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Inflammatory Bowel Disease
      #13950 - 07/14/03 01:51 PM
HeatherAdministrator

Reged: 12/09/02
Posts: 7795
Loc: Seattle, WA

All articles concerning Inflammatory Bowel Diseases such as Crohn's and Ulcerative Colitis should be posted here.



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Chemo Drug Improves Crohn's Symptoms new
      #13995 - 07/14/03 04:09 PM
HeatherAdministrator

Reged: 12/09/02
Posts: 7795
Loc: Seattle, WA

Chemo Drug Improves Crohn's Symptoms - Immune-Boosting Therapy Opposite of Standard Treatment

By Sid Kirchheimer
WebMD Medical News

Nov. 7, 2002 -- The painful and debilitating symptoms of Crohn's disease may be eased or even eliminated by a seemingly unlikely source -- a drug primarily used to boost immunity. A study shows Leukine to be a unique and promising new approach to treat the disease.


The irony: Crohn's has been thought to result from an overactive immune system, and traditional therapies have attempted to suppress -- not enhance -- immune activity.


Yet researchers discovered that the drug Leukine, which strengthens immune response by increasing the size and function of white blood cells, offered "significant improvement" in symptom relief for 12 of 15 Crohn's patients -- that's 80% -- who were part of the first study using this therapy.


Of those, eight went into remission, says researcher Joshua Korzenik, MD, of Washington University School of Medicine and a Crohn's specialist at Barnes-Jewish Hospital in St. Louis.


"It's a small study, but the outcome exceeded our expectations, especially since people were saying that the idea of stimulating immune systems that are already revved up is like throwing oil onto a raging fire," he tells WebMD. "While this treatment approach certainly isn't prime-time yet, we're extremely excited because it offers a different approach and new understanding to a disease that has defied explanation."


His findings, published in the Nov. 9 issue of The Lancet, are now the subject of a follow-up study at 30 sites throughout the U.S. If future findings are similarly promising, Leukine might be available for Crohn's patients within five years, says Korzenik. It is usually used in cancer patients who are undergoing chemotherapy.


Leukine could provide some relief to a baffling condition that plagues nearly 500,000 Americans, causing extreme pain, diarrhea, ulcers, and other inflammation in the intestines.


"What's particularly heinous about Crohn's is the typical onset occurs in the teens or early 20s, a time when people are establishing their self-identity," notes researcher Brian Dieckgraefe, MD, PhD, also at Washington University. "So, as if going through your teens isn't bad enough, these patients also have severe daily abdominal pain, diarrhea, intestinal ulcers and abscesses."


Therapy for Crohn's patients currently involves several immune-suppressing drugs, including steroids. But many cause side effects not experienced by the test subjects using Leukine, says Korzenik. Only one medication is specifically approved by the FDA to treat Crohn's -- Remicade, which is also used to treat rheumatoid arthritis.


"But Remicade requires continuous infusion, whereas Leukine is injected, so it's a lot easier to administer," notes Seymour Katz, MD, of New York University School of Medicine and a spokesman for the American College of Gastroenterology. "Does this mean that Leukine is the only answer for Crohn's? No. Does it offer some hope for Crohn's patients? Yes. Is this an exciting finding that brings a new approach to treatment? Absolutely."

© 2002 WebMD Inc. All rights reserved.

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Hormone replacement therapy prevents bone loss in patients with IBD new
      #14115 - 07/15/03 06:02 PM
HeatherAdministrator

Reged: 12/09/02
Posts: 7795
Loc: Seattle, WA

Gut. 1993 Nov;34(11):1543-6.

Hormone replacement therapy prevents bone loss in patients with inflammatory bowel disease.

Clements D, Compston JE, Evans WD, Rhodes J.

Department of Medicine, University Hospital of Wales, Cardiff.

Patients with inflammatory bowel disease have an increased prevalence of osteoporosis, and suffer high rates of spinal bone loss. Hormone replacement therapy (HRT) is effective in the treatment and prevention of osteoporosis but has not been studied in patients with inflammatory bowel disease. A two year prospective study of HRT in inflammatory bowel disease was performed in 47 postmenopausal women aged 44 to 67 years with ulcerative colitis (25) or Crohn's disease (22). Patients had radial and spinal bone density measured annually by single photon absorptiometry and quantitative computed tomography respectively. The mean (95% confidence intervals) annual change in radial bone density was +1.42%/yr (+0.58 to +2.26; P < 0.005) and for spinal bone +2.60%/yr (+1.06 to +4.15; p < 0.005). There was no significant correlation between rates of change of bone density at the two sites, or between the rates of change and the initial bone density either in the radius or spine. Twelve patients were given prednisolone during the study, and their rates of change for spinal bone density were lower, but values were not statistically significantly different from those who did not receive corticosteroids. Changes in bone density for patients with ulcerative colitis and Crohn's disease were not significantly different. The change in bone density did not correlate with the patients' age or number of years after the menopause. It is concluded that HRT is effective in prevention of bone loss in postmenopausal women with inflammatory bowel disease.

PMID: 8244141 [PubMed - indexed for MEDLINE]

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A study of the menopause, smoking, and contraception in women with Crohn's disease. new
      #14117 - 07/15/03 06:05 PM
HeatherAdministrator

Reged: 12/09/02
Posts: 7795
Loc: Seattle, WA

Q J Med. 1989 Jul;72(267):623-31.

A study of the menopause, smoking, and contraception in women with Crohn's disease.

Lichtarowicz A, Norman C, Calcraft B, Morris JS, Rhodes J, Mayberry J.

City Hospitals, Nottingham.

One hundred and ninety-six women with Crohn's disease from south-east Wales were asked to provide details of their menstrual cycles, age at menopause, history of surgery, smoking habits and use of oral contraceptives. One hundred and forty-six provided the information (response rate 77 per cent). Eighty-four were still menstruating, three were pregnant, 10 had undergone hysterectomy, one had a pharmacologically-induced menopause and 48 had had a physiological menopause. Of these 48 women, 33 were diagnosed as having Crohn's disease before the menopause. Twenty-five of these were smokers. The mean age at menopause was similar in smokers and non-smokers and in those diagnosed before and after the menopause. The mean age at menopause was between 46 and 47. A logistic analysis using the 'status quo' method showed that 50 per cent of women with Crohn's disease had the menopause at 47.6 years compared with 49.6 years in a group of healthy women from the same area. The two groups had similar smoking habits and it would seem that a premature menopause is associated with Crohn's disease.

PMID: 2608881 [PubMed - indexed for MEDLINE]
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Inflammatory Bowel Disease During Pregnancy. new
      #14124 - 07/15/03 06:20 PM
HeatherAdministrator

Reged: 12/09/02
Posts: 7795
Loc: Seattle, WA

Curr Treat Options Gastroenterol. 2003 Jun;6(3):227-236.

Inflammatory Bowel Disease During Pregnancy.

Tilson RS, Friedman S.

Gastroenterology Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. sfriedman1@partners.org

Physicians treating patients with Crohn's disease and ulcerative colitis will often need to care for them throughout pregnancy and deal with the surrounding issues of fertility, childbirth, and sexuality. Patients often worry about continuing medications during pregnancy and feel particularly at risk for poor birth outcomes. However, because pregnancy outcomes are most closely tied to disease activity at the time of conception, patients who are in remission when they conceive will have the most successful pregnancies. The overriding principle in treating pregnant patients with inflammatory bowel disease (IBD) is continued and close surveillance of disease activity, with aggressive medical, and if indicated, surgical treatment. With few exceptions, medicines used to induce remission before pregnancy should be continued throughout pregnancy. Pregnant women with active IBD should be followed by a gastroenterologist with experience in the issues surrounding pregnancy, and by an obstetrician with access to a tertiary referral center. Properly treated and followed, patients with IBD can expect outcomes from their pregnancies that approximate those of patients without the disease.

PMID: 12744822 [PubMed - as supplied by publisher]
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Bacteria in Milk Linked to Crohn's Disease and Possibly IBS new
      #17056 - 08/12/03 11:55 AM
HeatherAdministrator

Reged: 12/09/02
Posts: 7795
Loc: Seattle, WA

M. avium Implicated in Crohn's Disease, Perhaps Also Irritable Bowel Syndrome

By Richard Woodman

LONDON (Reuters Health) Aug 06 - Researchers said on Wednesday they had found a "highly significant" link between Crohn's disease and a mycobacterium that can be passed to humans in milk.

Professor John Hermon-Taylor and his research team at St. George's Hospital Medical School in London said they had detected Mycobacterium avium paratuberculosis (MAP) bacteria in 92% of ileocolonic biopsy specimens from patients with Crohn's disease but in only 26% of patients in a control group.

"The rate of detection of MAP in individuals with Crohn's disease is highly significant and implicates this pathogen in disease causation," they write in the July issue of the Journal of Clinical Microbiology.

"The problems caused by the MAP bug are a public health tragedy", said Dr. Hermon-Taylor, who has sent a copy of the paper to Britain's Chief Medical Officer, Liam Donaldson.

The study was backed by the medical charity Action Research, which said previous findings showed live MAP bacteria is present in 2% of retail pasteurised milk cartons.

"The discovery that the MAP bug is present in the vast majority of Crohn's sufferers means it is almost certainly causing the intestinal inflammation," the charity said in a statement.

It added: "Action Research does not recommend that anyone stops drinking milk. However, for those individuals with Crohn's disease or their close relatives, who may feel particularly at risk, it may be sensible to start drinking UHT milk. As UHT involves higher pasteurisation temperatures, it is probable that MAP is destroyed."

The charity called for Crohn's disease to be made a reportable condition, for more stringent milk pasteurisation, for tests for MAP in dairy herds, and procedures for reducing MAP infection on farms.

Hermon-Taylor said an unexpected finding of the research showed that patients with irritable bowel syndrome (IBS) were also infected with the MAP bug.

"In animals, MAP inflames the nerves of the gut," he said. "Recent work from Sweden shows that people with IBS also have inflamed gut nerves. There is a real chance that the MAP bug may be inflaming people's gut nerves and causing IBS."

J Clin Microbiol 2003;41:2915-2923.

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Familial Occurrence of Inflammatory Bowel Disease in Celiac Disease new
      #20915 - 09/16/03 03:30 PM
HeatherAdministrator

Reged: 12/09/02
Posts: 7795
Loc: Seattle, WA

Familial Occurrence of Inflammatory Bowel Disease in Celiac Disease

Inflammatory Bowel Diseases 2003; 9(5):321-323

Mario Cottone; Ciro Marrone; Angelo Casą; Lorenzo Oliva; Ambrogio Orlando; Emma Calabrese; Giuseppe Martorana; Luigi Pagliaro

Background:
The authors have previously reported a possible increased risk of the familial occurrence of Crohn's disease in patients with celiac disease.

Aim:
The aim of the current study was to evaluate in a case-control study the familial occurrence of inflammatory bowel disease (IBD) in first-degree relatives of patients with celiac disease.

Methods:
One hundred eleven consecutive patients with biopsy-proven celiac disease were interviewed to ascertain whether IBD was present in first-degree relatives. The number of relatives, their ages, and possible IBD status were collected in a questionnaire. When a diagnosis of familial IBD was reported, the diagnosis was checked in the hospital records. Two hundred twenty-two controls matched for age and sex (111 from the general population and 111 from orthopedic wards) were also interviewed regarding the possible occurrence of IBD in first-degree relatives. The &#967;2 test was used to evaluate the difference in proportion of familial occurrence of IBD among individuals with celiac disease and controls.

Results:
Among 600 first-degree relatives of patients with celiac disease, 10 cases of IBD were identified among first-degree relatives (7 cases of ulcerative colitis and 3 cases of Crohn's disease), whereas only 1 case of IBD was identified among the 1,196 first-degree relatives of control patients (p < 0.01). When ulcerative colitis and Crohn's disease were analyzed separately, only the prevalence of ulcerative colitis was statistically significant (p &#8804; 0.02).

Conclusions:
This case-control study shows that there is a significantly increased prevalence of familial ulcerative colitis in patients with celiac disease. There was no significant increase in the prevalence of Crohn's disease in patients with celiac disease. The possible role of this association is discussed.

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Heather is the Administrator of the IBS Message Boards. She is the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!

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Indeterminate Colitis new
      #20916 - 09/16/03 03:33 PM
HeatherAdministrator

Reged: 12/09/02
Posts: 7795
Loc: Seattle, WA

Inflammatory Bowel Diseases 2003; 9(5):324-331

Indeterminate Colitis

Karel Geboes; Gert De Hertogh

Summary:
A diagnosis of Crohn's disease (CD) and ulcerative colitis (UC) is based on a combination of clinical, histologic, endoscopic, and radiologic data. The distinction between UC and CD can be difficult because of the lack of a differentiating single gold standard. Indeterminate colitis (IC) was introduced by pathologists for the diagnosis of surgical colectomy specimens showing an overlap between the features of UC and CD. The diagnosis of IC was based on macroscopic and microscopic features. The term indeterminate colitis is in recent years more widely applied to include all cases with endoscopic, radiographic, and histologic evidence of chronic inflammatory bowel disease confined to the colon, but without fulfilment of diagnostic criteria for UC and CD. As for UC and CD, the diagnosis of IC has therefore become a clinicopathologic diagnosis. IC is generally considered to be a temporary diagnosis. The clinical characteristics of patients with IC are, however, somewhat different from the characteristics of those with UC. Furthermore, serologic markers such as perinuclear antineutrophil cytoplasmic antibody and anti-Saccharomyces cerevisiae, which are strongly linked with UC and CD, are both negative in a subset of patients w