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Self-assessment scale developed for patients with IBD-fatigue
Czuber-Dochan W. J Crohns Colitis. 2014;doi:10.1016/j.crohns.2014.04.013.
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June 9, 2014
Researchers from the United Kingdom have developed an inflammatory bowel disease fatigue patient self-assessment scale that is designed to more accurately and reliably measure the severity and impact of disease-associated fatigue.
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The IBD-F scale was developed and validated in a five-phase process between September 2010 and May 2013, and involved 567 patients with Crohn's disease or ulcerative colitis. Phase one entailed researcher-conducted interviews with patients (n=20) to qualitatively assess their experience with fatigue, its impact on their quality of life, and the efficacy of existing fatigue scales (Multidimensional Fatigue Inventory [MFI], Multidimensional Assessment of Fatigue [MAF]) in reflecting their specific experience and concerns. Phases two (n=16), three (n=30), four (n=36) and five (n=465) qualitatively and quantitatively assessed and refined the IBD-F scale. Participants completed drafts of the developing questionnaire, modifications were made based on commentary from subsequent interviews in phases two and three, and reliability was tested in phases four and five.
The final questionnaire entailed three sections, evaluating fatigue severity and frequency, its impact on daily activities, and duration of fatigue. The IBD-F scale was preferred over alternatives overall; patients interviewed reported it was "more attuned to their experience than the MAF and MFI." Agreement between scores associated with individual questions, measured through test-retest in phase four, was "relatively poor," but agreement between total scores was higher (ICC=0.74; 95% CI, 0.54-0.86).
Phase five revealed "moderate correlation" between sections one (ICC=0.73; P<.001) and two (ICC=0.78; P<.001) of the IBD-F scale and the MAF, along with the five MFI subscales (ICC=0.47-0.65; P<.001).
"The IBD-F scale consists of items generated specifically from the issues of importance to people with IBD fatigue," the researchers concluded, "and it has been found on initial testing to be valid and reasonably reliable."
http://www.healio.com/gastroenterology/inflammatory-bowel-disease/news/online/%7Bdbb71f02-1941-4695-abcd-3079eb60432a%7D/self-assessment-scale-developed-for-patients-with-ibd-fatigue
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Vitamin D Blog: Cancer Risk in IBD
Published: Jul 8, 2014
By Ashwin Ananthakrishnan, MBBS, MPH , Massachusetts General Hospital
In this Guest Blog, Ashwin N. Ananthakrishnan, MBBS, MPH, a gastroenterologist at Massachusetts General Hospital in Boston, discusses his recent study on vitamin D and its relationship with cancer in patients with inflammatory bowel disease.
Vitamin D has pleiotropic effects on the immune system and has been associated with reduced risk of autoimmunity, cardiovascular disease, and cancer. Yet there are no data on the association between vitamin D and cancer in chronic immune-mediated diseases where mechanisms of cancer may be distinct and other competing factors may influence both vitamin D status and cancer risk.
My team at Massachusetts General Hospital in Boston is interested in uncovering the connection between vitamin D and inflammatory bowel disease (IBD). Although a third of IBD patients are vitamin D deficient and an equal proportion have insufficient levels, there has been only limited study of potential longitudinal consequences.
Cross-sectional studies suggested an association between vitamin D status and disease activity, a finding that was confirmed in a study from our group demonstrating an inverse association with IBD-related hospitalizations and surgery. We have also shown that normalization of vitamin D levels is associated with a reduction in the risk of IBD-related surgery.
Since no prior studies have examined the effect of vitamin D status on the risk of cancers in patients with IBD, we looked into the issue using a well-characterized, multi-institutional IBD cohort involving 2,809 patients. We assessed several types of cancers to see if the effect of vitamin D is specific to certain cancer subtypes in the IBD population.
This study, published in Clinical Gastroenterology and Hepatology, involved a follow-up period of 11 years, during which 169 patients (7%) developed cancer (excluding nonmelanoma skin cancer), with 41 cases of colorectal cancer.
We found that low vitamin D is associated with an increased risk of metastatic and nonmetastatic cancers -- and the association was strongest for colorectal cancer.
There were, of course, limitations. Our cohort is based primarily at two referral centers, so the population may be skewed toward greater severity of underlying IBD. Also, we did not have information on body mass index or smoking status, both of which have been associated with overall risk of malignancy and colorectal cancer -- although the effect of BMI and smoking on IBD-related cancers has not been noted previously.
Nor did we have information on medications such as aspirin and nonsteroidal anti-inflammatory drugs, both of which have been inversely associated with the development of colorectal cancer. However, long-term use of such medications is uncommon in patients with IBD because of their potential to trigger disease relapses.
Nevertheless, to our knowledge, this remains the largest cohort containing information on the vitamin D status of patients with IBD. Based on our findings, an assessment of vitamin D status should routinely be part of comprehensive care of patients with IBD.
I know from treating patients with IBD that controlling symptoms can be a daily struggle. Luckily, vitamin D is relatively easy to monitor and maintain and may offer long-term health benefits for those with the disease. However, we need much more rigorous data to examine the role of vitamin D, safety with various doses of supplementation, and clinical trials examining its effect on disease activity and other outcomes in patients with IBD.
http://www.medpagetoday.com/Endocrinology/GeneralEndocrinology/46665
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Fecal lactoferrin differentiated IBD from IBS
Zhou X-L. BMC Gastroenterol. 2014;doi:10.1186/1471-230X-14-121.
July 22, 2014
Fecal lactoferrin as a diagnostic biomarker effectively distinguished between inflammatory bowel disease and irritable bowel syndrome in a recent study.
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Seeking a less invasive and more economical alternative to standard endoscopy and radiographic imaging for discounting inflammatory bowel disease (IBD) in patients with symptoms of irritable bowel syndrome (IBS), researchers in China assessed the diagnostic utility of fecal lactoferrin (FL) levels in discriminating between IBD and IBS. They performed a meta-analysis of seven relevant studies sourced from Medline, Embase and other databases through November 2013.
After analyzing a cohort of 1,012 adult and pediatric patients (609 with IBD, 381 with IBS, 22 controls), sensitivities of FL in differentiating IBD from IBS ranged from 0.69 to 0.86, with a pooled sensitivity of 0.78 (95% CI, 0.75-0.82). Specificities ranged from 0.83 to 1, with a pooled specificity of 0.94 (95% CI, 0.91-0.96). Pooled positive likelihood ratio was 12.31 (95% CI, 6.05-25.07), pooled negative likelihood ratio was 0.23 (95% CI, 0.18-0.29), pooled diagnostic OR was 52.65 (95% CI, 25.69-107.91) and the pooled summary receiver-operating characteristic AUC was 0.94 (95% CI, 0.9-0.98).
"To our knowledge, this study is the first … to assess the diagnostic performance of FL in differentiating between IBD and IBS," the researchers wrote. "This meta-analysis showed that FL appears to have good diagnostic precision in distinguishing IBD from IBS both in adults and children.
"Owing to study limitations [including a small cohort with few controls], additional high-quality original studies (especially in patients stratified by disease type, severity and distribution) are required to confirm the predictive value of FL."
http://www.healio.com/gastroenterology/irritable-bowel-syndrome/news/online/%7Be8dae45a-dce9-4242-bab6-91552d932acc%7D/fecal-lactoferrin-differentiated-ibd-from-ibs
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Hormonal contraception improved menstrual-related IBD symptoms
Gawron LM. Inflamm Bowel Dis. 2014;doi:10.1097/MIB.0000000000000134.
August 18, 2014
Hormonal contraception improved cyclical menstrual-related symptoms of inflammatory bowel disease in some women, according to recent study data.
Researchers performed a cross-sectional survey of 129 women treated for inflammatory bowel disease (IBD) at the Northwestern Medical Faculty Foundation's academic gastroenterology practice between 2010 and 2012. Participants were identified by database and questioned by telephone between March and November 2013 regarding cyclical menstrual-related IBD symptoms and how their contraceptives affect them.
Sixty percent of participants (mean age, 34.3 years; 85% white) were diagnosed with Crohn's disease. Cyclical IBD-related symptoms were reported by 60% of participants, with 42% and 72% citing symptoms in the pre-menstrual and menstrual phases, respectively (both P=.02). A current contraceptive method was used by 68% compared with 43% using hormonal contraception. Among those using hormonal contraception, 20% reported improved cyclical IBD symptoms, while 75% reported no change in symptoms, the most common being diarrhea (48%), pain (44%) and cramping (41%).
"In this subset of women with IBD, the majority report either improvement or no significant change in their disease-related symptoms," the researchers concluded. "This finding has several implications as follows: (1) contraception is unlikely to worsen IBD symptoms, (2) for at least a subset of patients with IBD, contraception use might improve symptoms by reducing the impact of menses on intestinal function, and (3) there is justification to study the use of contraception for disease management purposes in future studies."
http://www.healio.com/news/online/%7B637f28e2-bf9f-45c7-859d-9caeb2fd55e5%7D/hormonal-contraception-improved-menstrual-related-ibd-symptoms
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7 recent developments in Crohn's disease
Crohn's disease has been a hot topic recently, with an abundance of data being published in the journals this month. Here is a recap of the most trafficked news on Healio Gastroenterology about Crohn's disease.
1. Racial disparities exist among children with Crohn's disease
Jennifer Dotson
Disparities in hospital readmissions, complications and procedures in pediatric Crohn's disease patients are related to race, according to data from a recent retrospective review.
"We found racial inequalities exist among children and adolescents with Crohn's disease, likely due to a combination of genetic and environmental differences," Jennifer Dotson, MD, MPH, a gastroenterologist at Nationwide Children's Hospital in Columbus, Ohio, and principal investigator in the Center for Innovation and Pediatric Practice, said in a press release. "This is one of the first studies to investigate the rate of various health disparities in the Crohn's disease population in pediatrics, despite the fact that 25% of the time, Crohn's disease is diagnosed in childhood." Read more
2. Experts release international consensus statement on surveillance, management of dysplasia in inflammatory bowel disease
Tonya Kaltenbach
SCENIC, an international multidisciplinary group, has developed unifying consensus recommendations on surveillance and management of dysplasia in IBD.
"We recognized that there was variable practice in the surveillance methods for dysplasia detection in patients with IBD and there were also variable guidelines, both within the US and internationally," Tonya Kaltenbach, MD, MS, from the Veterans Affairs Palo Alto, who served on the panel, told Healio Gastroenterology. The need for an international consensus statement, she said, came from "an interest to provide a uniform recommendation" — namely on the use of chromoendoscopy for the detection of dysplasia. Read more
3. CRP, calprotectin, excludes IBD in patients with IBS symptoms
William D. Chey
Adding C-reactive protein and fecal calprotectin to symptom-based diagnostic criteria may help to rule out inflammatory bowel disease in patients with symptoms of irritable bowel syndrome, according to new research data.
"Though IBD is uncommon in patients with typical IBS symptoms and no alarming features, patients and providers remain concerned about this possibility," William D. Chey, MD, AGAF, FACG, FACP, from the University of Michigan Health System, told Healio Gastroenterology.
Adding C-reactive protein and fecal calprotectin to symptom-based diagnostic criteria may help to rule out inflammatory bowel disease in patients with symptoms of irritable bowel syndrome, according to new research data.
"Though IBD is uncommon in patients with typical IBS symptoms and no alarming features, patients and providers remain concerned about this possibility," William D. Chey, MD, AGAF, FACG, FACP, from the University of Michigan Health System, told Healio Gastroenterology.
William D. Chey
Chey and colleagues performed a systematic review and meta-analysis to assess the utility of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fecal calprotectin and fecal lactoferrin to aid in differentiating between IBS, IBD and healthy patients. After reviewing 1,252 relevant studies, 12 involving 1,059 IBD patients (52.7% male; mean age, 40.7 ± 13.3 years), 595 IBS patients (29.9% male; mean age, 40 ± 18.2 years) and 491 healthy controls (53.5% male; mean age, 38.7 ± 13.8 years) were included in the meta-analysis.
The researchers found that none of the biomarkers could distinguish patients with IBS from healthy controls, but CRP and calprotectin had some value in distinguishing IBD from IBS or healthy controls. High CRP was predictive of IBD, while low CRP indicated the absence of IBD; CRP ≥ 1.7 mg/dl and > 2.7 mg/dl indicated > 52% and > 90% likelihood of IBD, respectively, while CRP ≤ 0.5 indicated that the probability of having IBD was 1% or less.
Likelihood of IBD also increased with calprotectin level, which had a maximal predictive value of 78.7% at 1,000 µg/g. Patients with < 40 µg/g calprotectin had ≤ 1% chance of having IBD. However, calprotectin level could not rule out IBS entirely; on both sides of the fecal calprotectin range (20 µg/g - 1,000 µg/g) there was an 11.6% and 7.6% predictive probability of IBS, respectively, with a peak predictive probability of 280 µg/g (18.8%).
"Serum CRP and fecal calprotectin provide a noninvasive means by which to exclude IBD in patients with IBS symptoms and no alarming features," Chey said.
"Based upon these results, it may be reasonable for clinicians to consider ordering CRP or fecal calprotectin to improve their confidence in making a diagnosis of IBS," the researchers concluded, adding that "prospective studies to evaluate the clinical utility and cost effectiveness of adding CRP or fecal calprotectin to the evaluation of patients with suspected IBS in different populations would be of considerable interest." – by Adam Leitenberger
4. Slow IBD diagnosis in children leads to more advanced disease
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Slow diagnosis of inflammatory bowel disease in pediatric patients was associated with advanced bowel involvement at the time of diagnosis, according to recent data.
"Time from symptom onset to diagnosis for IBD among children and adolescents is too long: an average of 4 to 6 months," the researchers wrote. "The majority of pediatric IBD patients already have extensive involvement at diagnosis." Read more
5. FMT induces remission in pediatric patients with Crohn's disease
David L. Suskind
Children with Crohn's disease achieved remission after fecal microbiota transplant, recent study data found.
"The fecal microbiome is likely the cause or trigger of the immune response in IBD," David L. Suskind, MD, from the department of pediatrics, division of gastroenterology at Seattle Children's Hospital, told Healio Gastroenterology. "Therapies which affect the fecal microbiome such as FMT, have the potential to change our current treatment paradigm by altering the fecal microbiome instead of using medications which suppress the immune response." Read more
6. Smoking cessation programs for Crohn's improve outcomes, reduce costs
Stephanie Coward
Gilaad G. Kaplan
The integration of smoking cessation programs targeting patients with Crohn's disease is cost-effective for health care systems, recent study data found.
"Smoking is known to worsen the course of Crohn's disease, whereas individuals who quit have a similar prognosis to patients with Crohn's disease who never smoked," Stephanie Coward, MSc, and Gilaad G. Kaplan, MD, MPH, both from the University of Calgary in Alberta, Canada, told Healio Gastroenterology. "We conducted a cost-utility analysis to compare different smoking cessation strategies for patients with Crohn's disease." Read more
7. Mongersen appears to improve remission in Crohn's disease
Séverine Vermeire
Patients with Crohn's disease achieved remission and clinical response in greater proportions with mongersen, a novel oral SMAD7 antisense oligonucleotide, compared with placebo, according to recent study data.
"The impressive clinical effects of mongersen beg for follow-up studies to confirm that we have indeed entered a new phase of Crohn's disease treatment," Séverine Vermeire, MD, PhD, from the University Hospitals in Leuven, Belgium, wrote in an accompanying editorial.
http://www.healio.com/gastroenterology/inflammatory-bowel-disease/news/online/%7Bcb981f43-1d15-4ecd-9e0f-9bf44e650089%7D/7-recent-developments-in-crohns-disease
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FMT induces remission in active ulcerative colitis
Moayyedi P, et al. Gastroenterology. 2015;doi:10.1053/j.gastro.2015.04.001.
Grinspan AM, Kelly CR. Gastroenterology. 2015;doi:10.1053/j.gastro.2015.05.030.
June 29, 2015
Aiming to evaluate the safety and efficacy of FMT for treatment of active UC, Paul Moayyedi, MD, from McMaster University in Ontario, and colleagues performed a placebo-controlled, double-blind, randomized, parallel study. Adult participants were randomly assigned to receive 50-mL FMT from healthy anonymous donors (n = 38) or placebo (50 mL water; n = 37) via retention enema once a week for 6 weeks. Stool samples were collected weekly prior to enema for microbiome analysis, flexible sigmoidoscopy was performed at baseline and week 7, and the primary study outcome was remission at week 7.
The trial was stopped early for futility, but patients already enrolled were allowed to complete the trial. Of the 70 patients who completed the trial, 24% of the FMT group compared with 5% of the placebo group were in remission at week 7 (17% difference; 95% CI, 2%-33%) with comparable adverse events. Of the nine patients in remission after FMT, seven received FMT from a single donor. Of the four patients with UC for 1 year or less, three achieved remission, and of the 34 patients with UC for more than 1 year, six achieved remission (P = .04). Patients in the FMT group had greater diversity in their stool microbial composition vs. baseline compared with patients in the placebo group (P = .02).
"This is the first randomized, placebo-controlled trial, to evaluate the efficacy of FMT in active UC and suggests that this approach induces remission in a statistically significant proportion of cases," the authors wrote. "FMT may be more efficacious in patients with a recent diagnosis of UC, and this is biologically plausible, as a perturbation in the microbiome might be more easily restored early in the course of the disease. The efficacy of this approach may also be donor dependent and this may explain why some case series have shown promise, and other have had disappointing results."
Colleen R. Kelly
In a related editorial, Ari M. Grinspan, MD, from Icahn School of Medicine at Mount Sinai in New York, and Colleen R. Kelly, MD, from Brown University, explored the reasons why another recent randomized controlled trial of FMT for UC (Rossen, et al) was negative while this one was positive. First, Moayyedi and colleagues administered a higher number of FMTs per patient and via the lower rather than upper gastrointestinal route. "The upper GI route might render the active constituent of FMT ineffective by the time it reaches the diseased colon. It is also possible that there is a dose response or a threshold required for engraftment to be attained to alter effectively the gut microbiome and the downstream inflammatory cascade," they wrote. Moayyedi's study also permitted anti-tumor necrosis factor treatment, "and those subjects on immunosuppression did better, raising the question as to whether immune factors may have a role in successful FMT induction. These uncertainties make our ignorance clear; we still do not understand the active component of FMT."
Grinspan and Kelly concluded that for IBD, "based on the current data, FMT should remain in clinical trials and not clinical practice." – by Adam Leitenberger
Disclosure: Moayyedi reports he is a chair partly funded by an unrestricted donation given to McMaster University by AstraZeneca, and he has received honoraria for speaking and/or serving on the advisory board for AstraZeneca, Actavis and Shire. Grinspan reports he received research support from the Sinai Ulcerative Colitis Clinical, Experimental and System Studies. Kelly reports she has served as a consultant and site investigator for Seres Health and received research support from Assembly Biosciences.
http://www.healio.com/gastroenterology/inflammatory-bowel-disease/news/online/%7B9917554a-9c2a-4b0e-8ada-ded4a9028707%7D/fmt-induces-remission-in-active-ulcerative-colitis?utm_source=maestro&utm_medium=email&utm_campaign=gastroenterology%20news
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Probiotics not superior for maintaining ulcerative colitis remission
December 14, 2015
ORLANDO — A systematic review showed no significant difference in efficacy between probiotics and placebo or mesalazine for maintenance of remission in ulcerative colitis, according to a poster presentation at the 2015 Advances in IBD Meeting.
"Five years ago, a Cochrane review found only four studies and no evidence regarding the efficacy of probiotics [for preventing UC relapse], but much work has been published in recent years," Morris Gordon, PhD, from University of Central Lancashire and Blackpool Victoria Hospital in the UK, and colleagues wrote. They therefore performed an updated Cochrane systematic review of data published up to January 2015 to evaluate the safety and efficacy of probiotics for the maintenance of remission in UC.
The review included seven randomized controlled trials (n = 887), ranging in duration from 3 to 12 months and comparing probiotics to placebo or mesalazine. They found the efficacy of probiotics was not significantly different from placebo based on two small studies involving 92 patients, which had some risk of bias (OR = 0.56; 95% CI, 0.22-1.4).
They also found the efficacy of probiotics was not significantly different from mesalazine, based on four studies involving 638 patients (OR = 1.29; 95% CI, 0.92-1.8). Incidence of adverse events was also statistically comparable (OR = 1.16; 95% CI, 0.79-1.71).
"There is a trend in favor of mesalazine, but this is not statistically significant," Morris said during his poster presentation. "It seems very hard to draw any strong conclusions. … There is some evidence to suggest there may be a trend towards effectiveness [of probiotics] when compared to placebo, but this is not statistically significant. … It therefore appears that — for the moment — probiotics cannot be supported as a superior intervention either compared to placebo or mesalazine for the maintenance of remission in ulcerative colitis."
The investigators concluded that further research on the role of probiotics in maintaining remission in UC is warranted. – by Adam Leitenberger
Reference: Gordon M, Farrell M. Abstract P-054. Presented at Advances in Inflammatory Bowel Diseases; Dec. 10-12, 2015; Orlando, Fla.
http://www.healio.com/gastroenterology/inflammatory-bowel-disease/news/online/%7B26ad66a8-794d-4a6b-bade-a17f76828504%7D/probiotics-not-superior-for-maintaining-ulcerative-colitis-remission?utm_source=maestro&utm_medium=email&utm_campaign=gastroenterology%20news
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Dietary fiber associated with reduced Crohn's disease flares
Brotherton CS, et al. Clin Gastroenterol Hepatol. 2015;doi:10.1016/j.cgh.2015.12.029.
January 25, 2016
Researchers suggested re-evaluating recommendations to limit dietary fiber due to recent evidence that disease flares in patients with Crohn's disease may be reduced with the intake of dietary fiber. However, in the study, the reduced flares were not observed in patients with ulcerative colitis.
Using the Crohn's and Colitis Foundation of America Partners Internet cohort, Carol S. Brotherton, PhD, of the School of Nursing, George Mason University, Fairfax, Va., and colleagues examined the association of dietary fiber intake with flares in patients with chronic inflammatory bowel diseases.
For the study, 1,619 patients were identified; 1,130 were patients with Crohn's disease (CD), and 489 were patients with UC/indeterminate colitis. Completed dietary surveys were collected from the patients at baseline and at 6-month follow-up. Consumption of fiber and whole grains was classified into quartiles and deciles. At the 6-month follow-up period, the researchers considered a disease flare to be a disease activity index score above remission cut-off values. IBD-related surgical procedures or hospitalizations that occurred from the time of the baseline survey to follow-up were also considered a disease flare.
The risk for disease flare differed by type of disease. Patients with CD were about 40% less likely to have a disease flare when they did not avoid high fiber foods compared to those who reported that they did avoid high fiber foods (adjusted OR, 0.59; 95% CI, 0.43-0.81). Patients with CD in the highest quartile of fiber intake were significantly less likely to have a flare (crude OR = 0.57; 95% CI 0.38-0.86). For patients with UC, researchers found no link between dietary fiber intake and disease flare (aOR, 1.82; 95% CI, 0.92-3.6).
"The results of this study support findings reported in investigations occurring in the 1980s – low fiber eating does not result in improved outcomes for individuals with CD compared to individuals with CD not restricting fiber intake," the researchers wrote. "More research is needed to explore the causes of fiber restriction in CD. More prospective studies are needed to explore the potential benefits of fiber-containing foods in the diet of individuals with IBD, especially in specific phenotypes. As suggested by the authors of a recent IBD diet review, it is unlikely that a single diet will be found to be sufficient to manage all IBD phenotypes; however, it will be remarkable progress if a diet is found to be sufficient alone for some and adjunctive therapy for others." – by Suzanne Reist
http://www.healio.com/gastroenterology/inflammatory-bowel-disease/news/online/%7Bbba2cce0-6133-43f9-9548-5d85bf529269%7D/dietary-fiber-associated-with-reduced-crohns-disease-flares?utm_source=maestro&utm_medium=email&utm_campaign=gastroenterology%20news
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Why cannabis relieves IBD symptoms
Healthline/Medical News Today ' August 14, 2018
New research, published in the Journal of Clinical Investigation, reveals the molecular mechanism that explains why cannabis could help treat inflammatory bowel disease.
Inflammatory bowel disease (IBD) is an umbrella term that describes inflammatory conditions affecting the gastrointestinal tract, such as Crohn's disease and ulcerative colitis.
In the United States, approximately 1.6 million people are living with such disorders. Almost 70,000 new cases are diagnosed each year.
The chronic inflammation in IBD leads to often debilitating symptoms, such as abdominal pain, rectal bleeding, fatigue, and diarrhea.
Older studies and anecdotal reports have shown that people who use cannabis experience and maintain remission of the condition. Cannabis users say that the drug helps them to successfully manage "abdominal pain, joint pain, cramping, diarrhea, poor appetite, weight loss, and nausea."
What could explain this therapeutic effect? For the first time, researchers were able to find a biological mechanism that shows how cannabis relieves intestinal inflammation in IBD.
The scientists were led by Beth A. McCormick, vice chair and a professor of microbiology and physiological systems at the University of Massachusetts Medical School in Worcester.
How cannabinoids stop the inflammation
Prof. McCormick and her colleagues started their research by acknowledging an already known inflammation process that occurs when the body is infected with a pathogen.
The so-called neutrophil influx is a normal reaction of the immune system that sends neutrophilsâ€"a type of white blood cellâ€"to fight against foreign microorganisms such as viruses or bacteria.
However, if the immune cells react disproportionately, they can also destroy the epithelium, which is the protective layer of cells that lines the inside of the intestine.
So, in order to stop the overreaction of the immune response, special molecules are "dispatched" and transported across the epithelium to stop the inflammation.
The team found that the second process requires endogenous cannabinoids (endocannabinoids), which are naturally produced by our bodies and have a similar effect to the cannabinoids in cannabis.
By performing experiments in mice and human cell lines, the team found that if endocannabinoids are lacking or are insufficient, the body cannot control the inflammation process anymore and the neutrophils attack the protective intestinal layer.
The scientists believe that cannabis makes up for the natural cannabinoids, inducing the same anti-inflammatory effect that endocannabinoids would have.
Prof. McCormick comments on the findings, saying, "There's been a lot of anecdotal evidence about the benefits of medical marijuana, but there hasn't been a lot of science to back it up."
"For the first time, we have an understanding of the molecules involved in the process and how endocannabinoids and cannabinoids control inflammation. This gives clinical researchers a new drug target to explore to treat patients [with IBD]."
Prof. Beth A. McCormick
Study co-author Randy Mrsny, a professor in the Department of Pharmacy and Pharmacology at the University of Bath in the United Kingdom, also weighs in with a clarification.
According to him, "We need to be clear that while this is a plausible explanation for why marijuana users have reported cannabis relieves symptoms of IBD, we have thus far only evaluated this in mice and have not proven this experimentally in humans."
"We hope, however, that these findings will help us develop new ways to treat bowel diseases in humans," Prof. Mrsny concludes.
https://www.mdlinx.com/gastroenterology/top-medical-news/article/2018/08/14/7541445
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