None of the other three cases of inflammatory disease showed positive findings of dilatation of the mesenteric vasa recta, and they revealed relatively low uptake of labeled leukocytes in TLLS. A `scintigram score` was calculated by comparing uptake of tracer in five bowel segments with lumbar bone marrow activity, and a `CT score` was calculated by adding abnormalities of the intestine and mesenteric surroundings. The scintigram score correlated closely with CT score and clinical disease activity. (K.H.)

  6. Filiform serrated adenomatous polyposis arising in a diverted rectum of an inflammatory bowel disease patient

    DEFF Research Database (Denmark)

    Klarskov, Louise; Mogensen, Anne Mellon; Jespersen, Niels;

    2011-01-01

    Klarskov L, Mogensen AM, Jespersen N, Ingeholm P, Holck S. Filiform serrated adenomatous polyposis arising in a diverted rectum of an inflammatory bowel disease patient. APMIS 2011; 119: 393-8. A 54-year-old man, previously colectomized for inflammatory bowel disease, developed carcinoma...

  7. The vitamin D status in inflammatory bowel disease.

    Directory of Open Access Journals (Sweden)

    Lauren Elizabeth Veit

    Full Text Available CONTEXT: There is no consensus on the vitamin D status of children and adolescents with inflammatory bowel disease (IBD. AIM: To determine the vitamin D status of patients with IBD by comparing their serum 25(OHD concentration to that of healthy controls. HYPOTHESIS: Serum 25(OHD concentration will be lower in patients with IBD compared to controls. SUBJECTS AND METHODS: A case-controlled retrospective study of subjects with IBD (n = 58 of 2-20 years (male n = 31, age 16.38±2.21 years; female n = 27, age 16.56±2.08 years and healthy controls (n = 116; male n = 49, age 13.90±4.59 years; female n = 67, age 15.04±4.12 years. Study subject inclusion criteria: diagnosis of Crohn's disease (CD or ulcerative colitis (UC. Vitamin D deficiency was defined as 25(OHD of (<20 ng/mL (<50 nmol/L, overweight as BMI of ≥85th but <95th percentile, and obesity as BMI ≥95th percentile. Data were expressed as mean ± SD. RESULTS: Patients with CD, UC, and their controls had mean serum 25(OHD concentrations of 61.69±24.43 nmol/L, 53.26±25.51, and 65.32±27.97 respectively (ANOVA, p = 0.196. The overweight/obese controls had significantly lower 25(OHD concentration compared to the normal-weight controls (p = 0.031; whereas 25(OHD concentration was similar between the normal-weight and overweight/obese IBD patients (p = 0.883. There was no difference in 25(OHD between patients with UC and CD, or between subjects with active IBD and controls. However, IBD subjects with elevated ESR had significantly lower 25(OHD than IBD subjects with normal ESR (p = 0.025, as well as controls (65.3±28.0 nmol/L vs. 49.5±25.23, p = 0.045. CONCLUSION: There is no difference in mean serum 25(OHD concentration between children and adolescents with IBD and controls. However, IBD subjects with elevated ESR have significantly lower 25(OHD than controls. Therefore, IBD subjects with elevated ESR should be monitored for vitamin D

  8. Environmental factors and risk of developing paediatric inflammatory bowel disease - A population based study 2007-2009

    DEFF Research Database (Denmark)

    Jakobsen, Christian; Paerregaard, Anders; Munkholm, Pia;

    2012-01-01

    BACKGROUND AND AIMS: To identify environmental risk factors for developing inflammatory bowel disease (IBD) in children......BACKGROUND AND AIMS: To identify environmental risk factors for developing inflammatory bowel disease (IBD) in children...

  9. Wegener’s granulomatosis mimicking inflammatory bowel disease and presenting with chronic enteritis

    Directory of Open Access Journals (Sweden)

    Shahedi K

    2013-10-01

    Full Text Available Kamyar Shahedi,1,2 Ramy Magdy Hanna,1,2 Oleg Melamed,1,2 James Wilson2,31Department of Medicine Olive-View UCLA Medical Center, Sylmar, CA, 2David Geffen School of Medicine at UCLA, Los Angeles, CA, 3UCLA Medical Center-UCLA Stone Center, Los Angeles, CA, USAAbstract: Wegener’s granulomatosis, also known as anti-neutrophil cytoplasmic antibody (ANCA-associated vasculitis, is a small vessel vasculitis with primarily pulmonary, renal, and sinus disease manifestations. The prevalence of Wegener’s granulomatosis is three cases per 100,000 patients. Cardiovascular, neurologic, cutaneous, and joint manifestations have been reported in many case reports and case series. Gastrointestinal manifestations are less noted in Wegener’s granulomatosis, although they have been previously reported in the form of intestinal perforation and intestinal ischemia. Additionally, there are characteristic findings of vasculitis that are noted with active Wegener’s granulomatosis of the small bowel. We report a case of an elderly patient who presented with weight loss, diarrhea, and hematochezia. His symptoms were chronic and had lasted for more than 1 year before diagnosis. Inflammatory bowel disease or chronic enteritis due to Salmonella arizonae because of reptile exposure originally were suspected as etiologies of his presentation. The findings of proteinuria, renal failure, and pauci-immune glomerulonephritis on renal biopsy, in conjunction with an elevated c-ANCA titer, confirmed the diagnosis of Wegener’s granulomatosis with associated intestinal vasculitis. This case demonstrates an atypical presentation of chronic duodenitis and jejunitis secondary to Wegener’s granulomatosis, which mimicked inflammatory bowel disease.Keywords: ANCA-associated vasculitis, Wegener’s syndrome, pauci-immune glomerulonephritis, Salmonella arizonae, inflammatory bowel disease

  10. Probiotics in Inflammatory Bowel Diseases and Associated Conditions

    Directory of Open Access Journals (Sweden)

    David R. Mack

    2011-02-01

    Full Text Available A complex set of interactions between the human genes encoding innate protective functions and immune defenses and the environment of the intestinal mucosa with its microbiota is currently considered key to the pathogenesis of the chronic inflammatory bowel diseases (IBD. Probiotics offer a method to potentially alter the intestinal microbiome exogenously or may provide an option to deliver microbial metabolic products to alter the chronicity of intestinal mucosal inflammation characterizing IBD. At present, there is little evidence for the benefit of currently used probiotic microbes in Crohn’s disease or associated conditions affecting extra-intestinal organs. However, clinical practice guidelines are now including a probiotic as an option for recurrent and relapsing antibiotic sensitive pouchitis and the use of probiotics in mild ulcerative colitis is provocative and suggests potential for benefit in select patients but concerns remain about proof from trials.

  11. Colorectal cancer in patients with inflammatory bowel disease

    DEFF Research Database (Denmark)

    Andersen, Vibeke; Halfvarson, Jonas; Vogel, Ulla Birgitte

    2012-01-01

    The inflammatory bowel diseases (IBD), Crohn's disease (CD) and ulcerative colitis (UC), may be complicated by colorectal cancer (CRC). In a recent population-based cohort study of 47 347 Danish patients with IBD by Tine Jess and colleagues 268 patients with UC and 70 patients with CD developed CRC...... cholangitis were at increased risk. In this commentary, we discuss the mechanisms underlying carcinogenesis in IBD and current investigations of genetic susceptibility in IBD patients. Further advances will depend on the cooperative work by epidemiologist and molecular geneticists in order to identify genetic...... polymorphisms involved in IBD-associated CRC. The ultimate goal is to incorporate genotypes and clinical parameters into a predictive model that will refine the prediction of risk for CRC in colonic IBD. The challenge will be to translate these new findings into clinical practice and to determine appropriate...

  12. The Changing Face of Inflammatory Bowel Disease: Etiology, Physiopathology, Epidemiology

    Directory of Open Access Journals (Sweden)

    Clemente Actis

    2016-01-01

    Full Text Available Context The term inflammatory bowel disease (IBD classically includes ulcerative colitis (UC and Crohn’s disease (CD. An abnormally increased mucosal permeability seems to underlie UC, whereas CD is thought to be the result of an immune deficiency state. Evidence Acquisition While these phenomena may well be labeled as genetic factors, the environment has its role as well. Drugs (chiefly, antibiotics and non-steroidal anti-inflammatory molecules, with proton pump inhibitors recently joining the list and smoking habits are all being scrutinized as IBD causative factors. Results Once almost unknown, the prevalence of IBD, in the Eastern World and China, is now increasing by manifold, therefore arousing warning signals. Conclusions A multidisciplinary approach will soon be necessary, to face the tenacious behavior of IBD, on a global perspective.

  13. Oral Manifestations of Inflammatory Bowel Diseases: Two Case Reports

    Science.gov (United States)

    Pereira, Manoela Seadi; Munerato, Maria Cristina

    2016-01-01

    Inflammatory bowel diseases (IBD) are known as chronic inflammatory disorders of the digestive tract, represented mainly by Crohn’s disease (CD) and ulcerative colitis (UC). Among the main oral manifestations of IBD are cobblestoning of the oral mucosa, labial swellings with vertical fissures, pyostomatitis vegetans, angular cheilitis, perioral erythema, and glossitis. In this sense, understanding these nosological entities by dentists would help reach early and differential diagnosis. Thus, two case reports are presented and discussed based on theoretical references obtained by a literature review. The first case report refers to an adult patient whose IBD diagnosis was established after stomatological assessment. The second case was a patient with CD diagnosed in childhood with characteristic oral lesions. PMID:26864508

  14. Alopecia areata in patients with inflammatory bowel disease: an overview.

    Science.gov (United States)

    Sobolewska-Włodarczyk, Aleksandra; Włodarczyk, Marcin; Fichna, Jakub; Wiśniewska-Jarosińska, Maria

    2016-01-01

    Alopecia areata (AA) is one of the most common causes of non-scarring hair loss, which is associated with the premature induction of hair follicle regression. The pathogenesis of AA is unknown, although it is believed that a complicated autoimmune mechanism with Th1 lymphocytes and proinfammatory cytokines, such as IFN-γ, TNF-α, IL-1 and IL-2, may be involved. AA may occur as a single disease entity or coexist with other autoimmunological disorders. In some cases the relationship with infammatory bowel disease (IBD) was observed and the link between molecular pathways and main proinfammatory cytokines in IBD and AA has been suggested. AA is also described in literature as a side efect of biological therapy with the anti-TNF-α agents. To address the association between AA and IBD, in this review we discuss the most relevant clinical studies and case reports found in MEDLINE, Pubmed and EMBASE. PMID:27513834

  15. Probiotics in inflammatory bowel diseases and associated conditions.

    Science.gov (United States)

    Mack, David R

    2011-02-01

    A complex set of interactions between the human genes encoding innate protective functions and immune defenses and the environment of the intestinal mucosa with its microbiota is currently considered key to the pathogenesis of the chronic inflammatory bowel diseases (IBD). Probiotics offer a method to potentially alter the intestinal microbiome exogenously or may provide an option to deliver microbial metabolic products to alter the chronicity of intestinal mucosal inflammation characterizing IBD. At present, there is little evidence for the benefit of currently used probiotic microbes in Crohn's disease or associated conditions affecting extra-intestinal organs. However, clinical practice guidelines are now including a probiotic as an option for recurrent and relapsing antibiotic sensitive pouchitis and the use of probiotics in mild ulcerative colitis is provocative and suggests potential for benefit in select patients but concerns remain about proof from trials. PMID:22254095

  16. Recent advances using immunomodulators for inflammatory bowel disease

    DEFF Research Database (Denmark)

    Nielsen, Ole Haagen; Bjerrum, Jacob Tveiten; Herfarth, Hans;

    2013-01-01

    Use of the immunomodulators thiopurines and methotrexate (MTX) in the treatment of inflammatory bowel disease (IBD), i.e., Crohn's disease and ulcerative colitis (UC), is considered to be good clinical practice. However, despite being administered to a considerable number of IBD patients over...... to define the subgroup of IBD patients in need of immunomodulators, including those in need of combination therapy with biologic agents, especially because some side effects may be rather severe. Second, colorectal cancer is observed more often in IBD patients than in the background population. However...... on pharmacokinetics, pharmacogenetics, and therapeutic blood testing, as well as the occurrence of adverse events, when using AZA, 6-MP, and MTX in an attempt to determine a more up-to-date and rational treatment regimen in IBD....

  17. Lymphogranuloma venereum proctitis: A differential diagnose to inflammatory bowel disease

    DEFF Research Database (Denmark)

    Høie, Sverre; Knudsen, Lene Surland; Gerstoft, Jan

    2011-01-01

    a systematic search in the literature using PubMed and clinical cases from the Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark (Cases 1-3) and the Section of Surgery, Hamar Hospital, Norway (Case 4). Results. Clinical and endoscopic findings in LGV and IBD resemble...... as a differential diagnosis in patients with proctitis or IBD-related symptoms, especially among HIV-positive men. Hence LGV patients may be spared long-lasting examination, mistreatment and surgery....... manifestation of LGV is a proctitis, with a clinical presentation and endoscopic findings resembling those of inflammatory bowel diseases (IBDs). LGV is considered new in Scandinavia. This case report focuses on difficulties in differentiating LGV and IBD. Material and methods. This case report used...

  18. Therapy of Inflammatory Bowel Disease: A Surgeon’s Perspective

    Directory of Open Access Journals (Sweden)

    Zane Cohen

    1996-01-01

    Full Text Available Management of patients with inflammatory bowel disease (IBD can be extremely challenging and difficult. IBD patients, however, must be well aware of all therapy options and must be involved in the decision-making process. Both medical and surgical therapies have their own resultant toxicity and morbidity which must be taken into consideration. Gastroenterologists and surgeons must come together in their thinking about IBD patients and continue to undertake trials of both medical and surgical therapies in order to determine the best management for any individual patient. Topics including controversies related to the pelvic pouch procedure, stricturoplasty in the management of Crohn’s disease, assessment of trials using methotrexate and cyclosporine, and toxicity of medications and surgery are highlighted.

  19. Innate and adaptive immunity in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Britta Siegmund; Martin Zeitz

    2011-01-01

    Inflammatory bowel diseases are the consequence of a dysregulated mucosal immune system. The mucosal immune system consists of two arms, innate and adaptive immunity, that have been studied separately for a long time. Functional studies from in vivo models of intestinal inflammation as well as results from genome-wide association studies strongly suggest a cross-regulation of both arms. The present review will illustrate this interaction by selecting examples from innate immunity and adaptive immunity, and their direct impact on each other. Broadening our view by focusing on the cross-regulated areas of the mucosal immune system will not only facilitate our understanding of disease, but furthermore will allow identification of future therapeutic targets.

  20. Innate and adaptive immunity in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    BrittaSiegmund; MartinZeitz

    2011-01-01

    Inflammatory bowel diseases are the consequence of a dysregulated mucosal immune system. The mucosal immune system consists of two arms, innate and adaptive immunity, that have been studied separately for a long time. Functional studies from in vivo models of intestinal inflammation as well as results from genome-wide association studies strongly suggest a crossregulation of both arms. The present review will illustrate this interaction by selecting examples from innate immunity and adaptive immunity, and their direct impact on each other. Broadening our view by focusing on the cross-regulated areas of the mucosal immune system will not only facilitate our understanding of disease, but furthermore will allow identification of future therapeutic targets.