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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...

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

    DEFF Research Database (Denmark)

    Nielsen, O H; Vainer, B; Madsen, S M; Seidelin, J B; Heegaard, Niels Henrik Helweg

    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 dis...

  3. Linking estrogen receptor β expression with inflammatory bowel disease activity.

    Science.gov (United States)

    Pierdominici, Marina; Maselli, Angela; Varano, Barbara; Barbati, Cristiana; Cesaro, Paola; Spada, Cristiano; Zullo, Angelo; Lorenzetti, Roberto; Rosati, Marco; Rainaldi, Gabriella; Limiti, Maria Rosaria; Guidi, Luisa; Conti, Lucia; Gessani, Sandra

    2015-12-01

    Crohn disease (CD) and ulcerative colitis (UC) are chronic forms of inflammatory bowel disease (IBD) whose pathogenesis is only poorly understood. Estrogens have a complex role in inflammation and growing evidence suggests that these hormones may impact IBD pathogenesis. Here, we demonstrated a significant reduction (p exploitation of T cell-associated ERβ as a biomarker of endoscopic disease activity. PMID:26497217

  4. 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, are...... their related signalling proteins in influencing the progression of IBD....

  5. 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.)

  6. 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

  7. 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

  8. Role of interleukin 1 in inflammatory bowel disease--enhanced production during active disease.

    OpenAIRE

    Ligumsky, M; Simon, P L; Karmeli, F; Rachmilewitz, D

    1990-01-01

    Interleukin 1 is a polypeptide cytokine produced by various cell types and has been shown to have a major role in inflammatory and immunological responses. In experimental colitis it proved to be a dominant mediator and a reliable marker of inflammation. The aim of the present study was to determine in vitro the extent of production and release of interleukin 1 from colonic mucosa of patients with active untreated inflammatory bowel disease. Colonic mucosal biopsy specimens were obtained duri...

  9. 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...

  10. 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

  11. Bowel wall thickening in patients with Crohn's disease: CT patterns and correlation with inflammatory activity

    International Nuclear Information System (INIS)

    AIM: To assess CT patterns of bowel wall thickening in patients with Crohn's disease and to correlate these patterns with inflammatory activity. MATERIALS AND METHODS: We conducted a retrospective review of 58 helical abdominal CT scans of 53 patients with pathologically proven Crohn's disease. CT patterns of thickened bowel wall were divided into four types based on patterns of mural stratification and enhancement: type A, multilayered mural stratification; type B, two layers with strong mucosal enhancement and prominent low-density submucosa; type C, two layers without strong mucosal enhancement; and type D, homogeneous enhancement. We evaluated CT findings of the bowel and adjacent structures. We also reviewed pathologic features and clinical data to determine inflammatory activity. RESULTS: Fifty-five (95%) of 58 CT examinations showed bowel wall thickening. Of these 55 CT scans, type A pattern was found in 33 (60%), type B in 10 (18%), type C in five (9%), and type D in seven (13%). CT scans with type A showed significantly more wall thickening than those with either type C or type D. Histology revealed 43 cases with active disease and 12 with quiescent appearance. Thirty of 33 CT scans with type A and all 10 with type B were classified as acute disease, and three of five with type C and six of seven with type D as quiescent. CONCLUSION: In patients with Crohn's disease, CT patterns of bowel wall thickening correlated with inflammatory activity. Thickened bowel wall with layering enhancement is predictive of acute disease, and that of homogeneous enhancement suggests quiescence. Choi, D., et al. (2003)Clinical Radiology,58, 68--74

  12. 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...

  13. 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

  14. Therapeutic Role of Rifaximin in Inflammatory Bowel Disease: Clinical Implication of Human Pregnane X Receptor Activation

    OpenAIRE

    Cheng, Jie; Yatrik M. Shah; Ma, Xiaochao; Pang, Xiaoyan; Tanaka, Toshiya; Kodama, Tatsuhiko; Krausz, Kristopher W.; Frank J. Gonzalez

    2010-01-01

    Human pregnane X receptor (PXR) has been implicated in the pathogenesis of inflammatory bowel disease (IBD). Rifaximin, a human PXR activator, is in clinical trials for treatment of IBD and has demonstrated efficacy in Crohn's disease and active ulcerative colitis. In the current study, the protective and therapeutic role of rifaximin in IBD and its respective mechanism were investigated. PXR-humanized (hPXR), wild-type, and Pxr-null mice were treated with rifaximin in the dextran sulfate sod...

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

    Directory of Open Access Journals (Sweden)

    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.

  16. The Bowel Microbiota and Inflammatory Bowel Diseases

    Directory of Open Access Journals (Sweden)

    Gerald W. Tannock

    2010-01-01

    Full Text Available The human bowel contains a large and biodiverse bacterial community known as the microbiota or microbiome. It seems likely that the microbiota, fractions of the microbiota, or specific species comprising the microbiota provide the antigenic fuel that drives the chronic immune inflammation of the bowel mucosa that is characteristic of Crohn's disease and ulcerative colitis. At least twenty years of microbiological research have been expended on analysis of the composition of the bowel microbiota of inflammatory bowel disease patients in comparison to that of control subjects. Despite extensive speculations about the aetiological role of dysbiosis in inflammatory bowel diseases, knowledge that can be easily translated into effective remedies for patients has not eventuated. The causes of this failure may be due to poorly defined and executed bacteriological studies, as well as the overwhelming complexity of a biome that contains hundreds of bacterial species and trillions of bacterial cells.

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

    International Nuclear Information System (INIS)

    Whole-body gamma camera counting is an alternative to faecal 111In collection for quantifying disease activity in inflammatory bowel disease (IBD) but requires administration of imaging activities of 111In. 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 99mTc-granulocytes (∝200 MBq) and 111In-granulocytes (∝0.5 MBq). The 99mTc-cells were injected 45 min after the 111In-cells and immediately after a baseline 111In whole-body count. The decay-corrected count at 120 h was expressed as a fraction of baseline to give whole-body 111In retention (WBR). One patient was excluded as the injected cells were non-viable. Median 45-min intravascular 111In recovery was 35% in patients compared with 43% in six normal volunteers (p99mTc imaging from 87% to 96%. Only one of 11 patients with negative imaging had WBR 90%. There was a significant association between WBR and 99mTc image grade (Rs=0.73, ps=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.)

  18. 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...

  19. 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 t...... epidemiology of IBD....

  20. 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 ...

  1. 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.

  2. 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

  3. 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)

  4. 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 ...

  5. 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

  6. 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...

  7. Role of Magnetic Resonance Enterography in Differentiating between Fibrotic and Active Inflammatory Small Bowel Stenosis in Patients with Crohn's Disease

    OpenAIRE

    Francesca Fornasa; Chiara Benassuti; Luca Benazzato

    2011-01-01

    Objective: To assess the diagnostic accuracy of magnetic resonance imaging (MRI) in prospectively differentiating between fibrotic and active inflammatory small bowel stenosis in patients with Crohn′s disease (CD). Materials and Methods: A total of 111 patients with histologically proven CD presenting with clinical and plain radiographic signs of small bowel obstruction underwent coronal and axial MRI scans after oral administration of polyethylene glycol solution. A stenosis was judged prese...

  8. 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...

  9. 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...

  10. 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.

  11. PYODERMA GANGRENOSUM WITH INFLAMATORY BOWEL DISEASE

    OpenAIRE

    Guru Prasad; Jhansi Lakshmi; Krishna Rao; Parvathi; Durga Bhavani

    2015-01-01

    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 w...

  12. 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...... fructose caused marked abdominal distress in patients with demonstrable malabsorption. Ingestion of sucrose in these patients gave less pronounced symptoms of abdominal distress. Malabsorption of a 5-g dose of sorbitol could be detected in 8 of 13 patients. Mixtures of 25 g of fructose and 5 g of sorbitol...... caused significantly increased abdominal distress, and more than additive malabsorption was found in several cases. The present study shows that pronounced gastrointestinal distress may be provoked by malabsorption of small amounts of fructose, sorbitol, and fructose-sorbitol mixtures in patients with...

  13. [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

  14. 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

    -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...... to incidence rates per 1000 person-years of 4.16 vs. 2.70 for AF and 3.33 vs. 2.44 for stroke, compared with matched controls. Overall IBD-associated risk of AF corresponded to IRR 1.26 (1.16-1.36), but was driven by increased AF incidence during IBD flares [IRR 2.63 (2.26-3.06)] and persistent...

  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, 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

  16. [Inflammatory bowel disease and pregnancy].

    Science.gov (United States)

    Parfenov, A I

    2012-01-01

    Inflammatory bowel disease (IBD) in pregnant women in their characteristics do not differ from general population, unless they had operations on the pelvic organs. Women with a first pregnancy, regardless of the activity of IBD have an increased risk of adverse pregnancy and high risk births. Most treatment methods are compatible with pregnancy and breastfeeding. Women affected by IBD should discuss their plans for pregnancy with the doctor first in order to know the possible dangers. Every patient in the IBD during pregnancy must be observed by a gastroenterologist, accoucheur and pediatrician to ensure peace of mother and child. PMID:22830229

  17. 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.

  18. 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

  19. 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 ...

  20. Differentiation between active and chronic Crohn's disease using MRI small-bowel motility examinations — Initial experience

    International Nuclear Information System (INIS)

    Aim: To evaluate the influence of locally active Crohn's disease on systemic small-bowel motility in patients with chronic Crohn's disease compared to healthy individuals. Material and methods: Fifteen healthy individuals (11 men, four women; mean age 37 years) and 20 patients with histopathologically proven active (n = 15; 10 women, 5 men; mean age 45 years) or chronic (n = 5; four women, one man; mean age 48 years) Crohn's disease were included in this institutional review board-approved, retrospective study. Magnetic resonance imaging (MRI; 1.5 T) was performed after standardized preparation. Two-dimensional (2D) cine sequences for motility acquisition were performed in apnoea (27 s). Motility assessment was performed using dedicated software in three randomly chosen areas of the small-bowel outside known Crohn's disease-affected hotspots. The main quantitative characteristics (frequency, amplitude, occlusion rate) were compared using Student's t-test and one-way analysis of variance (ANOVA). Results: Three randomly chosen segments were analysed in each participant. Patients with active Crohn's disease had significantly (p < 0.05) reduced contraction frequencies (active Crohn's disease: 2.86/min; chronic: 4.14/min; healthy: 4.53/min) and luminal occlusion rates (active: 0.43; chronic: 0.70; healthy: 0.73) compared to healthy individuals and patients with chronic Crohn's disease. Contraction amplitudes were significantly reduced during active Crohn's disease (6.71 mm) compared to healthy participants (10.14 mm), but this only reached borderline significance in comparison to chronic Crohn's disease (8.87 mm). Mean bowel lumen diameter was significantly (p = 0.04) higher in patients with active Crohn's disease (16.91 mm) compared to healthy participants (14.79 mm) but not in comparison to patients with chronic Crohn's disease (13.68). Conclusion: The findings of the present study suggest that local inflammatory activity of small-bowel segments in patients with

  1. 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...

  2. 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

  3. 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.

  4. 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

    International Nuclear Information System (INIS)

    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

  5. 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

  6. 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.

  7. 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.

  8. 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

  9. Therapeutic Role of Rifaximin in Inflammatory Bowel Disease: Clinical Implication of Human Pregnane X Receptor Activation

    Science.gov (United States)

    Cheng, Jie; Shah, Yatrik M.; Ma, Xiaochao; Pang, Xiaoyan; Tanaka, Toshiya; Kodama, Tatsuhiko; Krausz, Kristopher W.

    2010-01-01

    Human pregnane X receptor (PXR) has been implicated in the pathogenesis of inflammatory bowel disease (IBD). Rifaximin, a human PXR activator, is in clinical trials for treatment of IBD and has demonstrated efficacy in Crohn's disease and active ulcerative colitis. In the current study, the protective and therapeutic role of rifaximin in IBD and its respective mechanism were investigated. PXR-humanized (hPXR), wild-type, and Pxr-null mice were treated with rifaximin in the dextran sulfate sodium (DSS)-induced and trinitrobenzene sulfonic acid (TNBS)-induced IBD models to determine the protective function of human PXR activation in IBD. The therapeutic role of rifaximin was further evaluated in DSS-treated hPXR and Pxr-null mice. Results demonstrated that preadministration of rifaximin ameliorated the clinical hallmarks of colitis in DSS- and TNBS-treated hPXR mice as determined by body weight loss and assessment of diarrhea, rectal bleeding, colon length, and histology. In addition, higher survival rates and recovery from colitis symptoms were observed in hPXR mice, but not in Pxr-null mice, when rifaximin was administered after the onset of symptoms. Nuclear factor κB (NF-κB) target genes were markedly down-regulated in hPXR mice by rifaximin treatment. In vitro NF-κB reporter assays demonstrated inhibition of NF-κB activity after rifaximin treatment in colon-derived cell lines expressing hPXR. These findings demonstrated the preventive and therapeutic role of rifaximin on IBD through human PXR-mediated inhibition of the NF-κB signaling cascade, thus suggesting that human PXR may be an effective target for the treatment of IBD. PMID:20627999

  10. EFFECT OF PREGNANE XENOBIOTIC RECEPTOR ACTIVATION ON INFLAMMATORY BOWEL DISEASE TREATED WITH RIFAXIMIN.

    Science.gov (United States)

    Wan, Y C; Li, T; Han, Y-D; Zhang, H-Y; Lin, H; Zhang, B

    2015-01-01

    The causes and pathogenesis of Inflammatory Bowel Disease (IBD) are still not clearly understood. This study aims to prove the important role of rifaximin played in inflammatory reaction caused by abnormity of the intestinal mucosal immune system. Intestinal microflora can greatly promote and maintain the inflammatory reaction of IBD, therefore, antibiotics can be used to treat IBD. Rifaximin is a medicine usually used for local intestinal infection. Many clinical and basic studies have shown that both a single application of rifaximin and the joint application with other medicines could achieve a good efficacy. This paper studied the activation of Pregnane Xenobiotic Receptor (PXR) in treating IBD with rifaximin and analyzed its efficacy in IBD when PXR was involved in the transport of medicine and metabolism. The results prove that rifaximin can not only serve as an anti-microbial drug, but can activate PXR and actually weaken the reaction of IBD. Thus it is safe to say that rifaximin has great potential in treating IBD. PMID:26122229

  11. 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.

  12. 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 

  13. 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

  14. 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,...

  15. 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.

  16. 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.

  17. 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...

  18. 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

  19. Small bowel neoplasia in coeliac disease

    OpenAIRE

    Rampertab, S D; Forde, K A; Green, P. H. R.

    2003-01-01

    There is an increased risk of small bowel adenocarcinoma in patients with coeliac disease compared with the normal population. It has been suggested that adenocarcinoma of the small intestine in coeliac disease arises through an adenoma-carcinoma sequence but there has been only one reported case of a small bowel adenoma in a patient with coeliac disease. We report three additional cases of a small bowel adenoma in the setting of coeliac disease. In addition, four cases of small bowel adenoca...

  20. 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.

  1. 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

  2. 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.

  3. Dysbiosis in inflammatory bowel disease

    OpenAIRE

    Tamboli, C P; Neut, C; Desreumaux, P; Colombel, J.F.

    2004-01-01

    Abundant data have incriminated intestinal bacteria in the initiation and amplification stages of inflammatory bowel diseases. However, the precise role of intestinal bacteria remains elusive. One theory has suggested a breakdown in the balance between putative species of “protective” versus “harmful” intestinal bacteria—this concept has been termed “dysbiosis”. Arguments in support of this concept are discussed.

  4. Smoking and inflammatory bowel disease.

    Science.gov (United States)

    Rubin, D T; Hanauer, S B

    2000-08-01

    It is well established that smoking cigarettes is associated with Crohn's disease (CD) and that non-smoking is associated with ulcerative colitis (UC). Furthermore, there is convincing evidence that smoking cigarettes has a negative effect on the course of CD, and that smoking cigarettes may improve the disease severity or have a 'protective' effect in some patients with UC. Despite these well-described associations, the mechanism by which cigarette smoking affects CD and UC is not known. Researchers have studied the systemic effects, cellular and humoral immune effects, mucosal changes, and the intestinal permeability changes with inflammatory bowel disease (IBD) and smoking. To date, none of these studies adequately explains the observed clinical patterns. It has been assumed that nicotine is the active agent in these associations, but clinical trials of nicotine chewing gum and transdermal nicotine in UC have shown limited benefit, and have been complicated by significant side-effects. Topical delivery systems for nicotine therapy are currently under development and await future clinical trials. PMID:10958212

  5. 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...

  6. 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.

  7. 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...... estimation regard genetic and environmental variance as separate entities, although it is now understood that there is a complex multidirectional interplay between genetic are environmental factors mediated by the microbiota, the epigenome, and the innate and acquired immune systems. Due to the limitations...

  8. 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...

  9. 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

  10. 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....

  11. 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

  12. CT enteroclysis in small bowel Crohn's disease

    International Nuclear Information System (INIS)

    The diagnostic evaluation of small bowel Crohn's disease has changed dramatically over the last decade. The introduction of wireless capsule endoscopy, double balloon endoscopy and the introduction of newer therapeutic agents have changed the role of imaging in the small bowel. Additionally, advances in multidetector CT technology have further changed how radiologic investigations are utilized in the diagnosis and management of small bowel Crohn's disease. This article describes how we perform CT enteroclysis in the investigation of small bowel Crohn's disease and discusses the role of CT enteroclysis in the current management of small bowel Crohn's disease.

  13. 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, ...

  14. Inflammatory Bowel Disease and Thrombosis

    OpenAIRE

    Ahmet Tezel; Muzaffer Demir

    2012-01-01

    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, s...

  15. 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.

  16. 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...

  17. Assessment of dynamic contrast enhancement of the small bowel in active Crohn's disease using 3D MR enterography

    International Nuclear Information System (INIS)

    Purpose: To retrospectively compare the dynamic contrast enhancement of the small bowel segments with and without active Crohn's disease at 3D MR enterography (MRE). Materials and methods: Thirteen patients (five men, eight women; mean age 41.2 years; range 29-56) were imaged on a 1.5-T MR scanner (Sonata, Siemens Medical) with standard MR sequences after having ingested 1000 ml of a 3% mannitol solution. Subsequently, high resolution 3D gradient-echo (volumetric interpolated breath-hold examination = VIBE) data sets were obtained pre-contrast and 20-40 s, 60-80 s, and 120-140 s after i.v. Gd-DOTA administration (0.2 mmol/kg). Signal enhancement was measured on single slices both in normal and histologically confirmed (12/13) inflamed small bowel wall segments as well as in the aorta, the psoas muscle, and the background to calculate signal-to-noise (SNR) and contrast-to-noise ratios (CNR). Results: Small bowel wall enhancement was significantly higher (p < 0.05) in inflamed compared to normal segments at 20-40 s (SNR inflamed: 58.7 ± 33.8 vs normal: 36.0 ± 19.8; p = 0.048; CNR inflamed: 34.8 ± 23.4 vs normal: 16.3 ± 11.2; p = 0.017) and at 60-80 s (SNR: 60.3 ± 25.1 vs 41.9 ± 20.0; p = 0.049; CNR: 34.9 ± 15.1 vs 19.3 ± 13.2; p = 0.01) after i.v. contrast administration, respectively. Even at 120-140 s CNR was still increased in inflamed segments (33.7 ± 16.0 vs 18.1 ± 13.2; p = 0.04), while differences in SNR did not attain statistical significance (63.0 ± 26.2 vs 45.3 ± 23.3; p = 0.15). Conclusion: In active Crohn's disease, histologically confirmed inflamed small bowel wall segments demonstrate a significantly increased early uptake of gadolinium on 3D VIBE sequences compared to normal small bowel segments.

  18. 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...

  19. 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; Munkholm, P

    2003-01-01

    microg/L (95% CI: 26-258 microg/L), P < 0.001) than patients with inactive UC (33 microg/L (19-163)) and age-matched controls (43 microg/L (20-124)). Patients with severe active CD had higher serum YKL-40 (59 microg/L (21-654), P < 0.001) than age-matched controls, but not higher than inactive CD...

  20. 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...

  1. 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...

  2. 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.

  3. Hypertrophic osteoarthropathy of chronic inflammatory bowel disease

    International Nuclear Information System (INIS)

    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. (orig.)

  4. 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.

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

    OpenAIRE

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

    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 anti-inflammatory mechanism of DS derivatives.

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

    International Nuclear Information System (INIS)

    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

  7. Pregnancy outcome in inflammatory bowel disease

    DEFF Research Database (Denmark)

    Bortoli, A; Pedersen, N; Duricova, D; D'Inca, R; Gionchetti, P; Panelli, M R; Ardizzone, S; Sanroman, A L; Gisbert, J P; Arena, I; Riegler, G; Marrollo, M; Valpiani, D; Corbellini, A; Segato, S; Castiglione, F; Munkholm, P

    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. Sleep disturbances and inflammatory bowel disease.

    Science.gov (United States)

    Ali, Tauseef; Orr, William C

    2014-11-01

    With an estimated 70 million Americans suffering, sleep disorders have become a global issue, and discovering their causes and consequences are the focus of many clinical research studies. Sleep is now also considered to be an important environmental and behavioral factor associated with the process of inflammation and the immune system. Increased sleepiness is considered part of the acute phase of response to tissue injury, and sleep loss activates inflammatory cytokines such as interleukin (IL)-1 and tumor necrosis factor (TNF)-α. Clinical studies in many immune-mediated diseases, such as systemic lupus erythematosus, rheumatoid arthritis, and ankylosing spondylitis, have revealed an association of sleep disturbances with disease activity. Recent research suggests that individuals with sleep abnormalities are also at greater risk of serious adverse health, economic consequences, and most importantly increased all-cause mortality. The importance of sleep in inflammatory bowel disease has recently gained attention with some published studies demonstrating the association of sleep disturbances with disease activity, subclinical inflammation, and risk of disease relapse. A comprehensive review of sleep physiology and its association with the immune system is provided here. Experimental and clinical studies exploring this relationship in inflammatory bowel disease are reviewed, and the clinical implications of this relationship and future directions for research are also discussed. PMID:25025716

  10. Increased expression of interleukin 17 in inflammatory bowel disease

    OpenAIRE

    Fujino, S; Andoh, A; Bamba, S; Ogawa, A.; Hata, K.; Araki, Y; Bamba, T; Fujiyama, Y.

    2003-01-01

    Background and aim: Interleukin (IL) 17 is a cytokine which exerts strong proinflammatory activities. In this study we evaluated changes in IL-17 expression in the inflamed mucosa and in the serum of patients with inflammatory bowel disease (IBD).

  11. MR colonography in inflammatory bowel disease.

    Science.gov (United States)

    Rimola, Jordi; Ordás, Ingrid

    2014-02-01

    MR colonography has a high diagnostic accuracy for detecting Crohn disease (CD) activity and determining the extent and severity of lesions. In the setting of stricturing CD, MR colonography can provide a detailed map of the lesions, which is useful for clinical decision making. MR colonography can be used as an alternative to conventional colonoscopy in the setting of CD, or as a complementary tool in selected patients with ulcerative colitis. This article reviews the spectrum of MR colonography findings in colonic inflammatory bowel disease and discusses the potential applications and limitations of MR colonography. PMID:24238130

  12. 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.

  13. Monitoring and Safety of Azathioprine Therapy in Inflammatory Bowel Disease

    OpenAIRE

    Kim, Mi Jin; Choe, Yon Ho

    2013-01-01

    Azathioprine is the most common drug used to maintain clinical remission in inflammatory bowel disease. This drug is also important as a steroid-sparing agent in steroid-dependent and chronically active inflammatory bowel disease. Nevertheless, many questions remain concerning the optimal treatment regimens of azathioprine. The dose of azathioprine has to be reduced or the therapy has to be discontinued frequently because of drug-induced toxicity. In this review, we discuss monitoring of thio...

  14. 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.

  15. 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...

  16. Clinical features of active tuberculosis that developed during anti-tumor necrosis factor therapy in patients with inflammatory bowel disease

    Science.gov (United States)

    Lee, Jang Wook; Park, Ji Hoon; Kim, Jeong Wook; Kang, Sang Bum; Koo, Ja Seol; Kim, Young-Ho; Kim, You Sun; Joo, Young Eun; Chang, Sae Kyung

    2016-01-01

    Background/Aims Anti-tumor necrosis factor (TNF) therapy for active ulcerative colitis (UC) and Crohn's disease (CD) is associated with increased risks of tuberculosis (TB) infection. We analyzed the incidence and clinical features of Korean patients with inflammatory bowel disease (IBD) who developed active TB during anti-TNF therapy. Methods Ten cases of active TB developed in patients treated with infliximab (n=592) or adalimumab (n=229) for UC (n=160) or CD (n=661) were reviewed. We analyzed demographics, interval between start of anti-TNF therapy and active TB development, tests for latent TB infection (LTBI), concomitant medications, and the details of diagnosis and treatments for TB. Results The incidence of active TB was 1.2% (10/821): 1.5% (9/592) and 0.4% (1/229) in patients receiving infliximab and adalimumab, respectively. The median time to the development of active TB after initiation of anti-TNF therapy was three months (range: 2–36). Three patients had past histories of treatment for TB. Positive findings in a TB skin test (TST) and/or interferon gamma releasing assay (IGRA) were observed in three patients, and two of them received anti-TB prophylaxis. Two patients were negative by both TST and IGRA. The most common site of active TB was the lungs, and the active TB was cured in all patients. Conclusions Active TB can develop during anti-TNF therapy in IBD patients without LTBI, and even in those with histories of TB treatment or LTBI prophylaxis. Physicians should be aware of the potential for TB development during anti-TNF therapy, especially in countries with a high prevalence of TB.

  17. 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

  18. 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.

  19. 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.

  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. 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. PMID:26354428

  2. 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.

  3. 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 ...

  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. Use of Prebiotics for Inflammatory Bowel Disease

    OpenAIRE

    Szilagyi, Andrew

    2005-01-01

    The relevance of diet in both the pathogenesis and the therapy of inflammatory bowel disease is an evolving science. Disturbance of intestinal microflora (dysbiosis) is putatively a key element in the environmental component causing inflammatory bowel disease. Prebiotics are among the dietary components used in an attempt to counteract dysbiosis. Such predominantly carbohydrate dietary components exert effects on the luminal environment by physicochemical changes through pH alteration, by pro...

  6. Skin gangrene as an extraintestinal manifestation of inflammatory bowel disease*

    Science.gov (United States)

    Komatsu, Yumi Cristina; Capareli, Gabriela Cunha; Boin, Maria Fernanda Feitosa de Camargo; Lellis, Rute; de Freitas, Thaís Helena Proença; Simone, Karine

    2014-01-01

    Inflammatory bowel diseases can commonly present many cutaneous lesions which can contribute to the diagnosis of the disease or its activity. The most frequent cutaneous or mucocutaneous manifestations suggesting ulcerative rectocolitis activity are erythema nodosum (3-10%), pyoderma gangrenosum (5-12%) and aphthous stomatitis (4%). Other reactive skin manifestations related to immunological mechanisms associated with the inflammatory bowel disease are: Sweet's syndrome, arthritis-dermatitis syndrome associated with inflammatory bowel disease and leukocytoclastic vasculitis. We describe the case of a young man with diagnosis of ulcerative rectocolitis, which presented an extensive cutaneous gangrene secondary to microvascular thrombosis. The case represents a dermatologic rarity and should be recognized as a cutaneous manifestation related to the hypercoagulability state observed in the disease's activity. PMID:25387503

  7. Skin gangrene as an extraintestinal manifestation of inflammatory bowel disease.

    Science.gov (United States)

    Komatsu, Yumi Cristina; Capareli, Gabriela Cunha; Boin, Maria Fernanda Feitosa de Camargo; Lellis, Rute; Freitas, Thaís Helena Proença de; Simone, Karine

    2014-01-01

    Inflammatory bowel diseases can commonly present many cutaneous lesions which can contribute to the diagnosis of the disease or its activity. The most frequent cutaneous or mucocutaneous manifestations suggesting ulcerative rectocolitis activity are erythema nodosum (3-10%), pyoderma gangrenosum (5-12%) and aphthous stomatitis (4%). Other reactive skin manifestations related to immunological mechanisms associated with the inflammatory bowel disease are: Sweet's syndrome, arthritis-dermatitis syndrome associated with inflammatory bowel disease and leukocytoclastic vasculitis. We describe the case of a young man with diagnosis of ulcerative rectocolitis, which presented an extensive cutaneous gangrene secondary to microvascular thrombosis. The case represents a dermatologic rarity and should be recognized as a cutaneous manifestation related to the hypercoagulability state observed in the disease's activity. PMID:25387503

  8. 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.

  9. 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.

  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. 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

  12. Rheumatic manifestations of inflammatory bowel disease

    OpenAIRE

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

    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...

  13. 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

  14. 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 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....

  15. 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.

  16. [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

  17. Raised serum activity of phospholipase A2 immunochemically related to group II enzyme in inflammatory bowel disease: its correlation with disease activity of Crohn's disease and ulcerative colitis.

    OpenAIRE

    Minami, T.; Tojo, H; Shinomura, Y; Tarui, S; Okamoto, M

    1992-01-01

    Calcium dependent phospholipase A2 activity in the mixed micelles of 1-palmitoyl-2-oleoyl-phosphatidylglycerol and cholate was measured in sera of 39 patients with Crohn's disease, 40 patients with ulcerative colitis, and 40 healthy controls. The phospholipase A2 activity was significantly raised in those sera of the patients with active Crohn's disease and those with moderate and severe ulcerative colitis. The major phospholipase A2 activity derived from the sera was separated into two peaks...

  18. 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.

  19. 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...

  20. Bringing the Inflamed and Fibrotic Bowel into Focus: Imaging in Inflammatory Bowel Disease

    OpenAIRE

    Adler, Jeremy; Stidham, Ryan. W.; Higgins, Peter D. R.

    2009-01-01

    Radiologic imaging has been a critical aid in the diagnosis, assessment, and management of inflammatory bowel disease since the first description of the disease by Crohn in 1932. Newer techniques, including computed tomography enterography, magnetic resonance enterography, and ultrasound, have entered clinical use for assessing disease activity and complications, and have largely replaced classic barium studies. We review the clinical utility of these imaging modalities and examine several im...

  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. 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...

  3. Role of Magnetic Resonance Enterography in Differentiating between Fibrotic and Active Inflammatory Small Bowel Stenosis in Patients with Crohn′s disease

    Directory of Open Access Journals (Sweden)

    Francesca Fornasa

    2011-01-01

    Full Text Available Objective: To assess the diagnostic accuracy of magnetic resonance imaging (MRI in prospectively differentiating between fibrotic and active inflammatory small bowel stenosis in patients with Crohn′s disease (CD. Materials and Methods: A total of 111 patients with histologically proven CD presenting with clinical and plain radiographic signs of small bowel obstruction underwent coronal and axial MRI scans after oral administration of polyethylene glycol solution. A stenosis was judged present if a small bowel segment had >80% lumen reduction as compared to an adjacent normal loop and mural thickening of >3 mm. At the level of the stenosis, both T2 signal intensity and post-gadolinium T1 enhancement were quantified using a 5-point scale (0: very low; 1: low; 2: moderate; 3: high; and 4: very high. A stenosis was considered fibrotic if the sum of the two values (activity score: AS did not exceed 1. Results: A small bowel stenosis was identified in 48 out of 111 patients. Fibrosis was confirmed at histology in all of the 23 patients with AS of 0 or 1, who underwent surgery within 3 days of the MRI examination. In the remaining 25 patients (AS: 2-8, an active inflammatory stenosis was suspected and remission of the obstructive symptoms was obtained by means of medical treatment. One of these patients (AS: 2, however, underwent surgery after 14 days, due to recurrence. MRI had 95.8% sensitivity, 100% specificity, and 97.9% accuracy in the diagnosis of fibrotic stenosis. Conclusion: MRI is reliable in differentiating fibrotic from inflammatory small bowel stenosis in CD.

  4. Disease Activity in Inflammatory Bowel Disease Is Associated with Increased Risk of Myocardial Infarction, Stroke and Cardiovascular Death – A Danish Nationwide Cohort Study

    Science.gov (United States)

    Kristensen, Søren Lund; Ahlehoff, Ole; Lindhardsen, Jesper; Erichsen, Rune; Jensen, Gunnar Vagn; Torp-Pedersen, Christian; Nielsen, Ole Haagen; Gislason, Gunnar Hilmar; Hansen, Peter Riis

    2013-01-01

    Purpose Chronic inflammatory diseases have been linked to increased risk of atherothrombotic events, but the risk associated with inflammatory bowel disease (IBD) is unclear. We therefore examined the risk of myocardial infarction (MI), stroke, and cardiovascular death in patients with IBD. Methods In a nationwide Danish population-based setting, a cohort of patients with incident IBD between 1996 and 2009 were identified in national registers. Hospitalizations with IBD as primary diagnosis, initiation of biological treatment and dispensed prescriptions of corticosteroids were all used as surrogate markers for disease activity, with flares classified as the first 120 days after diagnosis of IBD, and 120 days after a new corticosteroid prescription, biological treatment or IBD hospitalization, respectively. Continued corticosteroid prescriptions or IBD hospitalizations were defined as persistent activity, and periods free of such events were defined as remissions. Poisson regression was used to examine risk of MI, stroke, and cardiovascular death using a matched population-based comparison cohort as reference Results We identified 20,795 IBD patients with a mean age of 40.3 years that were matched according to age and sex with 199,978 controls. During the study period, there were 365 patients with MI, 454 with stroke, and 778 with cardiovascular death. Patients with IBD had an overall increased risk of MI (rate ratio [RR] 1.17 [95% confidence interval 1.05–1.31]), stroke (RR 1.15 [1.04–1.27], and cardiovascular death (RR 1.35 [1.25–1.45]). During flares and persistent IBD activity the RRs of MI increased to 1.49 (1.16–1.93) and 2.05 (1.58–2.65), the RRs of stroke to 1.53 (1.22–1.92) and 1.55 (1.18–2.04) and for cardiovascular death 2.32 (2.01–2.68) and 2.50 (2.14–2.92). In remission periods, the risk of MI, stroke and cardiovascular death was similar to controls. Conclusion Inflammatory bowel disease is associated with increased risk of MI, stroke

  5. 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...

  6. Iron deficiency anemia in inflammatory bowel disease.

    Science.gov (United States)

    Kaitha, Sindhu; Bashir, Muhammad; Ali, Tauseef

    2015-08-15

    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 laboratory 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 convenient, 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. PMID:26301120

  7. 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.

  8. 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.

  9. Monocytes in inflammatory bowel disease: absolute monocyte counts.

    OpenAIRE

    Mee, A. S.; Berney, J.; Jewell, D P

    1980-01-01

    Using a cytochemical staining technique, peripheral blood monocytes have been precisely identified and enumerated in patients with inflammatory bowel disease and compared with healthy and disease control subjects. For ulcerative colitis there was a significant monocytosis, which was closely correlated with the total white cell count and with the activity of the disease. For patients with Crohn's disease, the peripheral blood monocyte count was also raised compared with that of the control gro...

  10. 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.

  11. 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...

  12. Scintigraphic assessment of bowel involvement and disease activity in Crohn's disease using technetium 99m-hexamethyl propylene amine oxine as leukocyte label

    International Nuclear Information System (INIS)

    Using a novel labeling technique with technetium 99m-hexamethyl propylene amine oxine, we studied 29 patients with known or suspected Crohn's disease. Technetium 99m-hexamethyl propylene amine oxine leukocyte scanning (99mTc scan) was prospectively compared with the results of independently performed radiologic, endoscopic, and histologic examinations, and with findings at surgery, to assess the clinical usefulness of this technique to localize inflammatory lesions. In addition, uptake of technetium 99m-hexamethyl propylene amine oxine in the bowel was graded by comparing it with the uptake in liver and bone marrow and correlating this with established parameters of disease activity. The viability of homologous labeled leukocytes was greater than 95%. Less than 5% of lymphocytes were found in the final preparation. It was found that 45% +/- 12% of the label was bound to granulocytes, and 98% of the unbound label was washed off before reinjection. The results of 99mTc scan revealed a good correlation with those of barium enema (r = 0.880, p less than 0.001), of endoscopy/surgery (r = 0.983, p less than 0.001), and of all combined reference methods (r = 0.981, p less than 0.001). Activity as determined by 99mTc scan was weakly correlated with the results of Crohn's disease activity index (r = 0.559, p less than 0.01), van Hees index (r = 0.606, p less than 0.01), and erythrocyte sedimentation rate (r = 0.456, p less than 0.05) in 24 patients with proven Crohn's disease. The correlation was improved when the 99mTc scan was compared with a combination of these activity parameters and C-reactive protein (r = 0.781, p less than 0.001). Extraintestinal manifestations (joints) and complications (cholecystitis) were also identified correctly by the 99mTc scan

  13. 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 and a...

  14. Disease Activity in Inflammatory Bowel Disease Is Associated with Increased Risk of Myocardial Infarction, Stroke and Cardiovascular Death – A Danish Nationwide Cohort Study

    OpenAIRE

    Kristensen, Søren Lund; Ahlehoff, Ole; Lindhardsen, Jesper; Erichsen, Rune; Jensen, Gunnar Vagn; Torp-Pedersen, Christian; Nielsen, Ole Haagen; Gislason, Gunnar Hilmar; Hansen, Peter Riis

    2013-01-01

    Purpose Chronic inflammatory diseases have been linked to increased risk of atherothrombotic events, but the risk associated with inflammatory bowel disease (IBD) is unclear. We therefore examined the risk of myocardial infarction (MI), stroke, and cardiovascular death in patients with IBD. Methods In a nationwide Danish population-based setting, a cohort of patients with incident IBD between 1996 and 2009 were identified in national registers. Hospitalizations with IBD as primary diagnosis, ...

  15. Role of cytokines in inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    Fausto Sanchez-Muñoz, Aaron Dominguez-Lopez, Jesus K Yamamoto-Furusho

    2008-07-01

    Full Text Available Inflammatory bowel disease (IBD, which includes Crohn’s disease (CD and ulcerative colitis (UC, represents a group of chronic disorders characterized by inflammation of the gastrointestinal tract, typically with a relapsing and remitting clinical course. Mucosal macrophages play an important role in the mucosal immune 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 contributors 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 the inflammatory process in IBD. Therefore, several cytokine therapies have been developed and tested for the treatment of IBD patients.

  16. Extraintestinal Manifestations of Inflammatory Bowel Disease.

    Science.gov (United States)

    Vavricka, Stephan R; Schoepfer, Alain; Scharl, Michael; Lakatos, Peter L; Navarini, Alexander; Rogler, Gerhard

    2015-08-01

    Extraintestinal manifestations (EIM) in inflammatory bowel disease (IBD) are frequent and may occur before or after IBD diagnosis. EIM may impact the quality of life for patients with IBD significantly requiring specific treatment depending on the affected organ(s). They most frequently affect joints, skin, or eyes, but can also less frequently involve other organs such as liver, lungs, or pancreas. Certain EIM, such as peripheral arthritis, oral aphthous ulcers, episcleritis, or erythema nodosum, are frequently associated with active intestinal inflammation and usually improve by treatment of the intestinal activity. Other EIM, such as uveitis or ankylosing spondylitis, usually occur independent of intestinal inflammatory activity. For other not so rare EIM, such as pyoderma gangrenosum and primary sclerosing cholangitis, the association with the activity of the underlying IBD is unclear. Successful therapy of EIM is essential for improving quality of life of patients with IBD. Besides other options, tumor necrosis factor antibody therapy is an important therapy for EIM in patients with IBD. PMID:26154136

  17. 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 ...

  18. Environmental Risk Factors for Inflammatory Bowel Disease

    OpenAIRE

    Molodecky, Natalie A; Kaplan, Gilaad G

    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...

  19. 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...

  20. 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...

  1. Sellar inflammatory mass with inflammatory bowel disease

    OpenAIRE

    Freeman, Hugh J; Maguire, John

    2010-01-01

    Inflammatory bowel disease may be associated with different intracranial disorders. An inflammatory sellar mass is very rare but includes a variety of noninfectious causes including lymphocytic hypophysitis, granulomatous inflammation and Wegener’s granulomatosis. A 32-year-old man was diagnosed with an inflammatory sellar mass associated with an extensive colonic inflammatory process clinically characteristic of Crohn’s disease. The concurrent onset of these inflammatory disorders in distinc...

  2. 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.

  3. 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.

  4. Confocal Laser Endomicroscopy in Inflammatory Bowel Disease

    DEFF Research Database (Denmark)

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

    2015-01-01

    BACKGROUND AND AIMS: Confocal laser endomicroscopy is an endoscopic method that provides in vivo real-time imaging of the mucosa at a cellular level, elucidating mucosal changes that are undetectable by white light endoscopy. This paper systematically reviews current indications and perspectives...... 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...

  5. 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

  6. Assessment of dynamic contrast enhancement of the small bowel in active Crohn's disease using 3D MR enterography

    Energy Technology Data Exchange (ETDEWEB)

    Knuesel, Patrick R.; Kubik, Rahel A.; Crook, David W. [Department of Radiology, Kantonsspital Baden, CH-5404 Baden (Switzerland); Eigenmann, Franz [Department of Internal Medicine, Kantonsspital Baden, CH-5404 Baden (Switzerland); Froehlich, Johannes M. [Department of Radiology, Kantonsspital Baden, CH-5404 Baden (Switzerland)], E-mail: froehlich@guerbet.ch

    2010-03-15

    Purpose: To retrospectively compare the dynamic contrast enhancement of the small bowel segments with and without active Crohn's disease at 3D MR enterography (MRE). Materials and methods: Thirteen patients (five men, eight women; mean age 41.2 years; range 29-56) were imaged on a 1.5-T MR scanner (Sonata, Siemens Medical) with standard MR sequences after having ingested 1000 ml of a 3% mannitol solution. Subsequently, high resolution 3D gradient-echo (volumetric interpolated breath-hold examination = VIBE) data sets were obtained pre-contrast and 20-40 s, 60-80 s, and 120-140 s after i.v. Gd-DOTA administration (0.2 mmol/kg). Signal enhancement was measured on single slices both in normal and histologically confirmed (12/13) inflamed small bowel wall segments as well as in the aorta, the psoas muscle, and the background to calculate signal-to-noise (SNR) and contrast-to-noise ratios (CNR). Results: Small bowel wall enhancement was significantly higher (p < 0.05) in inflamed compared to normal segments at 20-40 s (SNR inflamed: 58.7 {+-} 33.8 vs normal: 36.0 {+-} 19.8; p = 0.048; CNR inflamed: 34.8 {+-} 23.4 vs normal: 16.3 {+-} 11.2; p = 0.017) and at 60-80 s (SNR: 60.3 {+-} 25.1 vs 41.9 {+-} 20.0; p = 0.049; CNR: 34.9 {+-} 15.1 vs 19.3 {+-} 13.2; p = 0.01) after i.v. contrast administration, respectively. Even at 120-140 s CNR was still increased in inflamed segments (33.7 {+-} 16.0 vs 18.1 {+-} 13.2; p = 0.04), while differences in SNR did not attain statistical significance (63.0 {+-} 26.2 vs 45.3 {+-} 23.3; p = 0.15). Conclusion: In active Crohn's disease, histologically confirmed inflamed small bowel wall segments demonstrate a significantly increased early uptake of gadolinium on 3D VIBE sequences compared to normal small bowel segments.

  7. 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

  8. Biomarkers in inflammatory bowel diseases

    DEFF Research Database (Denmark)

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

    2014-01-01

    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...... before. In this review, we report the current status of the proteomics IBD biomarkers and discuss various emerging proteomic strategies for identifying and characterizing novel biomarkers, as well as suggesting future targets for analysis....

  9. 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

  10. Diet and risk of inflammatory bowel disease

    DEFF Research Database (Denmark)

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

    2012-01-01

    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...... dioxide and aluminium silicate). Conclusions: A diet high in protein, particular animal protein, may be associated with increased risk of inflammatory bowel disease and relapses. N-6 polyunsaturated fatty acids may predispose to ulcerative colitis whilst n-3 polyunsaturated fatty acid may protect. These...... results should be confirmed in other countries and in younger subjects before dietary counselling is recommended in high risk subjects....

  11. 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.

  12. 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...

  13. 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...

  14. 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

  15. 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

  16. Inflammatory bowel disease: clinical aspects and treatments

    Directory of Open Access Journals (Sweden)

    Fakhoury M

    2014-06-01

    Full Text Available Marc Fakhoury,1 Rebecca Negrulj,2 Armin Mooranian,2 Hani Al-Salami2 1Biomedical Technology and Cell Therapy Research Laboratory, Department of Biomedical Engineering and Artificial Cells and Organs Research Center, Faculty of Medicine, McGill University, Montreal, QC, Canada; 2Biotechnology and Drug Development Research Laboratory, Curtin Health Innovation Research Institute, Biosciences Research Precinct, School of Pharmacy, Curtin University, Perth, WA, Australia Abstract: Inflammatory bowel disease (IBD is defined as a chronic intestinal inflammation that results from host-microbial interactions in a genetically susceptible individual. IBDs are a group of autoimmune diseases that are characterized by inflammation of both the small and large intestine, in which elements of the digestive system are attacked by the body's own immune system. This inflammatory condition encompasses two major forms, known as Crohn's disease and ulcerative colitis. Patients affected by these diseases experience abdominal symptoms, including diarrhea, abdominal pain, bloody stools, and vomiting. Moreover, defects in intestinal epithelial barrier function have been observed in a number of patients affected by IBD. In this review, we first describe the types and symptoms of IBD and investigate the role that the epithelial barrier plays in the pathophysiology of IBD as well as the major cytokines involved. We then discuss steps used to diagnose this disease and the treatment options available, and finally provide an overview of the recent research that aims to develop new therapies for such chronic disorders. Keywords: inflammatory bowel disease, Crohn's disease, ulcerative colitis, cytokines

  17. Osteoporosis in patients with inflammatory bowel disease

    International Nuclear Information System (INIS)

    The prevalence of osteoporosis in inflammatory bowel disease (IBD) has not been accurately established. Using single photon absorptiometry (SPA) and vertebral quantitative computerized tomography (QCT) the authors measured bone mineral content (BMC) in 75 unselected patients with IBD. Osteoporosis was present in 23 (31%). Seven had cortical and trabecular osteoporosis, 11 cortical only and five trabecular only. Three amenorrhoeic premenopausal females had clinically severe osteoporosis and a further 4 had vertebral crush fractures. The median lifetime steroid dose in osteoporotic patients was significantly greater than in patients with normal BMC; most patients with osteoporosis had small bowel IBD with one or more resections. Repeat QCT measurements in 18 patients after one year were unchanged in 12, increased in one and decreased between 10 and 37 mg/ml K2HPO4 in 5 of whom four were receiving steroids. Radial BMC decreased in one patient, increased in one and was unchanged in the remainder. Thus, osteoporosis was present in 30% of these patients, with severe clinical disease in three young females. Rapid spinal trabecular bone loss was demonstrated over the course of one year in some patients. Steroid therapy, amenorrhoe and small bowel IBD with resection appear to be important risk factors

  18. Can Probiotics Cure Inflammatory Bowel Diseases?

    Science.gov (United States)

    Korada, Siva Kumar; Yarla, Nagendra Sastry; Bishayee, Anupam; Aliev, Gjumrakch; Aruna Lakshmi, K; Arunasree, M K; Dananajaya, B L; Mishra, Vijendra

    2016-01-01

    Gastrointestinal (GI) disorders, especially microbial dysbiosis play role in several GI ailments such as irritable bowel syndrome, colorectal cancer, inflammatory bowel diseases, and antibiotic-associated diarrhoea. Role of inflammatory bowel disease (IBD) is multifactorial as it involves loss of maintaining intestinal epithelial barrier integrity, increased release of pro-inflammatory molecules, and microbial dysbiosis in gut microflora. Some specific pathogens also play a key role in the IBD development. The origin and causation are still in unfathomable condition and the exact root cause is unknown. Recently probiotic studies have been gaining importance because of their positive responses in their IBD experimental results. According to joint Food and Agricultural Organisation/World Health Organisation working group, probiotics are defined as live microorganisms which when administered in adequate amount confer health benefit on the host. These live beneficial microorganisms are considered helpful in improving gut colonization and perseverance thereby improves prophylactic effect. In the direction of IBD research, a number of studies are needed to standardize its methodology and its applicability on human usage. The particular review presents an overview of gut microflora and its impact on host health, types of IBD and existing therapies to treat this disorder, mechanism of several probiotic actions, role of probiotics in IBD prevention with their supporting evidences. PMID:26648465

  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. Inflammatory Bowel Disease and Cervical Neoplasia

    DEFF Research Database (Denmark)

    Rungoe, Christine; Simonsen, Jacob; Riis, Lene; Frisch, Morten; Langholz, Ebbe; Jess, Tine

    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...... with IBD were assessed by Cox proportional hazards regression analysis. Odds ratios (ORs) of cervical neoplasia before diagnosis of IBD were calculated by using conditional logistic regression. RESULTS: Women with CD underwent cervical cancer screening as often as women in the general population (IRR...

  1. The heart in inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    Tsianos E.V.

    2007-03-01

    Full Text Available SUMMARY Cardiovascular involvement in inflammatory bowel disease (IBD has been occasionally reported, mainly in the form of case reports. Endocardium derangement in IBD involves endocarditis and subendocardial abscess. Endocarditis may occur as a result of septicemia or due to the prolonged use of total parental nutrition (TPN catheters or/and immunosuppression. The cause of endocarditis may be bacterial or fungal and require surgery in several cases. Prophylaxis for endocarditis in selected IBD patients is discussed. Myocarditis or perimyocarditis in IBD is reported as an autoimmune phenomenon during bowel disease excacerbations or as a side-effect of 5-aminosalicylic acid (5-ASA formulations. Ulcerative colitis (UC patients seem to be at a higher risk for this complication compared to Crohn�s disease (CD patients. Myocardial infarctions, selenium deficiency during TPN, the role of prolonged steroid use and the association with giant cell myocarditis are topics which need further analysis. Pericardium involvement seems to be the most frequent type of cardiovascular complication in IBD caused by drugs (5-ASA, azathioprine, cyclosporine, pericardio-colonic fistulas or unknown causes (idiopathic and it may occasionally be the disease presenting symptom. Coronary artery status and other factors for cardiovascular risk, such as smoking, hyperlipidemia and exercise are also discussed. Electrocardiogram and ultrasonographic changes are not so uncommon and cardiogenic sudden death in IBD is reviewed. Intracavitary coagulation abnormalities, amyloidosis, heart failure and aortitis syndrome are topics included and discussed in this review. A list of tables contributes to a more systemic overview of this current knowledge. Key Words: heart, inflammatory bowel disease, ulcerative colitis, Crohn�s diseas

  2. 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

  3. 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.

  4. 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 of...... period, stool specimens for C. difficile toxins analysis were collected from 112 children with celiac disease as controls. RESULTS: Clostridium difficile occurrence was significantly higher in patients with IBD compared with patients with celiac disease (7.5% versus 0.8%; P = 0.008). Clostridium...... C. difficile infected patients. METHODS: In this prospective, comparative, multicenter study, 211 pediatric patients with IBD were enrolled from October 2010 to October 2011 and tested for the presence of C. difficile toxins A and B in their stools at 0, 6, and 12 months. During the same study...

  5. 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.

  6. Pathophysiology of acute small bowel disease with CT correlation

    Energy Technology Data Exchange (ETDEWEB)

    Sarwani, N., E-mail: nsarwani@hmc.psu.ed [Department of Radiology, Section of Abdominal Imaging, Penn State Milton Hershey Medical Center, Hershey, PA (United States); Tappouni, R.; Tice, J. [Department of Radiology, Section of Abdominal Imaging, Penn State Milton Hershey Medical Center, Hershey, PA (United States)

    2011-01-15

    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. 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...

  8. 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.

  9. Correlation between extraintestinal manifestations and clinical parameters with the histologic activity index in patients with inflammatory bowel diseases

    Directory of Open Access Journals (Sweden)

    Štulić Miloš

    2013-01-01

    Full Text Available Bacground/Aim. Crohn's disease (CD and ulcerative colitis (UC are chronic, idiopathic, inflammatory diseases of the digestive tract. The aim of this study was to determine a possible correlation between the clinical parameters of the disease activity degree and the presence of extraintestinal manifestations with disease activity histopathological degree, in patients presented with CD and UC. Methods. This cross-sectional study included 134 patients (67 with CD and UC, respectively treated at the Clinic of Gastroenterology, Clinical Center of Serbia, Belgrade. After clinical, laboratory, endoscopic, histopathologic and radiologic diagnostics, the patients were divided into two groups according to their histopathological activity. The group I comprised 79 patients whose values of five-grade histopathological activity were less than 5 (45 with CD and 34 with UC, while the group II consisted of 55 patients with the values higher than 5 (22 with CD and 33 with UC. The CD activity index (CDAI and Truelove and Witts' scale of UC were used for clinical evaluation of the disease activity. Results. CD extraintestinal manifestations were present in 28.9% and 63.6% of the patients in the groups I and II, respectively (p 0.05. Conclusion. In the patients presented with CD, the extraintestinal manifestations with higher CDAI suggested a higher degree of histopathological activity. On the contrary, in the UC patients, Truelove and Witts' scale and extraintestinal manifestations were not valid predictors of the disease histopathological activity.

  10. Pulmonary manifestations of inflammatory bowel disease.

    Science.gov (United States)

    Majewski, Sebastian; Piotrowski, Wojciech

    2015-12-10

    Bronchopulmonary signs and symptoms are examples of variable extraintestinal manifestations of the inflammatory bowel diseases (IBD). These complications of Crohn's disease (CD) and ulcerative colitis (UC) seem to be underrecognized by both pulmonary physicians and gastroenterologists. The objective of the present review was to gather and summarize information on this particular matter, on the basis of available up-to-date literature. Tracheobronchial involvement is the most prevalent respiratory presentation, whereas IBD-related interstitial lung disease is less frequent. Latent and asymptomatic pulmonary involvement is not unusual. Differential diagnosis should always consider infections (mainly tuberculosis) and drug-induced lung pathology. The common link between intestinal disease and lung pathology is unknown, but many hypotheses have been proposed. It is speculated that environmental pollution, common immunological mechanisms and predisposing genetic factors may play a role. PMID:26788078

  11. 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

  12. Is irritable bowel syndrome an infectious disease?

    Science.gov (United States)

    Thompson, John Richard

    2016-01-28

    Irritable bowel syndrome (IBS) is the most common of all gastroenterological diseases. While many mechanisms have been postulated to explain its etiology, no single mechanism entirely explains the heterogeneity of symptoms seen with the various phenotypes of the disease. Recent data from both basic and clinical sciences suggest that underlying infectious disease may provide a unifying hypothesis that better explains the overall symptomatology. The presence of small intestinal bowel overgrowth (SIBO) has been documented in patients with IBS and reductions in SIBO as determined by breath testing correlate with IBS symptom improvement in clinical trials. The incidence of new onset IBS symptoms following acute infectious gastroenteritis also suggests an infectious cause. Alterations in microbiota-host interactions may compromise epithelial barrier integrity, immune function, and the development and function of both central and enteric nervous systems explaining alterations in the brain-gut axis. Clinical evidence from treatment trials with both probiotics and antibiotics also support this etiology. Probiotics appear to restore the imbalance in the microflora and improve IBS-specific quality of life. Antibiotic trials with both neomycin and rifaximin show improvement in global IBS symptoms that correlates with breath test normalization in diarrhea-predominant patients. The treatment response to two weeks of rifaximin is sustained for up to ten weeks and comparable results are seen in symptom reduction with retreatment in patients who develop recurrent symptoms. PMID:26819502

  13. 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

  14. 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.

  15. 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

  16. 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

  17. 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.

  18. Correlations between Psoriasis and Inflammatory Bowel Diseases

    Directory of Open Access Journals (Sweden)

    Nevena Skroza

    2013-01-01

    Full Text Available For a long time the relationship between inflammatory bowel diseases (IBDs and psoriasis has been investigated by epidemiological studies. It is only starting from the 1990s that genetic and immunological aspects have been focused on. Psoriasis and IBD are strictly related inflammatory diseases. Skin and bowel represent, at the same time, barrier and connection between the inner and the outer sides of the body. The most important genetic correlations involve the chromosomal loci 6p22, 16q, 1p31, and 5q33 which map several genes involved in innate and adaptive immunity. The genetic background represents the substrate to the common immune processes involved in psoriasis and IBD. In the past, psoriasis and IBD were considered Th1-related disorders. Nowadays the role of new T cells populations has been highlighted. A key role is played by Th17 and T-regs cells as by the balance between these two cells types. New cytokines and T cells populations, as IL-17A, IL-22, and Th22 cells, could play an important pathogenetic role in psoriasis and IBD. The therapeutic overlaps further support the hypothesis of a common pathogenesis.

  19. 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...

  20. Potential viral pathogenic mechanism for new variant inflammatory bowel disease

    OpenAIRE

    Uhlmann, V; Martin, C. M.; Sheils, O; Pilkington, L; I. Silva; Killalea, A; Murch, S B; Walker-Smith, J; Thomson, M.; Wakefield, A J; O'Leary, J J

    2002-01-01

    Aims: A new form of inflammatory bowel disease (ileocolonic lymphonodular hyperplasia) has been described in a cohort of children with developmental disorder. This study investigates the presence of persistent measles virus in the intestinal tissue of these patients (new variant inflammatory bowel disease) and a series of controls by molecular analysis.

  1. 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.

  2. Familial risk of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Trier Møller, Frederik; Andersen, Vibeke; Wohlfarht, Jan;

    2015-01-01

    . 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......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...... pronounced in relatives of CD cases. IRRs increased with two or more IBD-affected relatives and were modified by age, with the highest family-related IRR observed in early life. CONCLUSIONS: The risk of IBD is significantly increased in first -, second-, and third-degree relatives of IBD-affected cases, with...

  3. 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 on...... the entire Danish population during 1977-2011 (n=8,295,773). Through a unique personal identification number assigned to each Danish citizen, sex, date and location of birth, identity of parents, and information on vital status and emigration were available. This information was used to establish...... kinship in the entire population. Individuals receiving at least 2 diagnoses of IBD during the time period (n=45,780) were identified using the Danish National Registry of Patients. Risk of IBD in family members to individuals with IBD was assessed by Poisson regression analysis. Results: The overall...

  4. 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

  5. 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

  6. Genetics and Pathogenesis of Inflammatory Bowel Disease.

    Science.gov (United States)

    Liu, Ta-Chiang; Stappenbeck, Thaddeus S

    2016-05-23

    We are currently in an exciting time when our understanding of genetic underpinnings of inflammatory bowel disease (IBD) has undergone a revolution, based in large part on novel genotyping and sequencing technologies. With >160 susceptible loci identified for IBD, the goal is now to understand at a fundamental level the function of these susceptibility alleles. Determining the clinical relevance of how these susceptible genes shape the development of IBD is also a high priority. The main challenge is to understand how the environment and microbiome play a role in triggering disease in genetically susceptible individuals, as the interactions may be complex. To advance the field, novel in vitro and mouse models that are designed to interrogate complex genetics and functionally test hypotheses are needed. Ultimately, the goal of genetics studies will be to translate genetics to patients with IBD and improve their care. PMID:26907531

  7. 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.

  8. 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.

  9. 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...

  10. 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...

  11. 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...

  12. 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......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...

  13. 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.

  14. 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

  15. 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.

  16. 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.

  17. CT enteroclysis in the diagnostics of small bowel diseases

    International Nuclear Information System (INIS)

    Background: The role of CT enteroclysis is gaining on importance in the diagnostics of small bowel diseases. The aim of the study was to present own experiences in CT enteroclysis application, with the use of a 64-detector CT unit. Material/Methods: CT enteroclyses were performed in 60 patients: 53 with the suspicion of the Crohns disease, 2 suspected for carcinoid, 1 with suspicion of the fistula between the small bowel and the bladder, 2 suspected for the tumor of the ileo-caecal region, and in 1 case, the aim of examination was to carry out an evaluation of the postsurgical state of the bowel-bowel anastomosis. We used own endoscopic technique of catheter insertion into the bowel, which shortens the examination time and improves patients comfort. Results: The catheter was correctly introduced into the small bowel in 58 patients (endoscopy had to be repeated in 4 cases). Only 2 examinations failed, because patients refused repeated endoscopy. Radiological signs of the Crohns disease were found in 50 out of 53 patients. In the 3 remaining patients, the appearance of the small bowel was normal. In 5 non-Crohns disease patients, CT enteroclysis enabled a good visualization of the pathology (tumors, fistula). Conclusions: CT enteroclysis with the use of the 64-detector CT unit is a valuable method in the diagnostics of small bowel diseases. It could supplement or precede capsule endoscopy. (authors)

  18. 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

  19. 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.

  20. 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. PMID:25206258

  1. 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.

  2. 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

  3. 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.

  4. 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.

  5. 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

  6. 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

  7. 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.

  8. Rheumatic manifestations of inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

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

    2009-11-01

    Full Text Available 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.

  9. Bone loss in inflammatory Bowel disease: our multicentric study

    Directory of Open Access Journals (Sweden)

    Alessandro Geraci

    2011-05-01

    Full Text Available Patients with inflammatory bowel disease are at increased risk of developing disorder in bone and mineral metabolism The study was aimed to determine if inflammatory bowel disease (IBD is a risk factor for osteoporosis in 103 adult patients. We included 103 IBD patients, 67 patients with Crohn’s disease (CD and 36 with ulcerative colitis (UC. Bone mineral density was measured by dual-energy X-ray absorptiometry. We used T score to express bone loss (osteopenia: -2.5 SD <-1 SD, osteoporosis: T <-2.5 SD. Plain x-rays were examined to search for vertebral compression or spontaneous fractures before DEXA. Among the 103 patients, 47.7% exhibited osteopenia of the femoral neck and 62.3% of the lumbar spine, with no significant difference between CD and UC. The prevalence of osteoporosis of the lumbar spine was significantly higher in CD patients (41.2% versus 8.7%. Osteoporosis is frequent in IBD patients, especially in CD patients. Female gender, malnutrition (body mass index <20 kg/m2, disease course (>2 years and active disease would be risk factors of bone mineral loss in IBD.

  10. 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 ...

  11. A Look into the Small Bowel in Crohn's Disease

    OpenAIRE

    Park, Soo Jung; Kim, Won Ho

    2012-01-01

    Crohn's disease (CD) is an inflammatory bowel disease that can affect the entire gastrointestinal tract, with the small bowel (SB) being the most commonly affected site. In some patients, refractory inflammation or chronic strictures of the SB are responsible for a debilitating course of the disease that might lead to severely reduced quality of life. Therefore, SB imaging is a crucial element in diagnosing and/or managing SB CD, and continues to evolve because of technologic advances. SB end...

  12. 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...

  13. Thromboembolism in inflammatory bowel disease: role of platelets.

    OpenAIRE

    Webberley, M. J.; M. 't Hart; Melikian, V.

    1993-01-01

    Patients with inflammatory bowel disease are susceptible to thromboembolism and recently small vessel thrombosis has been implicated as an aetiological factor in Crohn's disease. This study therefore investigated platelet function in 104 patients with inflammatory bowel disease of whom eight had previous thromboembolism. Thirty five patients had reproducible spontaneous platelet aggregation of more than 30% (0 in controls) (p < 0.0001). A further 20 patients showed hypersensitivity of platele...

  14. 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

  15. 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.

  16. [Assessment of disease severity and outcome of dietary, antibiotic, and immunosuppressive interventions by use of the canine IBD activity index in 21 dogs with chronic inflammatory bowel disease].

    Science.gov (United States)

    Münster, Michael; Hörauf, Angelika; Bilzer, Thomas

    2006-01-01

    Recently, the canine IBD activity index (CIBDAI) was developed for evaluation of the severity of illness, therapeutic strategies, and efficacy of therapy. The aim of the present study was to assess the severity of illness and the therapeutic strategy in dogs with IBD by the use of CIBDAI, serum albumin concentration, and histologic score (HPEG). Furthermore the use of CIBDAI and the efficacy of therapy in a prospective study during a 3 month treatment period were evaluated. Twentyone dogs with inflammatory bowel disease (lymphocytic-plasmacytic enteritis and enterocolitis) were examined in this study. In 11 dogs with IBD the severity of illness was assessed as low, according to CIBDAI and HPEG (CIBDAI score 4 or between 5 and 10 with HPEG score between 1 and 1.5). Six dogs were treated with hypoallergenic diet (Group D), five dogs were treated with hypoallergenic diet and metronidazole (15.6-22,3 mg/kg/day) (Group M). In 10 dogs with IBD the severity of illness was assessed as high (CIBDAI azathioprine (n=5; 0.9-2.3 mg/kg/day), sulfasalazine (n=4; 18.2-25 mg/kg/day) and hypoallergenic diet (n=10). Efficacy of therapy was evaluated prospectively 3 times in a 12 weeks treatment period. Remission (CIBDAI score or =4) indicated poor therapeutic response. Age, CIBDAI score and HPEG score were significantly different in IBD dogs with low severity of illness (age: median 60 months; CIBDAI score: median 5; HPEG score: median (1) and IBD dogs with high severity of illness (age: median 90 months; CIBDAI score: median 9.5; HPEG score: median 2.25) (p = 0.0101 and p = 0.0099, respectively). The presence of hypoalbuminemia was not significantly different between these two groups (p = 0.3108). There was no significant correlation between CIBDAI score and serum albumin concentration (r = 0.0394; p = 0.0802) or between CIBDAI score and HPEG score (r = 0.2587; p = 0.2574). In the treatment groups, HPEG score was only significantly different between D-group and group I (p 0.05). All

  17. 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

  18. Fecal lactoferrin in discriminating inflammatory bowel disease from Irritable bowel syndrome: a diagnostic meta-analysis

    OpenAIRE

    Zhou, Xing-lu; Xu, Wen; Tang, Xiao-xiao; Luo, Lai-sheng; Tu, Jiang-feng; Zhang, Chen-jing; Xu, Xiang; Wu, Qin-dong; Pan, Wen-Sheng

    2014-01-01

    Background To perform a meta-analysis evaluating the diagnostic ability of fecal lactoferrin (FL) to distinguish inflammatory bowel disease (IBD) from irritable bowel syndrome (IBS). Methods The Medline, EMBASE, Web of Science, Cochrane library and CNKI databases were systematically searched for studies that used FL concentrations to distinguish between IBD and IBS. The sensitivity, specificity, and other diagnostic indexes of FL were pooled using a random-effects model. Results Seven studies...

  19. 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...

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. Computed Tomography Enterography for Evaluation of Inflammatory Bowel Disease

    OpenAIRE

    Park, Min Jung; Lim, Joon Seok

    2013-01-01

    Computed tomography enterography (CTE) has become a main modality for the evaluation of inflammatory bowel disease (IBD). It simultaneously offers visualization of the small bowel and extraintestinal status, which is helpful for diagnosing IBD. Crohn disease has long segmental enhancing wall thickening related with the eccentric longitudinal distribution. In addition, mural stratification, fibrofatty proliferation, positive comb sign by increased mesenteric vascularity and internal/perianal f...

  5. 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...

  6. 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.

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

    International Nuclear Information System (INIS)

    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

  8. 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...

  9. 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

  10. 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

  11. 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.

  12. 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.

  13. 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...

  14. 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...

  15. 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

  16. Hydro-MRI in inflammatory bowel diseases: a comparison with colonoscopy and histopathology

    International Nuclear Information System (INIS)

    Purpose: To compare hydro-MRI with colonoscopy and biopsy specimen regarding the assessment of inflammatory activity and the differentiation of inflammatory bowel diseases. Material and methods: After an oral bowel opacification using 1000 ml of a 2.5% mannitol solution and a rectal bowel opacification using 250-500 ml of a 0.9% saline solution, axial and coronal breath-hold sequences ±Gd-DTPA (HASTE-['half-Fourier acquisition single-shot turbo spin echo'] and dynamic FLASH-['fast low angle shot']) were acquired in 27 patients with inflammatory bowel disease. The enhancement of the bowel wall as well as morphological MRI findings were correlated with colonoscopy and biopsy specimens. By means of the MRI findings, Crohn's disease (CD) and ulcerative colitis (UC) should be differentiated. Results: In CD, a significant correlation between the contrast enhancement of the inflamed bowel wall (Δ SI) and the endoscopic/histopathologic indices could be established (r=0.52; p=0.02 and r=0.72; p=0.001). In UC, no correlations between Δ SI and the endoscopic/histopathologic indices could be found. The correct diagnosis of CD and UC by MRI findings was possible in 22/27 patients (81%). Conclusion: Hydro-MRI with dynamic studies is suitable for the assessment of disease activity in CD, but unreliable in UC. Hydro-MRI provides useful information for the differentiation of CD and UC. (orig.)

  17. 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.

  18. 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.

  19. Cell Death and Inflammatory Bowel Diseases: Apoptosis, Necrosis, and Autophagy in the Intestinal Epithelium

    Directory of Open Access Journals (Sweden)

    Tiago Nunes

    2014-01-01

    Full Text Available Cell death mechanisms have been associated with the development of inflammatory bowel diseases in humans and mice. Recent studies suggested that a complex crosstalk between autophagy/apoptosis, microbe sensing, and enhanced endoplasmic reticulum stress in the epithelium could play a critical role in these diseases. In addition, necroptosis, a relatively novel programmed necrosis-like pathway associated with TNF receptor activation, seems to be also present in the pathogenesis of Crohn’s disease and in specific animal models for intestinal inflammation. This review attempts to cover new data related to cell death mechanisms and inflammatory bowel diseases.

  20. 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.

  1. 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.

  2. Rectal gel application of Withania somnifera root extract expounds anti-inflammatory and muco-restorative activity in TNBS-induced Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Jagtap Suresh

    2011-04-01

    Full Text Available Abstract Background Inflammatory Bowel Disease (IBD is marked with chronic inflammation of intestinal epithelium driven by oxidative stress. Traditional treatments with plant extracts gained renewed interest due to their ability to ameliorate the multi factorial conditions like inflammation. We investigated the beneficial effects of Withania somnifera in Trinitro Benzyl Sulfonic Acid (TNBS induced experimental IBD through a rectally applicable formulation. Methods The study included (i preparation of gel formulation from aqueous Withania somnifera root extract (WSRE, (ii biochemical assays to determine its performance potential, (iii testing of formulation efficacy in TNBS-induced IBD rat model, and (iv histo-patholgical studies to assess its healing and muco-regenerative effect in IBD-induced rats. For this purpose, concentration dependant antioxidant activity of the extracts were evaluated using biochemical assays like (a inhibition of lipid peroxidation, (b NO scavenging, (c H2O2 scavenging, and (d ferric reducing power assay. Results The extract, at 500 μg/ml, the highest concentration tested, showed 95.6% inhibition of lipid peroxidation, 14.8% NO scavenging, 81.79% H2O2 scavenging and a reducing capacity of 0.80. The results were comparable with standard antioxidants, ascorbic acid and curcumin. WSRE treatment positively scored on histopathological parameters like necrosis, edema, neutrophil infiltration. The post treatment intestinal features showed restoration at par with the healthy intestine. In view of these results, gel formulation containing an aqueous extract of W. somnifera, prepared for rectal application was tested for its anti-inflammatory activity in TNBS-induced rat models for IBD. Commercially available anti-inflammatory drug Mesalamine was used as the standard in this assay. Conclusions Dose of the rectal gel applied at 1000 mg of WSRE per kg rat weight showed significant muco-restorative efficacy in the IBD-induced rats

  3. Short Bowel Syndrome and Intestinal Failure in Crohn's Disease.

    Science.gov (United States)

    Limketkai, Berkeley N; Parian, Alyssa M; Shah, Neha D; Colombel, Jean-Frédéric

    2016-05-01

    Crohn's disease is a chronic and progressive inflammatory disorder of the gastrointestinal tract. Despite the availability of powerful immunosuppressants, many patients with Crohn's disease still require one or more intestinal resections throughout the course of their disease. Multiple resections and a progressive reduction in bowel length can lead to the development of short bowel syndrome, a form of intestinal failure that compromises fluid, electrolyte, and nutrient absorption. The pathophysiology of short bowel syndrome involves a reduction in intestinal surface area, alteration in the enteric hormonal feedback, dysmotility, and related comorbidities. Most patients will initially require parenteral nutrition as a primary or supplemental source of nutrition, although several patients may eventually wean off nutrition support depending on the residual gut anatomy and adherence to medical and nutritional interventions. Available surgical treatments focus on reducing motility, lengthening the native small bowel, or small bowel transplantation. Care of these complex patients with short bowel syndrome requires a multidisciplinary approach of physicians, dietitians, and nurses to provide optimal intestinal rehabilitation, nutritional support, and improvement in quality of life. PMID:26818425

  4. [Frequency of celiac disease and irritable bowel syndrome coexistance and its influence on the disease course].

    Science.gov (United States)

    Zwolińska-Wcisło, Małgorzata; Galicka-Latała, Danuta; Rozpondek, Piotr; Rudnicka-Sosin, Lucyna; Mach, Tomasz

    2009-01-01

    Celiac disease is increasingly recognized autoimmune enteropathy caused by a permanent gluten intolerance. Gluten is the main storage protein of wheat, in genetically predisposed individuals. Celiac disease risk in first degree relatives is about 10%. Diarrhea and changes of bowel movement, observed as well in celiac disease as in IBS, may lead to misdiagnosis of IBS basing on the Rome criteria or may be associated with coexistence of both diseases. The aim of the study was to assess the celiac disease prevalence in patients with irritable bowel syndrome. The study group comprised 200 patients (120 women and 80 men) aged 18-78 years (mean: 46.7 years) with diarrhoeal form of irritable bowel syndrome (IBS), according to the Rome criteria II. At the beginning and after a three month period anti tissue transglutaminase antibodies (IgA tTG) were estimated. Gastroscopy with biopsy where performed in those with IgA tTG titre above 1/200. 40 patients were immunologically positive and 14 of them have histopathologically proven celiac disease. In the group of patients with detected celiac disease, gluten free diet was applied besides the treatment with trimebutin or mebewerin, recommended for IBS. After 6 months the decrease of IgA tTG titre in the serum was observed. In 5 of these patients IgA tTG level was negative. It was associated with the significant decrease of clinical symptoms, such as diarrhea and flatulence. The remaining symptoms, such as abdominal pain, feeling of incomplete defecation demanded continuation of IBS treatment. With regard to often atypical celiac disease symptoms--adult active searching should be performed to differentiate from irritable bowel syndrome. PMID:19689036

  5. Detection of galectin-3 in patients with inflammatory bowel diseases: new serum marker of active forms of IBD?

    Czech Academy of Sciences Publication Activity Database

    Frolová, Lenka; Smetana, K. , Jr.; Borovská, Dana; Kitanovičová, Andrea; Klimešová, Klára; Janatková, I.; Malíčková, K.; Lukáš, M.; Drastich, P.; Beneš, Z.; Tučková, Ludmila; Manning, J. C.; André, S.; Gabius, H. J.; Tlaskalová, Helena

    2009-01-01

    Roč. 58, č. 8 (2009), s. 503-512. ISSN 1023-3830 R&D Projects: GA ČR GD310/08/H077; GA ČR GA303/06/0974; GA AV ČR 1QS500200572; GA MŠk 2B06155; GA MZd NR8963 Institutional research plan: CEZ:AV0Z50200510 Keywords : crohn's disease * galectin-3 * mucosal immunity Subject RIV: EC - Immunology Impact factor: 1.586, year: 2009

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

    International Nuclear Information System (INIS)

    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.

  7. 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.

  8. 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

  9. 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.

  10. 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.

  11. 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...

  12. Risk factors for small bowel cancer in Crohn's disease.

    Science.gov (United States)

    Lashner, B A

    1992-08-01

    Suspected risk factors for adenocarcinoma of the small bowel in Crohn's disease include surgically excluded small bowel loops, chronic fistulous disease, and male sex. Review of all seven University of Chicago cases failed to confirm any suspected risk factor. A case-control study was performed to identify possible alternatives. Each case was matched to four randomly selected controls from an inflammatory bowel disease registry matched for year of birth, sex, and confirmed small bowel Crohn's disease. Three factors were significantly associated with the development of cancer: (1) Four cancers developed in the jejunum, and jejunal Crohn's disease was associated with the development of cancer [odds ratio (OR) 8.0, 95% confidence interval (CI) 1.6-39.3]. (2) There was an association between the development of cancer and occupations known to be associated with an increased colorectal cancer risk (OR 20.3, CI 2.7-150.5). Three cases (a chemist with exposure to halogenated aromatic compounds and aliphatic amines, a pipefitter with exposure to asbestos, and a machinist with exposures to cutting oils, solvents, and abrasives) and one of 28 controls (a fireman with multiple hazardous exposures) had an occupational risk factor. (3) Among medications taken for at least six months, only 6-mercaptopurine use was associated with cancer (OR 10.8, CI 1.1-108.7). In conclusion, proximal small bowel disease, 6-mercaptopurine use, and hazardous occupations are associated with cancer of the small bowel in patients with Crohn's disease and can be added to the list of suspected risk factors. PMID:1499440

  13. 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.

  14. 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

  15. 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

  16. Imaging of inflammatory bowel disease. How?

    International Nuclear Information System (INIS)

    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.)

  17. 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 ...

  18. 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

  19. 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.

  20. 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.

  1. 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

  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. Disease Course and Surgery Rates in Inflammatory Bowel Disease

    DEFF Research Database (Denmark)

    Vester-Andersen, Marianne K; Prosberg, Michelle V; Jess, Tine; Andersson, Mikael; Bengtsson, Bo G; Blixt, Thomas; Munkholm, Pia; Bendtsen, Flemming; Vind, Ida

    2014-01-01

    OBJECTIVES: In this population-based 7-year follow-up of incident patients with ulcerative colitis (UC) or Crohn's disease (CD), we aimed to describe disease progression and surgery rates in an era influenced by the increased use of immunosuppressants and the introduction of biological therapy....... 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......, immunomodulators, and anti-tumor necrosis factor agents in CD was 86.4%, 64.3%, and 23.5%, respectively. The rate of first-time intestinal resection in CD was 29.1% (n=62), and the 7-year cumulative risk was 28.5%. The cumulative risk of colectomy in UC was 12.5% at 7 years. CONCLUSIONS: UC and CD are dynamic...

  4. 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...

  5. 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...

  6. 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.

  7. 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.

  8. 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...

  9. 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 ...

  10. 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...

  11. Assessment of Disease Activity in Small Bowel Crohn’s Disease: Comparison between Endoscopy and Magnetic Resonance Enterography Using MRIA and Modified MRIA Score

    Directory of Open Access Journals (Sweden)

    Arnaldo Scardapane

    2015-01-01

    Full Text Available Objectives. To retrospectively compare the results of the MRIA (magnetic resonance index of activity with a modified MRIA (mMRIA, which was calculated excluding from MRIA formula the data of relative contrast enhancement (RCE. Materials and Methods. MR-E and corresponding endoscopic records of 100 patients were reviewed. MRIA, mMRIA, and SES endoscopic index were calculated for all the patients. Namely, MRIA was calculated as follows: (1.5 × wall thickening + 0.02 × RCE + 5 × intramural edema + 10 × ulcers, while mMRIA was calculated with the modified formula (1.5 × wall thickening + 5 × intramural edema + 10 × ulcers. Results. Mean MRIA and mMRIA values were 19.3 and 17.68, respectively p<0.0001. A significant correlation p<0.0001 was observed between MRIA and mMRIA scores and between both MR indexes and SES p<0.0001. Conclusions. mMRIA was comparable to MRIA in the evaluation of disease activity in Crohn’s disease.

  12. Assessment of Disease Activity in Small Bowel Crohn's Disease: Comparison between Endoscopy and Magnetic Resonance Enterography Using MRIA and Modified MRIA Score

    Science.gov (United States)

    Scardapane, Arnaldo; Ambrosi, Annalisa; Salinaro, Emanuela; Mancini, Maria Elisabetta; Principi, Mariabeatrice; Di Leo, Alfredo; Lorusso, Filomenamila; Stabile Ianora, Amato Antonio; Angelelli, Giuseppe

    2015-01-01

    Objectives. To retrospectively compare the results of the MRIA (magnetic resonance index of activity) with a modified MRIA (mMRIA), which was calculated excluding from MRIA formula the data of relative contrast enhancement (RCE). Materials and Methods. MR-E and corresponding endoscopic records of 100 patients were reviewed. MRIA, mMRIA, and SES endoscopic index were calculated for all the patients. Namely, MRIA was calculated as follows: (1.5 × wall thickening + 0.02 × RCE + 5 × intramural edema + 10 × ulcers), while mMRIA was calculated with the modified formula (1.5 × wall thickening + 5 × intramural edema + 10 × ulcers). Results. Mean MRIA and mMRIA values were 19.3 and 17.68, respectively (p < 0.0001). A significant correlation (p < 0.0001) was observed between MRIA and mMRIA scores and between both MR indexes and SES (p < 0.0001). Conclusions. mMRIA was comparable to MRIA in the evaluation of disease activity in Crohn's disease. PMID:26759554

  13. 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...

  14. 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

  15. 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.

  16. 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

  17. 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.

  18. 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].

  19. 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. PMID:25267242

  20. The Economic Impact of Inflammatory Bowel Disease in Canada

    OpenAIRE

    2004-01-01

    Longobardi and colleagues examined the effect of inflammatory bowel disease (IBD) on employment, using data from 10,891 respondents aged 20 to 64 years from the 1998 cycle of the Canadian National Population Health Survey (NPHS) (1). This sample included 187 (1.7%) subjects who self-reported IBD or a similar bowel disorder. A significantly greater proportion of IBD than non-IBD respondents reported that they were not in the labour force (28.9% versus 18.5%). Even after adjusting for other fac...

  1. 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 ...

  2. 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

  3. 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...

  4. MR imaging of the small bowel in Crohn's disease

    International Nuclear Information System (INIS)

    MR and CT techniques optimized for small bowel imaging are playing an increasing role in the evaluation of small bowel disorders. Several studies have shown the advantage of these techniques over tradition barium fluoroscopic examinations secondary to improvements in spatial and temporal resolution combined with improved bowel distending agents. The preference of MR vs. CT has been geographical and based on expertise and public policy. With the increasing awareness of radiation exposure, there has been a more global interest in implementing techniques that either reduce or eliminate radiation exposure [Brenner DJ, Hall EJ. Computed tomography-an increasing source of radiation exposure. N Engl J Med 2007;357:2277-84]. This is especially important in patients with chronic diseases such as inflammatory bowel disease who may require multiple studies over a lifetime or in studies that require sequential imaging time points such as in assessment of gastrointestinal motility [Froehlich JM, Patak MA, von Weymarn C, Juli CF, Zollikofer CL, Wentz KU. Small bowel motility assessment with magnetic resonance imaging. J Magn Reson Imaging 2005;21:370-75]. A recent study showed that certain subgroups of patients with Crohn's disease may be exposed to higher doses of radiation; those diagnosed at an early age, those with upper tract inflammation, penetrating disease, requirement of intravenous steroids, infliximab or multiple surgeries [Desmond AN, O'Regan K, Curran C, et al. Crohn's disease: factors associated with exposure to high levels of diagnostic radiation. Gut 2008;57:1524-29]. Therefore it has been suggested that techniques that can reduce or eliminate radiation exposure should be considered for imaging [Brenner DJ, Hall EJ. Computed tomography-an increasing source of radiation exposure. N Engl J Med 2007;357:2277-84]. Owing to the excellent softtissue contrast, direct multiplanar imaging capabilities, new ultrafast breath-holding pulse sequences, lack of ionizing

  5. 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...

  6. 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...

  7. Role of Smad7 in inflammatory bowel diseases

    Directory of Open Access Journals (Sweden)

    Giovanni Monteleone

    2012-01-01

    Full Text Available 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 murine 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.

  8. 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.

  9. 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...... 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...... evidence of treatment was difficult to obtain, and epidemiologic data on the rarer forms of extraintestinal manifestations are scarce. However, updates on the pathophysiology and treatment regimens are given for each of these disorders. This paper offers a current review of original research papers and...

  10. 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

  11. Bacteria Associated With Colitis and Inflammatory Bowel Disease

    OpenAIRE

    Ye, Jingxiao

    2009-01-01

    Human gastrointestinal (GI) tract inhabits huge amount of microorganisms which contribute to the immune response in the gut. An immune system disorder disease inflammatory bowel disease (IBD) was believed to be associated with several factors including gut bacteria, immunological responses, and genetic characteristic. Yet, the etiology of the IBD is not clear. Experiments on animal models and human samples had supported that commensal bacteria play an important role in the IBD pathogenesis. T...

  12. 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...

  13. 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.

  14. 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...

  15. 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...

  16. Diet and nutritional factors in inflammatory bowel diseases

    OpenAIRE

    Owczarek, Danuta; Rodacki, Tomasz; Domagała-Rodacka, Renata; Cibor, Dorota; Mach, Tomasz

    2016-01-01

    Inflammatory bowel disease (IBD) development is affected by complex interactions between environmental factors, changes in intestinal flora, various predisposing genetic properties and changes in the immune system. Dietary factors seem to play an underestimated role in the etiopathogenesis and course of the disease. However, research about food and IBD is conflicting. An excessive consumption of sugar, animal fat and linoleic acid is considered a risk factor for IBD development, whereas a hig...

  17. 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.

  18. 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 ...

  19. Inflammatory bowel diseases in Finland : epidemiology, malignancies and mortality

    OpenAIRE

    Jussila, Airi

    2014-01-01

    Inflammatory bowel diseases (IBDs), CrohnÂŽs disease (CD) and ulcerative colitis (UC) are characterized by chronic mucosal inflammation and subsequent lesions in the colon or even throughout the gastrointestinal tract with involvement of other organs. They are chronic inflammatory conditions with long-term morbidity and often requiring expensive healthcare. The aetiology of IBD has remained obscure and is thought to be multifactorial. Over the past few years IBD has become a global disea...

  20. What’s new in inflammatory bowel disease in 2008?

    OpenAIRE

    Baumgart, Daniel C.

    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 epidemiology, intestinal physiology, mucosal immunology, mechanisms of epithelial cell injury and restitution, current medical therapy, modern surgical management, important extra-intestinal complications such as primary sclerosing cholangitis, cholangiocellular carcinoma and autoimmune hepatitis as well...

  1. Pancreatic and hepatobiliary disorders in inflammatory bowel disease

    OpenAIRE

    Heikius, B. (Bengt)

    2000-01-01

    Abstract Extraintestinal manifestations in inflammatory bowel disease (IBD) have been described with varying frequencies. The aim of this study was to estimate the prevalence of pancreatic duct abnormalities, exocrine and endocrine dysfunction, elevated pancreatic enzymes, hepato-biliary disease, coexisting cholangiographic and pancreatographic duct changes, and elevated serum levels of fibrosis markers in IBD, and to correlate the findings with clinical, endoscopic and histologic variable...

  2. Growth and body composition in children with Inflammatory Bowel Disease

    OpenAIRE

    Keshtkaran, Mona

    2012-01-01

    Crohn`s Disease (CD) and Ulcerative Colitis (UC), two types of Inflammatory Bowel Disease (IBD), are chronic, relapsing inflammatory conditions of the gastro-intestinal tract. Approximately 25% of cases are diagnosed in childhood and adolescence; affected children suffer from symptoms such as abdominal pain, bloody diarrhoea, fatigue, and poor nutritional state. Poor growth, in terms of both height and weight, precedes diagnosis and further weight may be lost with successive inflammatory exac...

  3. The Role of Physical Exercise in Inflammatory Bowel Disease

    OpenAIRE

    Jan Bilski; Bartosz Brzozowski; Agnieszka Mazur-Bialy; Zbigniew Sliwowski; Tomasz Brzozowski

    2014-01-01

    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 literat...

  4. Non Steroidal Anti-Inflammatory Drugs and Inflammatory Bowel Disease

    OpenAIRE

    Amir Klein; Rami Eliakim

    2010-01-01

    Inflammatory Bowel Diseases (IBD) are an immune mediated chronic or relapsing disorders of the gastrointestinal (GI) tract. IBD is characterized by a chronic intestinal inflammatory process with various components contributing to the pathogenesis of the disease including environmental factors such as smoking or use of Non Steroidal Anti-Inflammatory Drugs (NSAIDS). NSAIDS are among the most commonly used medications for the treatment of various inflammatory conditions. The main factor limitin...

  5. 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...

  6. 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...

  7. 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

  8. 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.

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

    International Nuclear Information System (INIS)

    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

  10. 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.

  11. 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.

  12. 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

  13. 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.

  14. Nanoparticle-based imaging of inflammatory bowel disease.

    Science.gov (United States)

    Wu, Yingwei; Briley, Karen; Tao, Xiaofeng

    2016-03-01

    Although inflammatory bowel disease (IBD) has been extensively studied, the pathogenesis is still not completely understood. As a result, the treatment options remain unsatisfactory and nonspecific. With the rapid advancement of diagnostic imaging techniques, imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) are playing a more important role in IBD diagnosis and evaluation. Recent developments in nanotechnology utilize an interdisciplinary approach to specifically target molecular or cellular IBD pathological process thereby generating nanoparticles (NPs) with high specificity and diagnostic and/or therapeutic efficacy. Nano-based imaging, which incorporates nanotechnology and imaging modalities, may allow for the early detection of IBD, the monitoring of disease activity, and may be used to monitor the therapeutic response at cellular and/or molecular level. In this review, we highlight issues related to nano-based imaging and its application in IBD field. WIREs Nanomed Nanobiotechnol 2016, 8:300-315. doi: 10.1002/wnan.1357 For further resources related to this article, please visit the WIREs website. PMID:26371464

  15. 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.

  16. 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.

  17. Ultrasound in Crohn's disease of the small bowel

    International Nuclear Information System (INIS)

    Objective: The purpose of this work is to prospectively evaluate high resolution ultrasonography with graded compression in the ability to detect Crohn's disease of the small bowel (CDSB) together with its complications and activity signs, compared with enteroclysis, CT and immunoscintigraphy in the mirror of the final diagnosis. Methods and material: In a series of 73 consecutive patients, who were referred for enteroclysis with suspected Crohn's disease of the small bowel computed tomography (CT), ultrasound (US), immunoscintigraphy with 99mTc labeled monoclonal antigranulocyte antibody (AGAb) examinations were performed within 10 days from each other. For the final evaluation the diagnosis of CDSB was based on combination of clinical and enteroclysis findings (73 cases) and in 17 cases additional surgical and pathological data were available. The results of other modalities were blinded to the radiologists performing and reading out the exams. The diagnostic values of each modality was assessed also in those 18 patients, who had early Crohn's disease. In the group of 43 patients with proven CDSB who had all the four imaging modalities, the modalities were compared in their ability to demonstrate various pathological conditions related to CD. Increased (>500 ml/min) flow measured by Doppler US in the superior mesenteric artery and increased color signs in the gut wall seen by power Doppler sonography were compared to CDAI. Results: Of the 73 patients the combination of enteroclysis and clinical tests demonstrated CDSB in 47. The sensitivity, specificity and accuracy of ultrasound were 88.4, 93.3 and 90.4%, respectively. Enteroclysis was the most accurate method. CT was more sensitive than US, but less specific. The accuracy of US, CT and scintigraphy were similar. In the group of 18 patients, who had early CDSB, the sensitivity of US decreased to only 67%, CT and scintigraphy had higher values. Intra- and perimural abscesses, and sinus tracts were also more

  18. Comparison of three commercial fecal calprotectin ELISA test kits used in patients with Inflammatory Bowel Disease

    DEFF Research Database (Denmark)

    Mirsepasi-Lauridsen, Hengameh Chloé; Bachmann Holmetoft, Ulla; Ingdam Halkjær, Sofie;

    2016-01-01

    OBJECTIVE: Fecal calprotectin is a noninvasive marker of intestinal inflammation used to distinguish between functional and organic bowel diseases and to evaluate disease activity among patients with Inflammatory Bowel Disease (IBD). The goal of this study was to compare three different ELISA tests...... measuring calprotectin in their accuracy to detect IBD and to distinguish between IBD patients with active or inactive disease. MATERIAL AND METHODS: This study includes in total 148 fecal samples, 96 from patients with a previously confirmed IBD diagnosis and 52 from healthy controls, aged from 25 to 86...... tests (EK-CAL, CALPRO and HK325) were performed on fecal specimens and results compared. RESULTS: The CALPRO calprotectin ELISA test was shown to have the best specificity of 96% compared to the HK325 and the EK-CAL calprotectin ELISA tests with 28% specificity and 74% specificity, respectively. A...

  19. The role of vitamin D3 in inflammatory bowel diseases.

    Science.gov (United States)

    Kosmowska-Miśków, Agnieszka

    2014-01-01

    Vitamin D3, combined with its nuclear receptor, regulates more than 900 genes, which is the reason why its effect is pleiotropic. Among other effects, it influences the immunological system. Its deficit may be one of the environmental factors taking part in the development of auto-immunological diseases. The studies reveal that, among others things, inflammatory bowel diseases occur in higher latitudes, with lower exposure to solar radiation and with decreased production of vitamin D3 in the skin. Patients with inflammatory bowel disease have vitamin D3 deficiency more frequently. The application of vitamin D3, especially among adults with inflammatory bowel diseases, positively influences bone turnover markers and mostly due to its influence on immunological processes, vitamin D3 may be useful in the treatment of the primary health condition. It is necessary to determine the dosage range, as well as the optimal level of vitamin D3 metabolite-25OHD3, where the immunosuppressant effect is the best, with no toxic effects. Studies of vitamin D3 analogues deprived of the hypercalcemic influence, but with other merits of the basic substance remaining intact, are particularly promising. PMID:25166432

  20. 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.

  1. 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

  2. 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...

  3. Rifaximin in the treatment of inflammatory bowel disease

    OpenAIRE

    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 long-term therapy. Rifaximin α 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’...

  4. 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...

  5. Clostridium difficile infection in patients with inflammatory bowel disease

    OpenAIRE

    Czepiel, Jacek; Biesiada, Grażyna; Perucki, William; Mach, Tomasz

    2014-01-01

    Clostridium difficile is a bacterium widely distributed in the human environment. In the last decade the incidence and severity of Clostridium difficile infection has grown, particularly in Europe and North America, making it one of the more common nosocomial infections. A group particularly susceptible to Clostridium difficile infection are patients with inflammatory bowel disease, especially those with involvement of the colon. This paper presents relevant data on Clostridium difficile infe...

  6. 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...

  7. Management of cutaneous disorders related to inflammatory bowel disease

    OpenAIRE

    Pellicer, Zaira; Santiago, Jesus Manuel; Rodriguez, Alejandro; Alonso, Vicent; Antón, Rosario; Bosca, Marta Maia

    2012-01-01

    Almost one-third of patients with inflammatory bowel disease (IBD) develop skin lesions. Cutaneous disorders associated with IBD may be divided into 5 groups based on the nature of the association: specific manifestations (orofacial and metastatic IBD), reactive disorders (erythema nodosum, pyoderma gangrenosum, pyodermatitis-pyostomatitis vegetans, Sweet’s syndrome and cutaneous polyarteritis nodosa), miscellaneous (epidermolysis bullosa acquisita, bullous pemphigoid, linear IgA bullous dise...

  8. Pharmacologic therapy for inflammatory bowel disease refractory to steroids

    OpenAIRE

    Martínez-Montiel MP; Casis-Herce B; Gómez-Gómez GJ; Masedo-González A; Yela-San Bernardino C; Piedracoba C; Castellano-Tortajada G

    2015-01-01

    MP Martínez-Montiel, B Casis-Herce , GJ Gómez-Gómez, A Masedo-González, C Yela-San Bernardino, C Piedracoba, G Castellano-Tortajada Division of Gastroenterology, Hospital 12 de Octubre, Madrid, SpainAbstract: Although corticosteroids are an effective treatment for induction of remission in inflammatory bowel disease (IBD), many patients are dependent on or refractory to corticosteroids. This review is based on scrutinizing current literature with emphasis on random...

  9. Pharmacologic therapy for inflammatory bowel disease refractory to steroids

    OpenAIRE

    Martinez-Montiel, Pilar

    2015-01-01

    MP Martínez-Montiel, B Casis-Herce , GJ Gómez-Gómez, A Masedo-González, C Yela-San Bernardino, C Piedracoba, G Castellano-Tortajada Division of Gastroenterology, Hospital 12 de Octubre, Madrid, SpainAbstract: Although corticosteroids are an effective treatment for induction of remission in inflammatory bowel disease (IBD), many patients are dependent on or refractory to corticosteroids. This review is based on scrutinizing current literature with em...

  10. Pharmacologic therapy for inflammatory bowel disease refractory to steroids

    Science.gov (United States)

    Martínez-Montiel, MP; Casis-Herce, B; Gómez-Gómez, GJ; Masedo-González, A; Yela-San Bernardino, C; Piedracoba, C; Castellano-Tortajada, G

    2015-01-01

    Although corticosteroids are an effective treatment for induction of remission in inflammatory bowel disease (IBD), many patients are dependent on or refractory to corticosteroids. This review is based on scrutinizing current literature with emphasis on randomized controlled trials, meta-analyses, and Cochrane reviews on the management of IBD refractory to corticosteroids. Based on this evidence, we propose algorithms and optimization strategies for use of immunomodulator and biologic therapy in IBD refractory to corticosteroids. PMID:26316792

  11. 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...

  12. 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...

  13. 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...

  14. 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 ...

  15. 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...

  16. 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...

  17. 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.

  18. 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.

  19. The burden of inflammatory bowel disease in Europe

    DEFF Research Database (Denmark)

    Burisch, Johan; Jess, Tine; Martinato, Matteo; Lakatos, Peter L

    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...

  20. 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...

  1. 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.

  2. 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.

  3. Low-Radiation-Dose Modified Small Bowel CT for Evaluation of Recurrent Crohn's Disease

    Directory of Open Access Journals (Sweden)

    A. Z. Kielar

    2012-01-01

    Full Text Available Crohn's disease affects any part of the GI tract, commonly the terminal ileum. To decrease radiation exposure we developed a low-radiation-dose unenhanced CT (modified small Bowel CT, MBCT to evaluate the small bowel using hyperdense oral contrast. Technique. MBCT was investigated in patients with pathologically proven Crohn's disease presenting with new symptoms from recurrent inflammation or stricture. After ethics board approval, 98 consecutive patients were retrospectively evaluated. Kappa values from two independent reviewers were calculated for presence of obstruction, active inflammation versus chronic stricture, and ancillary findings. Forty-two patients underwent surgery or colonoscopy within 3 months. Results. Kappa was 0.84 for presence of abnormality versus a normal exam and 0.89 for differentiating active inflammation from chronic stricture. Level of agreement for presence of skip areas, abscess formation, and fistula was 0.62, 0.75, and 0.78, respectively. In the subset with “gold standard” follow-up, there was 83% agreement. Conclusions. MBCT is a low-radiation technique with good to very good interobserver agreement for determining presence of obstruction and degree of disease activity in patients with Crohn's disease. Further investigation is required to refine parameters of disease activity compared to CT enterography and small bowel follow through.

  4. 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...

  5. Endothelial dysfunction in inflammatory bowel diseases: Pathogenesis, assessment and implications.

    Science.gov (United States)

    Cibor, Dorota; Domagala-Rodacka, Renata; Rodacki, Tomasz; Jurczyszyn, Artur; Mach, Tomasz; Owczarek, Danuta

    2016-01-21

    Endothelial dysfunction is considered one of the etiological factors of inflammatory bowel disease (IBD). An inflammatory process leads to functional and structural changes in the vascular endothelium. An increase of leukocyte adhesiveness and leukocyte diapedesis, as well as an increased vascular smooth muscle tone and procoagulant activity is observed. Structural changes of the vascular endothelium comprise as well capillary and venule remodeling and proliferation of endothelial cells. Hypoxia in the inflammatory area stimulates angiogenesis by up-regulation of vascular endothelial growth factor, fibroblast growth factor and tumor necrosis factor-α. Inflammatory mediators also alter the lymphatic vessel function and impair lymph flow, exacerbating tissue edema and accumulation of dead cells and bacteria. The endothelial dysfunction might be diagnosed by the use of two main methods: physical and biochemical. Physical methods are based on the assessment of large arteries vasodilatation in response to an increased flow and receptors stimulation. Flow-mediated vasodilatation (FMD) is the method that is the most widely used; however, it is less sensitive in detecting early changes of the endothelium function. Most of the studies demonstrated a decrease of FMD in IBD patients but no changes in the carotic intima-media thickness. Biochemical methods of detecting the endothelial dysfunction are based on the assessment of the synthesis of compounds produced both by the normal and damaged endothelium. The endothelial dysfunction is considered an initial step in the pathogenesis of atherosclerosis in the general population. In IBD patients, the risk of cardiovascular diseases is controversial. Large, prospective studies are needed to establish the role of particular medications or dietary elements in the endothelial dysfunction as well to determine the real risk of cardiovascular diseases. PMID:26811647

  6. 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

  7. Cogan's Syndrome in Patients With Inflammatory Bowel Disease - A Case Series

    DEFF Research Database (Denmark)

    Vavricka, Stephan R; Greuter, Thomas; Scharl, Michael; Mantzaris, Gerassimos; Shitrit, Ariella B; Filip, Rafal; Karmiris, Konstantinos; Thoeringer, Christoph K; Boldys, Hubert; Wewer, Anne V; Yanai, Henit; Flores, Cristina; Schmidt, Carsten; Kariv, Revital; Rogler, Gerhard; Rahier, Jean-François

    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 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...... 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...

  8. 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.

  9. Inflammatory Bowel Disease Patients Are at Increased Risk of Invasive Pneumococcal Disease

    DEFF Research Database (Denmark)

    Kantsø, Bjørn; Simonsen, Jacob; Hoffmann, Steen;

    2015-01-01

    OBJECTIVES: Inflammatory bowel disease (IBD), Crohn's disease (CD), and ulcerative colitis (UC) are chronic diseases characterized by an inappropriate immune response, which may also increase the risk of infections. We investigated the risk of invasive pneumococcal disease (IPD) before and after...

  10. Pharmacogenetics of azathioprine in inflammatory bowel disease: A role for glutathione-S-transferase?

    OpenAIRE

    Stocco, Gabriele; Pelin, Marco; Franca, Raffaella; De Iudicibus, Sara; Cuzzoni, Eva; Favretto, Diego; Martelossi, Stefano; Ventura, Alessandro; Decorti, Giuliana

    2014-01-01

    Azathioprine is a purine antimetabolite drug commonly used to treat inflammatory bowel disease (IBD). In vivo it is active after reaction with reduced glutathione (GSH) and conversion to mercaptopurine. Although this reaction may occur spontaneously, the presence of isoforms M and A of the enzyme glutathione-S-transferase (GST) may increase its speed. Indeed, in pediatric patients with IBD, deletion of GST-M1, which determines reduced enzymatic activity, was recently associated with reduced s...

  11. The epidemiology of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Burisch, Johan; Munkholm, Pia

    2015-01-01

    significantly higher among IBD patients. CONCLUSION: In recent years, self-management and patient empowerment, combined with evolving eHealth solutions, has utilized epidemiological knowledge on disease patterns and has been improving compliance and the timing of adjusting therapies, thus optimizing efficacy by...

  12. 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.

  13. Spiral CT colonography in inflammatory bowel disease

    International Nuclear Information System (INIS)

    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

  14. 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

  15. Capsule Endoscopy in Inflammatory Bowel Disease: Current Applications.

    Science.gov (United States)

    Singeap, Ana-Maria; Stanciu, Carol; Cojocariu, Camelia; Sfarti, Catalin; Trifan, Anca

    2015-06-01

    Since its introduction to clinical practice in 2001, small-bowel capsule endoscopy (SBCE) has become an important investigation procedure in many small bowel pathologies, including both suspected and known Crohn's disease (CD). SBCE has higher diagnostic yield than other radiologic and endoscopic modalities used in evaluation of patients with suspected CD. In addition, SBCE has proved useful, in a non-invasive and safe manner, as a monitoring method for evaluating the severity and extent of lesions, postoperative recurrence, and mucosal healing in patients with known CD. Monitoring of colonic inflammation in patients with ulcerative colitis (UC) using second-generation of colon capsule endoscopy (CCE-2) has also been reported. Besides its advantages, CE also has several limitations such as the inability to obtain biopsies and lack of therapeutic capabilities, hopefully to be overcome in the near future by advances in modern technologies. PMID:26058935

  16. Biologic therapy in inflammatory bowel disease

    DEFF Research Database (Denmark)

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

    2013-01-01

    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...... not preferred. Further treatment strategy depends on the response to induction therapy. Treatment efficacy is assessed by symptoms, clinical markers, paraclinical parameters and possibly by endoscopy. Effect of maintenance therapy should be evaluated at least every 26-52 weeks. During treatment with...

  17. 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

  18. 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.

  19. Assessment of Disease Activity in Small Bowel Crohn’s Disease: Comparison between Endoscopy and Magnetic Resonance Enterography Using MRIA and Modified MRIA Score

    OpenAIRE

    Arnaldo Scardapane; Annalisa Ambrosi; Emanuela Salinaro; Maria Elisabetta Mancini; Mariabeatrice Principi; Alfredo Di Leo; Filomenamila Lorusso; Amato Antonio Stabile Ianora; Giuseppe Angelelli

    2015-01-01

    Objectives. To retrospectively compare the results of the MRIA (magnetic resonance index of activity) with a modified MRIA (mMRIA), which was calculated excluding from MRIA formula the data of relative contrast enhancement (RCE). Materials and Methods. MR-E and corresponding endoscopic records of 100 patients were reviewed. MRIA, mMRIA, and SES endoscopic index were calculated for all the patients. Namely, MRIA was calculated as follows: (1.5 × wall thickening + 0.02 × RCE + 5 × intramural ed...

  20. Cytokine and anti-cytokine therapies for inflammatory bowel disease.

    Science.gov (United States)

    Ogata, Haruhiko; Hibi, Toshifumi

    2003-01-01

    Although the pathogenesis of inflammatory bowel disease (IBD) remains elusive, it appears that there is chronic activation of the immune and inflammatory cascade in genetically susceptible individuals. Current disease management guidelines have therefore focused on the use of anti-inflammatory agents, aminosalicylates and corticosteroids. These conventional therapies continue to be a first choice in the management of IBD. Immunomodulators, such as azathioprine, 6-mercaptopurine, methotrexate or cyclosporin, are demonstrating increasing importance against steroid-resistant and steroid-dependent patients. However, some patients are still refractory to these therapies. Recent advances in the understanding of the pathophysiological conditions of IBD have provided new immune system modulators as therapeutic tools. Other immunosuppressive agents including FK506 and thalidomide have expanded the choice of medical therapies available for certain subgroups of patients. Furthermore, biological therapies have begun to assume a prominent role. Studies with chimeric monoclonal anti-TNF-alpha antibody treatment have been reported with dramatic successes. However, observations in larger numbers of treated patients are needed to explicate fully the safety of or risks posed by this agent such as developing lymphoma, or other malignancies. Another anti-inflammatory cytokine-therapy includes anti anti-IL-6R, anti-IL-12 or toxin-conjugated anti IL-7R, recombinant cytokines (IL-10 or IL-11). Given the diversity of proinflammatory products under its control, NF-kappaB may be viewed as a master switch in lymphocytes and macrophages, regulating inflammation and immunity. Although some of them still need more confirmatory studies, those immune therapies will provide new insights into cell-based and gene-based treatment against IBD in near future. PMID:12769750

  1. 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.

  2. 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.

  3. Increased risk of venous thromboembolism and arterial cardiovascular events in patients with inflammatory bowel disease

    DEFF Research Database (Denmark)

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

    2012-01-01

    This focused review describes the current knowledge of the association between inflammatory bowel disease (IBD) and cardiovascular disease. Atherosclerosis is a chronic inflammatory disease, and as well as venous thromboembolism this disease shares inflammatory mechanisms with IBD. Patients...

  4. 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...... and UC in patients with psoriasis. METHODS: All Danish individuals aged ≥ 18 years between 1 January 1997 and 31 December 2012 were linked in nationwide registers. Psoriasis severity was defined in two models: hospital visits and medication. Incidence rates per 10 000 person-years were calculated, and...... incidence rate ratios (IRRs) were estimated by Poisson regression. RESULTS: In the total cohort (n = 5 554 100) there were 75 209 incident cases of psoriasis, 11 309 incident cases of CD and 30 310 incident cases of UC, during follow-up. The adjusted IRRs (95% confidence intervals) of CD were 1·28 (1...

  5. 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. PMID:26632379

  6. 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.

  7. Bladder, bowel, and sexual dysfunction in Parkinson's disease.

    Science.gov (United States)

    Sakakibara, Ryuji; Kishi, Masahiko; Ogawa, Emina; Tateno, Fuyuki; Uchiyama, Tomoyuki; Yamamoto, Tatsuya; Yamanishi, Tomonori

    2011-01-01

    Bladder dysfunction (urinary urgency/frequency), bowel dysfunction (constipation), and sexual dysfunction (erectile dysfunction) (also called "pelvic organ" dysfunctions) are common nonmotor disorders in Parkinson's disease (PD). In contrast to motor disorders, pelvic organ autonomic dysfunctions are often nonresponsive to levodopa treatment. The brain pathology causing the bladder dysfunction (appearance of overactivity) involves an altered dopamine-basal ganglia circuit, which normally suppresses the micturition reflex. By contrast, peripheral myenteric pathology causing slowed colonic transit (loss of rectal contractions) and central pathology causing weak strain and paradoxical anal sphincter contraction on defecation (PSD, also called as anismus) are responsible for the bowel dysfunction. In addition, hypothalamic dysfunction is mostly responsible for the sexual dysfunction (decrease in libido and erection) in PD, via altered dopamine-oxytocin pathways, which normally promote libido and erection. The pathophysiology of the pelvic organ dysfunction in PD differs from that in multiple system atrophy; therefore, it might aid in differential diagnosis. Anticholinergic agents are used to treat bladder dysfunction in PD, although these drugs should be used with caution particularly in elderly patients who have cognitive decline. Dietary fibers, laxatives, and "prokinetic" drugs such as serotonergic agonists are used to treat bowel dysfunction in PD. Phosphodiesterase inhibitors are used to treat sexual dysfunction in PD. These treatments might be beneficial in maximizing the patients' quality of life. PMID:21918729

  8. 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

  9. CT enterography: a preliminary experience in the evaluation of small bowel diseases

    Energy Technology Data Exchange (ETDEWEB)

    Costa-Silva, Luciana [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Medical School. Dept. of Supplementary Propedeutics; Martins, Tatiana [Ecoar Medicina Diagnostica, Belo Horizonte, MG (Brazil); Passos, Maria do Carmo Friche [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Medical School. Dept. of Medical Practice

    2010-09-15

    Objective: the present study was aimed at demonstrating the value of computed tomography enterography (CT enterography) and how this imaging method can be useful in the diagnostic elucidation and assessment of patients with small bowel diseases. Materials and methods: retrospective evaluation of 35 patients submitted to CT enterography in a 16-row multidetector CT equipment from May/2008 to March/2009. All the patients received intravenous and neutral oral iodinated contrast agents (polyethylene glycol). Main indications were: Crohn's disease, diarrhea of undetermined origin and suspicion of neoplasia. Results: a good correlation was observed between CT enterography findings and clinical, laboratory and endoscopic data related to the disease activity in patients with Crohn's disease. In 15 cases alterations compatible with Crohn's disease were identified, nine of them suggesting disease activity. A diagnosis was achieved in the majority of the patients with diarrhea. Carcinoid tumors were identified in two patients. Conclusion: CT enterography is a simple and effective method in the evaluation of inflammatory/neoplastic small bowel diseases, particularly in cases of Crohn's disease, indicating disease activity. One of the main advantages of this method is the possibility of evaluating associated mesenteric and extraintestinal alterations (author)

  10. CT enterography: a preliminary experience in the evaluation of small bowel diseases

    International Nuclear Information System (INIS)

    Objective: the present study was aimed at demonstrating the value of computed tomography enterography (CT enterography) and how this imaging method can be useful in the diagnostic elucidation and assessment of patients with small bowel diseases. Materials and methods: retrospective evaluation of 35 patients submitted to CT enterography in a 16-row multidetector CT equipment from May/2008 to March/2009. All the patients received intravenous and neutral oral iodinated contrast agents (polyethylene glycol). Main indications were: Crohn's disease, diarrhea of undetermined origin and suspicion of neoplasia. Results: a good correlation was observed between CT enterography findings and clinical, laboratory and endoscopic data related to the disease activity in patients with Crohn's disease. In 15 cases alterations compatible with Crohn's disease were identified, nine of them suggesting disease activity. A diagnosis was achieved in the majority of the patients with diarrhea. Carcinoid tumors were identified in two patients. Conclusion: CT enterography is a simple and effective method in the evaluation of inflammatory/neoplastic small bowel diseases, particularly in cases of Crohn's disease, indicating disease activity. One of the main advantages of this method is the possibility of evaluating associated mesenteric and extraintestinal alterations (author)

  11. 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

  12. Inflammatory bowel disease: is it a primary immunodeficiency?

    Science.gov (United States)

    Glocker, Erik; Grimbacher, Bodo

    2012-01-01

    Inflammatory bowel diseases (IBD) such as ulcerative colitis and Crohn's disease are chronic and relapsing conditions, characterized by abdominal pain, diarrhea, bleeding and malabsorption. IBD has been considered a hyperinflammatory state due to disturbed interactions between the immune system and the commensal bacterial flora of the gut. However, there is evidence that Crohn's disease might be the consequence of a reduced release of pro-inflammatory cytokines and an impaired acute inflammatory response, thereby suggesting that IBD might be an immunodeficiency rather than an excessive inflammatory reaction. This theory has been supported by observations in patients with primary immunodeficiencies such as the Wiskott-Aldrich syndrome and IPEX (immunodysregulation, polyendocrinopathy, enteropathy, X-linked syndrome). In contrary, defects in the anti-inflammatory down-regulation of the immune response as they are seen in patients with Mendelian defects in the IL10 signaling pathway support the hyper-inflammatory theory. In this review, we describe and discuss primary immunodeficiencies associated with IBD and show that the bowel is a highly sensitive indicator of dysregulations, making IBD a model disease to study and identify key regulators required to balance the human mucosal immune system. PMID:21997382

  13. 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.

  14. 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.

  15. Role of Rifaximin in Inflammatory Bowel Disease Treatment.

    Science.gov (United States)

    Scribano, Maria Lia

    2015-01-01

    Inflammatory bowel diseases are characterised by an altered composition of the intestinal microbiota, which may contribute to their development and maintenance in susceptible hosts. The involvement of bacteria in the inflammation has provided the rationale for a therapeutic manipulation of the gut flora through the use of antibiotics. However, the role of antibiotics has not been clearly demonstrated and their long-term employment is often restricted by an elevated number of adverse events. The use of rifaximin, which is characterised by an excellent safety profile thanks to its negligible intestinal absorption, appears to have some promise. Study results suggest that rifaximin could be useful in Crohn's disease, and a new gastroresistant formulation (rifaximin-extended intestinal release) has recently shown its efficacy in patients with moderate Crohn's disease. Less consistent data support the use of rifaximin in ulcerative colitis and in pouchitis, although the results of some studies have been encouraging. Further large controlled trials are warranted to confirm the role of rifaximin in inflammatory bowel disease treatment. PMID:26202194

  16. 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...

  17. 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...

  18. Inflammatory bowel disease: a paradigm for the link between coagulation and inflammation

    OpenAIRE

    Yoshida, Hideo; Granger, D. Neil

    2009-01-01

    Inflammatory bowel diseases (IBD) are associated with platelet activation and an increased risk for thromboembolism. While the mechanisms that underlie the altered platelet function and hypercoagulable state in IBD remain poorly understood, emerging evidence indicates that inflammation and coagulation are inter-dependent processes that can initiate a vicious cycle wherein each process propagates and intensifies the other. This review addresses the mechanisms that may account for the mutual ac...

  19. 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

    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 associa.......48). There was negligible heterogeneity among the study-specific associations. CONCLUSIONS: Our findings suggest that job strain, an indicator of work-related stress, is not a major risk factor for Crohn's disease or ulcerative colitis.......-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...

  20. Biologic targeting in the treatment of inflammatory bowel diseases [Retraction

    Directory of Open Access Journals (Sweden)

    Bosani M

    2014-01-01

    Full Text Available Bosani M, Ardizzone S, Porro GB. Biologics: Targets and Therapy. 2009;3:77–97.This paper has been retracted after we were made aware that it contains a large amount of reused, and uncited material that was not placed within quotation marks.The following statement has been supplied by Dr Sandro Ardizzone:The review entitled "Biologic targeting in the treatment of inflammatory bowel disease" has been commissioned by this journal and published in 2009 (Matteo Bosani, Sandro Ardizzone, Gabriele Bianchi Porro. Biologics: Targets & Therapy 2009;3:77–97. The paper was written by our young coworker (Dr M Bosani. He has consulted many papers, including our previous reviews published years before. The not perfect knowledge of English language has greatly influenced the writing of the paper itself. So he saved in word file several parts of our previous papers (Ardizzone S, Bianchi Porro G. Inflammatory bowel disease: new insights into pathogenesis and treatment. J Intern Med 2002;252:475–496 – Ardizzone S, Bianchi Porro G. Biologic therapy for inflammatory bowel disease. Drugs 2005:2253–2286, and then transferred to the final paper. He was unaware as we are, of the fact that he could not reuse previously published material in other journals. The reuse of this material was made in good faith.Taking our responsibility for what happened, we intend to apologize for this inconvenience to the Editor (Dr Doris Benbrook and Publisher (Dr Tim Hill. Moreover, for the reasons mentioned above, I consider appropriate to retract the paper itself.This retraction relates to this paper.

  1. 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

  2. Clostridium difficile Infection in Patients with Inflammatory Bowel Disease.

    Science.gov (United States)

    Fu, Nancy; Wong, Titus

    2016-06-01

    Clostridium difficile infection (CDI) is now the leading cause of nosocomial infection. There has been an upsurge of CDI in patients with inflammatory bowel disease (IBD). IBD patients with CDI have increased morbidity and mortality. The establishment, proliferation, and recurrence of CDI in IBD patients form a complex interplay of microbial, environmental, and host-susceptibility factors. Different risk factors have been found predisposing IBD patients to CDI. Vancomycin performs better than metronidazole in treating IBD patients with CDI. Fecal microbiota transplantation continues to be a very effective therapy. New therapeutic modalities such as vaccinations and bile salts are currently being investigated. PMID:27137789

  3. 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...

  4. 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...

  5. 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

  6. Comparative tolerability of treatments for inflammatory bowel disease.

    Science.gov (United States)

    Stein, R B; Hanauer, S B

    2000-11-01

    Despite limited understanding of therapeutic aetiopathogenesis of ulcerative colitis and Crohn's disease, there is a strong evidence base for the efficacy of pharmacological and biological therapies. It is equally important to recognise toxicity of the medical armamentarium for inflammatory bowel disease (IBD). Sulfasalazine consists of sulfapyridine linked to 5-aminosalicylic acid (5-ASA) via an azo bond. Common adverse effects related to sulfapyridine 'intolerance' include headache, nausea, anorexia, and malaise. Other allergic or toxic adverse effects include fever, rash, haemolytic anaemia, hepatitis, pancreatitis, paradoxical worsening of colitis, and reversible sperm abnormalities. The newer 5-ASA agents were developed to deliver the active ingredient of sulfasalazine while minimising adverse effects. Adverse effects are infrequent but may include nausea, dyspepsia and headache. Olsalazine may cause a secretory diarrhoea. Uncommon hypersensitivity reactions, including worsening of colitis, pancreatitis, pericarditis and nephritis, have also been reported. Corticosteroids are commonly prescribed for treatment of moderate to severe IBD. Despite short term efficacy, corticosteroids have numerous adverse effects that preclude their long term use. Adverse effects include acne, fluid retention, fat redistribution, hypertension, hyperglycaemia, psycho-neurological disturbances, cataracts, adrenal suppression, growth failure in children, and osteonecrosis. Newer corticosteroid preparations offer potential for targeted therapy and less corticosteroid-related adverse effects. Azathioprine and mercaptopurine are associated with pancreatitis in 3 to 15% of patients that resolves upon drug cessation. Bone marrow suppression is dose related and may be delayed. The adverse effects of methotrexate include nausea, leucopenia and, rarely, hypersensitivity pneumonia or hepatic fibrosis. Common adverse effects of cyclosporin include nephrotoxicity, hypertension, headache

  7. [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

  8. Indium-111-labeled autologous leukocyte imaging and fecal excretion. Comparison with conventional methods of assessment of inflammatory bowel disease

    International Nuclear Information System (INIS)

    This study was designed to evaluate the role of 111In-labeled leukocyte imaging and fecal excretion in the assessment of inflammatory bowel disease. We compared these tests to various indices of disease activity in Crohn's disease, to Truelove's grading in ulcerative colitis, and to endoscopy, x-ray, and pathology in both diseases. Eleven controls, 16 patients with Crohn's disease, 13 with ulcerative colitis, and 3 with other types of acute bowel inflammation were studied (positive controls). Indium scanning was performed at 1, 4, and 24 hr. Fourteen of 16 patients with active Crohn's disease had positive scans but in only five was localization accurate. One patient had inactive ulcerative colitis, and the scan was negative. Of 12 patients with active ulcerative colitis, 10 had positive scans but disease localization was accurate in only four. Disease extent was correctly defined in 1 of the 3 Positive Controls. There was no significant difference in the accuracy of scanning at 1, 4, or 24 hr. 111In fecal excretion was significantly higher in patients with inflammatory bowel disease than in controls, and there was correlation between 111In fecal excretion and most of the indices of disease activity in Crohn's disease. In ulcerative colitis, 111In fecal excretion did not correlate with Truelove's grading but reflected colonoscopic assessment of severity. In conclusion, 111In-labeled leukocyte scanning lacks sensitivity with respect to disease extent, but fecal excretion of 111In correlates well with disease severity as determined by other methods

  9. 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.

  10. Rifaximin Resistance in Escherichia coli Associated with Inflammatory Bowel Disease Correlates with Prior Rifaximin Use, Mutations in rpoB, and Activity of Phe-Arg-β-Naphthylamide-Inhibitable Efflux Pumps

    OpenAIRE

    Kothary, Vishesh; Scherl, Ellen J.; Bosworth, Brian; Jiang, Zhi-Dong; Herbert L. DuPont; Harel, Josee; Simpson, Kenneth W.; Dogan, Belgin

    2013-01-01

    Escherichia coli is implicated in the pathogenesis of inflammatory bowel disease (IBD). Rifaximin, a nonabsorbable derivative of rifampin effective against E. coli, improves symptoms in mild-to-moderate IBD. However, rifaximin resistance can develop in a single step in vitro. We examined the prevalence and mechanisms of rifaximin resistance in 62 strains of E. coli isolated from the ileal mucosa of 50 patients (19 with ileal Crohn's disease [L1+L3], 6 with colonic Crohn's disease [L2], 13 wit...

  11. 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.

  12. Looking beyond symptom relief: evolution of mucosal healing in inflammatory bowel disease

    OpenAIRE

    Iacucci, Marietta; Ghosh, Subrata

    2011-01-01

    The focus of effective management of inflammatory bowel disease, especially Crohn’s disease, has shifted from short-term symptom control to long-term modification of disease course and complications. Intestinal healing has achieved prominence as a goal of therapy that influences long-term disease course. We review the natural history of inflammatory bowel disease, the markers of disease control that may reflect outcomes and the specific role of mucosal healing. We may aim at better mucosal he...

  13. 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

  14. 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.

  15. 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.

  16. 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

  17. Epidemiology of inflammatory bowel disease: focus on Asia.

    Science.gov (United States)

    Ng, Siew C

    2014-06-01

    The epidemiology of inflammatory bowel disease (IBD) is changing globally. Incidence and prevalence may have stabilized in high-incidence areas such as North America and Europe but they continue to rise in previously low-incidence areas such as Eastern Europe, Asia, and much of the developing world. This epidemiological shift likely relates to westernization of lifestyle, changes in diet, and improved hygiene as part of socioeconomic development in developing countries. In Asia, UC is more prevalent than CD, although the UC:CD ratio is narrowing in certain areas. Clinical manifestations of IBD in Asia resemble the Western population, but with some differences, including higher prevalence of males and ileo-colonic CD, less familial clustering, lower surgical rates and extra-intestinal manifestations. These differences may relate to time, genetics and environmental factors. Studying the epidemiology of IBD in an area of rapidly increasing incidence may lead to discovery of important etiologic factors associated with disease development. PMID:24913377

  18. 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

  19. Pharmacologic therapy for inflammatory bowel disease refractory to steroids

    Directory of Open Access Journals (Sweden)

    Martínez-Montiel MP

    2015-08-01

    Full Text Available MP Martínez-Montiel, B Casis-Herce , GJ Gómez-Gómez, A Masedo-González, C Yela-San Bernardino, C Piedracoba, G Castellano-Tortajada Division of Gastroenterology, Hospital 12 de Octubre, Madrid, SpainAbstract: Although corticosteroids are an effective treatment for induction of remission in inflammatory bowel disease (IBD, many patients are dependent on or refractory to corticosteroids. This review is based on scrutinizing current literature with emphasis on randomized controlled trials, meta-analyses, and Cochrane reviews on the management of IBD refractory to corticosteroids. Based on this evidence, we propose algorithms and optimization strategies for use of immunomodulator and biologic therapy in IBD refractory to corticosteroids.Keywords: immunomodulators, anti-tumor necrosis factor alpha, Crohn's disease, ulcerative colitis, drug levels, treatment optimization

  20. 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.

  1. 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

  2. Antibiotics and probiotics in treatment of inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Paolo Gionchetti; Fernando Rizzello; Karen M Lammers; Claudia Morselli; Lucia Sollazzi; Samuel Davies; Rosy Tambasco; Carlo Calabrese; Massimo Campieri

    2006-01-01

    Many experimental and clinical observations suggest that intestinal microflora plays a potential role in the pathogenesis of inflammatory bowel disease (IBD).Manipulation of the luminal content using antibiotics or probiotics represents a potentially effective therapeutic option. The available studies do not support the use of antibiotics in ulcerative colitis (UC). Antibiotics are effective in treating septic complications of Crohn's disease (CD) but their use as a primary therapy is more controversial, although this approach is frequently and successfully adopted in clinical practice.There is evidence that probiotic therapy may be effective in the prevention and treatment of mild to moderate UC. In contrast, a lack of successful study data at present precludes the widespread use of probiotics in the treatment of CD.Both antibiotics and probiotics appear to play a beneficial role in the treatment and prevention of pouchitis and further trials are warranted to fully quantify their clinical efficacy.

  3. 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.

  4. 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.

  5. 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...

  6. Iron deficiency anemia in patients with inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    Goldberg ND

    2013-06-01

    Full Text Available Neil D Goldberg Emeritus Chief of Gastroenterology, University of Maryland St. Joseph Medical Center, Towson, MD, USA Abstract: Iron deficiency anemia is the most common form of anemia worldwide, caused by poor iron intake, chronic blood loss, or impaired absorption. Patients with inflammatory bowel disease (IBD are increasingly likely to have iron deficiency anemia, with an estimated prevalence of 36%–76%. Detection of iron deficiency is problematic as outward signs and symptoms are not always present. Iron deficiency can have a significant impact on a patient's quality of life, necessitating prompt management and treatment. Effective treatment includes identifying and treating the underlying cause and initiating iron replacement therapy with either oral or intravenous iron. Numerous formulations for oral iron are available, with ferrous fumarate, sulfate, and gluconate being the most commonly prescribed. Available intravenous formulations include iron dextran, iron sucrose, ferric gluconate, and ferumoxytol. Low-molecular weight iron dextran and iron sucrose have been shown to be safe, efficacious, and effective in a host of gastrointestinal disorders. Ferumoxytol is the newest US Food and Drug Administration-approved intravenous iron therapy, indicated for iron deficiency anemia in adults with chronic kidney disease. Ferumoxytol is also being investigated in Phase 3 studies for the treatment of iron deficiency anemia in patients without chronic kidney disease, including subgroups with IBD. A review of the efficacy and safety of iron replacement in IBD, therapeutic considerations, and recommendations for the practicing gastroenterologist are presented. Keywords: anemia, inflammatory bowel disease, intravenous iron, iron deficiency, oral iron, therapy

  7. 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

  8. Comparison between a clinical activity index (Harvey–Bradshaw-Index), laboratory inflammation markers and quantitative assessment of bowel wall vascularization by contrast-enhanced ultrasound in Crohn's disease

    International Nuclear Information System (INIS)

    Purpose: Due to its character as a remitting inflammatory disease, patients suffering from Crohn's disease (CD) often undergo several imaging studies subjecting the mostly young patients to ionizing. Contrast enhanced ultrasound for capillary microvascular assessment might be a new diagnostic tool for identifying the activity of inflammation by ultrasound techniques. Materials and methods: We prospectively evaluated 45 patients with proven Crohn's disease performing contrast enhanced ultrasound (CEUS) and laboratory assessment including C-reactive protein (CRP), leucocytes and hematocrit as well as calculating the Harvey–Bradshaw Index (HBI). Thereafter, we applied the quantification software Qontrast® to obtain contrast-enhanced sonographic perfusion maps. Results: Analysis of the 41 finally included patients revealed a correlation of CRP to HBI and TTP[s], respectively. Moreover, an association was found for HBI and TTP[s] and for HBI and TTP[s]/Peak [%]. Analysis of 34 patients with a Peak [%] ≥25 showed a close association of HBI and CRP. Besides, in these patients CRP correlated to TTP[s] and to TTP[s]/Peak [%]. We found a strong negative correlation between HBI and TTP[s] (r = −0.645, p < 0.01), thus, the higher the clinical activity the shorter the time-to-peak. Conclusion: Quantitative evaluation with CEUS, particularly the calculation of TTP[s] in patients with a Peak [%] ≥25, provides a simple method to assess the inflammatory activity in CD.

  9. Faecal S100A12 as a non-invasive marker distinguishing inflammatory bowel disease from irritable bowel syndrome

    NARCIS (Netherlands)

    Kaiser, T; Langhorst, J; Wittkowski, H; Becker, K; Friedrich, A W; Rueffer, A; Dobos, G J; Roth, J; Foell, D

    2007-01-01

    OBJECTIVE: S100A12 is a pro-inflammatory protein that is secreted by granulocytes. S100A12 serum levels increase during inflammatory bowel disease (IBD). We performed the first study analysing faecal S100A12 in adults with signs of intestinal inflammation. METHODS: Faecal S100A12 was determined by E

  10. Curcumin as a therapeutic agent in the chemoprevention of inflammatory bowel disease.

    Science.gov (United States)

    Sreedhar, Remya; Arumugam, Somasundaram; Thandavarayan, Rajarajan A; Karuppagounder, Vengadeshprabhu; Watanabe, Kenichi

    2016-05-01

    Inflammatory bowel diseases (IBD), mainly Crohn's disease (CD) and ulcerative colitis (UC) are chronic ailments of the gastrointestinal tract, characterized by recurrent inflammation. Current therapeutic strategies are based on the mitigation of symptoms, including inflammatory remission and healing of mucosal manifestations. Extensive studies have suggested that continuous oxidative damage can lead to the inflammatory signaling cascade in IBD. Curcumin, a potent modulator of cell signaling, is popular for its antioxidant and anti-inflammatory activities, and has already been shown remarkable therapeutic results in IBD. Here, we review and discuss the effects of curcumin as a therapeutic agent in the chemoprevention of IBD. PMID:26995272

  11. Drug therapy: dose-response relationship of oral mesalazine in inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    C. J. J. Mulder

    1998-01-01

    Full Text Available Mesalazine is widely used in the treatment of inflammatory bowel disease. Little is known about the doseresponse relationship and about possible dose related side effects. In ulcerative colitis higher dosages of mesalazine (3 g are more effective in maintaining a remission than lower dosages (1.5 g. In mild to moderately active ulcerative colitis, studies also indicate that higher dosages might be more effective in inducing remission. Dose-comparing studies in Crohn's disease are even more sparse, but the available results indicate higher efficacy at higher dose levels.

  12. Usefulness of CT in assessing disease activity of Crohn's disease

    International Nuclear Information System (INIS)

    The purpose of this study is to determine the CT features indicating active disease as well as to evaluate the usefulness of CT in assessing disease activity in patients with Crohn's disease. Thirty-six patients with Crohn's disease underwent a total of 50 abdominal CT scans. To characterize clinical disease activity, the Crohn's disease activity index (CDAI) was calculated using clinical and laboratory patient data, and C-reactive protein (CRP), levels were also measured. Without knowledge of clinical disease activity, computed tomograms were evaluated in terms of site, target sign, degree of bowel wall enhancement, length, bowel wall thickness, extraluminal hypervascularity, ascites, lymphadenopathy, fibrofatty proliferation, and degree of pericolic or perienteric infiltration. Each finding was compared with the clinical parameters of disease activity. Both CDAI and CRP were significantly higher in patients with hypervascularity (p=0.005 and 0.028, respectively), long length of involved bowel (p=0.001, 0.001), moderate to severe pericolic or perienteric infiltration (p=0.009, 0.003), or ascites (p=0.001, 0.008). Only CRP was significantly higher in those with heterogeneous bowel wall enhancement (p=0.001), marked bowel wall enhancement (p=0.042), target sign (p=0.031), or severe bowel wall thickening (r=0.410, p=0.003). For other CT findings such as the location, lymphadenopathy, and fibrofatty proliferation, there were no statistically significant differences in CDAI or CRP levels. A number of CT findings varied according to clinical disease activity. These findings are, therefore, useful for evaluating disease activity in patients with Crohn's disease

  13. Serologic and laboratory markers in prediction of the disease course in inflammatory bowel disease

    OpenAIRE

    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.

  14. Vitamin D and gastrointestinal diseases: inflammatory bowel disease and colorectal cancer

    OpenAIRE

    Raman, Maitreyi; Milestone, Andrew N.; Walters, Julian R.F.; Hart, Ailsa L.; Ghosh, Subrata

    2011-01-01

    Over the past 5 years, there has been a rapid resurgence of interest in vitamin D outside of its traditional role in metabolic bone disease. Some nontraditional roles ascribed to vitamin D include anti-inflammatory and immune-modulating effects. These effects have led to possible implications in the pathophysiology of immune-mediated diseases including multiple sclerosis and inflammatory bowel disease (IBD). In addition, vitamin D insufficiency has been linked to higher rates of cancers inclu...

  15. The epidemiology and the pathogenesis of inflammatory bowel disease.

    Science.gov (United States)

    Karlinger, K; Györke, T; Makö, E; Mester, A; Tarján, Z

    2000-09-01

    The etiology of inflammatory bowel disease (IBD) is still unknown. However, a satisfactory solution cannot be far away. IBD actually encompasses two diseases, i.e. Crohn's disease (CD) and ulcerous colitis (UC). These diseases resemble each other so closely that they cannot be distinguished even pathologically, but differ from each other sufficiently to regard them as independent entities. Epidemiological observations may be helpful in identifying the true causative factors of this evasive disease. Geographically, the prevalence of the disease has a slope from North to South and, to a lesser degree, from West to East. The Western-Eastern discrepancy can be attributed to a difference in Western life styles. The incidence of the disease has been increasing world-wide of late, but its spread has been slowing down in highly affected countries. Racial and ethnic relations in different populations and immigration studies offer interesting data which can reflect genetic, inherited, environmental and behavioural factors. The disease seems to have a characteristic racial-ethnic distribution: the Jewish population is highly susceptible everywhere, but its prevalence in that population nears that of the domestic society in which they live. In Hungary, the Roma (Gypsies) have a considerably lower prevalence than the average population. This can be attributed to a genetic or environmental influence. According to age, the onset of the disease occurs more often in the second or the third decade of life, but there also is another peak in the 60s. Regarding sexual distribution, there is a slight preponderance of colitis ulcerosa in men and of Crohn's disease in women. It may correspond to the stronger auto-immune affection in the process of Crohn's disease. Environmental factors and behavioural influences also are investigated. Diet, the role of the early ages, smoking habits and the influence of hormonal status and drugs are viewed as useful contributing factors in the

  16. The epidemiology and the pathogenesis of inflammatory bowel disease

    International Nuclear Information System (INIS)

    The etiology of inflammatory bowel disease (IBD) is still unknown. However, a satisfactory solution cannot be far away. IBD actually encompasses two diseases, i.e. Crohn's disease (CD) and ulcerous colitis (UC). These diseases resemble each other so closely that they cannot be distinguished even pathologically, but differ from each other sufficiently to regard them as independent entities. Epidemiological observations may be helpful in identifying the true causative factors of this evasive disease. Geographically, the prevalence of the disease has a slope from North to South and, to a lesser degree, from West to East. The Western-Eastern discrepancy can be attributed to a difference in Western life styles. The incidence of the disease has been increasing world-wide of late, but its spread has been slowing down in highly affected countries. Racial and ethnic relations in different populations and immigration studies offer interesting data which can reflect genetic, inherited, environmental and behavioural factors. The disease seems to have a characteristic racial-ethnic distribution: the Jewish population is highly susceptible everywhere, but its prevalence in that population nears that of the domestic society in which they live. In Hungary, the Roma (Gypsies) have a considerably lower prevalence than the average population. This can be attributed to a genetic or environmental influence. According to age, the onset of the disease occurs more often in the second or the third decade of life, but there also is another peak in the 60s. Regarding sexual distribution, there is a slight preponderance of colitis ulcerosa in men and of Crohn's disease in women. It may correspond to the stronger auto-immune affection in the process of Crohn's disease. Environmental factors and behavioural influences also are investigated. Diet, the role of the early ages, smoking habits and the influence of hormonal status and drugs are viewed as useful contributing factors in the

  17. The epidemiology and the pathogenesis of inflammatory bowel disease

    Energy Technology Data Exchange (ETDEWEB)

    Karlinger, Kinga E-mail: karlking@radi.sote.hu; Gyoerke, Tamas; Makoe, Erno; Mester, Adam; Tarjan, Zsolt

    2000-09-01

    The etiology of inflammatory bowel disease (IBD) is still unknown. However, a satisfactory solution cannot be far away. IBD actually encompasses two diseases, i.e. Crohn's disease (CD) and ulcerous colitis (UC). These diseases resemble each other so closely that they cannot be distinguished even pathologically, but differ from each other sufficiently to regard them as independent entities. Epidemiological observations may be helpful in identifying the true causative factors of this evasive disease. Geographically, the prevalence of the disease has a slope from North to South and, to a lesser degree, from West to East. The Western-Eastern discrepancy can be attributed to a difference in Western life styles. The incidence of the disease has been increasing world-wide of late, but its spread has been slowing down in highly affected countries. Racial and ethnic relations in different populations and immigration studies offer interesting data which can reflect genetic, inherited, environmental and behavioural factors. The disease seems to have a characteristic racial-ethnic distribution: the Jewish population is highly susceptible everywhere, but its prevalence in that population nears that of the domestic society in which they live. In Hungary, the Roma (Gypsies) have a considerably lower prevalence than the average population. This can be attributed to a genetic or environmental influence. According to age, the onset of the disease occurs more often in the second or the third decade of life, but there also is another peak in the 60s. Regarding sexual distribution, there is a slight preponderance of colitis ulcerosa in men and of Crohn's disease in women. It may correspond to the stronger auto-immune affection in the process of Crohn's disease. Environmental factors and behavioural influences also are investigated. Diet, the role of the early ages, smoking habits and the influence of hormonal status and drugs are viewed as useful contributing factors in

  18. Contrasting Pattern of Chronic Inflammatory Bowel Disease in Primary and Autoimmune Sclerosing Cholangitis

    Directory of Open Access Journals (Sweden)

    Ingvar Bjarnason

    2015-10-01

    Interpretation: Collectively these findings lend support to the suggestion that the chronic inflammatory bowel disease associated with PSC and in particular AISC may represent a distinct nosologic entity different from classic ulcerative colitis and Crohn's disease.

  19. Hemorrhoids and anal fissures in inflammatory bowel disease.

    Science.gov (United States)

    D'Ugo, S; Stasi, E; Gaspari, A L; Sileri, P

    2015-12-01

    Perianal disease is a common complication of inflammatory bowel disease (IBD). It includes different conditions from more severe and potentially disabling ones, such as abscesses and fistulas, to more benign conditions such as hemorrhoids, skin tags and fissures. Most literature has been focused on anal sepsis and fistulae, as they carry the majority of disease burden and often alter the natural course of the disease. Hemorrhoids and anal fissures in patients with IBD have been overlooked, although they can represent a challenging problem. The management of hemorrhoids and fissures in IBD patients may be difficult and may significantly differ compared to the non-affected population. Historically surgery was firmly obstructed, and hemorrhoidectomy or sphincterotomy in patients with associated diagnosis of IBD was considered harmful, although literature data is scant and based on small series. Various authors reported an incidence of postoperative complications higher in IBD than in the general populations, with potential severe events. Considering that a spontaneous healing is possible, the first line management should be a medical therapy. In patients non-responding to conservative measures it is possible a judicious choice of surgical options on a highly selective basis; this can lead to acceptable results, but the risk of possible complications needs to be considered. In this review it is analyzed the current literature on the incidence, symptoms and treatment options of hemorrhoids and anal fissures in patients with Crohn's disease and ulcerative colitis. PMID:26446683

  20. Stimulating erythropoiesis in inflammatory bowel disease associated anemia

    Institute of Scientific and Technical Information of China (English)

    Georgia Tsiolakidou; Ioannis E Koutroubakis

    2007-01-01

    Anemia is a frequent complication in patients with inflammatory bowel disease (IBD), and is associated with decreased quality of life and increased rate of hospitalization. The primary therapeutic targets of IBDassociated anemia are iron deficiency and anemia of chronic disease. An important prognostic parameter of the success or failure of therapy is the outcome of the underlying disease. Iron deficiency should be appropriately managed with iron supplementation.However, the use of oral iron therapy is limited by several problems, the most important being gastrointestinal side effects leading occasionally to disease relapse and poor iron absorption. Intravenous iron preparations are more reliable, with iron sucrose demonstrating the best efficacy and tolerability. Treatment with erythropoietin or darbepoetin has been proven to be effective in patients with anemia, who fail to respond to intravenous iron. Patients with ongoing inflammation have anemia of chronic disease and may require combination therapy comprising of intravenous iron sucrose and erythropoietin. After initiating treatment, careful monitoring of hemoglobin levels and iron parameters is needed in order to avoid recurrence of anemia. In conclusion, anemia in the setting of IBD should be aggressively diagnosed, investigated, and treated. Future studies should define the optimal dose and schedule of intravenous iron supplementation and appropriate erythropoietin therapy in these patients.

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

    Directory of Open Access Journals (Sweden)

    Joanna Balding

    2004-01-01

    Full Text Available 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 various cytokines (interleukin (IL-1β, IL-6, tumour necrosis factor (TNF, IL-10, IL-1 receptor antagonist. Association of these genotypes to disease incidence and pathophysiology was investigated. No strong association was found with occurrence of IBD. Variation was observed between the ulcerative colitis study group and the control population for the TNF-α-308 polymorphism (p=0.0135. There was also variation in the frequency of IL-6-174 and TNF-α-308 genotypes in the ulcerative colitis group compared with the Crohn's disease group (p=0.01. We concluded that polymorphisms in inflammatory genes are associated with variations in IBD phenotype and disease susceptibility. Whether the polymorphisms are directly involved in regulating cytokine production, and consequently pathophysiology of IBD, or serve merely as markers in linkage disequilibrium with susceptibility genes remains unclear.

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

    Science.gov (United States)

    Wong, Celestine; 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 to exert beneficial outcomes for IBD. Postulated mechanisms include direct interactions with the gut mucosa through immunomodulation, or indirectly through the microbiome. Component species of the microbiome may degrade dietary-fibre polysaccharides and ferment the products to form short-chain fatty acids such as butyrate. Prebiotic dietary fibres may also act more directly by altering the composition of the microbiome. Longer term benefits in reducing the risk of more aggressive disease or colorectal cancer may require other dietary fibre sources such as wheat bran or psyllium. By critically examining clinical trials that have used dietary fibre supplements or dietary patterns containing specific types or amounts of dietary fibres, it may be possible to assess whether varying the intake of specific dietary fibres may offer an efficient treatment for IBD patients. PMID:27314323

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

    Directory of Open Access Journals (Sweden)

    Celestine Wong

    2016-06-01

    Full Text Available 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 to exert beneficial outcomes for IBD. Postulated mechanisms include direct interactions with the gut mucosa through immunomodulation, or indirectly through the microbiome. Component species of the microbiome may degrade dietary-fibre polysaccharides and ferment the products to form short-chain fatty acids such as butyrate. Prebiotic dietary fibres may also act more directly by altering the composition of the microbiome. Longer term benefits in reducing the risk of more aggressive disease or colorectal cancer may require other dietary fibre sources such as wheat bran or psyllium. By critically examining clinical trials that have used dietary fibre supplements or dietary patterns containing specific types or amounts of dietary fibres, it may be possible to assess whether varying the intake of specific dietary fibres may offer an efficient treatment for IBD patients.

  4. 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...... available, and subsequently, to perform a systematic review of studies performed in the last decade on the treatment of iron-deficiency anemia in IBD. Given that intravenous therapies have been introduced in the last decade, a systematic review performed in PubMed, EMBASE, the Cochrane Library......, and the websites of WHO, FDA, and EMA covered prospective trials investigating the management of iron-deficiency anemia in IBD published since 2004. A total of 632 articles were reviewed, and 13 articles (2906 patients) with unique content were included. In general, oral supplementation in iron-deficiency anemia...

  5. Minimally invasive surgery for inflammatory bowel disease: Current perspectives.

    Science.gov (United States)

    Shrestha, Badri

    2016-05-01

    The surgical management of complicated and recurrent inflammatory bowel disease (IBD), has remained a challenge. Minimally invasive surgery (MIS), in the form of laparoscopic resections, single port approach and robotic-assisted dissections in the management of IBD, have been examined in several prospective studies. All of them have shown advantages over open surgery in terms of reduction of physical trauma of surgery, recovery time, better cosmetic outcomes and shorter hospitalization. However, it is important to appreciate that not all patients with IBD are suitable for MIS, so a combination of both open and MIS should be adopted to achieve optimum outcomes. A review on this subject performed by Neumann et al in this issue of World Journal of Gastrointestinal Pharmacology and Therapeutics have provided evidence in support of the contemporary practice of MIS in the management of IBD and the accompanying commentary further critically evaluates their application in clinical practice. PMID:27158536

  6. Minimally invasive surgery for inflammatory bowel disease: Current perspectives

    Science.gov (United States)

    Shrestha, Badri

    2016-01-01

    The surgical management of complicated and recurrent inflammatory bowel disease (IBD), has remained a challenge. Minimally invasive surgery (MIS), in the form of laparoscopic resections, single port approach and robotic-assisted dissections in the management of IBD, have been examined in several prospective studies. All of them have shown advantages over open surgery in terms of reduction of physical trauma of surgery, recovery time, better cosmetic outcomes and shorter hospitalization. However, it is important to appreciate that not all patients with IBD are suitable for MIS, so a combination of both open and MIS should be adopted to achieve optimum outcomes. A review on this subject performed by Neumann et al in this issue of World Journal of Gastrointestinal Pharmacology and Therapeutics have provided evidence in support of the contemporary practice of MIS in the management of IBD and the accompanying commentary further critically evaluates their application in clinical practice. PMID:27158536

  7. Mesenchymal stromal cells and chronic inflammatory bowel disease.

    Science.gov (United States)

    Algeri, M; Conforti, A; Pitisci, A; Starc, N; Tomao, L; Bernardo, M E; Locatelli, F

    2015-12-01

    Recent experimental findings have shown the ability of mesenchymal stromal cells (MSCs) to home to damaged tissues and to produce paracrine factors with anti-inflammatory properties, potentially resulting in reduction of inflammation and functional recovery of the damaged tissues. Prompted by these intriguing properties and on the basis of encouraging preclinical data, MSCs are currently being studied in several immune-mediated disorders. Inflammatory bowel diseases (IBD) represent a setting in which MSCs-based therapy has been extensively investigated. Phase I and II studies have documented the safety and feasibility of MSCs. However, efficacy results have so far been conflicting. In this review, we will discuss the biologic rationale that makes MSCs a promising therapeutic tool for IBD, and analyze recent experimental and clinical findings, highlighting current limitations and future perspectives of MSCs-related immunotherapy for IBD. PMID:26170204

  8. Danish cohort of monozygotic inflammatory bowel disease twins

    DEFF Research Database (Denmark)

    Moller, Frederik Trier; Knudsen, Lina; Harbord, Marcus;

    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......, 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...

  9. Intestinal microbiota: The explosive mixture at the origin of inflammatory bowel disease?

    Science.gov (United States)

    Bringiotti, Roberto; Ierardi, Enzo; Lovero, Rosa; Losurdo, Giuseppe; Di Leo, Alfredo; Principi, Mariabeatrice

    2014-11-15

    Inflammatory bowel diseases (IBDs), namely Crohn's disease and ulcerative colitis, are lifelong chronic disorders arising from interactions among genetic, immunological and environmental factors. Although the origin of IBDs is closely linked to immune response alterations, which governs most medical decision-making, recent findings suggest that gut microbiota may be involved in IBD pathogenesis. Epidemiologic evidence and several studies have shown that a dysregulation of gut microbiota (i.e., dysbiosis) may trigger the onset of intestinal disorders such as IBDs. Animal and human investigations focusing on the microbiota-IBD relationship have suggested an altered balance of the intestinal microbial population in the active phase of IBD. Rigorous microbiota typing could, therefore, soon become part of a complete phenotypic analysis of IBD patients. Moreover, individual susceptibility and environmental triggers such as nutrition, medications, age or smoking could modify bacterial strains in the bowel habitat. Pharmacological manipulation of bowel microbiota is somewhat controversial. The employment of antibiotics, probiotics, prebiotics and synbiotics has been widely addressed in the literature worldwide, with the aim of obtaining positive results in a number of IBD patient settings, and determining the appropriate timing and modality of this intervention. Recently, novel treatments for IBDs, such as fecal microbiota transplantation, when accepted by patients, have shown promising results. Controlled studies are being designed. In the near future, new therapeutic strategies can be expected, with non-pathogenic or modified food organisms that can be genetically modified to exert anti-inflammatory properties. PMID:25400998

  10. Intestinal microbiota: The explosive mixture at the origin of inflammatory bowel disease?

    Institute of Scientific and Technical Information of China (English)

    Roberto; Bringiotti; Enzo; Ierardi; Rosa; Lovero; Giuseppe; Losurdo; Alfredo; Di; Leo; Mariabeatrice; Principi

    2014-01-01

    Inflammatory bowel diseases(IBDs), namely Crohn’s disease and ulcerative colitis, are lifelong chronic disorders arising from interactions among genetic, immunological and environmental factors. Although the origin of IBDs is closely linked to immune response alterations, which governs most medical decision-making, recent findings suggest that gut microbiota may be involved in IBD pathogenesis. Epidemiologic evidence and several studies have shown that a dysregulation of gut microbiota(i.e., dysbiosis) may trigger the onset of intestinal disorders such as IBDs. Animal and human investigations focusing on the microbiota-IBD relationship have suggested an altered balance of the intestinal microbial population in the active phase of IBD. Rigorous microbiota typing could, therefore, soon become part of a complete phenotypic analysis of IBD patients. Moreover, individual susceptibility and environmental triggers such as nutrition, medications, age or smoking could modify bacterial strains in the bowel habitat. Pharmacological manipulation of bowel microbiota is somewhat controversial. The employment of antibiotics, probiotics, prebiotics and synbiotics has been widely addressed in theliterature worldwide, with the aim of obtaining positive results in a number of IBD patient settings, and determining the appropriate timing and modality of this intervention. Recently, novel treatments for IBDs, such as fecal microbiota transplantation, when accepted by patients, have shown promising results. Controlled studies are being designed. In the near future, new therapeutic strategies can be expected, with non-pathogenic or modified food organisms that can be genetically modified to exert anti-inflammatory properties.

  11. Incidence and initial disease course of inflammatory bowel diseases in 2011 in Europe and Australia

    DEFF Research Database (Denmark)

    Vegh, Z; Burisch, J; Pedersen, N; Kaimakliotis, I; Duricova, D; Bortlik, M; Avnstrøm, S; Vinding, K Kofod; Olsen, J; Nielsen, K R; Katsanos, K H; Tsianos, E V; Lakatos, L; Schwartz, D; Odes, S; Lupinacci, G; De Padova, A; Jonaitis, L; Kupcinskas, L; Turcan, S; Tighineanu, O; Mihu, I; Barros, L F; Magro, F; Lazar, D; Goldis, A; Fernandez, A; Hernandez, V; Niewiadomski, O; Bell, S; Langholz, E; Munkholm, P; Lakatos, P L

    2015-01-01

    BACKGROUND AND AIMS: The aim of the present study was to validate the IBD (inflammatory bowel diseases) incidence reported in the 2010 ECCO-EpiCom (European Crohn's and Colitis Organization-Epidemiological Committee) inception cohort by including a second independent inception cohort from partici...

  12. Inflammatory bowel disease after liver transplantation : Risk factors for recurrence and De novo disease

    NARCIS (Netherlands)

    Verdonka, RC; Dijkstra, G; Haagsma, EB; Shostrom, VK; Van den Berg, AP; Kleibeuker, JH

    2006-01-01

    Inflammatory bowel disease (IBD) is associated with primary sclerosing cholangitis (PSC) and autoimmune hepatitis (AIH) and can recur or develop de novo after orthotopic liver transplantation (OLT). The aim of this study was to investigate the incidence and severity of IBD after liver transplantatio

  13. 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; Turk, Niksa; Kaimakliotis, Ioannis; Duricova, Dana; Shonová, Olga; Vind, Ida; Avnstrøm, Søren; Thorsgaard, Niels; Krabbe, Susanne; Andersen, Vibeke; Dahlerup Jens, Frederik; Kjeldsen, Jens; Salupere, Riina; Olsen, Jóngerð; Nielsen, Kári Rubek; Manninen, Pia; Collin, Pekka; Katsanos, Konstantinnos H; Tsianos, Epameinondas V; Ladefoged, Karin; Lakatos, Laszlo; Bailey, Yvonne; O'Morain, Colm; Schwartz, Doron; Odes, Selwyn; Martinato, Matteo; Lombardini, Silvia; Jonaitis, Laimas; Kupcinskas, Limas; Turcan, Svetlana; Barros, Louisa; Magro, Fernando; Lazar, Daniela; Goldis, Adrian; Nikulina, Inna; Belousova, Elena; Fernandez, Alberto; Hernandez, Vicent; Almer, Sven; Zhulina, Yaroslava; Halfvarson, Jonas; Tsai, Her-Hsin; Sebastian, Shaji; Lakatos, Peter Laszlo; Langholz, Ebbe; Munkholm, Pia

    2014-01-01

    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...

  14. Economic burden of inflammatory bowel disease: a UK perspective.

    Science.gov (United States)

    Luces, Carlvin; Bodger, Keith

    2006-08-01

    Inflammatory bowel diseases (IBDs) are chronic, relapsing conditions that have no permanent drug cure, may occur for the first time in early life and have the potential to produce long-term morbidity. In the era of emerging biological drug therapies, the costs associated with IBD have attracted increased attention. This review considers the available information on the macroeconomics of ulcerative colitis and Crohn's disease. In relation to direct medical costs, the consistent findings are: hospital (in-patient) costs are incurred by a minority of sufferers but account for approximately half the total cost; and drug costs contribute less than a quarter of the total healthcare costs. Data for levels of costs associated with lost productivity are more variable, but some studies have estimated that 'indirect' costs falling on society exceed medical expenditures. Lifetime costs for IBD are comparable to a number of major diseases, including heart disease and cancer. Over the next 5-10 years, the contribution of drug costs to the overall profile of cost-of-illness will change significantly as biological therapies play an increasing role. A key economic question is whether the health gains realized from exciting new drugs will also lead to reduced expenditures on hospitalization and surgery. PMID:20528516

  15. Patterns of airway involvement in inflammatory bowel diseases

    Institute of Scientific and Technical Information of China (English)

    Ilias; Papanikolaou; Konstantinos; Kagouridis; Spyros; A; Papiris

    2014-01-01

    Extraintestinal manifestations occur commonly in inflammatory bowel diseases(IBD). Pulmonary manifestations(PM) of IBD may be divided in airway disorders, interstitial lung disorders, serositis, pulmonary vasculitis, necrobiotic nodules, drug-induced lung disease, thromboembolic lung disease and enteropulmonary fistulas. Pulmonary involvement may often be asymptomatic and detected solely on the basis of abnormal screening tests. The common embryonic origin of the intestine and the lungs from the primitive foregut, the co-existence of mucosa associated lymphoid tissue in both organs, autoimmunity, smoking and bacterial translocation from the colon to the lungs may all be involved in the pathogenesis of PM in IBD. PM are mainly detected by pulmonary function tests and highresolution computed tomography. This review will focus on the involvement of the airways in the context of IBD, especially stenoses of the large airways, tracheo-bronchitis, bronchiectasis, bronchitis, mucoid impaction, bronchial granulomas, bronchiolitis, bronchiolitis obliterans syndrome and the co-existence of IBD with asthma, chronic obstructive pulmonary disease, sarcoidosis and a1-antitrypsin deficiency.

  16. Therapeutic approaches targeting intestinal microflora in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Akira Andoh; Yoshihide Fujiyama

    2006-01-01

    Inflammatory bowel diseases, ulcerative colitis, and Crohn's disease, are chronic intestinal disorders of unknown etiology in which in genetically susceptible individuals, the mucosal immune system shows an aberrant response towards commensal bacteria.The gastrointestinal tract has developed ingenious mechanisms to coexist with its autologous microflora,but rapidly responds to invading pathogens and then returns to homeostasis with its commensal bacteria after the pathogenic infection is cleared. In case of disruption of this tightly-regulated homeostasis, chronic intestinal inflammation may be induced. Previous studies showed that some commensal bacteria are detrimental while others have either no influence or have a protective action. In addition, each host has a genetically determined response to detrimental and protective bacterial species. These suggest that therapeutic manipulation of imbalance of microflora can influence health and disease. This review focuses on new insights into the role of commensal bacteria in gut health and disease, and presents recent findings in innate and adaptive immune interactions. Therapeutic approaches to modulate balance of intestinal microflora and their potential mechanisms of action are also discussed.

  17. Current concepts of the pathogenesis of inflammatory bowel disease.

    LENUS (Irish Health Repository)

    Shanahan, F

    2012-02-03

    Although the cause of inflammatory bowel disease is not known, the pathogenesis involves an immune-mediated tissue damage that is the result of an interaction among genetic predisposing factors, exogenous triggers and endogenous modifying influences. Multiple genes are involved and operate at the level of the immune response and at the target organ. Exogenous triggers include the enteric microflora which might stimulate the mucosal immune system in genetically predisposed individuals. Endogenous modifying factors such as the psychoneuroendocrine system have regulatory effects on the immune system and the inflammatory response, and may influence the course of the disease. While autoimmune phenomena do occur, particularly in ulcerative colitis, there is no evidence that they are directly responsible for the tissue damage. It appears more likely, particularly in Crohn\\'s disease, that tissue injury may occur as an indirect or "bystander" effect of mucosal T-cell hyperactivation, perhaps in response to a normal enteric microbial antigen. Most of the immunologic and histologic features of Crohn\\'s disease can be explained by the effects of T-cell derived and other cytokines on the epithelium, the local immune system, the microvasculature, and the recruitment of auxiliary effector cells such as neutrophils.

  18. Mucosal barrier, bacteria and inflammatory bowel disease: possibilities for therapy.

    Science.gov (United States)

    Merga, Yvette; Campbell, Barry J; Rhodes, Jonathan M

    2014-01-01

    The mucosal barrier has three major components, the mucus layer, the epithelial glycocalyx and the surface epithelium itself, whose integrity largely depends on tight junction function. In health, there is relatively little direct interaction between the luminal microbiota and the epithelium - the continuous mucus layer in the colon keeps the surface epithelium out of contact with bacteria and the ileo-caecal valve ensures that the distal small intestine is relatively microbe free. Most interaction takes place at the Peyer's patches in the distal ileum and their smaller colonic equivalents, the lymphoid follicles. Peyer's patches are overlain by a 'dome' epithelium, 5% of whose cells are specialised M (microfold) epithelial cells, which act as the major portal of entry for bacteria. There are no goblet cells in the dome epithelium and M cells have a very sparse glycocalyx allowing easy microbial interaction. It is intriguing that the typical age range for the onset of Crohn's disease (CD) is similar to the age at which the number of Peyer's patches is greatest. Peyer's patches are commonly the sites of the initial lesions in CD and the 'anti-pancreatic' antibody associated with CD has been shown to have as its epitope the glycoprotein 2 that is the receptor for type-1 bacterial fimbrial protein (fimH) on M cells. There are many reasons to believe that the mucosal barrier is critically important in the pathogenesis of inflammatory bowel disease (IBD). These include (i) associations between both CD and ulcerative colitis (UC) with genes that are relevant to the mucosal barrier; (ii) increased intestinal permeability in unaffected relatives of CD patients; (iii) increased immune reactivity against bacterial antigens, and (iv) animal models in which altered mucosal barrier, e.g. denudation of the mucus layer associated with oral dextran sulphate in rodents, induces colitis. Whilst some IBD patients may have genetic factors leading to weakening of the mucosal barrier

  19. Chromium 51-ethylenediaminetetraacetate test: a useful test in the assessment of inflammatory bowel disease

    International Nuclear Information System (INIS)

    We evaluated the usefulness of urinary excretion values in assessing mucosal damage in inflammatory bowel disease after administration of chromium 51-labeled EDTA either orally or rectally. In the oral study, 19 controls, 18 patients with Crohn's disease, and 13 patients with ulcerative colitis were given 100 microCi 51Cr-EDTA by mouth. The amount of 51Cr-EDTA in a 24-hour urine collection was expressed as a percentage of the ingested dose. The patients with Crohn's disease of the small bowel excreted 6.3% +/- 4.3%, which was significantly (P less than 0.001) higher than the percentage in patients with ulcerative colitis (1.7% +/- 1.1%) and controls (1.4% +/- 0.6%). In the enema study, 19 patients with ulcerative colitis, two with Crohn's disease, two with radiation colitis, and four controls (spastic colitis, lactose intolerance) were given 100 microCi 51Cr-EDTA by retention enema. The patients with active colonic inflammation excreted 8.4% +/- 3.9% of the dose given by enema, which was significantly (P less than 0.01) higher than in other controls (1.9% +/- 0.91%) or patients with inactive colitis (2.2% +/- 1.9%). The 51Cr-EDTA excretion test is a safe, inexpensive test useful in evaluating patients with inflammatory bowel disease. It can be given orally to screen patients with abdominal complaints who are suspected of having Crohn's disease involving the small intestine, and when given by enema it provides additional objective assessment of idiopathic ulcerative colitis or proctitis

  20. Chromium 51-ethylenediaminetetraacetate test: a useful test in the assessment of inflammatory bowel disease

    Energy Technology Data Exchange (ETDEWEB)

    O' Morain, C.A.; Abelow, A.C.; Chervu, L.R.; Fleischner, G.M.; Das, K.M.

    1986-11-01

    We evaluated the usefulness of urinary excretion values in assessing mucosal damage in inflammatory bowel disease after administration of chromium 51-labeled EDTA either orally or rectally. In the oral study, 19 controls, 18 patients with Crohn's disease, and 13 patients with ulcerative colitis were given 100 microCi /sup 51/Cr-EDTA by mouth. The amount of /sup 51/Cr-EDTA in a 24-hour urine collection was expressed as a percentage of the ingested dose. The patients with Crohn's disease of the small bowel excreted 6.3% +/- 4.3%, which was significantly (P less than 0.001) higher than the percentage in patients with ulcerative colitis (1.7% +/- 1.1%) and controls (1.4% +/- 0.6%). In the enema study, 19 patients with ulcerative colitis, two with Crohn's disease, two with radiation colitis, and four controls (spastic colitis, lactose intolerance) were given 100 microCi /sup 51/Cr-EDTA by retention enema. The patients with active colonic inflammation excreted 8.4% +/- 3.9% of the dose given by enema, which was significantly (P less than 0.01) higher than in other controls (1.9% +/- 0.91%) or patients with inactive colitis (2.2% +/- 1.9%). The /sup 51/Cr-EDTA excretion test is a safe, inexpensive test useful in evaluating patients with inflammatory bowel disease. It can be given orally to screen patients with abdominal complaints who are suspected of having Crohn's disease involving the small intestine, and when given by enema it provides additional objective assessment of idiopathic ulcerative colitis or proctitis.

  1. The Search for Causative Environmental Factors in Inflammatory Bowel Disease.

    Science.gov (United States)

    Rogler, Gerhard; Zeitz, Jonas; Biedermann, Luc

    2016-01-01

    Inflammatory bowel disease (IBD) has become a 'prototype disease' for chronic auto-inflammatory disorders with a polygenic background and important multifaceted environmental trigger components. The environmental factors contribute both to pathogenesis and disease flares. Thus, IBD is a disease par excellence to study the interactions between host genetics, environmental factors (such as infections or smoking) and 'in-vironmental' factors - for example, our intestinal microbiota. Longitudinal intercurrent events, including the impact of long-term medication on disease progression or stabilization, can exemplarily be studied in this disease group. Whilst alterations in the human genome coding relevant variant protein products have most likely not emerged significantly over the last 50 years, the incidence of Crohn's disease and ulcerative colitis has dramatically increased in Western countries and more recently in the Asia Pacific area. An interesting concept indicates that 'Western lifestyle factors' trigger chronic intestinal inflammation or disease flares in a genetically susceptible host. To understand the disease pathogenesis as well as triggers for flares or determinants of disease courses, we must further investigate potential en(in)vironmental factors. As environmental conditions, in contrast to genetic risk factors, can be influenced, knowledge on those risk factors becomes crucial to modulate disease incidence, disease course or clinical presentation. It is obvious that prevention of environmentally triggered disease flares would be a goal most relevant for IBD patients. An increased prevalence of IBD in urban environment has been documented in Switzerland by the Swiss IBD cohort study. Several studies have attempted to identify such factors; however, only a few have been validated. The best investigated environmental factor identified in IBD cohort analyses is smoking. Other environmental factors that have been associated with clinical presentation or

  2. Fecal calprotectin is equally sensitive in Crohn's disease affecting the small bowel and colon

    DEFF Research Database (Denmark)

    Jensen, Michael Dam; Kjeldsen, Jens; Nathan, Torben

    2011-01-01

    The utility of fecal calprotectin (fCal) in small bowel Crohn's disease (CD) remains to be clarified. The primary aim of this study was to determine levels of fCal in CD restricted to the small bowel compared with CD affecting the colon, in patients undergoing their first diagnostic work-up. In...

  3. Inter-observer agreement for detection of small bowel Crohn's disease with capsule endoscopy

    DEFF Research Database (Denmark)

    Jensen, Michael Dam; Nathan, Torben; Kjeldsen, Jens

    2010-01-01

    OBJECTIVE: Compared to other modalities, capsule endoscopy (CE) has a high diagnostic yield for diagnosing small bowel Crohn's disease (CD). The aim of this study was to determine the inter-observer agreement for detection of small bowel CD with predefined diagnostic criteria. MATERIAL AND METHODS...

  4. 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. PMID:26894839

  5. Inflammatory bowel disease in Asia: a systematic review.

    Science.gov (United States)

    Prideaux, Lani; Kamm, Michael A; De Cruz, Peter P; Chan, Francis K L; Ng, Siew C

    2012-08-01

    The incidence and prevalence of inflammatory bowel diseases (IBD), Crohn's disease (CD) and ulcerative colitis (UC), are lower in Asia than in the West. However, across Asia the incidence and prevalence of IBD has increased rapidly over the last two to four decades. These changes may relate to increased contact with the West, westernization of diet, increasing antibiotics use, improved hygiene, vaccinations, or changes in the gut microbiota. Genetic factors also differ between Asians and the Caucasians. In Asia, UC is more prevalent than CD, although CD incidence is rapidly increasing in certain areas. There is a male predominance of CD in Asia, but a trend towards equal sex distribution for UC. IBD is diagnosed at a slightly older age than in the West, and there is rarely a second incidence peak as in the West. A positive family history is much less common than in the West, as are extra-intestinal disease manifestations. There are clear ethnic differences in incidence within countries in Asia, and an increased incidence in IBD in migrants from Asia to the West. Research in Asia, an area of rapidly changing IBD epidemiology, may lead to the discovery of critical etiologic factors that lead to the development of IBD. PMID:22497584

  6. The Roles of Cathelicidin LL-37 in Inflammatory Bowel Disease.

    Science.gov (United States)

    Sun, Lihua; Wang, Wensheng; Xiao, Weidong; Yang, Hua

    2016-08-01

    Human cathelicidin LL-37, the only member of the cathelicidin family of host defense peptides expressed in humans, plays a crucial role in host defense against pathogen invasion, as well as in regulating the functions of anti-inflammation, antitumorigenesis, and tissue repair. It is primarily produced by phagocytic leukocytes and epithelial cells, and mediates a wide range of biological responses. Emerging evidence from several studies indicates that LL-37 plays a prominent and complex role in inflammatory bowel disease (IBD). Although overexpression of LL-37 has been implicated in the inflamed and noninflamed colon mucosa in patients with ulcerative colitis, LL-37 expression was not changed in the inflamed or noninflamed colon or ileal mucosa in patients with Crohn's disease. Furthermore, studies in animal models and human patients further characterized the protective effect of cathelicidins both in ulcerative colitis and Crohn's disease. These data suggest the intricate functions of LL-37 in IBD. They will also create many strategies and opportunities for therapeutic intervention in IBD in the future. This review aims to elucidate the structure and bioactivity of LL-37 and also discuss the recent progress in understanding the relationship between LL-37 and IBD. PMID:27135484

  7. Anemia in inflammatory bowel disease: an underestimated problem?

    Directory of Open Access Journals (Sweden)

    Gerhard eRogler

    2015-01-01

    Full Text Available Anemia is one of the most frequent complications and/or extraintestinal manifestations of inflammatory bowel disease (IBD. Iron deficiency is the most important cause of anemia in Crohn’s disease and ulcerative colitis patients. Iron deficiency even without anemia may impact the quality of life of our IBD patients. In the last ten years the understanding of the pathophysiology of iron deficiency anemia and anemia of chronic diseases has increased, new diagnostic tools have been developed and new therapeutic strategies have been discussed. Hepcidin has been identified to be a central regulator of iron absorption from the intestine and of iron plasma levels. Hepcidin is regulated by iron deficiency but also as an acute phase protein by pro-inflammatory mediators such as interleukin-6. Innovative diagnostic tools with respect to iron metabolism have not been introduced in clinical routine or are not available for routine diagnostics. As iron substitution therapy is easy these days with a preference for intravenous substitution the impact of differential diagnosis of anemia in IBD patients is underestimated.

  8. Clostridium difficile Carriage Rate in Outpatients with Inflammatory Bowel Diseases

    Directory of Open Access Journals (Sweden)

    Mohammad Hosain Salari

    2013-10-01

    Full Text Available Abstract Background and objective: Closteridium difficile is a gram positive, anaerobic and spore-forming bacillus. Inflammatory bowel disease or IBD includes Crohn's disease and ulcerative colitis. Inflammation of the intestinal mucosa in these patients can be as a risk factor for colonization of Clostridium difficile. The purpose of this study was to analysis of Clostridium difficile carriage in the IBD outpatients. Materials and methods: Stool specimens were obtained from 50 outpatients with IBD. Stools were cultured on selective media under anaerobic conditions. Filtered extract of bacteria was exposed to HeLa cell culture for analysis of toxin production after identification of Clostridium difficile isolates. Results: The results showed that 3 IBD patients (6% had stool cultures positive for Clostridium difficile. Stool cultures were negative in all patients with Crohn's disease. All 3 patients had ulcerative colitis. Only one isolate was positive for toxin production. Conclusion: The ulcerated colitis than Crohn's patients had higher carriage. In general IBD outpatients carriage rates for Clostridium difficile was low.

  9. Single-Port Laparoscopic Surgery for Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Emile Rijcken

    2012-01-01

    Full Text Available 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 operative techniques, equipment, surgical results, hospital stay, and readmissions. Results. 34 articles, published between 2010 and 2012, were identified reporting on 301 patients with IBD that underwent surgical treatment in SPLS technique. Surgical procedures included ileocolic resections, sigmoid resections, colectomies with end ileostomy or ileorectal anastomosis, and restorative proctocolectomies with ileum-pouch reconstruction. There was a wide variety in the surgical technique and the employed equipment. The overall complication profile was similar to reports on standard laparoscopic surgery in IBD. Conclusions. In experienced hands, single port laparoscopic surgery appears to be feasible and safe for the surgical treatment of selected patients with IBD. However, evidence from prospective randomized trials is required in order to clarify whether there is a further benefit apart from the avoidance of additional trocar incisions.

  10. Role of bacteria in the etiopathogenesis of inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Increased numbers of mucosa-associated Escherichia coli are observed in both of the major inflammatory bowel diseases, Crohn's disease (CD) and ulcerative colitis (DC). A potential pathophysiological link between the presence of pathogenic invasive bacteria and genetic host susceptibility of patients with ileal CD is suspected. In CD patients, with increased ileal expression of the CEACAM6 molecule acting as a receptor recognized by type 1 pilus bacterial adhesin, and with the identification of mutations in the NOD2-encoding gene, the presence of pathogenic invasive bacteria could be the link between abnormal ileal bacterial colonization and innate immune responses to invasive bacteria. In a susceptible host, the sequential etiological steps of the disease induced by adherent-invasive E. Coli (AIEC) are: (1) abnormal colonization via binding to the CEACAM6 receptor, which is overexpressed in the ileal mucosa of CD patients; (2) ability to adhere to and to invade intestinal epithelial cells, which allows bacteria to cross the mucosal barrier; (3) survival and replication within infected macrophages in the lamina propria; and (4) induction of tumor necrosis factor-a secretion and granuloma formation.

  11. Colorectal cancer surveillance in inflammatory bowel disease: The search continues

    Institute of Scientific and Technical Information of China (English)

    Anis Ahmadi; Steven Polyak; Peter V Draganov

    2009-01-01

    Patients with inflammatory bowel disease (IBD) are at increased risk for colorectal cancer (CRC). Risk factors for the development of CRC in the setting of IBD include disease duration, anatomic extent of disease,age at time of diagnosis, severity of inflammation,family history of colon cancer, and concomitant primary sclerosing cholangitis. The current surveillance strategy of surveillance colonoscopy with multiple random biopsies most likely reduces morbidity and mortality associated with IBD-related CRC. Unfortunately,surveillance colonoscopy also has severe limitations including high cost, sampling error at time of biopsy,and interobserver disagreement in histologically grading dysplasia. Furthermore, once dysplasia is detected there is disagreement about its management.Advances in endoscopic imaging techniques are already underway, and may potentially aid in dysplasia detection and improve overall surveillance outcomes.Management of dysplasia depends predominantly on the degree and focality of dysplasia, with the mainstay of management involving either proctocolectomy or continued colonoscopic surveillance. Lastly, continued research into additional chemopreventive agents may increase our arsenal in attempting to reduce the incidence of IBD-associated CRC.

  12. Inflammatory bowel diseases: an update of current treatment alternatives.

    Directory of Open Access Journals (Sweden)

    Lucrecia Suárez

    2009-11-01

    Full Text Available Inflammatory bowel diseases (IBD are characterized for having an unpredictable clinical course with periods of inactivity alternating with relapses, a very variable response to treatment and the constant threat of diverse complications. Management of IBD in children may be of particular complexity, added to the fact that published clinical trials are limited, and scientific evidence seems contradictory, explain in part why to current date there is no international consensus regarding treatment in this age group. A suitable therapy should aim at inducing and maintaining remission for as long as possible, encourage adequate growth and preventing potential complications from appearing. In more recent years, development of new therapeutic agents has allowed a more integrative approach which takes in consideration other aspects of the disease such as nutritional status, psychological welfare and general quality of life. One must also keep in mind that none of these therapeutic resources is exempt of side effects on short and long term basis, consequently, it is imperative to be thoughtful of individual features in order to make accurate clinical decisions and offer a tailored management plan which should be able to modify the disease evolution.

  13. Diet and nutritional factors in inflammatory bowel diseases.

    Science.gov (United States)

    Owczarek, Danuta; Rodacki, Tomasz; Domagała-Rodacka, Renata; Cibor, Dorota; Mach, Tomasz

    2016-01-21

    Inflammatory bowel disease (IBD) development is affected by complex interactions between environmental factors, changes in intestinal flora, various predisposing genetic properties and changes in the immune system. Dietary factors seem to play an underestimated role in the etiopathogenesis and course of the disease. However, research about food and IBD is conflicting. An excessive consumption of sugar, animal fat and linoleic acid is considered a risk factor for IBD development, whereas a high fiber diet and citrus fruit consumption may play a protective role. Also, appropriate nutrition in particular periods of the disease may facilitate achieving or prolonging remissions and most of all, improve the quality of life for patients. During disease exacerbation, a low fiber diet is recommended for most patients. In the remission time, an excessive consumption of alcohol and sulfur products may have a negative effect on the disease course. Attempts are also made at employing diets composed in detail in order to supplement IBD therapy. A diet with a modified carbohydrate composition, a semi-vegetarian diet and a diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols are under investigation. Due to chronic inflammation as well as side effects of chronically used medications, patients with IBD are also at increased risk of nutritional factor deficiencies, including iron, calcium, vitamin D, vitamin B12, folic acid, zinc, magnesium and vitamin A. It should also be remembered that there is no single common diet suitable for all IBD patients; each of them is unique and dietary recommendations must be individually developed for each patient, depending on the course of the disease, past surgical procedures and type of pharmacotherapy. PMID:26811635

  14. Inflammatory bowel diseases: Current problems and future tasks

    Institute of Scientific and Technical Information of China (English)

    Giovanni; C; Actis; Floriano; Rosina; Rinaldo; Pellicano

    2014-01-01

    Current knowledge on inflammatory bowel disease(IBD)is mainly endorsed by controlled trials and epidemiologic studies. Yet,we seldom look at the messages from real-world practice. Among a patient population followed since2008,we looked at an unselected sample of 64 IBD patients [26 Crohn’s disease(CD) and 38 ulcerative colitis(UC)] who had been seen as out-patients in the last year.Inducing remission,mesalamines(86% for UC/69% for CD/33%-16% as MMX formulation) prevailed as prescrip-tions; steroids(55%/19% for UC/CD) ranked second.Prescription of third-party drugs(antibiotics,NSAIDs,biologics) and adherence,were issues in the maintenance.34% of CD,and 23% of UC patients showed accompany-ing immunologic diseases: CD-associated familiar psoriasis(4:9) ranked first. Main Message. The association between IBD(CD mainly) and psoriasis,now found in our practice,matches current basic science gathering IBD together with psoriasis(and perhaps chronic respiratory disease) under the comprehensive term "barrier organ disease" wherein an epithelial surface with sensor system srules contacts between outer antigens and a reactive underneath tissue,with the balance between inflammation and quiescence kept at any time by mucosal permeability.IBD is thus viewed as a polyfactorial/polygenic/syndromic disorder,embedded into a galaxy of immune conditions offering multiple points of attack. This mindset of splitting the IBDs into pathogenic categories may allow overcoming the uniformly targeting of a single cytokine by biological drugs,in favor of demarcating the boundaries between different disease-subtype-specific indications,and paving the way to future personalized strategies.

  15. Inflammatory bowel diseases: Current problems and future tasks.

    Science.gov (United States)

    Actis, Giovanni C; Pellicano, Rinaldo; Rosina, Floriano

    2014-08-01

    Current knowledge on inflammatory bowel disease (IBD) is mainly endorsed by controlled trials and epidemiologic studies. Yet, we seldom look at the messages from real-world practice. Among a patient population followed since 2008, we looked at an unselected sample of 64 IBD patients [26 Crohn's disease (CD) and 38 ulcerative colitis (UC)] who had been seen as out-patients in the last year. Inducing remission, mesalamines (86% for UC/69% for CD/33%-16% as MMX formulation) prevailed as prescriptions; steroids (55%/19% for UC/CD) ranked second. Prescription of third-party drugs (antibiotics, NSAIDs, biologics) and adherence, were issues in the maintenance. 34% of CD, and 23% of UC patients showed accompanying immunologic diseases: CD-associated familiar psoriasis (4:9) ranked first. Main Message. The association between IBD (CD mainly) and psoriasis, now found in our practice, matches current basic science gathering IBD together with psoriasis (and perhaps chronic respiratory disease) under the comprehensive term "barrier organ disease" wherein an epithelial surface with sensor systems rules contacts between outer antigens and a reactive underneath tissue, with the balance between inflammation and quiescence kept at any time by mucosal permeability. IBD is thus viewed as a polyfactorial/polygenic/syndromic disorder, embedded into a galaxy of immune conditions offering multiple points of attack. This mindset of splitting the IBDs into pathogenic categories may allow overcoming the uniformly targeting of a single cytokine by biological drugs, in favor of demarcating the boundaries between different disease-subtype-specific indications, and paving the way to future personalized strategies. PMID:25133045

  16. Clinical, serological and genetic predictors of inflammatory bowel disease course

    Institute of Scientific and Technical Information of China (English)

    Laurent Beaugerie; Harry Sokol

    2012-01-01

    Patients with extensive or complicated Crohn's disease (CD) at diagnosis should be treated straightaway with immunosuppressive therapy according to the most recent guidelines.In patients with localized and uncomplicated CD at diagnosis,early use of immunosuppressive therapy is debated for preventing disease progression and limiting the disabling clinical impact.In this context,there is a need for predictors of benign or unfavourable subsequent clinical course,in order to avoid over-treating with risky drugs those patients who would have experienced spontaneous mid-term asymptomatic disease without progression towards irreversible intestinal lesions.At diagnosis,an age below 40 years,the presence of perianal lesions and the need for treating the first flare with steroids have been consistently associated with an unfavourable subsequent 5-year or 10-year clinical course.The positive predictive value of unfavourable course in patients with 2 or 3 predictors ranges between 0.75 and 0.95 in population-based and referral centre cohorts.Consequently,the use of these predictors can be integrated into the elements that influence individual decisions.In the CD postoperative context,keeping smoking and history of prior resection are the strongest predictors of disease symptomatic recurrence.However,these clinical predictors alone are not as reliable as severity of early postoperative endoscopic recurrence in clinical practice.In ulcerative colitis (UC),extensive colitis at diagnosis is associated with unfavourable clinical course in the first 5 to 10 years of the disease,and also with long-term colectomy and colorectal inflammation-associated colorectal cancer.In patients with extensive UC at diagnosis,a rapid step-up strategy aiming to achieve sustained deep remission should therefore be considered.At the moment,no reliable serological or genetic predictor of inflammatory bowel disease clinical course has been identified.

  17. The emerging therapy with probiotics in the management of inflammatory bowel disease: current status

    Directory of Open Access Journals (Sweden)

    Rajiv Kumar

    2013-08-01

    Full Text Available Inflammatory Bowel Disease (IBD comprises Ulcerative Colitis (UC and Crohn’s Disease (CD with unknown aetiology. Most of the drugs used to treat IBD as standard treatment produce adverse effects during long term therapy. Evidence has suggested a role of intestinal microbiota in IBD. The use of probiotics and prebiotics is the natural approach to treat IBD. The objective of this article was to review the studies on probiotics that cover the therapeutic status in Inflammatory Bowel Disease. Appraisal of published articles from peer reviewed journals, search from PubMed and Wiley Blackwell website for English language publications using defined key words according to disease type. Studies have shown that probiotic agents play an important role in IBD and these are VSL#3, Bifido-ferminted milk, Escherichia coli Nissle 1917, Saccharomyces boulardi and “BIO-THREE for inducing remission in patients with active UC, for preventing relapses in inactive UC patients and also in UC patients with ileo-anal pouch anastomosis. Lactobacillllus rhamnosus GG and Lactobacillllus johnsonii LA1 can prevent endoscopic recurrences in patients with inactive CD. Probiotic intervention study designs in IBD patients searched were RCT vs Placebo / RCT vs standard treatment . Studies - with uncontrolled design, - with prebiotics intervention and with helminths were also searched. There is a promising role of probiotics and prebiotics in chronic mucosal inflammation that occurs in Inflammatory Bowel Disease. Sufficient evidence to support the role of probiotics in CD are not available. Well designed RCT studies based on intention -to- treat analyses are required. [Int J Basic Clin Pharmacol 2013; 2(4.000: 360-367

  18. The effectiviness of hepatitis-B vaccination in inflammatory bowel disease

    OpenAIRE

    DİŞİBEYAZ, Selçuk; TÜRKMEN, Aygül; Parlak, Erkan; SAYDAM, Gül; ÜLKER, Aysel

    2002-01-01

    Background and aim: Inflammatory bowel disease patients are at high risk for hepatitis- B Virus infection due to the frequent need for hospitalisation, blood transfusion and endoscopic examination. The aim of this study was to evaluate the responsiveness of inflammatory bowel disease patients to hepatitis- B Virus vaccination. Material and methods: A total of 41 patients (24 ulcerative colitis and 17 Crohn's disease) and 28 healthy controls were vaccinated with a recombinant hepatitis- ...

  19. 78 FR 52824 - Proposed Information Collection (Bowel and Bladder Care Billing Form) Activity: Comment Request

    Science.gov (United States)

    2013-08-26

    ... AFFAIRS Proposed Information Collection (Bowel and Bladder Care Billing Form) Activity: Comment Request... evaluate the Bowel and Bladder Care Billing Form used by caregivers of eligible Veterans to document time...@va.gov . Please refer to ``OMB Control No. 2900-NEW (Bowel and Bladder Care Billing Form)'' in...

  20. Interobserver and intermodality agreement for detection of small bowel Crohn's disease with MR enterography and CT enterography

    DEFF Research Database (Denmark)

    Jensen, Michael D; Ormstrup, Tina; Vagn-Hansen, Chris Aksel;

    2011-01-01

    Magnetic resonance enterography (MRE) and computed tomography enterography (CTE) visualizes small bowel Crohn's disease (CD) and its complications with high accuracy. The aim of this study was to determine the interobserver and intermodality agreement for detection of small bowel CD....

  1. Isotretinoin exposure and risk of inflammatory bowel disease.

    Science.gov (United States)

    Rashtak, Shadi; Khaleghi, Shahryar; Pittelkow, Mark R; Larson, Joseph J; Lahr, Brian D; Murray, Joseph A

    2014-12-01

    IMPORTANCE Isotretinoin is the standard treatment for refractory severe nodulocystic acne.A true association between prior isotretinoin use and development of inflammatory bowel disease (IBD) is uncertain. Addressing the reality of this association is important in decision making for both the clinician and the patient when isotretinoin treatment is indicated.OBJECTIVE To assess the risk of IBD mainly in patients with acne with and without isotretinoin exposure.DESIGN, SETTING, AND PARTICIPANTS In this retrospective, single-center study, the electronic medical records of patients who were primarily seeking acne treatment were reviewed for isotretinoin exposure. International Classification of Diseases, Ninth Revision (ICD-9) codes were used to search for IBD diagnosis. participants included 1078 patients from 1995 to 2011,with isotretinoin referenced in their medical records, and who had ongoing local medical care defined as having had a serum sample collected between 2006 to 2011 for any reason while an Olmsted County, Minnesota, resident at the time of serum sample collection.EXPOSURES The exposed group included the patients with confirmed prior isotretinoin exposure (n = 576), and the nonexposed group were defined as patients who never received isotretinoin or received it after the diagnosis of IBD (n = 502).MAIN OUTCOMES AND MEASURES Risk of IBD among isotretinoin-exposed vs non exposed patients.RESULTS Both groups were comparable by race, prior systemic antibiotic use, and systemic tetracycline use. Inflammatory bowel disease developed less frequently in the isotretinoin-exposed group vs the nonexposed group (0.9%vs 2.6%; P = .03; unadjusted odds ratio [OR], 0.33; 95%CI, 0.12-0.93; P = .04). The negative association between isotretinoin exposure and IBD remained after adjusting for sex (OR, 0.28; 95%CI, 0.10-0.80;P = .02) and for sex and non acne indication (OR, 0.28; 95%CI, 0.10-0.79; P = .02).CONCLUSIONS AND RELEVANCE Our study did not show an increased risk

  2. Efficacy of small bowel follow-through with oral administration of methylcellulose in the diagnosis of small bowel disease

    International Nuclear Information System (INIS)

    To evaluate the usefulness of modified Small Bowel Follow Through (SBFT) with oral administration of methylcellulose in patients with small bowel diseases. Mean transit time was 142 minutes, and the maximum diameter of the jejunum and ileum was 2.9 cm and 2.1 cm respectively: in 45 patients (63%) the examination was concluded within 2 hours. The quality of images was excellent in 29 cases (41%), good in 30 (42%), fair in 8 (11%), and poor in 3 (4%). Images related to the inflammatory and vascular disease were graded as 'good' or 'excellent' in 92% and 89% of cases, respectively, and the image quality of lesions of the jejunum and ileum were graded, respectively, as 'good' or 'excellent' in 96 % and 63% of cases. Using this modified technique, sensitivity and specificity were 90% and 99%, respectively. Modified SBFT with the oral administration of methylcellulose is a simple but highly sensitive method of evaluating small bowel diseases. It is especially valuable in cases of inflammatory and vascular disease of the small intestine and lesions in the jejunum. (author). 15 refs., 4 tabs., 5 figs

  3. Identification of a macro-alkaline phosphatase complex in a patient with inflammatory bowel disease.

    Science.gov (United States)

    McTaggart, Malcolm P; Rawson, Catherine; Lawrence, David; Raney, Barbara S; Jaundrill, Linnet; Miller, Lorna A; Murtinho-Braga, Joseph; Kearney, Edward M

    2012-07-01

    We report the rare finding of a macro-alkaline phosphatase (macroALP) complex in a patient with a previously unexplained raised alkaline phosphatase activity. The clinical symptoms were persistent, daily diarrhoea for two months with blood in the stool. The patient was subsequently diagnosed with inflammatory bowel disease, specifically ulcerative colitis, following a rectal biopsy and colonoscopy. Two cases of macroALP associated with ulcerative colitis have been reported before, suggesting there could be an increased prevalence of macroALP in these patients. PMID:22454544

  4. Role of the intestinal barrier in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Mike G Laukoetter; Porfirio Nava; Asma Nusrat

    2008-01-01

    A critical function of the intestinal mucosa is to form a barrier that separates luminal contents from the interstitium. The single layer of intestinal epithelial cells (IECs) serves as a dynamic interface between the host and its environment. Cell polarity and structural properties of the epithelium is complex and is important in the development of epithelial barrier function. Epithelial cells associate with each other via a series of intercellular junctions. The apical most intercellular junctional complex referred to as the Apical Junction Complex (AJC) is important in not only cell-cell recognition, but also in the regulation of paracellular movement of fluid and solutes. Defects in the intestinal epithelial barrier function have been observed in a number of intestinal disorders such as inflammatory bowel disease (IBD). It is now becoming evident that an aberrant epithelial barrier function plays a central role in the pathophysiology of IBD. Thus, a better understanding of the intestinal epithelial barrier structure and function in healthy and disease states such as IBD will foster new ideas for the development of therapies for such chronic disorders.

  5. Nutritional status and nutritional therapy in inflammatory bowel diseases

    Institute of Scientific and Technical Information of China (English)

    Corina Hartman; Rami Eliakim; Raanan Shamir

    2009-01-01

    Underweight and specific nutrient deficiencies are frequent in adult patients with inflammatory bowel disease (IBD). In addition, a significant number of children with IBD, especially Crohn's disease (CD) have impaired linear growth. Nutrition has an important role in the management of IBD. In adults with CD, enteral nutrition (EN) is effective in inducing clinical remission of IBD, although it is less efficient than corticosteroids. Exclusive EN is an established primary therapy for pediatric CD. Limited data suggests that EN is as efficient as corticosteroids for induction of remission. Additional advantages of nutritional therapy are control of inflammation, mucosal healing, positive benefits to growth and overa ll nutritional status with minimal adverse effects. The available evidence suggests that supplementary EN may be effective also for maintenance of remission in CD. More studies are needed to confirm these findings. However, EN supplementation could be considered as an alternative or as an adjunct to maintenance drug therapy in CD. EN does not have a primary therapeutic role in ulcerative colitis. Specific compositions of enteral diets-elemental diets or diets containing specific components-were not shown to have any advantage over standard polymeric diets and their place in the treatment of CD or UC need further evaluation. Recent theories suggest that diet may be implicated in the etiology of IBD, however there are no proven dietary approaches to reduce the risk of developing IBD.

  6. Thrombospondin-1 and VEGF in inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    Canan Alkim

    2012-01-01

    Full Text Available Angiogenesis is an important process in the pathogenesis of chronic inflammation. We aimed to study the angiogeneic balance in inflammatory bowel disease (IBD by evaluating the expression of vascular endothelial growth factor (VEGF and thrombospondin-1 (TSP-1 on colonic epithelial cells, together with the expression of inducible nitric oxide synthase (iNOS.Twenty-one ulcerative colitis (UC, 14 Crohn's disease (CD, 11 colorectal cancer patients, and 11 healthy controls colonic biopsy samples were evaluated immunohistochemically.The expressions of TSP-1, VEGF, and iNOS in UC and CD groups were higher than expression in healthy control group, all with statistical significance. However, in colorectal cancer group, VEGF and iNOS expressions were increased importantly, but TSP-1 expression was not statistically different from healthy control group's expression. Both TSP-1 and VEGF expressions were correlated with iNOS expression distinctly but did not correlate with each other.Both pro-angiogeneic VEGF and antiangiogeneic TSP-1 expressions were found increased in our IBD groups, but in colorectal cancer group, only VEGF expression was increased. TSP-1 increases in IBD patients as a response to inflammatory condition, but this increase was not enough to suppress pathologic angiogenesis and inflammation in IBD.

  7. Probiotics and prebiotics in chronic inflammatory bowel diseases

    Institute of Scientific and Technical Information of China (English)

    Julia B Ewaschuk; Levinus A Dieleman

    2006-01-01

    The prokaryotic and eukaryotic cells of the colon exist in a highly complex, but harmonious relationship.Disturbances in this remarkable symbiosis can result in the development of inflammatory bowel diseases (IBD).Although the etiology of IBD is not entirely understood,it is known that the chronic inflammation of Crohn's disease, ulcerative colitis and chronic pouchitis are a result of an overly aggressive immune response to the commensal intestinal flora in genetically susceptible hosts. Recent studies have enhanced our ability to understand the interaction between the host and its intestinal microflora and the role the microflora plays in maintaining intestinal homeostasis. As we begin to understand the benefits conferred to the intestine by the microflora, the notion of modifying the composition of the bacterial load to improve human health has arisen.A significant body of research now exists investigating the role of probiotics and prebiotics in ameliorating chronic intestinal inflammation. This article will begin with an overview of the role of the commensal microflora in maintaining mucosal immune homeostasis, and how a dysregulated immune response to the intestinal microflora results in IBD. This will be followed by a summary of the use of probiotics and prebiotics in experimental and human IBD.

  8. Effects of Resveratrol on Inflammatory Bowel Disease: A Review

    Directory of Open Access Journals (Sweden)

    Mee Young Hong

    2014-06-01

    Full Text Available Inflammatory bowel disease (IBD is an autoimmunedisease characterized by chronic inflammation in the colon and small intestine. IBD produces many symptoms that can cause discomfort and a modified lifestyle. IBD has no cure, only drugs used to suppress its inflammation, which have exhibited harmful side effects. Resveratrol, 3,5,40 -trihydroxy-trans-stilbene, is a natural phenol with anti-inflammatory attributes. Studies have found consistent results showing that resveratrol supplementation in experimental rodent models of IBD can reduce inflammatory biomarkers. This review presents experimental animal models of IBD showing that resveratrol supplementation can down-regulate inflammatory pathways of MAPK and NF-κb, lessen COX-2, modify cytokines, diminish leukocytes, alter intestinal microflora, and decrease clinical symptoms in vivo, all of which contribute to an improved state of the disease. These outcomes, however, have not yet been studiedin naturally occurring IBD in humans. Future research should attempt and refine to determine if resveratrol could be an effective therapy for IBD in humans.

  9. Risk factors for osteoporosis in inflammatory bowel disease patients

    Institute of Scientific and Technical Information of China (English)

    Carla; Andrade; Lima; Andre; Castro; Lyra; Raquel; Rocha; Genoile; Oliveira; Santana

    2015-01-01

    Inflammatory bowel disease(IBD) patients exhibit higher risk for bone loss than the general population. The chronic inflammation causes a reduction in bone mineral density(BMD), which leads to osteopenia and osteoporosis. This article reviewed each risk factor for osteoporosis in IBD patients. Inflammation is one of the factors that contribute to osteoporosis in IBD patients, and the main system that is involved in bone loss is likely RANK/RANKL/osteoprotegerin. Smoking is a risk factor for bone loss and fractures, and many mechanisms have been proposed to explain this loss. Body composition also interferes in bone metabolism and increasing muscle mass may positively affect BMD. IBD patients frequently use corticosteroids, which stimulates osteoclastogenesis. IBD patients are also associated with vitamin D deficiency, which contributes to bone loss. However, infliximab therapy is associated with improvements in bone metabolism, but it is not clear whether the effects are because of inflammation improvement or infliximab use. Ulcerative colitis patients with proctocolectomy and ileal pouches and Crohn’s disease patients with ostomy are also at risk for bone loss, and these patients should be closely monitored.

  10. Inflammatory Bowel Disease: Autoimmune or Immune-mediated Pathogenesis?

    Directory of Open Access Journals (Sweden)

    Zhonghui Wen

    2004-01-01

    Full Text Available The pathogenesis of Crohn's disease (CD and ulcerative colitis (UC, the two main forms of inflammatory bowel disease (IBD, is still unclear, but both autoimmune and immune-mediated phenomena are involved. Autoimmune phenomena include the presence of serum and mucosal autoantibodies against intestinal epithelial cells in either form of IBD, and against human tropomyosin fraction five selectively in UC. In addition, perinuclear antineutrophil cytoplasmic antibodies (pANCA are common in UC, whereas antibodies against Saccharomyces cerevisiae (ASCA are frequently found in CD. Immune-mediate phenomena include a variety of abnormalities of humoral and cell-mediated immunity, and a generalized enhanced reactivity against intestinal bacterial antigens in both CD and UC. It is currently believed that loss of tolerance against the indigenous enteric flora is the central event in IBD pathogenesis. Various complementary factors probably contribute to the loss of tolerance to commensal bacteria in IBD. They include defects in regulatory T-cell function, excessive stimulation of mucosal dendritic cells, infections or variants of proteins critically involved in bacterial antigen recognition, such as the products of CD-associated NOD2/CARD15 mutations.

  11. The Mongolian gerbil as a model for inflammatory bowel disease.

    Science.gov (United States)

    Bleich, Eva-Maria; Martin, Myriam; Bleich, André; Klos, Andreas

    2010-06-01

    Mongolian gerbils are used as biomedical research models for a variety of diseases and are in some cases suited better than other rodents for basic research and therapeutic studies. The aim of this study was to establish and characterize a dextran sulphate sodium (DSS)-induced model in gerbils for the human inflammatory bowel disease (IBD) and to utilize them for a therapeutic study in vivo. Four concentrations (0.5%, 1%, 2% and 4%) of DSS were administered via drinking water for 7 days; based on these results, a concentration of 3% DSS was given for 9 days in a second approach. Fluid uptake and general clinical condition were assessed daily using a clinical score. Caecum and colon were scored histologically. Fluid uptake was affected by addition of DSS to the drinking water. First clinical symptoms were observed at day 4 of DSS treatment with a considerable increase in clinical score parameters only in gerbils receiving 2% or 4% DSS. Histologically, ulceration and inflammation were observed predominantly in the caecum of gerbils treated with at least 1% DSS; reproducible inflammation in the colon required at least 2% DSS. Using 3% DSS for 9 days, considerably more inflammation was induced in the colon, comparable with lesions usually observed in the mouse model. Using an optimized protocol, DSS treatment induces reproducibly typhlocolitis in Mongolian gerbils, rendering them as a useful model for IBD. PMID:20113376

  12. Age at diagnosis of inflammatory bowel disease influences early development of colorectal cancer in inflammatory bowel disease patients: A nationwide, long-term survey

    NARCIS (Netherlands)

    J.E. Baars (Judith); E.J. Kuipers (Ernst); M. van Haastert (M.); J.J. Nicolai (Jan); A.C. Poen (Alexander); C.J. van der Woude (Janneke)

    2012-01-01

    textabstractBackground: Data on clinical characteristics of patients with inflammatory bowel disease (IBD)-related colorectal cancer (CRC) are scarce and mainly originate from tertiary referral centres. We studied patient and disease characteristics of IBD-related CRC in a nationwide IBD cohort in g

  13. Risk factors of work disability in patients with inflammatory bowel disease - A Dutch nationwide web-based survey Work disability in inflammatory bowel disease

    NARCIS (Netherlands)

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

    2014-01-01

    Background: Inflammatory bowel disease (IBD) is associated with high costs to society. Few data on the impact of IBD on work disability and potential predictive factors are available. Aim: To assess the prevalence of and predictive factors for work disability in Crohn's disease (CD) and ulcerative c

  14. Surgical treatment of inflammatory bowel diseases; Chirurgische Behandlung entzuendlicher Darmerkrankungen

    Energy Technology Data Exchange (ETDEWEB)

    Fuerst, H.; Schildberg, F.W. [Chirurgische Klinik und Poliklinik, Ludwig Maximilians Univ. Muenchen, Klinikum Grosshadern (Germany)

    1998-01-01

    Purpose: To summarize current knowledge on surgical therapy in patients with inflammatory bowel disease (Crohn`s disease, ulcerative colitis and diverticulitis). Material and methods: To discuss surgical indications and strategies, we reviewed major peer review publications of the last 10 years, and we also analysed data from patients with Crohn`s disease who were treated in our institution between 1978 and 1994. Results: With Crohn`s disease (305 patients), emergency surgery should be avoided as much as possible, since morbidity (50% vs 8.8%) and mortality (11% vs 0.6%) rise significantly in comparison to elective procedures. With ulcerative colitis, operative therapy is indicated in patients with secondary malignoma, and urgent surgery is requested in cases with associated perforation, toxic megacolon or massive bleeding. With diverticulitis, the first episode should be managed conservatively. Surgery is indicated in patients with recurrent episodes or with secondary complications. (orig.) [Deutsch] In dieser Uebersichtsarbeit wird die operative Behandlung der entzuendlichen Darmerkrankungen M. Crohn, Colitis ulcerosa und Divertikulitis dargestellt. Anhand einer Literaturuebersicht wird sowohl die Operationsindikation als auch das operative Vorgehen besprochen, wobei beim M. Crohn auch Daten des eigenen Patientengutes zwischen 1978-1994 eingehen. Anhand der Daten von 305 Patienten wird deutlich, dass eine Notfalloperation bei M. Crohn vermieden werden muss, da darunter die Komplikationsrate (50% vs. 8,8%) und die Letalitaet (11% vs. 0,6%) deutlich steigen. Absolute Operationsindikationen bei Colitis ulcerosa sind die Perforation, das toxische Megakolon, Blutungen und das Auftreten eines Karzinoms. Der erste Schub einer Divertikulitis wird konservativ behandelt, bei Rezidivschueben sowie bei Kompliktionen besteht eine Operationsindikation. Wesentlich ist die rechtzeitige Operationsindikation bei M. Crohn und Divertikulitis, um Notfallsituationen zu vermeiden. Ziel

  15. The impact of helical computed tomography on the diagnosis of unsuspected inflammatory bowel disease in the large bowel

    International Nuclear Information System (INIS)

    Inflammatory bowel diseases (IBD) are diagnoses that can be easily overlooked clinically. The aim of this study was to investigate if CT is able to make a contribution to the identification of previously unsuspected cases of IBD. We retrospectively identified cases in which the possibility of an IBD was raised in CT reports (over a 4-year period), by utilising a keyword search of the radiology database. Cases with a previously known or suspected IBD were rigorously excluded by review of case notes, and endoscopic, radiological, histological and microbiological findings. The CT images of the identified cases were reviewed by a blinded observer to document the extent of bowel wall thickening, the location of lesion(s), and presence of peri-colic fat abnormality, ascites and/or collections. The observer also attempted to corroborate the presence, and to identify the type, of IBD based on the CT appearances alone. Thirty-five cases (out of approximately 19,000 body CTs performed) of clinically unsuspected IBD were identified, of which 27 underwent further investigation. An IBD was confirmed in 48% (13 of 27): Crohn's disease (n=6), ulcerative colitis (n=2), pseudomembranous colitis (n=3) and other (n=2), of which 70% (9 of 13) were correctly typed by the reviewer. Inflammatory bowel disease was not substantiated in the remainder (14 of 27), although 7 of these had other bowel pathologies: diverticular disease (n=4); and carcinoma (n=3). Prospectively determining the presence, and furthermore type, of IBD on CT is challenging largely because of the considerable overlap in the appearances of the individual IBDs and indeed of normality. Nevertheless, CT is able to identify clinically unsuspected cases and radiologists should be alert to this treatable and not infrequently elusive diagnosis. (orig.)

  16. Measurement and clinical implications of choroidal thickness in patients with inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    Ibrahim Koral Onal

    2015-10-01

    Full Text Available ABSTRACTPurpose:Ocular inflammation is a frequent extraintestinal manifestation of inflammatory bowel disease (IBD and may parallel disease activity. In this study, we evaluated the utility of a choroidal thickness measurement in assessing IBD activity.Methods:A total of 62 eyes of 31 patients with IBD [Crohn's disease (CD, n=10 and ulcerative colitis (UC, n=21] and 104 eyes of 52 healthy blood donors were included in this study. Choroidal thickness was measured using enhanced depth imaging optical coherence tomography. The Crohn's disease activity index (CDAI and the modified Truelove Witts score were used to assess disease activity in CD and UC, respectively.Results:No significant differences in mean subfoveal, nasal 3000 μm, or temporal 3000 μm choroidal thickness measurements (P>0.05 for all were observed between IBD patients and healthy controls. Age, smoking, CD site of involvement (ileal and ileocolonic involvement, CDAI, CD activity, and UC endoscopic activity index were all found to be significantly correlated with choroidal thickness by univariate analysis (P<0.05. Smoking (P<0.05 and the CD site of involvement (P<0.01 were the only independent parameters associated with increased choroidal thickness at all measurement locations.Conclusions:Choroidal thickness is not a useful marker of disease activity in patients with IBD but may be an indicator of ileal involvement in patients with CD.

  17. Neural control disturbances of the gastrointestinal tract and visceral pain in inflammatory bowel diseases 

    Directory of Open Access Journals (Sweden)

    Katarzyna Ciesielczyk

    2013-04-01

    Full Text Available Inflammatory bowel disease (IBD is a chronic intestinal inflammatory condition, the etiology of which is composed of factors such as the environment, genetic predisposition, gut dysbiosis and inadequate immune response. The pathologic findings in Crohn’s disease and ulcerative colitis are related to dysfunction of gastrointestinal secretion and motility and also disturbed visceral sensory function, with accompanying intestinal and parenteral complications. The systemic inflammatory response affects neurological control via the gut-brain axis, which modulates the cooperation of the autonomic nervous system (ANS, enteric nervous system (ENS and gut-associated lymphoid tissue (GALT. In chronic inflammation the intestinal neuropathy disrupts peristalsis and intestinal secretion as well as causing unpleasant symptoms of the patients. Pain receptors are stimulated by inflammatory mediators, and due to the intensified activation of the nociceptive system visceral hypersensitivity through central and peripheral sensitization is generated. Chronic visceral pain negatively influences the course of disease and the quality of the patient’s life. The growing knowledge about the neurological control dysfunction of the intestine and immune system dysregulation could provide proper directives for treatment of inflammatory bowel diseases.

  18. Characterisation and therapeutic manipulation of the gut microbiome in inflammatory bowel disease.

    Science.gov (United States)

    Schulberg, J; De Cruz, P

    2016-03-01

    Inflammatory bowel diseases are thought to develop as a result of dysregulation of the relationship that exists between the gut microbiota, host genetics and the immune system. The advent of culture-independent techniques has revolutionised the ability to characterise the role of the gut microbiota in health and disease based on the microbiota's genetic make-up. Inflammatory bowel diseases are characterised by dysbiosis which is an imbalance between pro- and anti-inflammatory bacteria and a reduction in bacterial diversity. Emerging data suggest that it is not only the presence of the gut microbiota but the functional activity of the microbiota that appears to play an important role in health and disease. Current strategies to manipulate therapeutically the gut microbiota using dietary modification, prebiotics, probiotics, antibiotics and faecal microbiota transplantation aim to restore the balance to a state of normobiosis. However, the ability of such strategies to correct dysbiosis and thereby achieve therapeutic benefit is yet to be fully characterised. PMID:26968595

  19. Role of imaging in the evaluation of inflammatory bowel disease: How much is too much?

    Science.gov (United States)

    Haas, Kelly; Rubesova, Erika; Bass, Dorsey

    2016-02-28

    Inflammatory bowel disease (IBD) is a lifelong condition with waxing and waning disease course that requires reassessment of disease status as well as screening for complications throughout a patient's lifetime. Laboratory testing, endoscopic assessment, and fecal biomarkers are often used in the initial diagnosis and ongoing monitoring of a patient with IBD. Imaging plays an integral role in the diagnosis and evaluation of IBD. Different imaging modalities can be used over the course of a patient's lifetime, from the initial screening and diagnosis of IBD, to determining the extent of intestinal involvement, monitoring for disease activity, and evaluating for complications of uncontrolled IBD. The various imaging modalities available to the provider each have a unique set of risks and benefits when considering cost, radiation exposure, need for anesthesia, and image quality. In this article we review the imaging techniques available for the evaluation of IBD including fluoroscopic small bowel follow-through, computed tomography enterography, magnetic resonance enterography, and transabdominal ultrasound with particular focus on the judicious use of imaging and the risks and benefits of each option. We also review the risks of ionizing radiation, strategies to reduce exposure to ionizing radiation, and current imaging guidelines among pediatric and adult patient with IBD. PMID:26981221

  20. Common misconceptions about 5-aminosalicylates and thiopurines in inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    Javier P Gisbert; María Chaparro; Fernando Gomollón

    2011-01-01

    Misconceptions are common in the care of patients with inflammatory bowel disease (IBD). In this paper, we state the most commonly found misconceptions in clinical practice and deal with the use of 5-aminosalicylates and thiopurines, to review the related scientific evidence, and make appropriate recommendations. Prevention of errors needs knowledge to avoid making such errors through ignorance. However, the amount of knowledge is increasing so quickly that one new danger is an overabundance of information. IBD is a model of a very complex disease and our goal with this review is to summarize the key evidence for the most common daily clinical problems. With regard to the use of 5-aminosalicylates, the best practice may to be consider abandoning the use of these drugs in patients with small bowel Crohn' s disease. The combined approach with oral plus topical 5-aminosalicylates should be the first-line therapy in patients with active ulcerative colitis; once-daily treatment should be offered as a first choice regimen due to its better compliance and higher efficacy. With regard to thiopurines, they seem to be as effective in ulcerative colitis as in Crohn' s disease. Underdosing of thiopurines is a form of undertreatment. Thiopurines should probably be continued indefinitely because their withdrawal is associated with a high risk of relapse. Mercaptopurine is a safe alternative in patients with digestive intolerance or hepatotoxicity due to azathioprine. Finally, thiopurine methyltransferase (TPMT) screening cannot substitute for regular monitoring because the majority of cases of myelotoxicity are not TPMT-related.

  1. The Social Construction of Inflammatory Bowel Disease Using Social Media Technologies.

    Science.gov (United States)

    Frohlich, Dennis Owen

    2016-11-01

    Many people with inflammatory bowel disease (IBD), sometimes lacking adequate face-to-face sources of support, turn to online communities to meet others with the disease. These online communities are places of support and education, but through the use of social media communication technologies, people with IBD are redefining what it means to live with the disease. This ethnographic study followed 14 online communities to understand how people with IBD used social media technologies to construct their own meanings about living with the disease. The following redefinitions were observed: the refiguring of the body is beautiful; inflammatory bowel disease is serious and deadly; inflammatory bowel disease is humorous; the disease makes one stronger; and the disease is invisible, but needs to be made visible. This study will help health communication scholars understand how technology is appropriated by patients, and will help practitioners understand how their patients conceptualize their disease. PMID:27050670

  2. Prevalence and Incidence of Antimicrobial-Resistant Organisms among Hospitalized Inflammatory Bowel Disease Patients

    Directory of Open Access Journals (Sweden)

    Alon Vaisman

    2013-01-01

    Full Text Available BACKGROUND: Patients with inflammatory bowel disease (IBD experience frequent hospitalizations and use of immunosuppressive medications, which may predispose them to colonization with antimicrobial-resistant organisms (ARO.

  3. Pharmacology and optimization of thiopurines and methotrexate in inflammatory bowel disease

    DEFF Research Database (Denmark)

    Coskun, Mehmet; Steenholdt, Casper; de Boer, Nanne K.;

    2016-01-01

    Improving the efficacy and reducing the toxicity of thiopurines and methotrexate (MTX) have been areas of intense basic and clinical research. An increased knowledge on pharmacodynamics and pharmacokinetics of these immunomodulators has optimized treatment strategies in inflammatory bowel disease...

  4. Overlapping gastroesophageal reflux disease and irritable bowel syndrome: Increased dysfunctional symptoms

    OpenAIRE

    Yarandi, Shadi Sadeghi; Nasseri-Moghaddam, Siavosh; Mostajabi, Pardis; Malekzadeh, Reza

    2010-01-01

    AIM: To investigate the association of gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) in Iranian patients and examine the prevalence of functional symptoms of the gastrointestinal tract in patients presenting with either IBS, GERD or both.

  5. Noninvasive methods in evaluation of inflammatory bowel disease: where do we stand now? An update

    Directory of Open Access Journals (Sweden)

    Cansel Turkay

    2010-01-01

    Full Text Available The inflammatory bowel diseases, consisting of Crohn's disease, ulcerative colitis and indeterminate colitis, are distinguished by idiopathic and chronic inflammation of the digestive tract. The distinction between inflammatory bowel diseases and functional bowel disorders, such as irritable bowel syndrome, can be complex because they often present with similar symptoms. Rapid and inexpensive noninvasive tests that are sensitive, specific and simple are needed to prevent patient discomfort, delay in diagnosis, and unnecessary costs. None of the current commercially available serological biomarker tests can be used as a stand-alone diagnostic in clinics. Instead, these are used as an adjunct to endoscopy in diagnosis and prognosis of the disease.Along these lines,, fecal lactoferrin and calprotectin tests seem to be one step further from other tests with larger number of studies, higher sensitivity and specificity and wider availability.

  6. Systematic review: influenza A (H1N1) virus in patients with inflammatory bowel disease

    OpenAIRE

    2009-01-01

    Abstract Background: Infection with influenza A (H1N1)v (swine flu) has caused widespread anxiety, among patients who are potentially immunocompromised, such as those being treated for inflammatory bowel disease. Aims: Provide guidance for physicians and their patients on the risk, prevention and management of influenza A (H1N1)v infection. Methods: Medline was searched using the following key words: `swine flu?, `immunosuppression?, inflammatory bowel disease?, `recommendati...

  7. Whipple's disease demonstrated by double contrast small bowel enema with barium and methylcellulose

    International Nuclear Information System (INIS)

    The radiologic findings on small bowel enema examination using barium and methylcellulose (SBE+Ba+MC) in a patient with Whipple's disease before and after treatment are described. The changes on SBE+Ba+MC corresponded well to the clinical and morphologic picture. The advantages of this double contrast technique compared to the enteroclysis with barium alone are demonstrated. The SBE+Ba+MC is a good method to demonstrate the manifestations of Whipple's disease involving the small bowel and the mesentery. (orig.)

  8. Magnetic Resonance Imaging of the Perineum in Pediatric Patients with Inflammatory Bowel Disease

    OpenAIRE

    Jamieson, Douglas H.; Shipman, Peter; Jacobson, Kevan

    2013-01-01

    Magnetic resonance imaging (MRI) has profoundly changed and improved the investigation of abdominal and pelvic inflammatory bowel disease (IBD) in pediatrics. Using an imaging modality without ionizing radiation is of particular advantage because the pediatric IBD population is young and often requires repeat evaluation. MRI of the pelvis has become the imaging gold standard for detecting and monitoring perianal disease while bowel-directed imaging techniques (eg, enterography, enteroclysis a...

  9. Magnetic resonance imaging of the perineum in pediatric patients with inflammatory bowel disease

    OpenAIRE

    Jamieson, Douglas H.; Shipman, Peter; Jacobson, Kevan

    2013-01-01

    Magnetic resonance imaging (MRI) has profoundly changed and improved the investigation of abdominal and pelvic inflammatory bowel disease (IBD) in pediatrics. Using an imaging modality without ionizing radiation is of particular advantage because the pediatric IBD population is young and often requires repeat evaluation. MRI of the pelvis has become the imaging gold standard for detecting and monitoring perianal disease while bowel-directed imaging techniques (eg, enterography, enteroclysis a...

  10. Inflammatory bowel disease in children--clinical, endoscopic, radiologic and histopathologic investigation.

    OpenAIRE

    Seo, J. K.; Yeon, K. M.; Chi, J. G.

    1992-01-01

    This paper reviews our five years' clinical experience (1987 to 1991) of 22 patients with inflammatory bowel disease (IBD). There were 12 patients with Crohn's disease and 10 patients with ulcerative colitis. The mean age at diagnosis was 8.7 years (2 to 14 years). Clinical impressions before referral were chronic diarrhea in 11, irritable bowel syndrome in 5, colon polyp in 4, lymphoma in 3, intestinal tuberculosis in 2, amoebic colitis in 2, ulcerative colitis in 2 children and other diseas...

  11. Prevalence of amebiasis in inflammatory bowel disease in Turkey

    Institute of Scientific and Technical Information of China (English)

    Sebnem Ustun; Hande Dagci; Umit Aksoy; Yuksel Guruz; Galip Ersoz

    2003-01-01

    AIM: To explore the prevalence of amebiasis in inflammatory bowel disease (IBD) in Turkey.METHODS: In this study, amoeba prevalence in 160 cases of IBD, 130 of ulcerative colitis and 30 of Crohn′s disease were investigated in fresh faeces by means of wet mount+Lugol′s iodine staining, modified formol ethyl acetate and trichrome staining methods and to compare the diagnostic accuracy of wet mount+Lugol′s iodine staining,modified formol ethyl acetate and trichrome staining methods in the diagnosis of Entamoeba histolytica (E. histolytica)/Entamoeba dispar (E. dispar).RESULTS: E. histolytica/E. dispar cysts and trophozoites were found in 14 (8.75 %) of a total of 160 cases, 13 (10.0 %)of the 130 patients with ulcerative colitis and 1 (3.3 %) of the 30 patients with Crohn′s disease. As for the 105 patients in the control group who had not any gastrointestinal complaints, 2 (1.90 %) patients were found to have E.histolytica/E. dispar cysts in their faeces. Parasite prevalence in the patient group was determined to be significantly higher than that in the control group (Fischer′s Exact Test, P<0.05).When the three methods of determining parasites were compared with one another, the most effective one was found to be trichrome staining method (Kruskal-Wallis Test, P<0.01).CONCLUSION: Consequently, amoeba infections in IBD cases have a greater prevalence compared to the normal population. The trichrome staining method is more effective for the detection of E. histolytica/E. dispar than the wet mount+Lugol′s iodine staining, modified formol ethyl acetate methods.

  12. Inflammatory bowel disease: the role of environmental factors.

    Science.gov (United States)

    Danese, Silvio; Sans, Miquel; Fiocchi, Claudio

    2004-07-01

    Environmental factors are essential components of the pathogenesis of inflammatory bowel disease (IBD) and primarily responsible for its growing incidence around the globe. Epidemiological, clinical and experimental evidence support an association between IBD and a large number of seemingly unrelated environmental factors, which include smoking, diet, drugs, geographical and social status, stress, microbial agents, intestinal permeability and appendectomy. Data supporting the involvement of each of these factors in predisposing to, triggering, or modulating the course or outcome of IBD vary from strong to tenuous. Smoking and the enteric bacterial flora are the ones for which the most solid evidence is currently available. Smoking increases the risk of Crohn's disease (CD) and worsens its clinical course, but has a protective effect in ulcerative colitis (UC). Presence of enteric bacteria is indispensable to develop gut inflammation in most animal models of IBD, and modulation of the quantity or quality of the flora can be beneficial in patients with IBD. Surprisingly, evidence for a major role of the diet in inducing or modifying IBD is limited, while that for nonsteroidal anti-inflammatory drugs is more convincing than for oral contraceptives. Northern geographic location, and a high social, economical, educational or occupational status increase the risk of IBD, an observation fitting the hygiene hypothesis for allergic and autoimmune diseases. Stress is also associated with IBD, but more as a modifier than an inducing factor, and its contribution is more obvious in IBD animal models than human IBD. Finally, an increased intestinal permeability may increase the risk for developing CD, whereas an appendectomy lowers the risk of developing UC. PMID:15288007

  13. Etiology of inflammatory bowel disease: A unified hypothesis

    Institute of Scientific and Technical Information of China (English)

    Xiaofa Qin

    2012-01-01

    Inflammatory bowel disease (IBD),including both ulcerative colitis (UC) and Crohn's disease (CD),emerged and dramatically increased for about a century.Despite extensive research,its cause remains regarded as unknown.About a decade ago,a series of findings made me suspect that saccharin may be a key causative factor for IBD,through its inhibition on gut bacteria and the resultant impaired inactivation of digestive proteases and over digestion of the mucus layer and gut barrier (the Bacteria-Protease-Mucus-Barrier hypothesis).It explained many puzzles in IBD such as its emergence and temporal changes in last century.Recently I further found evidence suggesting sucralose may be also linked to IBD through a similar mechanism as saccharin and have contributed to the recent worldwide increase of IBD.This new hypothesis suggests that UC and CD are just two symptoms of the same morbidity,rather than two different diseases.They are both caused by a weakening in gut barrier and only differ in that UC is mainly due to increased infiltration of gut bacteria and the resultant recruitment of neutrophils and formation of crypt abscess,while CD is mainly due to increased infiltration of antigens and particles from gut lumen and the resultant recruitment of macrophages and formation of granulomas.It explained the delayed appearance but accelerated increase of CD over UC and many other phenomena.This paper aims to provide a detailed description of a unified hypothesis regarding the etiology of IBD,including the cause and mechanism of IBD,as well as the relationship between UC and CD.

  14. Diagnosis of inflammatory bowel disease: Potential role of molecular biometrics

    Institute of Scientific and Technical Information of China (English)

    Amosy; E; M’Koma

    2014-01-01

    Accurate diagnosis of predominantly colonic inflammatory bowel disease(IBD) is not possible in 30% of patients. For decades, scientists have worked to find a solution to improve diagnostic accuracy for IBD, encompassing Crohn’s colitis and ulcerative colitis. Evaluating protein patterns in surgical pathology colectomy specimens of colonic mucosal and submucosal compartments, individually, has potential for diagnostic medicine by identifying integrally independent, phenotype-specific cellular and molecular characteristics. Mass spectrometry(MS) and imaging(I) MS are analytical technologies that directly measure molecular species in clinical specimens, contributing to the in-depth understanding of biological molecules. The biometric-system complexity and functional diversity is well suited to proteomic and diagnostic studies. The direct analysis of cells and tissues by Matrix-Assisted-Laser Desorption/Ionization (MALDI) MS/IMS has relevant medical diagnostic potential. MALDI-MS/IMS detection generates molecular signatures obtained from specific cell types within tissue sections. Herein discussed is a perspective on the use of MALDI-MS/IMS and bioinformatics technologies for detection of molecular-biometric patterns and identification of differentiating proteins. I also discuss a perspective on the global challenge of transferring technologies to clinical laboratories dealing with IBD issues. The significance of serologic-immunometric advances is also discussed.

  15. Neuroimmunomodulation in the Gut: Focus on Inflammatory Bowel Disease.

    Science.gov (United States)

    Bernardazzi, Claudio; Pêgo, Beatriz; de Souza, Heitor Siffert P

    2016-01-01

    Intestinal immunity is finely regulated by several concomitant and overlapping mechanisms, in order to efficiently sense external stimuli and mount an adequate response of either tolerance or defense. In this context, a complex interplay between immune and nonimmune cells is responsible for the maintenance of normal homeostasis. However, in certain conditions, the disruption of such an intricate network may result in intestinal inflammation, including inflammatory bowel disease (IBD). IBD is believed to result from a combination of genetic and environmental factors acting in concert with an inappropriate immune response, which in turn interacts with nonimmune cells, including nervous system components. Currently, evidence shows that the interaction between the immune and the nervous system is bidirectional and plays a critical role in the regulation of intestinal inflammation. Recently, the maintenance of intestinal homeostasis has been shown to be under the reciprocal control of the microbiota by immune mechanisms, whereas intestinal microorganisms can modulate mucosal immunity. Therefore, in addition to presenting the mechanisms underlying the interaction between immune and nervous systems in the gut, here we discuss the role of the microbiota also in the regulation of neuroimmune crosstalk involved in intestinal homeostasis and inflammation, with potential implications to IBD pathogenesis. PMID:27471349

  16. Differential patterns of histone acetylation in inflammatory bowel diseases

    Directory of Open Access Journals (Sweden)

    Adcock Ian M

    2011-01-01

    Full Text Available Abstract Post-translational modifications of histones, particularly acetylation, are associated with the regulation of inflammatory gene expression. We used two animal models of inflammation of the bowel and biopsy samples from patients with Crohn's disease (CD to study the expression of acetylated histones (H 3 and 4 in inflamed mucosa. Acetylation of histone H4 was significantly elevated in the inflamed mucosa in the trinitrobenzene sulfonic acid model of colitis particularly on lysine residues (K 8 and 12 in contrast to non-inflamed tissue. In addition, acetylated H4 was localised to inflamed tissue and to Peyer's patches (PP in dextran sulfate sodium (DSS-treated rat models. Within the PP, H3 acetylation was detected in the mantle zone whereas H4 acetylation was seen in both the periphery and the germinal centre. Finally, acetylation of H4 was significantly upregulated in inflamed biopsies and PP from patients with CD. Enhanced acetylation of H4K5 and K16 was seen in the PP. These results demonstrate that histone acetylation is associated with inflammation and may provide a novel therapeutic target for mucosal inflammation.

  17. Childhood inflammatory bowel disease: Parental concerns and expectations

    Institute of Scientific and Technical Information of China (English)

    AS Day; KE Whitten; TD Bohane

    2005-01-01

    AIM: To document the concerns and expectations of parents of children with inflammatory bowel disease (IBD)within the context of a multidisciplinary IBD clinic, and to highlight the importance of a holistic approach to the care of these children.METHODS: The parents of 60 children with IBD were surveyed by mailed questionnaire. Parents were asked to provide details of their concerns regarding their child's condition and to express their expectations of medical care. In addition, enquiry was made in respect to the respondents' learning about IBD.RESULTS: Forty-six questionnaires (77%) returned. Fiftytwo percent of the patients were male. Patients were aged a mean of 10.9 (±4.1) years and diagnosed at an average age of 2.1 (±1.8) years previously. The most common concerns expressed by the parents related to the side- effects of medications and the future prospects for their child. Overall, parents were satisfied with aspects of care within the IBD clinic but many suggested additional personnel such as counselors or educators should be available. Parents also reported the need for continuing education and easy access to up-to-date information.CONCLUSION: Parents of children and adolescents with IBD have many common concerns regarding their child's condition. On-going attention to holistic care, including psychosocial and educational elements for patients and families, is appropriate in the context of the chronic and unpredictable nature of IBD.

  18. Hypnotherapy for Inflammatory Bowel Disease Across the Lifespan.

    Science.gov (United States)

    Szigethy, Eva

    2015-07-01

    Inflammatory bowel disease (IBD) is an autoimmune disorder characterized by lifelong relapsing gastrointestinal symptoms and associated with high rates of chronic pain, depression, and anxiety. In this review the author covers the existing literature including randomized controlled studies, open trials, and case reports as well as expert opinion in evaluating how hypnotherapy can be most beneficial in adolescents and adults with IBD. Hypnotherapy evidence for functional gastrointestinal disorders (FGIDs) is also reviewed as many of the gut-focused hypnotherapy (GHT) approaches used in IBD trials were developed for this latter population. Collectively, the strongest evidence of use of hypnotherapy is its association with reduced IBD-related inflammation and improved health-related quality of life with mixed results in terms of its effects on psychological and pain outcomes in adults with IBD. Studies of hypnotherapy for FGID symptoms show consistently more positive results. Post-operative hypnotherapy may also be helpful based on findings in other surgical samples. Adolescents with IBD have not been as systematically studied but small case series support the use of hypnotherapy to improve inflammation and pain. Future studies are needed to better delineate the specific brain-gut pathways which are most influenced by hypnotherapy in the IBD population and to investigate the longer-term course of the positive short-term findings. PMID:26046718

  19. Contribution of genetics to a new vision in the understanding of inflammatory bowel disease

    Institute of Scientific and Technical Information of China (English)

    AS Pe(n)a

    2006-01-01

    Inflammatory bowel diseases (IBD), such as Crohn's disease (CD) and ulcerative colitis (UC), are chronic inflammatory autoimmune conditions of the gastrointestinal tract. Other organs, such as the eyes, skin and articulations, are often affected and IBD may be accompanied by other diseases of autoimmune origin. There is no single etiological factor responsible for the onset of IBD. Recent advances in genetics and in the molecular mechanisms of the proteins coded by these genes have given rise to a new vision in understanding these complex diseases. Activation of specific genes that affect antigen presentation and the handling of cells by innate immunity may lead to autoimmunity with the consequent activation of the major histocompatibility complex (MHC) and multiple cytokines involved in the regulation of acquired immunity. In this review IBD is described as a constellation of diseases that can best be classified as barrier diseases. This vision, developed by Kiel in Germany, includes the idea that changes in our environment due to the westernization of civilization have not been met with adaptation of the innate immune system, and this has given rise to autoimmune diseases. These diseases affect 1-5 of 1000 individuals and represent a major burden on the national health systems of many countries on different continents. On a world scale, a major challenge is to generate interventions to prevent the development of these diseases in Asia, Latin America and Africa.

  20. Blood transfusion for the treatment of acute anaemia in inflammatory bowel disease and other digestive diseases

    OpenAIRE

    García-Erce, José Antonio; Gomollón, Fernando; Muñoz, Manuel

    2009-01-01

    Allogeneic blood transfusion (ABT) is frequently used as the first therapeutic option for the treatment of acute anaemia in patients with inflammatory bowel disease (IBD), especially when it developed due to gastrointestinal or perioperative blood loss, but is not risk-free. Adverse effects of ABT include, but are not limited to, acute hemolytic reaction (wrong blood or wrong patient), febrile non-hemolytic transfusional reaction, bacterial contamination, transfusion-related acute lung injury...