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

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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
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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

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Posts: 7795
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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
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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 Casŕ; 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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Indeterminate Colitis new
      #20916 - 09/16/03 03:33 PM
HeatherAdministrator

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Posts: 7795
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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 with IC. Therefore, the possibility that IC could be a separate entity must be investigated.

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Detection of Pulmonary Involvement in Inflammatory Bowel Disease new
      #22104 - 09/30/03 01:20 PM
HeatherAdministrator

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

Journal of Clinical Gastroenterology 2003; 37(4):292-298

Pulmonary Function Tests and High-Resolution CT in the Detection of Pulmonary Involvement in Inflammatory Bowel Disease

Necla Songur, MD; Yildiran Songur, MD; Meric Tuzun, MD; Ibrahim Dogan, MD; Dilek Tuzun, MD; Arzu Ensari, MD; Baki Hekimoglu, MD

Goals:
To assess the pulmonary involvement detected by pulmonary function tests (PFT) and high-resolution computed tomography (HRCT) in inflammatory bowel disease (IBD) patients and to investigate the relationship of the pulmonary abnormalities with respiratory symptoms and bowel disease activity.

Methods:
23 patients with ulcerative colitis, 13 patients with Crohn disease and 14 control subjects took part in this prospective, controlled study. In all patients, detailed clinical information was obtained and extent and activity of the bowel disease were established. Each patient underwent PFT and HRCT scanning.

Results:
A pulmonary function abnormality was present in 21 of 36 patients. In IBD patients, DLCO were significantly lower, but RV/TLC was significantly higher than those of controls. HRCT revealed air trapping, fibrosis, emphysema, bronchiectasis and alveolitis in 19 patients. One-third of the patients with PFT abnormality, and 42% of the patients with HRCT abnormality were respiratory symptom free. Approximately 80% of the patients with pulmonary involvement had active bowel disease.

Conclusions:
Pulmonary involvement is common in patients with IBD. A high degree of suspicion is necessary to detect the pulmonary abnormality in IBD, because considerably large proportions of the symptom free patients have abnormal findings on HRCT and PFT.

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Colonoscopy Prep new
      #23729 - 10/17/03 12:05 PM
HeatherAdministrator

Reged: 12/09/02
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The following is an excerpt from Jill Sklar's book, The First Year Crohn's Disease and Ulcerative Colitis (Marlowe 2002), which is available here on helpforibs.com or at any major bookstore. Jill hereby gives this as her contribution to humanity:

Colonoscopy
The colonoscopy is a very versatile and useful procedure that is used for many purposes including examining for cancer, locating and excising polyps and securing biopsies that can be later examined for CD or UC. In the past, it was done on patients who were fully awake but less sadistic methods are used now, leaving most patients to ask if the procedure has started when it is already done.

As you probably have heard, the worst part is the prep, an amazing statement given that there are at least a half a dozen ways that the prep is done. The goal of the preps is to strip away any fecal matter from the intestines, thus thoroughly cleansing the intestinal walls for a better view for the endoscopist. All of the preps involve ingesting a substance that then causes intense peristaltic waves and quick evacuation of the bowels, usually taking one to three hours.

Perhaps one of the older preparation ways is the use of a product called Go-Litely, which should probably be named Go Hard and Hurtfully. This involves drinking a glass of barely palatable salty liquid every few minutes until the only thing coming out of you resembles water; a gallon is the usual amount prescribed. A variation of that is Nu-Litely, a less salty, less cumbersome but no more palatable concoction that works in the same manner. Some doctors prescribe different mixes of castor oil, citrate magnesium, Ducolax tablets or suppositories and Fleets enemas to be taken at various times in the two days leading up to the big day. Another relatively new product is Fleets phosphosoda, an intensely briny tasting liquid. The label says that the patient can mix three tablespoons of the liquid with three ounces of water; for a usual colonoscopy prep, a dose the night before and another the morning of the test usually does the trick. The X prep is similar in that it involves drinking about two doses of two ounces of the nasty tasting prep liquid. Finally, the newest prep, Visicol, allows the patient to skip the bad taste by swallowing pills chased with an eight-ounce glass of clear liquid. On the day before the test and the morning of the test, the patient has to swallow three pills every 15 minutes over an hour and a half, with the last dose being two pills; the total of pills swallowed is 40.

There are drawbacks to every prep, chiefly swallowing things that will make you feel queasy. Because this prep is primarily done at home there are a few things you can do to make it more comfortable for yourself. Remember, these are tips and suggestions; I am not a doctor and although I have survived this test more times than any doctor I know, you should always follow the directives that your doctor gives to you regarding medication and bowel cleansing solutions.

We'll start with a shopping list. Since you will be headed to the store to pick up the bottles and boxes of prep materials, pick up the following as you will need them if you don't already have them:

1.Kleenex brand Cottonelle toilet paper infused with both aloe and vitamin E or a box of baby wipes infused with aloe (the quilted wipes provide that extra degree of comfort but may not be advisable if you have a septic system).

2. Hemorrhoidal cream such as Anusol HC or any other one with HC on the label. The HC stands for hydrocortisone, a topical steroid that helps reduce swelling and itching.

3. KY Jelly or Vaseline.

4. Plenty of reading material. I prefer to read magazines that I never read as it certainly provides a diversion so I pick up such paragons of journalism such as The National Enquirer, The Star, The Sun or the Weekly World News. Any other reading material that you would consider fun or distracting is a plus here as well.

5. Scented candles or fragrant bath oil in a pleasing, relaxing scent.

6. A heating pad or hot water bottle.

7. Lots of your favorite clear liquid food items (avoid all with red or purple dyes as the dye can mistaken for inflammation) such as Canada Dry, Jell-O, Italian ice, popsicles, chicken or beef broth. Also, be sure to pick up some electrolyte containing liquids such as Gatorade or Pedialyte.

First, I have a little rule of what ever goes in must come out, kind of like Newton's law but with a little digestive twist – call it Jill's law. The older preps used to dictate a diet devoid of roughage and fat followed for three days before the test, with a clear liquid diet on the last day. Why? Because these things tend to hang out in the colon the longest. With less in there, it made the prep a little easier. People were told to eat baked chicken, baked fish or scrambled egg whites for protein; oils or fats less than two tablespoons for the whole day, which meant no cheese, egg yolks or fried foods; doses of soluble fiber such as plain pasta, white rice, baked potatoes and white bread; sweets like angel food cake or vanilla wafers; and plenty of clear liquids such as broth, weak tea or coffee without cream, soda pop and clear juices such as apple juice or white grape juice. The last part, the clear liquids, was all a person could have the day before. But some doctors theorized that the newer preps could do the job without the diet, still stripping everything in their path.

I, however, still believe in the old diet. As a patient who has more colonoscopies than I care to remember, the diet helps to eliminate the bulk of the feces prior to prep, leaving less to evacuate. It also makes the liquid fast easier to tolerate for me. I also add a Ducolax tablet two nights before the blessed event to help get some of the heavy lifting out of the way first. My feeling is that if I can get the prep done in one dose, I have eliminated some of the misery. I also add clear electrolyte beverages like Gatorade or Pedialyte to the diet, sipping them almost constantly in the two days before the test. This will help to boost some of your electrolyte levels as many electrolytes are lost during the prep, leaving some people to feel cold, shaky and faint. I am not a fan of Gatorade but I love the Pedialyte as it tastes almost like Kool-Aid. I mix a bit of the orange flavor with Canada Dry ginger ale and crushed ice, a sort-of pre-colonoscopy cocktail.

For swallowing the nasty prep liquids, the rules for swallowing yucky things apply again; only this time, you may have more options than you do in a hospital setting. With the Go-Litely and Nu-Litely, you can add a little Crystal Lite for a bit of flavor. Lemons or limes dipped in sugar and tucked into the cheek counterbalance the salty flavor as well as can hard candy. Some people also swear by having the liquid as cold as possible. If you do this, be aware that you might have a sudden, sharp headache more commonly known as brain freeze.

Do not stray away from the bathroom. In fact, have it as stocked as it can be. You will need KY Jelly or Vaseline, the hemorrhoidal cream, the special toilet paper or baby wipes, reading material, bedtime clothing, a bath towel, the aromatherapy tools and anything else you can think of to add to your comfort. One friend of mine hauls in her television for the event.

You may feel somewhat nauseous and this is natural. Use cold cloths on your forehead or splash cold water on your face to fend off vomiting. Pacing helps as well but don't go too far from the bathroom because soon you will have an urge to go that you have never known before.

Before you begin to empty out, it helps a bit to coat your anus with the KY Jelly or Vaseline. The velocity of which your intestinal contents exit pared with the volume of the intestinal contents and the fact that some unabsorbed digestive enzymes will find their way out can make for a very sore anus and rectum. To ward this off a bit, it helps to thoroughly coat the anus and anal canal with the petroleum products. As the emptying begins, use the gentle wipes and flush often.

As the bowel evacuation subsides, you may feel cold and weak with muscle cramps. At this time, I usually draw a hot bath filled with scented bath crystals or oils and surround it with scented candles. This is soothing. If I still feel the urge to go, I am two steps from the toilet and a bath towel is always nearby. Before getting into my nightgown, I use a little soothing hemorrhoidal cream.

Following the first part of the prep, most doctors allow their patients to continue drinking clear liquids until midnight. This is important as the bowel cleanse solutions often draw in water from the body; paired with the diarrhea during the prep, this can make you dehydrated. Try to shoot for at least 24 ounces if you can. Also, if you are particularly nervous, a glass or white wine or a shot of vodka both count as clear liquids in my book and can help you to sleep.

On the day of the test, you will be asked to disrobe. Women may have to take a pregnancy test. An IV will be inserted in your arm before you are wheeled into the endoscopy suite. Draping will cover your body and your doctor will place a sedative in your IV. Usually, the painkiller Demerol is used with the sedative Valium and Versed, a short-term amnesia drug. Another option is to use a short-term anesthesia, administered by an anesthesiologist. While you are out, your doctor will insert the endoscopic tool and examine the colon, taking biopsies as well.

The next thing you should remember is waking up in recovery. You may be given juice to drink. When you are able to stand up, you can get dressed. The doctor who performed the test will discuss his or her findings with you and with the person who drove you to the test before you are allowed to leave. You may be woozy the rest of the day but you should recover by the next day.

If you experience sharp pain or a lot of bleeding, you should call the doctor. Rarely, a perforation of the intestines can occur.




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Environmental Factors May Play a Role in the Pathogenesis of IBD new
      #29622 - 12/01/03 05:56 PM
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Environmental Factors May Play a Role in the Pathogenesis of IBD

NEW YORK (Reuters Health) Nov 14 - The clinical spectrum of inflammatory bowel disease (IBD) is evolving, results of a study published in the October issue of the Journal of Pediatrics suggest. The findings point to changing environmental factors as contributors to the pathogenesis of the disease

In a population-based study, Dr. Subra Kugathasan, of the Medical College of Wisconsin, Milwaukee, and colleagues examined the incidence of pediatric IBD and defined clinical characteristics of the disease. Demographic and clinical data on all new cases of IBD in Wisconsin over a 2-year period were prospectively analyzed.

The overall incidence of IBD in children was 7.05 per 100,000, according to the researchers. The incidences of Crohn's disease (CD) and ulcerative colitis (UC) were 4.56 and 2.14 per 100,000, respectively.

The mean ages of diagnosis for IBD, CD, and UC were 12.5 years, 13.5 years, and 11.8 years, respectively.

The IBD incidence rates were similar among all ethnic groups, as well as among children from sparsely versus densely populated regions. Only 11% of the newly diagnoses IBD cases had first- or second-degree relatives with a history of the disease.

The lack of family history and the higher incidence of Crohn's disease than ulcerative colitis suggest to the investigators that new environmental factors are involved.

Also, they point out, the incidence of IBD in children they documented is the highest ever reported.

"A parallel phenomenon is the dramatic increase in asthma during the same period in the West," Dr. Kugathasan and colleagues note. "The concomitant emergence of chronic inflammation in the lung and gut also supports the concept that changing environmental factors play a pivotal role in the increased frequency of these disorders in children."

J Pediatr 2203;143:525-531.

http://www.medscape.com/viewarticle/464442?mpid=21407

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Increased Anal Resting Pressure and Rectal Sensitivity in Crohn's Disease new
      #32150 - 12/16/03 11:59 AM
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Diseases of the Colon & Rectum 2003; 46(12):1685-1689

Increased Anal Resting Pressure and Rectal Sensitivity in Crohn's Disease

Peter Andersson, M.D., Ph.D. *; Gunnar Olaison, M.D., Ph.D. *; Olof Hallböök, M.D., Ph.D. *; Bernt Boeryd, M.D., Ph.D. †; Rune Sjödahl, M.D., Ph.D., F.R.C.S. *

PURPOSE:
Anal pathology occurs in 20 to 80 percent of patients with Crohn's disease in which abscesses, fistulas, and fissures account for considerable morbidity. The etiology is not clearly defined, but altered anorectal pressures may play a role. This study was designed to investigate anorectal physiologic conditions in patients with Crohn's disease compared with healthy controls.

METHODS:
Twenty patients with Crohn's disease located in the ileum (n = 9) or the colon (n = 11) without macroscopic proctitis or perianal disease were included. All were subjected to rectal examination, anorectal manometry, manovolumetry, and rectoscopy. Comparison was made with a reference group of 173 healthy controls of whom 128 underwent anorectal manometry, 29 manovolumetry, and 16 both examinations.

RESULTS:
Maximum resting pressure and resting pressure area were higher in patients than in controls (P = 0.017 and P = 0.011, respectively), whereas maximum squeeze pressure and squeeze pressure area were similar. Rectal sensitivity was increased in patients expressed as lower values both for volume and pressure for urge (P = 0.013 and P = 0.014, respectively) as well as maximum tolerable pressure (P = 0.025).

CONCLUSIONS:
This study demonstrates how patients with Crohn's disease without macroscopic proctitis have increased anal pressures in conjunction with increased rectal sensitivity. This may contribute to later development of anal pathology, because increased intra-anal pressures may compromise anal circulation, causing fissures, and also discharging of fecal matter into the perirectal tracts, which may have a role in infection and fistula development.

http://ipsapp003.lwwonline.com/content/getfile/164/91/18/abstract.htm


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Bone Disease and Intestinal Problems May Share a Common Cause new
      #35699 - 01/07/04 11:47 AM
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By Megan Rauscher

NEW YORK (Reuters Health) Dec 26 - Scientists have evidence in mice that osteoporosis-like bone disorders and inflammatory intestinal disorders are both caused by abnormal regulation of a common protein.

Dr. Simon R. Carding from the University of Leeds in England and colleagues report their study in the December issue of the journal Immunity. "Autoimmune associated bone disease and intestinal inflammation are closely linked with deregulation and hyperactivation of autoreactive CD4 T cells," they write. "How these T cells are activated and mediate disease is not clear."

Mice engineered to lack a key regulator of CD4 T cells have overactive T cells and spontaneously develop ulcerative colitis and osteopenia, the scientists explain. Dr. Carding and colleagues' experiments indicate that this is caused by increased production of the ligand for receptor activator of NFkB (RANKL).

"We find that the hyperactive CD4 T cells produce too much of this protein, which then contributes to bone breakdown and bowel inflammation," Dr. Carding said.

Treating mice with exogenous recombinant osteoprotegerin -- a protein that interferes with RANKLs binding to its receptor -- reversed bone loss and improved colitis.

"This study shows that some bone diseases and intestinal problems may share a common cause," Dr. Carding told Reuters Health. "If similar mechanisms occur in humans, then osteoprotegerin might prove a useful treatment for intestinal disorders such as ulcerative colitis and Crohn's disease," he said, which are both often accompanied by bone loss.

Immunity 2003;19:849-861.

http://www.medscape.com/viewarticle/466447?mpid=23090

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Once-Daily Probiotic Treatment Maintains Remission in Ulcerative Colitis patients with Pouchitis new
      #41041 - 01/26/04 03:33 PM
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Once-Daily Probiotic Treatment Maintains Remission in Ulcerative Colitis Patients with Pouchitis


Mindy Hung


Jan. 7, 2004 — Once-daily high-dose probiotic therapy (VSL#3) sustains antibiotic-introduced remission in ulcerative colitis patients with pouchitis, according to a randomized, double-blind study published in the January issue of Gut.

"In parallel with clinical, endoscopic, and histological remission, a high level of QOL [quality of life] was maintained with this therapy," Toshiki Mimura, MD, and colleagues from St. Mark's Hospital in London, U.K., report.

Investigators drew 36 patients with recurrent (occurrence at least twice in the previous year) or refractory (requiring continuous use of antibiotics) pouchitis from St. Mark's Hospital and a center in Bologna, Italy.

All patients had a Pouchitis Disease Activity Index (PDAI) score of 7 or higher, with zero being no inflammation and 18 being the worst. Researchers induced remission in all patients with a four-week course of the antibiotics metronidazole (400 mg or 500 mg twice daily) and ciprofloxacin (500 mg twice daily).

Twenty patients were randomized to receive placebo, while 16 patients received 6g VSL#3 (3-g sachets containing 300 billion bacteria/g, made up of four strains of lactobacilli, three strains of bifidobacteria, and one strain of Streptococcus salivarius subsp thermophilus) once daily for one year or until relapse.

The researchers conducted physical examination prior to randomization and every two months for 12 months, or until relapse, which was defined as an increase in clinical PDAI score of 2 or higher together with an increase in the endoscopic PDAI score of 3 or higher compared with baseline. Researchers performed endoscopic and histological evaluations before randomization, at two months, and at 12 months.

The primary end point was a cumulative maintained remission rate at 12 months. Health-related QOL, a secondary outcome, was assessed at study entry, every two months, and at the time of relapse using the inflammatory bowel disease questionnaire (IBDQ).

Researchers evaluated the other secondary outcome, patient satisfaction with the treatment at study entry, every two months and at the time of relapse. Subjects chose their answer from the following options: (1) very dissatisfied, unhappy most of the time; (2) generally dissatisfied, unhappy; (3) neither dissatisfied nor satisfied; (4) generally satisfied, pleased; (5) very satisfied, happy most of the time.

Researchers confirmed the presence of viable probiotic bacteria in the stool of patients in the active group via stool analysis of a subgroup of 12 patients receiving active treatment or placebo at the beginning of treatment and after 60 days.

The median compliance rate was 96% in the VSL#3 group and 97% in the placebo group.

Seventeen patients (85%) in the VSL#3 group maintained remission at one year, while in the placebo group, one patient (6%) maintained remission (P < .0001). Two patients in the VSL#3 group relapsed at month two and month eight while one patient dropped out due to acute gastroenteritis-like symptoms.

The IBDQ score remained high in the VSL#3 group (P = .30) but deteriorated in the placebo group (P = .0005) over the year.

In terms of patient satisfaction, the investigators did not find a significant difference at entry between the two groups (median, 4 vs. 4 points; P = .26) but they differed significantly at the time of relapse or 12 months (4 points in the VSL#3 group vs. 2 points in the placebo group; P < .0001).

"This study has demonstrated that in patients with recurrent or refractory pouchitis who have achieved remission with intense antibiotic treatment, the probiotic therapy VSL#3 is highly effective in maintaining remission," write Dr. Mimura and colleagues.

This study was partially supported by VSL Pharmaceuticals, Inc.

Gut. 2004;53:108-114

Reviewed by Gary D. Vogin, MD


http://www.medscape.com/viewarticle/466792

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5-ASA Therapy for Inflammatory Bowel Disease No Bar to Colon Cancer new
      #44152 - 02/10/04 01:29 PM
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5-ASA Therapy for Inflammatory Bowel Disease No Bar to Colon Cancer

NEW YORK (Reuters Health) Jan 28 - Contrary to previous reports, new study findings suggest that treatment with 5-aminosalicylate (5-ASA) does not prevent colorectal cancer in patients with inflammatory bowel disease.

In studies in the UK and Denmark, Dr. Charles N. Bernstein and colleagues from the University of Manitoba in Winnipeg, Canada note that 5-ASA use has been linked to a reduced risk of cancer in patients with ulcerative colitis and Cohn's disease. However, it is possible that patient selection bias may have influenced the results.

To investigate, the researchers report in December issue of The American Journal of Gastroenterology, that they compared 25 inflammatory bowel disease patients who were diagnosed with colon cancer in Manitoba between 1997 and 2000 and 348 matched patients who did not develop cancer.

The investigators suggest that the main advantage of this study was that "it is population-based and is not sampling only those subjects who present to referral centers,"

Among patients exposed to 5-ASA, the average duration of use and the daily dose were similar in each group. In fact, the researchers note that the cancer patients were more likely to have been exposed to 5-ASA than were comparison patients. However, the difference was not statistically significant.

The researchers conclude that 5-ASA does not reduce the risk of colon cancer in such patients. However, they add that further studies with a larger sample size and longer duration of use are needed to completely rule out an anti-cancer effect.

Am J Gastroenterol 2003;98:2784-2788.

http://www.medscape.com/viewarticle/467896?mpid=24237

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Elan Reports Successful Results of Antegren Trial for Crohn's Disease new
      #44153 - 02/10/04 01:30 PM
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Elan Reports Successful Results of Antegren Trial for Crohn's Disease

By Kevin Smith

DUBLIN (Reuters) Jan 29 - Irish pharmaceutical firm Elan Corp Plc raised market hopes for its much-vaunted experimental drug Antegren on Thursday after it announced successful results from a key clinical trial in Crohn's disease.

The data are "very significant for patients with Crohn's disease-- the safety aspects of the drug and its efficacy are very encouraging," Lars Ekman, Elan's head of research and development, told Reuters in a telephone interview.

"This is a big step forward, a major breakthrough," he said.

Elan is pinning its future on Antegren, principally as a treatment for MS. Data from phase III studies of Antegren's effect on MS are expected by late 2004 or early 2005.

The results of the phase III trial on Crohn's disease showed no recurrence of the disease during a 6-month course of the drug, Elan said.

There was a significant treatment difference of more than 30% in patients taking the drug compared with those taking a placebo, and no difference in the rate of side effects, it said.

The result is a boost for Elan after a trial last summer of the drug's effects on the initial phase of a Crohn's attack failed to show any difference between the drug and the placebo. The latest trial showed the drug to be effective in the longer-term treatment of the disease.

(Additional reporting by Ben Hirschler in London)

http://www.medscape.com/viewarticle/468001?mpid=24237

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Data links Crohn's disease and antibiotics new
      #46423 - 02/24/04 02:07 PM
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Data link Crohn's disease, antibiotics - But it is unclear whether antibiotic use is a disease trigger or a result of patients seeking symptom relief.

By Victoria Stagg Elliott, AMNews staff. March 1, 2004.


--------------------------------------------------------------------------------

Use of antibiotics is a potential risk factor for the development of Crohn's disease, according to a paper published in the February issue of the journal Gut.

Researchers at England's University of Nottingham and Cambridge University analyzed the British General Practice Research Database for information about antibiotic use of those with and without the disease. The database includes information about diagnosing and prescribing practices of 5% of the nation's physicians and is considered to be one of the world's largest computerized databases of longitudinal anonymous patient medical records from this setting.

The researchers found that those with Crohn's received twice as many prescriptions over a five-year period and were 30% more likely to have been prescribed antibiotics.

Although Crohn's disease is primarily regarded as a genetic condition, researchers have been hunting for environmental reasons why the disease has increased significantly over the past few decades. Antibiotics are just one of many environmental triggers being scrutinized, along with factors such as appendectomies, the birth control pill, and smoking.

"Finding the environmental trigger is the million dollar question," said Subra Kugaphasan, MD, a pediatric gastroenterologist at the Medical College of Wisconsin in Milwaukee.

Researchers conceded that antibiotic use may be due in part to patients hunting for relief from symptoms before receiving a definitive diagnosis.

"Our data provide some support for antibiotic exposure playing a role, but we now need other studies particularly in children and looking at antibiotic use early in life," said Dr. Richard Logan one of the authors and a professor of clinical epidemiology at the University of Nottingham.

Experts said that although the study was provocative, the numbers did not seem strong enough to draw its conclusion even if they did reach statistical significance. Experts did say that studies like this should give physicians additional pause when it comes to prescribing antibiotics.

"Here is another condition that should make all physicians circumspect with regard to the application of antibiotics unless it's truly indicated," said Marvin L. Corman, MD, vice chair of surgery at North Shore-Long Island Jewish Medical Center in New York.

--------------------------------------------------------------------------------


ADDITIONAL INFORMATION:

Which comes first?

Objective: To determine if antibiotic use is linked to the development of Crohn's disease.

Participants: Patients with and without Crohn's who had five years' worth of data in Britain's General Practice Research Database.

Method: Data were extracted based on smoking status, drug prescriptions, age and sex. Logistic regression was used to investigate the relationship between Crohn's and antibiotic use.

Results: Seventy-one percent of those with Crohn's had used antibiotics in the previous five years, compared to 58% of controls. Those with the disease had twice as many antibiotic prescriptions than those without.

Conclusion: There is a statistically significant association between antibiotic use and Crohn's disease, although it is unclear whether this is the cause of the disease or a result of seeking treatment for symptoms.

Source: Gut, February

--------------------------------------------------------------------------------

Weblink
"Antibiotic use and the development of Crohn's disease," Gut, February (gut.bmjjournals.com/cgi/content/abstract/53/2/246)

Facts about Crohn's from the National Digestive Diseases Information Clearing House (digestive.niddk.nih.gov/ddiseases/pubs/crohns)


--------------------------------------------------------------------------------

Copyright 2004 American Medical Association. All rights reserved.

http://www.ama-assn.org/amednews/2004/03/01/hlsc0301.htm

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Faulty Gene for Crohn's Disease Found new
      #60852 - 04/13/04 03:19 PM
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Faulty gene for bowel disease found

By ANDRÉ PICARD
From Monday's Globe and Mail

Canadian researchers have isolated a gene that predisposes people to Crohn's disease, a painful disorder that strikes young people and that has sharply increased in frequency in recent years.

The discovery will have an immediate impact, allowing researchers to distinguish more readily between Crohn's and colitis, both inflammatory bowel diseases.

"The diagnostic benefits will be immediate," said Katherine Siminovitch, a professor of medicine at the University of Toronto. "That's important because you really want to catch these diseases in the early stages . . . then you can start a therapy that might put patients in remission and even eradicate the disease."

Dr. Siminovitch said, however, that development of new drugs based on this genetic finding is a long-term prospect; new treatments are probably a decade away.

The research, published in today's edition of the medical journal Nature Genetics, is nonetheless welcomed by people suffering from Crohn's disease.

"This is an exciting event for us," said Michael Howarth, executive director of the Crohn's and Colitis Foundation of Canada.

"It's important because it's one more piece in the puzzle. Finding the cure is not likely going to be one big event, but come about by finding out a little more every year."

More than 150,000 Canadians suffer from inflammatory bowel disease.

It most often strikes between the ages of 15-25, though a growing number of people are being diagnosed in their late 50s.

Crohn's and colitis affect the digestive system and cause the intestinal tissue to become inflamed, form sores and bleed easily, leading to problems eating, bloody diarrhea and excruciating pain.

Most sufferers experience periods of remission and flare-ups of the disease, often requiring long-term medication, hospitalization or surgery.

Jessica Grossman, 14, of Toronto, was diagnosed as having Crohn's five years ago. Since then, she has suffered greatly, enduring a number of drug treatments, all of which had severe side effects but none of which worked, and then surgery to remove her colon.

"It makes me happy to know they did this research because I don't want other people to go through what I did," Jessica said in an interview. She is currently in remission and remarkably healthy and active.

But Jonathan Grossman, Jessica's father, said he is excited by the new finding.

"We're quite cognizant of the fact that Crohn's doesn't just go away, so we really hope this will result in new treatments," he said.

"Anything that alleviates the suffering of people with Crohn's would be a godsend."

Inflammatory bowel disease does not have a single cause but is believed to result from a combination of genetic and environmental factors, such as diet and exposure to disease. (When the body fights off disease, there is inflammation, and these diseases have their roots in inflammation gone awry.) The newly isolated gene is located on Chromosome 5.

It produces a protein that sits on the cell surface and regulates how substances enter and leave the cell. In a majority of Crohn's disease patients, this protein functions improperly and allows in toxins.

Three years ago, French researchers discovered another abnormality, on Chromosome 16, that predisposes people to Crohn's.

Dr. Siminovitch, who is also the founding scientist of Ellipsis Biotherapeutics Corp., said a person with both genetic abnormalities has a tenfold risk of developing Crohn's disease.

She and her fellow researchers are now working on the development of a chemical that would alter the protein to restore its normal function. That chemical would become the basis of new drugs. The problem with drugs now being used to treat Crohn's is that they are non-specific, and as a result have a lot of side effects.

Dr. Siminovitch said the findings could also shed light on the basic causes of chronic inflammation.

From www.globeandmail.com


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Pipeline Treatments, Novel Procedures Offer New Options for GI Diseases new
      #76353 - 06/04/04 06:41 PM
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CONTACT: Tuesday, May 18, 3:00 pm CDT Kellie Hanzak, 202-955-6222 khanzak@spectrumscience.com Jessica Willocks, 301-941-2625 jwillocks@gastro.org

In New Orleans: Morial Convention Center 504-670-6420

RESEARCH HONES IN ON THERAPIES AND DIAGNOSIS OF BOWEL DISEASES

Pipeline Treatments, Novel Procedures Offer New Options for GI Diseases

New Orleans, LA – Inflammatory bowel diseases collectively cause significant lifestyle sacrifices and suffering and millions of dollars in related health care costs every year, partially due to a lack of effective diagnostic procedures and therapies. In new studies presented today at Digestive Disease Week in New Orleans, researchers show evidence of accurate and effective new methods for diagnosis, as well as improved treatment options, for sufferers of ulcerative colitis and Crohn's diseases.

Digestive Disease Week (DDW) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.

"We are pleased to see more attention directed toward improving the lives of people suffering from inflammatory bowel diseases," said Jim Lewis, M.D., of the University of Pennsylvania. "For too long, the rate of discovery was slow. Now we are seeing more answers for the millions of sufferers."

Capsule Endoscopy in IBD: Findings and Effects on Clinical Outcomes (Abstract 105669*)

The M2A video capsule or "camera pill" allows gastroenterologists their best view yet of the small bowel, assisting in the diagnosis of inflammatory bowel disease. Until now, studies have not analyzed the influence of capsule endoscopy on clinical decision-making and therapeutic outcomes in IBD.

According to research presented by scientists from Mount Sinai Medical Center, use of the video capsule improves clinical outcomes significantly.

2 – 2 – 2 Bowel Diseases

For the study, the team of researchers reviewed the results of capsule endoscopy in patients with IBD-related indications. A total of 65 patients met the inclusion criteria and fit in four categories: A) abnormal small bowel series, rule out Crohn's Disease (CD); B) abdominal pain, normal radiologic studies, rule out CD; C) known ulcerative or Crohn's colitis; normal small bowel series and persistent symptoms, rule out small bowel disease; and D) known CD, with persistent obscure bleeding.

Overall, for 20 of the 21 patients (95 percent) in whom major diagnostic findings were discovered using capsule endoscopy, therapeutic decisions based on the results led to clinical improvement in patient outcome. In groups A and B, an absence of small bowel findings in 30 of 32 patients helped rule out CD. Throughout an average follow-up of 19 months, no evidence of CD developed, leading to a negative predictive value for the capsule study of 100 percent in this setting. In groups C and D, researchers discovered positive diagnostic findings on capsule endoscopy in 18 of 33 patients.

"Based on our research, we believe that capsule endoscopy may play an important role in clinical diagnosis and therapeutic decisions in patients with IBD indications," said Peter Legnani, M.D., lead author of the study. "We hope that the ease of use of the capsule may encourage more patients to undergo screening to confirm diagnosis of IBD and receive appropriate treatment."

Basiliximab (anti-CD25) for the Treatment of Steroid Resistant Ulcerative Colitis (Abstract 104640*)

Steroid therapy is one of the most effective treatments for ulcerative colitis (UC), which causes inflammation and ulcers in the lining of the large intestine, but up to 30 percent of patients will have a poor response to steroids. These steroid-resistant individuals present a difficult clinical challenge to gastroenterologists, because few treatment options exist after steroids other than removal of the entire colon (colectomy).

Basiliximab (Simulect®), a novel monoclonal antibody, has potential as a new treatment option, according to research from Henry Wellcome Laboratories at the University of Bristol in England.

3 – 3 – 3 Bowel Diseases

Basiliximab has been proven effective as a steroid sensitizer in steroid resistant UC both in the lab and in humans. This uncontrolled pilot study examined an extended series of 30 steroid resistant UC patients treated with basiliximab. Twenty patients with moderately active disease and 10 patients with severe disease were treated with a single intravenous (IV) dose of basiliximab (40 mg) in addition to their standard steroid therapy to monitor for remission within eight weeks, defined by an Ulcerative Colitis Symptom Score (UCSS) of less than two.

A total of 24 out of the 30 patients (80%) improved their UCSS score, with 19 of 30 (63%) achieving full remission. In the moderate disease group, 14 of 20 patients (70%) achieved full remission, and an additional five of 20 (25%) showed an improvement. In the severe disease group, five of the 10 patients (50%) achieved remission, while five required colectomy. There were no infusion reactions.

"These studies show that the use of basiliximab can provide significant improvements or remission for patients with ulcerative colitis," said Tom Creed, M.D., lead author of the study. "We hope that a larger, controlled trial will confirm these results and help make this potentially valuable therapy available to patients who can benefit from it."

Randomized, Double-Blind, Placebo Controlled, Parallel Arm, Safety and Efficacy Trial of Once-Daily, Oral OPC-6535 in the Treatment of Active Ulcerative Colitis (Abstract 105516*)

For patients suffering from severe ulcerative colitis (UC), new treatments that are safe and have minimal side effects are desperately needed. In this randomized study, researchers at the University of Chicago examined the effectiveness and tolerability of the compound OPC-6535 to treat UC. OPC-6535 was administered orally in a once-daily 25 mg or 50 mg dose to subjects with a new or established diagnosis of UC, flare within 12 weeks, and Disease Activity Index (DAI) of four to 11 on a scale of 12. A total of 186 patients were given either OPC-6535 or placebo for eight weeks. Patients were permitted to take 5-ASA (aminosalicylic acid) if they were stable for 14 days before entry and subsequent study duration (approximately 75% of subjects); 5-ASA is a standard treatment for UC.

4 – 4 – 4 Bowel Diseases

ore than half (55%) of the 25 mg group and 48 percent of the 50 mg group showed clinical improvement. The average change in DAI was significantly greater in the 25 mg group and was nearly statistically significant in the 50 mg OPC-6535 group versus placebo. Improvement in physician global assessment was more noticeable in the 50 mg dosage group, as a significantly higher proportion of these patients achieved remission (DAI 0-1) compared to the other treatment groups.

Responses were uniformly greater in the subgroup of patients with more severe disease. No differences were observed between 5-ASA users and non-users. "Based on these results, we are confident that OPC-6535 could be an effective treatment option for patients with ulcerative colitis, particularly in those with moderately severe disease," said Stephen Hanauer, M.D., lead author of the study.

"Further clinical studies are needed to confirm the best dose, but we were pleased to see a positive response to higher doses, as the efficacy may be even greater." ### Digestive Disease Week (DDW) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.

Jointly sponsored by the American Association for the Study of Liver Diseases (AASLD), the American Gastroenterological Association (AGA), the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Surgery of the Alimentary Tract (SSAT), DDW takes place May 15-20, 2004 in New Orleans, Louisiana. The meeting showcases approximately 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology. *Abstract numbers listed above correlate to abstract ID numbers listed on the DDW Web site, www.ddw.org. They do not coincide with program numbers as found in the printed DDW Program Guide.

http://www.ddw.org/media/newsReleases/IBDTherapies.pdf

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Parasite Therapy for Crohn's and Colitis? new
      #96565 - 08/08/04 03:00 PM
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Patrick B. Massey, M.D., Ph.D.,
"The Alternative Approach", Daily Herald, August 2, 2004

Is it possible that an intestinal parasite holds a key to the treatment and possible cure for Crohn's disease, ulcerative colitis and other inflammatory bowel diseases (IBD)? Research at the University of Iowa suggests that infection by specific intestinal parasites may reduce the pain and inflammation associated with these serious diseases.

Crohn's disease and ulcerative colitis are part of a group of chronic inflammatory diseases of the gastrointestinal tract. The cause is unknown.

Crohn's disease is characterized by fever, abdominal pain, diarrhea and fatigue. Symptoms of ulcerative colitis include bloody diarrhea, abdominal pain, fatigue, dehydration, anemia and weight loss. In the most severe cases, surgery may be necessary to remove the affected
parts of the bowel.

IBD is becoming more common and our success at ridding our bodies of parasites may be to blame. With sanitation, better food and medications, intestinal parasites are relatively rare in industrialized societies, and that is a good thing. However, by making our lives increasingly hygienic, we may have made ourselves more susceptible to auto-immune diseases like Crohn's and ulcerative
colitis.

A successful parasite is very good at avoiding detection by the host. Parasites that live in the intestines, such as whip worms, or in the blood, such as malaria, survive by manipulating the host's self defense mechanisms. They are able to depress the immune system in a way that limits detection and response. They are able to moderate the
immune response in a way that may also prevent IBD.

IBD is often treated with powerful medications that suppress the immune response. These medications have saved the lives of many people with life-threatening Crohn's disease and ulcerative colitis. However, as good as these medications are, the side effects can be severe and
limit their use.

Other options are needed. Research involving intestinal parasites by Dr. Robert Summers of the University of Iowa, supported by the National Institutes of Health, may provide clues for a more natural (and effective) treatment of IBD.

In his study, 29 patients with active Crohn's disease ingested the pig whip worm, Trichuris suis. This parasite cannot multiply in the human intestine and is not transmissible from human to human. These patients
consumed the parasite every three weeks for 24 weeks. At 12 weeks, the symptoms of Crohn's disease decreased by 75 percent - and for 62 percent of the patients, the disease went into remission. At 24 weeks, the remission rate was an incredible 72.4 percent. There were no complications or adverse reactions.

In another study at the University of Iowa, patients with ulcerative colitis had a 48 percent improvement after 12 weeks, again without complications.

These response and remission rates with the pig whip worm are similar to those seen with medication, but apparently without the complications often associated with the drugs.

Now, I do not recommend infecting yourself with intestinal parasites. However, the increases we are seeing in many of the chronic diseases - heart disease, cancer, IBD, asthma, arthritis and others - are directly related to our modern lifestyle. We need to find safer solutions.

I believe that in nature everything has an antidote and that studying nature will reveal the solutions to many chronic medical problems. Parasite therapy for IBD is a novel approach.

About the Author: Patrick B. Massey M.D. Ph.D. is Medical Director for Alternative & Complementary Medicine, Alexian Brothers Hospital Network.

Website: www.ALT-MED.org.
<http://www.ALT-MED.org>



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Diet May Influence Relapse in Ulcerative Colitis new
      #115476 - 10/24/04 07:50 PM
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Diet May Influence Relapse in Ulcerative Colitis


Laurie Barclay, MD


Sept. 20, 2004 — Potentially modifiable dietary factors, such as high meat or alcoholic beverage intake, may increase the likelihood of relapse for patients with ulcerative colitis (UC), according to the results of a prospective cohort study published in the September issue of Gut.

"The causes of relapses of UC are unknown," write Sarah L. Jowett, MRCP, from the University of Newcastle upon Tyne, U.K., and colleagues. "Dietary factors have been implicated in the pathogenesis of UC."

To determine the effect of customary diet on likelihood of relapse, 191 patients in remission were recruited from two district general hospitals and followed for one year. Relapse was defined using a validated disease activity index; a food frequency questionnaire determined nutrient intake; and multivariate logistic regression, controlling for nondietary factors, determined adjusted odds ratios for relapse.

Of the 191 patients, 96% completed the study, and 52% relapsed. Compared with the lowest tertile of meat consumption, the highest tertile was associated with triple the risk of relapse (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.3 - 7.8. Intake of red and processed meat was an even greater risk factor (OR, 5.19; 95% CI, 2.1 - 12.9. The top tertile of intake for protein (OR, 3.00; 95% CI, 1.25 - 7.19) and alcohol (OR, 2.71; 95% CI, 1.1 - 6.67) also increased the likelihood of relapse, as did high intake of sulfur (OR, 2.76; 95% CI, 1.19 - 6.4) or sulphate (OR, 2.6 (95% CI, 1.08 - 6.3).

Contrary to commonly held beliefs, increased intake of milk or dairy products did not increase risk of relapse, and increased intake of dietary fiber did not appear to protect against relapse.

Study limitations include potential criticisms of the dietary assessment tool; assessment of habitual diet at only one time point for each individual; failure to perform sigmoidoscopy or analysis of stool samples; and incomplete data for sulfur and sulphate content of the diet.

"Potentially modifiable dietary factors, such as a high meat or alcoholic beverage intake, have been identified that are associated with an increased likelihood of relapse for UC patients," the authors write. "Further studies are needed to determine if it is the sulphur compounds within these foods that mediates the likelihood of relapse and if reducing their intake would reduce relapse frequency."

Northumbria Healthcare Trust funded Dr. Jowett.

In an accompanying commentary, Herbert Tilg, from University Hospital Innsbruck in Austria, and Arthur Kaser, from Brigham and Women's Hospital and Harvard Medical School in Boston, Massachusetts, note that the role of dietary factors in UC relapse may be mediated by hydrogen sulfide production.

"This provocative and clinically important report by Jowett et al reopens the topic of diet and relapsing UC," Drs. Tilg and Kaser write. "The findings are well taken and may offer a new perspective for potential intervention by practical lifestyle modifications, and as such are eagerly awaited by our patients. Despite this excitement, interventional studies are now needed, setting the scene for specific dietary recommendations and for further defining the role of sulphur/sulphate which may even lead to novel therapies."

Gut. 2004;53:1399-1401, 1479-1484

Reviewed by Michael W. Smith, MD

http://www.medscape.com/viewarticle/489613?src=mp

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Increased Incidence of Inflammatory Bowel Disease: The Price of the Decline of Infectious Burden? new
      #125865 - 11/28/04 02:58 PM
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From Current Opinion in Gastroenterology

Increased Incidence of Inflammatory Bowel Disease: The Price of the Decline of Infectious Burden?

Posted 11/11/2004

Hélčne Feillet; Jean-François Bach

Abstract and Introduction
Abstract
Purpose of Review: It is now apparent that the increase in the incidence of autoimmune and allergic diseases in Western countries is explained by the decrease in infections. The question is posed to determine whether a similar explanation can be proposed for the increased incidence of inflammatory bowel disease.
Recent Findings: Studies performed in murine experimental models of inflammatory bowel disease have shown that colitis onset can be prevented by bacteria, bacterial extracts, or helminths. Particular interest was given to probiotics (either live or killed), which protect from disease in a toll-like receptor 9 dependent fashion. This protective effect involves regulatory cytokines as indicated by in vitro studies on human inflamed colonic cells. At the clinical level, there is strong suggestion but still limited proof that probiotics improve inflammatory bowel disease through immunoregulatory mechanisms.
Summary: Converging clinical and experimental data strongly suggest the protective nonspecific role of infections on inflammatory bowel disease independently from the triggering role of some specific bacteria. The extension to inflammatory bowel disease of the hygiene hypothesis opens new therapeutic perspectives including the revisiting of probiotics and other forms of exposure to bacteria or parasite components.

Introduction
Converging epidemiologic data reveal a steady increase in the incidence of inflammatory bowel disease (IBD) during the last half of the twentieth century, even if a plateau has now been reached in some high-incidence areas such as northern Europe and North America.[1*,2] This increase in incidence is real but should be qualified in terms of the improvement of disease awareness and diagnosis. During the same period, an obvious trend towards the decline of infectious diseases was noted.[3]

As has been previously done for allergic and autoimmune diseases, it was tempting to hypothesize a causal relation between these two observations (according to the hygiene hypothesis). Because of decreased solicitation by infectious agents, the immune system mounts immunopathologic responses against various antigens (autoantigens, allergens, and antigens from some specific pathogens), giving rise to immune disorders.




--------------------------------------------------------------------------------

Hélčne Feillet and Jean-François Bach, Necker Hospital, Paris, France

Curr Opin Gastroenterol 20(6):560-564, 2004. © 2004 Lippincott Williams & Wilkins

Section 1 of 7 Next Page: Suggestive Epidemiological Data
To view this whole article, follow the link:

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Probiotics Prove Just As Effective As a Popular Prescription Drug for Ulcerative Colitis new
      #131903 - 12/20/04 01:37 PM
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12.10.04 -- Probiotics Prove Just As Effective As a Popular Prescription Drug for Ulcerative Colitis


By Greg Arnold, DC, CSCS, October 21, 2004, abstracted from "Maintaining remission of ulcerative colitis with the probiotic Escherichia coli Nissle 1917 is as effective as with standard mesalazine" in the November 2004 issue of Gut

Inflammatory bowel disease (IBD) includes a number of chronic, relapsing inflammatory disorders involving the gastrointestinal tract. It is estimated that more than 600,000 people in the United States have some form of inflammatory bowel disease.1 Classically, inflammatory bowel disease includes ulcerative colitis and Crohn's disease.

Ulcerative colitis (UC) presents as inflammation extending throughout the entire colon. Research increasingly suggests that the inflammation associated with UC and IBD is related to an overabundance of "bad" bacteria and a deficiency of "good bacteria" known as probiotics.(2, 3) Now a new study4 has found probiotics act just as well as prescription drugs in helping relapses in UC.

Researchers studied 327 IBD patients, with 162 receiving 200 mg Escherichia Coli Nissle once daily while 165 received 500 mg mesalazine, a prescription drug regarded as the "gold standard" for treating IBD, three times daily for one year. Patients were assessed were regularly assessed for signs of relapse using the Rachmilewitz clinical and endoscopic activity indices, and according to histology at the end of the study.

Compared to the relapses of patients on mesalazine (38/112 = 33.9 percent), the probiotic group had a similar percentage of relapse (40/110 = 36.4 percent). "The probiotic drug E. coli Nissle 1917 shows efficacy and safety in maintaining remission equivalent to the gold standard mesalazine in patients with UC" and that these results re-emphasize "the pathogenetic significance of the enteric flora."

Although both groups tolerated their treatment well with no reported adverse side effects, a note of caution should be raised about mesalazine, since it has been the subject of research regarding dangerous side effects that include pancreas and kidney damage,5 making probiotics all the more reasonable as an effective option for UC.

Reference:
1 Botoman VA. Management of inflammatory bowel disease. Am Fam Physician. 1998 Jan 1;57(1):57-68, 71-2

2 Kanauchi, O. Modification of intestinal flora in the treatment of inflammatory bowel disease. Curr Pharm Des. 2003;9(4):333-46

3 Linskins, RK. The bacterial flora in inflammatory bowel disease: current insights in pathogenesis and the influence of antibiotics and probiotics. Scand J Gastroenterol Suppl. 2001(234):29-40

4 Kruis S. Maintaining remission of ulcerative colitis with the probiotic Escherichia coli Nissle 1917 is as effective as with standard mesalazine. Gut 2004 Nov; 53(11): 1617-23

5 Sulphasalazine and mesalazine: serious adverse reactions re-evaluated on the basis of suspected adverse reaction reports to the Committee on Safety of Medicines. Gut 2002 Oct; 51(4): 536-9

http://www.nowfoods.com/?action=itemdetail&item_id=42683

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Calming Crohn's Disease with Fish Oil and Antioxidants new
      #136195 - 01/07/05 04:55 PM
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Calming Crohn's Disease with Fish Oil and Antioxidants


By Sheila Russell, Ph.D. Abstracted from "Fish oil and antioxidants alter the composition and function of circulating mononuclear cells in Crohn disease" in the American Journal of Clinical Nutrition 2004;80:1137-44.

Crohn's disease is an inflammatory disease that can affect any area within the gut, including the intestines, stomach, esophagus, and the mouth. This disease can manifest itself at any age, from young childhood to advanced age. Crohn's disease occurs in whites at a rate of 2-5 times than that of non-whites3 and tends to run in some families.

The exact cause of this disease is unknown, and persons afflicted with Crohn's must also contend with two very common complications: malnutrition1 and bone loss.2 The development of malnutrition is due to poor absorption in the diseased area. The cause of bone loss is believed to be part of the inflammatory process. Researchers believe that immune cells present within the diseased area become activated. Then some of these activated cells migrate into the circulation where they cause additional sites of inflammation, such as in the bone, causing bone resorption. Therefore, treatments for this disease need to be able to combat the inflammation, not only in the gut, but also in the bones.

Supplementing with fish oil and antioxidants may be one way to prevent inflammatory cells from forming in the gut and to decreasing the overall tendency of circulating defense cells to cause inflammation. Based on a previous report showing that fish oil could inhibits Crohn's disease relapse in some patients with inactive disease,4 researchers wanted to know if fish oil along with antioxidants could work in patients with active Crohn's disease. Therefore, they conducted a study involving 62 adults with Crohn's disease.

Subjects received, either a fish oil supplement (2.7 g EPA and DHA) and an antioxidant supplement (200 mcg selenium, 3 mg manganese, 30 mg vitamin E, 450 mcg vitamin A and 90 mg vitamin C), or a placebo daily for 24 weeks. Blood samples were drawn to evaluate the effectiveness of the dietary supplements. Researchers analyzed the circulating defense cells to measure changes in the amounts and types of chemicals these cells were producing.

Results from the study showed that in subjects who consumed the fish oil and antioxidants, circulating defense cell contained more EPA and DHA. Circulating defense cells were also producing less inflammatory chemicals. These results are promising and demonstrate that alterations in the consumption of the type of fats in the diet can affect the state of the inflammatory cells. Now, whether or not these alterations within the circulating cells would lead to disease remission is unknown at this time. Additional clinical testing is required in persons with Crohn's disease before the benefits of this regiment can be determined.

Reference:

1 Harries AD, Jones LA, Heatley RV, Rhodes J. Malnutrition in inflammatory bowel disease: an anthropometric study. Hum Nutr Clin Nutr 1982;36:307-13

2 Bjarnason I, Macpherson A, mackintosh C, Buxton-Thomas M, Forgacs I, Moniz C. Reduced bone density in patients with inflammatory bowel disease. Gut 1997;40:228-33

3 Crawford JM. The gastrointestinal tract. in Robbins Pathologic Basis of Disease, 5th ed. eds. Cotran RS, Kumar V, Ribbing SL. W.B. Saunders Co. Philadelphia 1994, pg 801

4 Belluzzi A, Brignola C, Campieri M, Pera A, Boschi S, Miglioli M. Effect of an enteric-coated fish-oil preparation on relapses in Crohn's disease. N Engl J Med 1996;334:1557-41


http://www.nowfoods.com/?action=itemdetail&item_id=42749&TPL_NAME=printview.tpl&CSPID=a39d6fefcfee85d6e3b5b0129922e23b

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Biotic Therapy Cuts Inflammation in Ulcerative Colitis new
      #152022 - 02/19/05 05:59 PM
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Biotic Therapy Cuts Inflammation in Ulcerative Colitis



By David Douglas

NEW YORK (Reuters Health) Feb 04 - Synbiotic therapy, involving prebiotic and probiotic agents, reduces chronic inflammation in patients with active ulcerative colitis, Scottish researchers report in the February issue of Gut.

As lead investigator Dr. Elizabeth Furrie told Reuters Health, "Feeding twice daily with the synbiotic therapy for one month induced highly significant reduction in the inflammatory state of the colon that translated to clinical improvement. This therapy has demonstrated no side effects and can be taken in conjunction with conventional treatment."

Dr. Furrie and colleagues at the University of Dundee note that the immune response to normal commensal microorganisms is believed to be associated with such inflammatory processes in ulcerative colitis.

To see whether modulation of gut flora might alter the disease process, the researchers combined the probiotic Bifidobacterium longum and a prebiotic, the enriched inulin mixture Synergy 1 to provide a growth substrate.

In total, 18 patients with active ulcerative colitis were randomized in a double-blind fashion to 4 weeks of synbiotic therapy or to placebo.

Over this period, sigmoidoscopy scores on a 7-point scale fell in the active treatment group from 4.5 to 3.1. In placebo patients, there was an increase from 2.6 to 3.2.

In addition, mRNA levels of human beta defensins 2, 3 and 4 -- which are strongly upregulated in those with the disease -- were significantly reduced. This was also true of the inflammatory cytokines tumor necrosis factor alpha and interleukin 1 alpha.

Biopsies also showed that the synbiotic group had reduced inflammation as well as regeneration of epithelial tissue.

Following these encouraging results, the researchers call for a large-scale trial to "investigate the long term effect of synbiotic use in inducing and maintaining remission in patients with active disease."

Gut 2005;54:242-249.

http://www.merckmedicus.com/pp/us/hcp/hcp_newsarticle.jsp?newsid=345863&newsgroup=2

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Fish oil, soluble fiber, and antioxidants for corticosteroid sparing in ulcerative colitis new
      #173164 - 04/24/05 03:33 PM
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Clinical Gastroenterology and Hepatology
April 2005 • Volume 3 • Number 4

Original Articles

An oral supplement enriched with fish oil, soluble fiber, and antioxidants for corticosteroid sparing in ulcerative colitis: A randomized, controlled trial

Douglas L. Seidner &#8270; &#8270; [MEDLINE LOOKUP]
Bret A. Lashner &#8270; [MEDLINE LOOKUP]
Aaron Brzezinski &#8270; [MEDLINE LOOKUP]
Phillip L.C. Banks ‡ [MEDLINE LOOKUP]
John Goldblum § [MEDLINE LOOKUP]
Claudio Fiocchi ¶ [MEDLINE LOOKUP]
Jeffry Katz ¶ [MEDLINE LOOKUP]
Gary R. Lichtenstein &#8741; [MEDLINE LOOKUP]
Peter A. Anton # [MEDLINE LOOKUP]
Lori Y. Kam &#8270;&#8270; [MEDLINE LOOKUP]
Keith A. Garleb ‡‡ 1 [MEDLINE LOOKUP]
Stephen J. Demichele ‡‡ 1 [MEDLINE LOOKUP]

The Enteral Nutrition in Ulcerative Colitis Study Group

Background & Aims: N-3 fatty acids from fish oil, antioxidants, and short-chain fatty acids (SCFAs) produced during the fermentation of soluble fiber may attenuate inflammation associated with ulcerative colitis (UC). We assessed the efficacy of a nutritionally balanced oral supplement enriched with fish oil, fructooligosaccharides, gum arabic, vitamin E, vitamin C, and selenium on disease activity and medication use in adults with mild to moderate UC.

Methods: A total of 121 patients with UC and a disease activity index (DAI) from 3–9 on a 12-point scale were block randomized for extent of disease and smoking status. In addition to their usual diet, patients consumed 18 oz of the oral supplement or a carbohydrate-based placebo formula each day for 6 months. Clinical and histologic responses were assessed at 3 and 6 months or at the final visit. A change in average prednisone use between groups was tested by using a linear mixed-effects model. Results: Eighty-six patients completed the study. Baseline characteristics were not different between groups except for a higher total DAI score in the oral supplement group (7.3 ± 1.3; n = 36) compared with the placebo group (6.2 ± 2.0; n = 50) (P < .05). Both groups showed significant and similar degree of improvement at 6 months in DAI (&#8722;2.5 for oral supplement and &#8722;2.8 for placebo) and histologic index (&#8722;1.9 for oral supplement vs. &#8722;2.0 for placebo). Both intent-to-treat and completed patients given oral supplement had a significantly greater rate of decrease in the dose of prednisone required to control clinical symptoms over 6 months as compared with the placebo group (P < .001).

Conclusions: The improvement in clinical response combined with a decreased requirement for corticosteroids suggest that this enriched oral supplement can be a useful adjuvant therapy in patients with UC.

Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
§Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
‡STATPROBE, Dublin, Ohio, USA
¶Department of Gastroenterology, Case Western Reserve University, Cleveland, Ohio, USA
&#8741;Department of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania
#Department of Gastroenterology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
&#8270;&#8270;Department of Gastroenterology, University of Southern California Medical Center, Los Angeles, California
‡‡Strategic Discovery R&D, Ross Products Division, Abbott Laboratories, Columbus, Ohio, USA
Supported in part by a grant from Ross Products Division, Abbott Laboratories.
1Drs Garleb and Demichele are employees of Ross Products Division, Abbott Laboratories.
&#8270;Address requests for reprints to: Douglas L. Seidner, MD, Department of Gastroenterology\A30, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195fax: (216) 444-6305.
Email address: seidned@ccf.org (Douglas L. Seidner)
Copyright © 2005 by American Gastroenterological Association

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IBD Patients May Benefit From Folic Acid Supplementation new
      #180700 - 05/22/05 07:02 PM
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IBD Patients May Benefit From Folic Acid Supplementation

NEW YORK (Reuters Health) Apr 29 - Homocysteine levels are increased in both the mucosa and blood of patients with Crohn's disease and ulcerative colitis, according to a new study, suggesting that this molecule may play a pathogenic role in intestinal inflammation. Further, the effect could be abolished by folate supplementation.

Elevated homocysteine "contributes to the pathophysiology" of several chronic inflammatory diseases, investigators note in the April issue of the American Journal of Gastroenterology. But whether homocysteine is involved in mucosal inflammation in patients with inflammatory bowel disease (IBD) has not been explored, until now.

In their study of 83 patients with Crohn's, 83 with ulcerative colitis, and 70 healthy controls, plasma and mucosal homocysteine levels were significantly higher in IBD patients relative to control subjects.

Specifically, they observed that IBD-derived intestinal lamina propria mononuclear cells (LPMC) released higher homocysteine than control-derived LPMC.

Culturing intestinal microvascular endothelial cells in homocysteine alone, or in combination with TNF-alpha to mimic the in vivo IBD intestinal conditions, effectively triggered an inflammatory reaction in these cells, leading to upregulation of various endothelial cell adhesion molecules.

The team also observed low folate levels in the IBD patients. Folate levels were inversely correlated with homocysteine levels and, in in vitro studies, the addition of folic acid, a homocysteine scavenger, blocked the homocysteine-triggered inflammatory effects.

Therefore, Dr. Silvio Danese, from Catholic University in Rome, Italy and colleagues think it would be "reasonable to hypothesize a beneficial effect of folic acid supplementation in IBD patents to eliminate the homocysteine-mediated inflammatory events, especially mononuclear cell adhesion."

Am J Gastroenterol 2005;100:896-895.:


http://www.medscape.com/viewarticle/504063?src=mp

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The Clinical Epidemiology of Inflammatory Bowel Disease new
      #207552 - 08/22/05 04:45 PM
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The Clinical Epidemiology of Inflammatory Bowel Disease

Bret A. Lashner, MD


Introduction
Several important advances regarding the clinical epidemiology of inflammatory bowel disease (IBD) were presented during this year's Digestive Disease Week (DDW) meeting. Among the advanced imaging techniques examined, computed tomography (CT) enterography, chromoendoscopy, and magnetic resonance (MR) colography appear to be the leading technologies, whereas wireless capsule endoscopy appears to be less useful than previously believed. Additionally, genetic linkages in IBD are being discovered or confirmed at a very rapid rate, as highlighted in key discussions during these meeting proceedings. Investigators are also elucidating the natural history of IBD from large, meticulously maintained databases to confirm incidence and surgery rates, associations with other diseases, and risk of complications, such as pouchitis or cancer. As further evident from the focus of key sessions at this year's meeting, cancer surveillance in IBD remains a hotly debated topic with somewhat conflicting studies to sort through.

This clinical overview discusses some of the more key DDW sessions documenting these advances.

Advanced Imaging in IBD
There is mounting evidence that chromoendoscopy is a preferred imaging technique for cancer surveillance in ulcerative colitis. This technique could be improved even further with the addition of confocal laser microscopy. In a randomized clinical trial involving 153 patients with long-standing ulcerative colitis, 80 patients underwent conventional colonoscopic surveillance and 73 underwent chromoendoscopy with confocal endomicroscopy for detection of lesions suspicious for neoplasia.[1] Significantly more neoplastic lesions were found in the chromoendoscopy group (19 vs 4; P = .0007). Compared with conventional histology, confocal endomicroscopy had a sensitivity of 95% and a specificity of 98% for identifying neoplastic lesions Therefore, the study authors concluded that chromoendoscopy, as compared with conventional endoscopy, was able to identify lesions likely to be neoplastic, and that confocal laser microscopy could confirm neoplasia in these lesions in vivo.

Wireless capsule endoscopy is used in clinical practice to diagnose Crohn's disease or as a tool to assess extent and severity of disease. In a study by Esrailian and colleagues[2] presented during these meeting proceedings, 41 experts in IBD were asked to judge the appropriateness of wireless capsule endoscopy in 5 case scenarios. The overwhelming majority of experts (> 83% for each case) deemed wireless capsule technology to be "inappropriate" in cases of (1) suspected Crohn's disease; (2) newly diagnosed Crohn's disease; (3) new perianal fistulas; (4) steroid-refractory stricture in Crohn's disease; and (5) postoperative fibrostenotic Crohn's disease. At the present time, experts seem to agree that wireless capsule endoscopy is not helpful in the diagnosis or management of patients with Crohn's disease. Children may be at higher risk than adults for complications from wireless capsule endoscopy. Indeed, a retrospective review by Moy and colleagues[3] found a 22.5% risk for complications among 32 studies in 31 children. Three patients had capsules that did not pass the pylorus by 8 hours (2 patients needed endoscopic removal) and 4 had capsules that did not pass through the small bowel (3 required surgical removal or bowel resection and 1 required steroid treatment). Thus, it is doubtful that the potential benefits of wireless capsule endoscopy justify the risk in pediatric patients.

The utility of CT enterography was evaluated in 51 patients with Crohn's disease of the small bowel to determine whether the additional information provided by this modality changed clinical management (eg, steroid use choices).[4] Although CT enterography correlated poorly with other radiologic and clinical findings, it did change management in 34 (67%) of the patients. On the basis of the additional findings on CT enterography, steroids were added in the management of 14 patients, and 20 patients had steroid therapy reduced or eliminated. Therefore, such application of technology appears to be promising.

Solem and colleagues[5] compared the sensitivity, specificity, and accuracy of CT enterography, wireless capsule endoscopy, small bowel x-ray, and ileoscopy during colonoscopy in the diagnosis of small bowel Crohn's disease. Forty-two patients with suspected or known Crohn's disease were offered all 4 tests sequentially. CT enterography and ileocolonoscopy had the highest accuracy (86% and 85%, respectively). Small bowel x-ray had an accuracy of 79% due to a relatively low sensitivity (65%), and wireless capsule endoscopy had a low accuracy (67%) due to a poor specificity (53%). On the basis of these results, CT enterography appears likely to improve our current approach to diagnosing Crohn's disease.

MR colonography, without colonic cleansing, has been proposed for use in the pediatric IBD patient. In a study by Falconieri and colleagues,[6] 22 pediatric patients (14 with ulcerative colitis, 2 with Crohn's disease, and 6 normal [controls]) underwent unprepped MR colonography to compare the findings with colonoscopy. Twelve of the 14 patients with ulcerative colitis had thickened bowel wall (abnormal MR colonography) that correlated with the extent of disease. The sensitivity and specificity of this test was 81% and 85%, respectively. Thus, on the basis of these findings, MR colonography, with no radiation exposure and no preparation, has certain advantages over other forms of testing for investigation of colonic involvement in pediatric IBD.

Genetic Susceptibility in IBD
Some patients with chronic pouchitis may have undiagnosed Crohn's disease. Pouchitis is a common complication after ileal pouch-anal anastomosis for ulcerative colitis, and innate immune responses targeted against enteric bacteria have a role in its pathogenesis. Meier and colleagues[7] conducted a retrospective study of 97 patients with ileal pouch-anal anastomoses to determine whether genetic polymorphisms in the innate immune receptor toll-like receptor 4 and the IBD susceptibility gene NOD2/CARD15 were associated with pouchitis. The L1007fsinsC mutation in CARD15 was found to be associated with chronic pouchitis -- all patients who harbored this mutation developed pouchitis. No patient with intermittent pouchitis or no pouchitis was found to harbor this mutation. Additionally, the toll-like receptor 4 polymorphisms, a common defect in innate immunity dysfunction, were not associated with pouchitis. The study authors concluded that patients with chronic pouchitis had genetic polymorphisms similar to those found in patients with Crohn's disease, whereas in those without pouchitis, the frequency of these polymorphisms was similar to that reported in ulcerative colitis patients and the general population. Thus, CARD15 mutations, particularly the L1007fsinsC polymorphism, may predispose to the development of chronic pouchitis following ileal pouch-anal anastomosis for ulcerative colitis.

There is a purported linkage with IBD on chromosome 10 near the DLG5 gene (codes for an important scaffolding protein). Cummings and colleagues[8] conducted a case-control study to examine the contribution of variants in this gene to disease heterogeneity in IBD. The study authors compared 699 IBD patients with 360 controls; no associations with DLG5 polymorphisms were found, even when patients were stratified according to CARD15 polymorphisms. In another cohort involving 981 IBD patients and 305 controls, the OCTN (carnitine/organic cation transporter) gene cluster on chromosome 5 (the IBD5 locus) was found to be associated with fistulizing Crohn's disease (odds ratio [OR]: 1.47, 95% confidence interval [CI] 1.03-2.11).[9] No associations with IBD (ie, a particular phenotype) were found for the DLG5 gene.

Studying phenotypic homogeneous subgroups of IBD patients may increase the likelihood of finding genotype-phenotype correlations. In a study involving 867 IBD-affected relative pairs, linkage was found for CARD15 (IBD1 locus) and ileal Crohn's disease (lod score [measure of degree of linkage] = 2.56; P = .035), the IBD2 locus and extensive ulcerative colitis (lod = 3.27; P < .001), Crohn's disease in non-Jewish patients and IBD3 (lod = 2.93 for colonic disease, lod = 2.97 for perianal disease), and evidence for linkage on IBD5 was seen in non-Jewish patients with colonic disease (lod =2.85).[10] Very few of these associations could have been identified without examining homogeneous subgroups.

Blood samples were collected from 595 patients with IBD and 627 controls followed for more than 10 years in the European Cooperative IBD study. Data from this cohort are unique in that they can facilitate the investigation of whether genetic or immune markers influence longitudinal changes in disease phenotypes. Riis and colleagues[11] studied mutations in CARD15 and ASCA (anti-Saccharomyces cerevisiae) with regard to longitudinal changes in disease phenotype among IBD patients The immune marker ASCA and CARD15 were found to be associated with a change in behavior over time from inflammatory to stricturing or fistulizing Crohn's disease (OR: 3.2; 95% CI: 1.2-8.8). Indeed, both genetic factors and abnormal immune responses to bacterial stimuli are believed to play a role in the pathogenesis underlying Crohn's disease. Recently, an association between Crohn's disease and CARD8 located in the IBD6 region (19p13) has been reported. In a study of 354 patients with Crohn's disease and 225 matched controls, the combination of CARD8 mutations in the IBD6 region on chromosome 19 and anti-OmpC (antibody to a protein expressed by Escherichia coli) was found to be synergistically associated with fistulizing Crohn's disease.[12] The study authors theorized that a mutation in the CARD8 protein could lead to a dysregulated immune response that when coupled with an aberrant immune response to commensal bacteria (anti-OmpC mutation) could lead to an aggressive, transmural inflammatory disease.

Natural History of IBD
Autoimmune manifestations are reported to be associated with both Crohn's disease and ulcerative colitis. In this context, Bernstein and colleagues[13] assessed the coincident occurrence of IBD and other autoimmune disorders using population-based data from Manitoba. Odds ratios significantly greater than 1 were found for asthma, bronchitis, and psoriasis with Crohn's disease, and for asthma, bronchitis, psoriasis, multiple sclerosis, and chronic renal disease with ulcerative colitis. Asthma was the most common autoimmune disorder found to be coincident with IBD. Thyroiditis and neuropathy were not more common in patients with IBD compared with controls. In a related investigation, Tang and colleagues[14] conducted a retrospective study using the University of Manitoba IBD database to examine fistula formation in patients with Crohn's disease. They found that 19.2% of the Crohn's disease population had fistulas. If perianal fistulas were present, the risk of having a concomitant luminal fistula was found to be significantly increased (OR: 4.45; 95% CI: 2.92-6.76). Therefore, the presence of perianal fistulas should prompt an examination for luminal fistulous disease. In another study reported during these meeting proceedings, Bernstein and colleagues[15] assessed the burden of IBD using population-based data from 5 provinces in Canada. Incidence rates for Crohn's disease per 100,000 ranged between 12.2 and 22.5, and for ulcerative colitis ranged between 8.6 and 21.2. Prevalence of disease per 100,000 persons ranged between 231 and 325 for Crohn's disease, and between 182 and 255 for ulcerative colitis. For all IBD, the female:male ratio ranged from 1.14 to 1.29. Thus, overall, the prevalence of IBD in Canada was found to be 491/100,000 persons; that is, 0.5% of the population has IBD.

Is there an association between early postoperative pouch histology and development of pouchitis after ileal pouch-anal anastomosis for ulcerative colitis? To predict the development of acute or chronic pouchitis, investigators from Toronto took biopsies from the pouch of patients soon after surgery and evaluated 109 patients for a mean of 11.5 years.[16] Early inflammation was found to be a predictor of chronic pouchitis (hazard ratio 7.4; 95% CI: 2.14-24.2). The investigators suggested that such patients should be considered for early prophylactic therapy to prevent development of chronic pouchitis. Early histology did not predict the occurrence of acute pouchitis.

What is the colectomy risk in ulcerative colitis after 10 years? The European Cohort IBD group studied 784 patients with ulcerative colitis for a minimum of 10 years to evaluate colectomy rates.[17] They found that only 7.6% of patients had colectomies. It is interesting to note that northern European countries had much higher colectomy rates than southern European countries. Despite the fact that no information on extent of disease was presented, the purported colectomy rate of 20% to 30% in patients with ulcerative colitis is likely to be a gross overestimate.

Cancer Surveillance in IBD
Are older patients with late-onset IBD at risk for colorectal cancer and do they require frequent colonoscopic surveillance? Investigators from the Hines VA Hospital in Hines, Illinois, followed 114 older ulcerative colitis patients with late-onset disease and compared outcomes with a comparable group of 6829 non-IBD controls.[18] The annual incidence of cancer in the ulcerative colitis group was 0.14% compared with 0.11% in controls (P = not significant). On the basis of these findings, the investigators suggested that older patients with late-onset ulcerative colitis should undergo surveillance at the same intervals suggested for those with sporadic disease.

The long-term safety of infliximab, an anti-tumor necrosis factor-alpha monoclonal antibody, is currently under investigation. In a case-control study, Biancone and colleagues[19] evaluated the development of neoplasia in 392 patients with Crohn's disease treated with infliximab compared with matched controls. Nine patients treated with infliximab and 6 controls developed neoplasia (OR: 1.51; P = .60). Among those patients in the infliximab-treated group who developed neoplasia, there was 1 cholangiocarcinoma, 3 breast cancers, 2 skin cancers, 1 laryngeal cancer, and 2 anal canal cancers. Among the controls who developed neoplasia, there was 1 ileal adenocarcinoma, 2 skin cancers, 1 lymphoma, 1 cecal adenocarcinoma, and 1 breast cancer. Thus, the results of this study suggest that infliximab did not significantly increase the risk of neoplasia.

Recent reports have suggested that dysplasia and colorectal cancer may be endoscopically visible in many patients with IBD. Rubin and colleagues[20] conducted a retrospective review of a large registry of patients with ulcerative colitis who underwent surveillance examinations over a 10-year period; 1339 examinations were performed in 622 patients. Sixty-four dysplastic lesions were found in 44 patients during this study interval; 35 of 56 (62.5%) dysplastic lesions were visible to the endoscopist, and 7 of 8 (87.5%) cancers were visible. Visible lesions included polyps or masses, strictures, or irregular mucosa. The sensitivity of visibly (ie, by endoscopy) identifying neoplastic lesions was 79.5%. Chromoendoscopy is likely to increase this sensitivity rate much further by making even more lesions visible.

At present, it remains unclear why some patients with IBD have an increased risk of colorectal neoplasia. Jess and colleagues[21] conducted a nested case-control study to investigate risk factors for colorectal neoplasia in 2 large population-based IBD cohorts; 52 patients with ulcerative colitis and neoplasia were compared with a matched set of controls. Significant risk factors for neoplasia included primary sclerosing cholangitis (OR: 8.7), active disease (OR: 3.1), continuously active disease for more than 1 year (OR: 4.0), sulfasalazine use (OR: 1.13), mesalamine use (OR: 1.22), and a higher cumulative dose of steroids (OR: 1.05). These study findings did not support the accumulating evidence that mesalamine may have chemopreventive effects for neoplasia.

Results of population-based studies have demonstrated a slightly increased mortality rate for patients with Crohn's disease over the last 40 years. Wolters and colleagues[22] presented the results of a study assessing mortality risk in a European cohort of Crohn's disease patients 10 years post diagnosis. In this European cooperative study of 371 incident cases of Crohn's disease followed for at least a decade, there were 37 deaths (SMR [standardized mortality ratio] 1.72; 95% CI: 1.21-2.38). There were 8 deaths from gastrointestinal malignancies vs only 0.86 expected (SMR 8.14; 95% CI: 3.26-16.78). In this cohort, patients with Crohn's disease had an increased mortality risk, especially from gastrointestinal malignancies.

Recent reports have suggested a high risk for progression to high-grade dysplasia or cancer among IBD patients with flat low-grade dysplasia; this has led to more aggressive surgical intervention. Jess and colleagues[23] reported the results of a study to assess the true long-term outcome of colorectal dysplasia in a population-based IBD cohort. Among 691 incident ulcerative colitis cases followed in a cancer surveillance program, there were 9 with dysplasia in flat mucosa, 1 with a dysplasia-associated lesion or mass (DALM), and 23 with adenoma-like masses (ALMs). In patients with ALMs, 3 had recurrent adenomas, 3 developed flat low-grade dysplasia, 2 developed DALMs, and 1 developed multifocal Dukes' C adenocarcinoma. Although these findings did not confirm the previously reported risk for progression in flat dysplastic lesions, they did document ALMs as worrisome lesions in patients with ulcerative colitis.

Conclusion
On the basis of data presented during this year's DDW meeting, and as discussed above, the clinical care of IBD patients may evolve and change. Although findings suggest that CT enterography and MR colography will be used more often to diagnose IBD and its complications; wireless capsule endoscopy has not yet found its place in the care of these patients. Chromoendoscopy is sure to improve outcomes from cancer in IBD, but much additional study is needed regarding treatment recommendations for lesions found with such testing. Last, as investigators continue to identify and confirm genes associated with IBD, the closer clinicians are to finding the cause and cure of IBD.

References
Kiesslich R, Goetz M, Schneider C, et al. Confocal endomicroscopy as a novel method to diagnose colitis-associated neoplasm in ulcerative colitis: A prospective randomized trial. Gastroenterology. 2005;128(suppl 2):A-73. [Abstract 483]
Esrailian E, Targownik EL, Spiegel BM, et al. Is wireless capsule endoscopy appropriate for the diagnosis and management of Crohn's disease? A survey of North American Inflammatory Bowel Disease experts. Gastroenterology. 2005;128(suppl 2):A-73. [Abstract 484]
Moy L, Levine J. Wireless capsule endoscopy in the pediatric age group: Experience and complications. Gastroenterology. 2005;128(suppl 2):A-73. [Abstract 485]
Higgins PD, Caoili E, Zimmermann M, et al. CT enterography adds information to clinical management in small bowel Crohn's disease. Gastroenterology. 2005;128(suppl 2):A73-A74. [Abstract 487]
Solem CA, Loftus EV, Fletcher JG, et al. Small bowel imaging in Crohn's disease: A prospective, blinded, 4-way comparison trial. Gastroenterology. 2005;128(suppl 2):A74 [Abstract 488]
Falconieri P, Laghi A, Paolantonio P, et al. Un-prepped MR colonography in pediatric patients with inflammatory bowel disease. Gastroenterology. 2005;128(suppl 2):A-49. [Abstract 342]
Meier C, Aisenberg J, Legnant P, et al. Innate immune receptor polymorphisms in pouchitis: Is NOD2/CARD15 a susceptibility factor? Gastroenterology. 2005;128(suppl 2):A-112. [Abstract 726]
Cummings JRF, Kerrlinger KR, Ahmad T, Jewell DP. Genotype-phenotype analyses of the IBD susceptibility gene DLG5. Gastroenterology. 2005;128(suppl 2):A-112. [Abstract 727]
Vermeire S, Pierik M. Henckaerts L, et al. Study on DLG5 and OCTN polymorphisms shows association of the OCTN TC risk haplotype with perianal and fistulizing Crohn's disease but not with susceptibility to IBD. Gastroenterology. 2005;128(suppl 2):A-113. [Abstract 731]
Achkar JP, Dassopoulous T, Silverberg M, et al. Disease location refines genomic localization in inflammatory bowel disease: IBD is an extensive ulcerative colitis locus. Gastroenterology. 2005;128(suppl 2):A-112-A113. [Abstract 728]
Riis L, Wolters F, Solberg C, et al. ASCA is associated with CARD15 mutations and longitudinal changes in behavior of Crohn's disease: A population based ED-IBD study. Gastroenterology. 2005;128(suppl 2):A-113. [Abstract 729]
Picornell Y, Abreu MT, Ippoliti A, et al. CARD8 variant and the expression of anti-OmpC are synergistically associated with internal penetrating Crohn's disease. Gastroenterology. 2005;128(suppl 2):A-113.[Abstract 730]
Bernstein CN, Blanchard JF, Wajda A. A population-based study of comorbidity and other autoimmune diseases in IBD. Gastroenterology. 2005;128(suppl 2):A-113. [Abstract 732]
Tang LY, Rawsthorne P, Bernstein CN. In Crohn's disease is there an association between perianal fistulzing disease and luminal fistulizing disease? A population-based study. Gastroenterology. 2005;128(suppl 2):A-113-A114. [Abstract 733]
Bernstein CN, Wajda A, Blanchard JF, et al. The burden of IBD in Canada: A population-based study. Gastroenterology. 2005;128(suppl 2):A-114. [Abstract 735]
Johnson P, MacNeill N, Baladjay L, et al. Early post-operative pouch histology predicts future chronic pouchitis after ileal pouch-anal anastomosis for ulcerative colitis. Gastroenterology. 2005;128(suppl 2):A-114. [Abstract 734]
Hoie C, Wolters F, Riis L, et al. Colectomy rates in ulcerative colitis in a European inception cohort followed for ten years by the EC-IBD study group. Gastroenterology. 2005;128(suppl 2):A-114. [Abstract 736]
Hoffman SD, Sontag SJ, Levis W, et al. Late onset inflammatory bowel disease in older patients does not require frequent surveillance. Gastroenterology. 2005;128(suppl 2):A-121-A122. [Abstract 777]
Biancone L, Kohn A, Colombo E, et al. Development of neoplasia in Crohn's disease patients treated with infliximab: A case-control study in an Italian population. Gastroenterology. 2005;128(suppl 2):A-122. [Abstract 778]
Rubin DT, Rothe JA, Cohen RD, Hanauer SB. Is dysplasia and colorectal cancer endoscopically visible in patients with ulcerative colitis? Gastroenterology. 2005;128(suppl 2):A-122. [Abstract 779]
Jess T, Loftus EV, Velayos FS, et al. Risk factors for cancer and dysplasia in inflammatory bowel disease: A nested case-control study of population-based cohorts from Copenhagen County and Olmsted County. Gastroenterology. 2005;128(suppl 2):A-122. [Abstract 780]
Wolters F, Schouten L, Sijbrandij J, et al. Increased mortality ten years after diagnosis in a Europe-wide population based cohort of Crohn's disease patients (EC-IBD Study Group). Gastroenterology. 2005;128(suppl 2):A-122. [Abstract 781]
Jess T, Loftus EV, Velayos FS, et al. Are adenomas more harmful than flat low-grade dysplasia in patients with inflammatory bowel disease? A population-based cohort study from Olmsted County, Minnesota, 1940-2002. Gastroenterology. 2005;128(suppl 2):A-123. [Abstract 782]

http://www.medscape.com/viewarticle/506628

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Differentiation of Inflammatory Bowel Disease and Irritable Bowel Syndrome
      #210440 - 09/01/05 11:13 AM
HeatherAdministrator

Reged: 12/09/02
Posts: 7795
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Rectal Mucosal Nitric Oxide in Differentiation of Inflammatory Bowel Disease and Irritable Bowel Syndrome

Clinical Gastroenterology and Hepatology
Volume 3, Issue 8 , August 2005, Pages 777-783

Claudia I. Reinders, Max Herulf;, Tryggve Ljung, Jakob Hollenberg, Eddie Weitzberg§, Jon O. Lundberg, and Per M. Hellström

Division of Pharmacology, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
‡Department of Gastroenterology and Hepatology, Karolinska University Hospital Solna, Stockholm, Sweden
§Department of Anaesthesiology and Intensive Care, Karolinska University Hospital Solna, Stockholm, Sweden


Background & Aims: Differentiating patients with functional bowel disorders from those with inflammatory bowel disease (IBD) can be difficult. Rectal luminal levels of nitric oxide (NO) are greatly increased in IBD. To further evaluate this disease marker, we compared NO in patients with irritable bowel syndrome (IBS) with those found in patients with active IBD and in healthy control subjects. Methods: Rectal NO was measured with chemiluminescence technique by using a tonometric balloon method in 28 healthy volunteers, 39 patients with IBS, 86 with IBD (Crohn's disease and ulcerative colitis), and 12 patients with collagenous colitis. In addition, NO was measured before and after a 4-week treatment period in patients with active ulcerative colitis and repeatedly during 2 weeks in healthy volunteers. Results: NO was low in healthy control subjects (median, 45; 25th–75th percentile, 34–64 parts per billion [ppb]), and variations over time were small. In IBS patients NO was slightly increased (150, 53–200 ppb; P < .001), whereas patients with active IBD or collagenous colitis had greatly increased NO levels (3475, 575–8850 ppb, and 9950, 4475–19,750 ppb, respectively; P < .001). With a cutoff level of 250 ppb, NO had a sensitivity of 95% and a specificity of 91% in discriminating between active bowel inflammation and IBS. Rectal NO correlated with disease activity in IBD and collagenous colitis and decreased markedly in IBD patients responding to anti-inflammatory treatment. Conclusions: Rectal NO is a minimally invasive and rapid tool for discriminating between active bowel inflammation and IBS and a possibly useful add-on for monitoring patients with IBD.

Abbreviations used in this paper: CI, confidence interval; GI, gastrointestinal; HBI, Harvey Bradshaw index; IBD, inflammatory bowel disease; IBS, irritable bowel syndrome; NO, nitric oxide; ppb, parts per billion


Supported by grants from the Knowledge Foundation, the Swedish Research Council, and Karolinska Institutet. Eddie Weitzberg and Jon O. Lundberg own shares in Aerocrine AB, a company that manufactures equipment for measurements of nitric oxide.
Address requests for reprints to: Claudia Reinders, MSc, Department of Physiology and Pharmacology, Division of Pharmacology, Karolinska Institutet, SE-171 77 Stockholm, Sweden. fax: +46 8 33 22 78.

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B7GGW-4GV2755-K&_user=10&_handle=V-WA-A-W-WC-MsSAYVA-UUW-U-AAWDWECCVA-AAWVYDZBVA-WECDUEZWB-WC-U&_fmt=summary&_coverDate=08%2F31%2F2005&_rdoc=17&_orig=browse&_srch=%23toc%2320161%232005%23999969991%23603702!&_cdi=20161&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=f0dd70723cf0e5dc95f617a69215484f

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Cannabinoids Show Promise for Inflammatory Bowel Disease new
      #210445 - 09/01/05 11:23 AM
HeatherAdministrator

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

Cannabinoids Show Promise for Inflammatory Bowel Disease

NEW YORK (Reuters Health) Aug 12 - Cannabis-based drugs may have therapeutic potential in inflammatory bowel disease, UK researchers report in the August issue of Gastroenterology.

"The system that responds to cannabis in the brain is present and functioning in the lining of the gut," lead researcher Dr. Karen Wright, of the University of Bath, explained to Reuters Health. "There is an increased presence of one component of this system during inflammatory bowel diseases -- Crohn's and ulcerative colitis."

Dr. Wright and her colleagues established the location of cannabinoid receptors CB1 and CB2 in human colonic tissue and used human colonic epithelial cells lines in cannabinoid-binding and in wound-healing experiments.

Expression of both receptors was detected on plasma cells in the lamina propria, but only CB2 was present on macrophages.

CB2 was increased and immunoreactivity was seen in the epithelium of colonic tissue characteristic of inflammatory bowel disease. Cannabinoids enhanced epithelial wound closure via CB1-related mechanisms.

Thus continued Dr. Wright, "cannabinoids, which we make ourselves, as well as synthetic cannabinoids, can promote wound healing in the gut, which is extremely interesting given that inflammatory bowel disease involves damaged gut linings."

Although no data are available yet, she added, relevant case studies of the use of cannabinoids are taking place in the UK and a clinical trial is being conducted in Germany.

Gastroenterology 2005.


http://www.medscape.com/viewarticle/510626?src=mp

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Oral Contraceptives and HRT a Risk Factor for Inflammatory Bowel Disease new
      #213003 - 09/13/05 01:22 PM
HeatherAdministrator

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

Risk Factors for Inflammatory Bowel Disease in the General Population

L. A. García Rodríguez; A. González-Pérez; S. Johansson; M.-A. Wallander


Background: The aetiology of inflammatory bowel disease remains largely unknown.

Aim: We performed a comprehensive assessment of potential risk factors associated with the occurrence of inflammatory bowel disease.

Methods: We identified a cohort of patients 20–84 years old between 1995 and 1997 registered in the General Practitioner Research Database in the UK. A total of 444 incident cases of IBD were ascertained and validated with the general practitioner. We performed a nested case–control analysis using all cases and a random sample of 10 000 frequency-matched controls.

Results: Incidence rates for ulcerative colitis, Crohn's disease, and indeterminate colitis were 11, 8, and 2 cases per 100 000 person-years, respectively. Among women, we found that long-term users of oral contraceptives were at increased risk of developing UC (OR: 2.35; 95% CI: 0.89–6.22) and CD (OR: 3.15; 95% CI: 1.24–7.99). Similarly, long-term users of HRT had an increased risk of CD (OR: 2.60; 95% CI: 1.04–6.49) but not UC. Current smokers experienced a reduced risk of UC along with an increased risk of CD. Prior appendectomy was associated with a decreased the risk of UC (OR: 0.37; 95% CI: 0.14–1.00).

Conclusions: Our results support the hypothesis of an increased risk of inflammatory bowel disease associated with oral contraceptives use and suggest a similar effect of hormone replacement therapy on CD. We also confirmed the effects of smoking and appendectomy on inflammatory bowel disease.


L. A. García Rodríguez*, A. González-Pérez*, S. Johansson, M.-A. Wallander

*Centro Espańol de Investigación Farmacoepidemiológica (CEIFE), Madrid, Spain;

AstraZeneca R&D Mölndal, Sweden;
Section of Preventive Cardiology, Göteborg University, Sweden;
Department of Public Health and Caring Science, Uppsala University, Sweden


Aliment Pharmacol Ther. 2005;22(4):309-315.

©2005 Blackwell Publishing

To read this article in full, please click here:

http://www.medscape.com/viewarticle/510581?src=mp

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