Bowel Disease In Remission Research Articles

Exercise decreases risk of future active disease in patients with inflammatory bowel disease in remission.

Although exercise impacts quality of life in patients with inflammatory bowel disease, little is known about its role in disease activity. Among patients with inflammatory bowel disease in remission, we aimed to evaluate the association between exercise and subsequent active disease. We performed a prospective study using the Crohn's and Colitis Foundation of America Partners' internet-based cohort of individuals with self-reported inflammatory bowel disease. We identified participants in remission, defined as short Crohn's disease activity index <150 or simple clinical colitis activity index ≤2. The primary exposure was exercise status, measured using the validated Godin leisure-time activity index. The primary study outcome, assessed after 6 months, was active disease defined using the above disease activity index thresholds. We used bivariate and multivariate analyses to describe the independent association between exercise and risk of active disease. We identified 1308 patients with Crohn's disease (CD) and 549 with ulcerative or indeterminate colitis (UC/IC) in remission, of whom 227 (17.4%) with CD and 135 (24.6%) with UC/IC developed active disease after 6 months. Higher exercise level was associated with decreased risk of active disease for CD (adjusted risk ratio: 0.72, 95% confidence interval: 0.55-0.94) and UC/IC (adjusted risk ratio: 0.78, 95% confidence interval: 0.54-1.13). In patients with CD in remission, those with higher exercise levels were significantly less likely to develop active disease at 6 months. In patients with UC/IC in remission, patients with higher exercise levels were less likely to develop active disease at 6 months; however this was not statistically significant.

FECAL CALPROTECTIN: levels for the ethiological diagnosis in Brazilian patients with gastrointestinal symptoms.

Determination of fecal calprotectin can provide an important guidance for the physician, also in primary care, in the differential diagnosis of gastrointestinal disorders, meanly between inflammatory bowel diseases and irritable bowel syndrome. Objectives The aims of the present study were to prospectively investigate, in Brazilian adults with gastrointestinal complaints, the value of fecal calprotectin as a biomarker for the differential diagnosis between functional and organic disorders and to correlate the concentrations with the activity of inflammatory bowel diseases. The study included consecutive patients who had gastrointestinal complaints in which the measurement levels of fecal calprotectin were recommended. Fecal calprotectin was measured using a Bühlmann (Basel, Switzerland) ELISA kit. A total of 279 patients were included in the study, with median age of 39 years (range, 18 to 78 years). After clinical and laboratorial evaluation and considering the final diagnosis, patients were allocated into the following groups: a) Irritable Bowel Syndrome: 154 patients (102 female and 52 male subjects). b) Inflammatory Bowel Diseases group: 112 patients; 73 with Crohn's disease; 38 female and 35 male patients; 52.1% (38/73) presented active disease, and 47.9% (35/73) had disease in remission and 39 patients with ulcerative colitis;19 female and 20 male patients; 48.7% (19/39) classified with active disease and 49.3% (20/39) with disease in remission. A significant difference (P<0.001) was observed between the median value of fecal calprotectin in Irritable Bowel Syndrome group that was 50.5 µg/g (IQR=16 - 294 µg/g); 405 µg/g (IQR=29 - 1980 µg/g) in Crohn's disease patients and 457 µg/g (IQR=25 - 1430 µg/g) in ulcerative colitis patients. No difference was observed between the values found in the patients with Crohn's disease and ulcerative colitis. Levels of fecal calprotectin were significantly lower in patients with inflammatory bowel diseases in remission when compared with active disease (P<0.001). The present study showed that the determination of fecal calprotectin assists to differentiate between active and inactive inflammatory bowel diseases and between inflammatory bowel diseases and irritable bowel syndrome.

Exercise Decreases Risk of Future Active Disease in Patients with Inflammatory Bowel Disease in Remission:

Exercise Decreases Risk of Future Active Disease in Patients with Inflammatory Bowel Disease in Remission:

Coexisting irritable bowel-like symptoms in inflammatory bowel disease in remission is associated with impaired social functioning and increased bodily pain.

Irritable bowel-like symptoms are frequently reported among patients with inflammatory bowel disease (IBD) deemed to be in remission. Previous studies have indicated that patients with coexisting irritable bowel syndrome (IBS) might have poorer health-related quality of life (HRQoL) than those without. However, it is not known what areas of HRQoL are most affected. In this study, we investigated the impact of coexisting IBS on HRQoL in IBD. Patients deemed to be in remission and not on current biological or steroid treatment were identified from a cohort of 140 IBD outpatients. HRQoL was measured using the generic Short Form-36 and the disease-specific Inflammatory Bowel Disease Questionnaire. Calprotectin in stools was measured as an objective marker of inflammation. Eighty-nine patients fulfilled the criteria for remission. Of these 89 patients, a total of 21 were irritable bowel-like symptom positive according to the Rome II criteria, whereas the comparable number in Rome III was 30. The level of calprotectin in stools was elevated in irritable bowel-like symptom positive patients, and HRQoL scores were clinically significantly reduced compared with those without IBS-like symptoms. These differences remained even when controlling for calprotectin through univariate analyses. Patients experiencing IBS-like symptoms in IBD are associated with poorer HRQoL even after controlling for objective disease markers. The HRQoL areas that are particularly affected are social functioning and bodily pain.

Gene Expression Analysis of Peripheral Cells for Subclassification of Pediatric Inflammatory Bowel Disease in Remission

ObjectiveIn current clinical practice, optimal treatment of inflammatory bowel disease (IBD) aims at the induction and maintenance of clinical remission. Clinical remission is apparent when laboratory markers of inflammation are normal and clinical symptoms are absent. However, sub-clinical inflammation can still be present. A detailed analysis of the immune status during this inactive state of disease may provide a useful tool to categorize patients with clinical remission into subsets with variable states of immune activation.DesignBy using Affymetrix GeneChips, we analysed RNA gene expression profiles of peripheral blood leukocytes from pediatric IBD patients in clinical remission and controls. We performed (un)supervised clustering analysis of IBD-associated genes and applied Ingenuity® pathway software to identify specific molecular profiles between patients.ResultsPediatric IBD patients with disease in clinical remission display heterogeneously distributed gene expression profiles that are significantly distinct from controls. We identified three clusters of IBD patients, each displaying specific expression profiles of IBD-associated genes.ConclusionThe expression of immune- and IBD-associated genes in peripheral blood leukocytes from pediatric IBD patients in clinical remission was different from healthy controls, indicating that sub-clinical immune mechanisms are still active during remission. As such, RNA profiling of peripheral blood may allow for non-invasive patient subclassification and new perspectives in treatment regimes of IBD patients in the future.

Tu1897 Chronic Stress Induces Changes in IL-6 mRNA and Modulators of Pain Transmission, TRPV1 and CB1, in an Animal Model of Inflammatory Bowel Disease in Remission

Tu1897 Chronic Stress Induces Changes in IL-6 mRNA and Modulators of Pain Transmission, TRPV1 and CB1, in an Animal Model of Inflammatory Bowel Disease in Remission

P-762 - Depression and anxiety in inflammatory bowel disease in remission

The presence of anxiety and depression has important implications for Inflammatory Bowel Diseases (IBD) management. The aims of our study were to examine the levels of anxiety and depression in IBD patients in remission and compared to those without IBD. A total of 180 patients with IBD, 88 with Crohn's disease (CD) and 92 with ulcerative colitis (UC), in remission (defined by clinical criteria), aged 19–65, of both genders (96 males and 84 females), without known or evident psychiatric disorders, without other chronic disease or the history of surgical treatment, were enrolled in the study. The control group consisted of 180 subjects without IBD. The levels of anxiety and depression were obtained by the Hamilton Anxiety Rating Scale (HAMA-14) and Hamilton Depression Rating Scale (HAMD-21). Among IBD patients 56.7% of them had no anxiety, 32.1% had mild anxiety and 11.2% had moderate anxiety. Without depression was 11.1% of patients, mild depression had a 55.6%, 32.2% had moderate depression and 1.1% had severe depression. There was a statistically significant difference in distribution of patients by categories of anxiety (P < 0.01) and by categories of depression (P < 0.01). In the control group, 94% were free of anxiety and 61.1% had no depression. There was no statistically significant difference between CD and UC. There was significant difference between control and IBD group by levels of anxiety and depression.

The Immune System in Irritable Bowel Syndrome

The potential relevance of systemic and gastrointestinal immune activation in the pathophysiology and symptom generation in the irritable bowel syndrome (IBS) is supported by a number of observations. Infectious gastroenteritis is the strongest risk factor for the development of IBS and increased rates of IBS-like symptoms have been detected in patients with inflammatory bowel disease in remission or in celiac disease patients on a gluten free diet. The number of T cells and mast cells in the small and large intestine of patients with IBS is increased in a large proportion of patients with IBS over healthy controls. Mediators released by immune cells and likely from other non-immune competent cells impact on the function of enteric and sensory afferent nerves as well as on epithelial tight junctions controlling mucosal barrier of recipient animals, isolated human gut tissues or cell culture systems. Antibodies against microbiota antigens (bacterial flagellin), and increased levels of cytokines have been detected systemically in the peripheral blood advocating the existence of abnormal host-microbial interactions and systemic immune responses. Nonetheless, there is wide overlap of data obtained in healthy controls; in addition, the subsets of patients showing immune activation have yet to be clearly identified. Gender, age, geographic differences, genetic predisposition, diet and differences in the intestinal microbiota likely play a role and further research has to be done to clarify their relevance as potential mechanisms in the described immune system dysregulation. Immune activation has stimulated interest for the potential identification of biomarkers useful for clinical and research purposes and the development of novel therapeutic approaches.

IBS-like symptoms and quality of life in inflammatory bowel disease in remission

IBS-like symptoms and quality of life in inflammatory bowel disease in remission

A multiprofessional education programme for patients with inflammatory bowel disease: A randomized controlled trial

Objective. Health-related quality of life is impaired in patients with inflammatory bowel disease and improved disease-related information can improve this situation. The aims of this study were to create an education programme that could be readily applicable at the clinic and would be suitable for newly diagnosed patients with inflammatory bowel disease, and to investigate whether the programme could improve their health-related quality of life. Material and methods. Ninety-three patients with inflammatory bowel disease in remission were included and randomized to an intervention group or a control group. The intervention group attended a multiprofessional education programme while the control group received regular information. Four questionnaires were used for measuring health-related quality of life. Both groups completed the questionnaires at baseline and after 6 months. The intervention group also completed the questionnaires after 1 month. Results. No significant differences were found when comparing the two groups at 6 months. However, the multiprofessional education programme was highly appreciated by the patients. Conclusions. In the present study no improvement could be seen in health-related quality of life in patients with inflammatory bowel disease after participating in an education programme in comparison with the control group. This might be due to the fact that the questionnaires were not sensitive enough or that some patients were not in clinical remission. The patients’ enthusiasm for the multiprofessional education programme has led to its being part of the regular care at the clinic.

Disturbed in vitro adrenergic modulation of cytokine production in inflammatory bowel diseases in remission

Objective Psychological stress has been implicated in the pathophysiology of both inflammatory and functional gastrointestinal (GI) diseases. The goal of this study was to address neuroendocrine modulation of cytokine production by peripheral blood cells in GI diseases. Methods We analyzed the in vitro effects of the β-adrenergic agonist terbutaline and the glucocorticoid agonist dexamethasone on TNF-α and IL-10 production by LPS-stimulated monocytes in whole cell blood cultures in patients with inflammatory bowel diseases in remission ( N = 10), diarrhoea-predominant irritable bowel syndrome (IBS, N = 12), patients with a recent gastroenteritis (post-infectious group, N = 10), and healthy controls ( N = 15). Results In response to terbutaline, there was a significant increase in IL-10 production (concentration effect: p < 0.05), which was diminished in IBD (group effect: p < 0.01), comparable in IBS and controls, but enhanced in the post-infectious group (group x concentration effect: p < 0.05). In contrast, terbutaline resulted in a concentration-dependent suppression of TNF-α production, which was comparable in all groups. Dexamethasone suppressed TNF-α production in a dose-dependent manner in all groups, but this effect was significantly more pronounced in post-infectious subjects (group effect: p < 0.05). Conclusions In IBD, disturbed adrenergic regulation of IL-10 could be part of the mechanism(s) underlying the modulation of disease activity by psychological stress. Diarrhoea-predominant IBS was not associated with altered adrenergic or glucocorticoid regulation of cytokine production by peripheral blood cells, whereas a recent history of gastroenteritis was associated with disturbed neuroendocrine modulation of cytokine production, which may play role in the pathophysiology of post-infectious IBS.

5-Aminosalicylate therapy is associated with higher 6-thioguanine levels in adults and children with inflammatory bowel disease in remission on 6-mercaptopurine or azathioprine

Small uncontrolled trials have suggested that 5-aminosalicylate (5-ASA) medications increase 6-thioguanine nucleotide (6-TGn) levels in adults with Crohn's disease (CD) on azathioprine (AZA) or 6-mercaptopurine (6-MP), presumably through the inhibition of thiopurine methyltransferase (TPMT). We tested the theory that coadministration of 5-ASA agents with AZA/6-MP results in higher 6-TGn levels in a large cohort of children and adults with CD or ulcerative colitis (UC). A retrospective cohort study identified all children and adults treated for IBD with AZA/6-MP at 2 tertiary medical centers. Patients were included if their TPMT genotype was known and 6-TGn and 6-methymercaptopurine (6-MMP) levels had been obtained after 3 months of clinical remission at a stable dose of AZA/6-MP. 6-TGn and 6-MMP levels were compared between patients taking and those not taking 5-ASA medications through the use of linear regression models to identify and adjust for potentially confounding variables. Of the 126 patients included, 88 were taking 5-ASA medications. Patients on 5-ASA agents had higher mean 6-TGn levels after adjustment for confounding variables (Delta6-TGn, 47.6 +/- 21.8 pmol/8 x 10 red blood cells; P = 0.03). CD and TPMT heterozygosity was independently associated with higher 6-TGn levels (P = 0.01 and P = 0.03, respectively). 5-ASA exposure was not associated with a change in 6-MMP levels. We found that 5-ASA therapy is associated with higher 6-TGn levels in children and adults with IBD on 6-MP/AZA. TPMT inhibition may not explain this effect because 5-ASA exposure did not affect 6-MMP levels. The observed association of CD with higher 6-TGn levels is novel and needs to be verified in prospective studies.

Autonomic imbalance during the day in patients with inflammatory bowel disease in remission. Evidence from spectral analysis of heart rate variability over 24 hours

Background. Autonomic function in inflammatory bowel disease has not yet been studied by means of analysis of 24-hour heart rate variability. Aim. To measure heart rate variability in inflammatory bowel disease patients in remission. Patients and methods. Study population comprised 27 patients with inflammatory bowel disease in remission and 28 healthy, sex- and age-matched controls. Two frequency ranges were analysed: low frequency (0.06–0.15 Hz) and high frequency (0.15–0.40 Hz). Results. Mean values of low frequency and low frequency/high frequency ratio were lower in patients than in controls (p<0.001). High frequency in patients tended to be higher than in controls (p=0.09). The only factor that had a marginal effect on heart rate variability indexes was age. In high frequency, there was a significant time effect (p=0.001) for both groups. There was also a significant time effect in low frequency/high frequency ratio in both groups (p<0.001). During daytime, the mean values in low frequency/high frequency ratio were lower in patients than in controls (p<0.001). Conclusions. There is a shift in the autonomic balance in patients with inflammatory bowel disease in remission towards a condition of relative parasympathetic predominance, which, in the first place, reflects a sympathetic pullback. This imbalance has a circadian rhythm and it is more pronounced during the day.

Quality of life in inflammatory bowel disease in remission: the impact of IBS-like symptoms and associated psychological factors

OBJECTIVES: Quality of life is reduced in inflammatory bowel disease (IBD). Whether or not this is true in IBD patients in long-standing remission is unclear. Symptoms compatible with irritable bowel syndrome (IBS) are common in IBD patients in remission. The importance of psychological factors in this process is a matter of controversy. METHODS: Forty-three patients with ulcerative colitis (UC) and 40 with Crohn’s disease (CD), who had been in remission for at least 1 yr according to laboratory parameters and clinical and endoscopical appearance, were included. These patients completed four different self-administered questionnaires, evaluating GI symptoms, anxiety, depression, and psychological general well-being. The two patient groups were compared with the general population, and within-group comparisons in psychometric scores were made between patients with and without IBS-like symptoms. RESULTS: The psychological well-being in IBD patients in long-standing remission was similar to that of the general population, despite the presence of more severe GI symptoms. CD patients reported more psychosocial dysfunction, reduced well-being, and GI symptoms than UC patients. Thirty-three percent of UC patients and 57% of CD patients had IBS-like symptoms. The group with IBS-like symptoms (both UC and CD) had higher levels of anxiety and depression and more reduced well-being than those without. Anxiety and reduced vitality were found to be independent predictors for IBS-like symptoms in these patients. CONCLUSION: The prevalence of IBS-like symptoms in IBD patients in long-standing remission is two to three times higher than that in the normal population. Psychological factors seem to be of importance in this process. However, as a group IBD patients in remission demonstrate psychological well-being comparable to that of the general population.

Symptoms of irritable bowel syndrome in inflammatory bowel disease in remission and relation-ship to psychological factors

Symptoms of irritable bowel syndrome in inflammatory bowel disease in remission and relation-ship to psychological factors

Psychologigal well-being and gastrointestinal symptoms in inflammatory bowel disease in remission

Psychologigal well-being and gastrointestinal symptoms in inflammatory bowel disease in remission

Metabolic features of inflammatory bowel disease in a remission phase of the disease activity.

To evaluate the anthropometric and metabolic characteristics of patients with Crohn's disease (CD) and ulcerative colitis (UC), comparing both groups with healthy volunteers. A cross-sectional study. The Department of Internal Medicine, Catholic University Hospital, Rome, Italy. Thirty-four patients with biopsy-proven inflammatory bowel disease (18 CD; 16 UC) in clinical remission (SCDAI < 3 and Powell-Tuck index < 4) not receiving steroid therapy. All patients had a clinical examination. Blood indicators of inflammation and nutritional status. Body composition was assessed by both anthropometry and bioimpedance and metabolic variables were measured by indirect calorimetry over a 60-90 min period. CD had a lower body weight than both controls (58.1 kg, range 41.5-71.0 vs. 66.4 kg, range 57.0-76.0; P < 0.001) and UC) 58.1 kg, range 41.5-71.0 vs. 69.6 kg, range 50.5-94.0; (P < 0.001). Fat-free mass (FFM) did not differ between the groups, whilst fat mass was significantly lower in CD than in UC (P < 0.05) and controls (P < 0.001). Normalizing the basal metabolic rate by FFM, a higher value was found in CD compared with UC (143 kJ kg-1) d-(-1), range 97.5-179 vs. 133 kJ kg-1 d-1, range 123-148; P < 0.05) and control subject 143 kj kg-1 d-1, range 97.5-179 vs. 134 kj kg-1 d-1, range 122-162; P < 0.05). The nonprotein respiratory quotient was significantly lower in CD compared to UC 0.80, range 0.73-0.84 vs. 0.84, range 0.79-0.91; P < 0.01) and controls (0.80, range 0.73-0.84 vs. 0.83, range 0.81-0.87; P < 0.001), with a consequently higher lipid oxidation rate in CD. CD subjects showed a decreased fat mass and enhanced utilization of lipids compared with UC and controls. These data could be explained by the larger intestinal involvement and considered as a contribution to lipid tissue wasting in CD.

Review and Analysis of the Effects of Olestra, a Dietary Fat Substitute, on Gastrointestinal Function and Symptoms

Olestra, a dietary fat substitute, was recently made available to consumers in savory snacks in three cities. Early reports of gastrointestinal complaints attributed to olestra attracted media coverage and fostered confusion among physicians and consumers about the nature of olestra and its effects on the digestive system. We reviewed all published studies of olestra's gastrointestinal effects and all relevant unpublished studies submitted to the Food and Drug Administration. Each study was analyzed by a group of expert gastroenterologists and epidemiologists. The symptoms reported with olestra ingestion are similar to those reported with ingestion of fiber and sorbitol, although the mechanisms involved in changing stool characteristics differ among these food additives. Olestra's effects on stool habit and characteristics are due to its presence in the stool. Large amounts are more likely to induce gastrointestinal symptoms than small amounts. There is no evidence that olestra induces pathological change in bowel function: there is no increased fluid or electrolyte nor is there altered gastrointestinal motility or microflora. Olestra and triglyceride ingestion resulted in a similar frequency of symptoms in normal adults and children and in people with chronic inflammatory bowel disease in remission. Olestra traverses the digestive tract intact to become a stool additive. Some subjects develop a change in bowel habit and stool characteristics due to the presence of more olestra in the stool. These changes resemble those associated with ingestion of sorbitol and fiber.

Respiratory burst of circulating polymorphonuclear leukocytes and plasma elastase levels in patients with inflammatory bowel disease in remission.

The activation of circulating polymorphonuclear leukocytes was determined in terms of superoxide radical generation and granulocyte elastase release in untreated patients with ulcerative colitis (N = 10) and Crohn's disease (N = 9) in remission and in control subjects (N = 10). Superoxide radical generation was determined by monitoring spectrophotometrically the reduction of ferricytochrome, after stimulation of cells with phorbol myristate acetate. Plasma elastase concentration was measured by a solid-phase enzyme immunoassay technique as the complex with alpha-1-proteinase inhibitor. Superoxide formation by polymorphonuclear leukocytes from patients with ulcerative colitis and Crohn's disease was significantly lower compared with controls [median (range) nmol/min/mg protein: Crohn's disease 7.8 (7.1-9.6); ulcerative colitis 8.25 (7.4-10.3); controls 14.7 (13.6-15.8)] (P < 0.001), while no difference was found between the two groups of patients. In contrast plasma elastase levels in patients with ulcerative colitis and Crohn's disease were similar to that of controls. This defective respiratory burst of polymorphonuclear leukocytes in patients with inflammatory bowel disease in remission, in absence of an altered degranulation, could represent an important factor for the pathogenesis of these diseases.

Prospective study of verocytotoxin–producing, enteroaggregative and diffusely adherentEscherichia coliin different diarrhoeal states

One hundred and eighty-one stool specimens from patients with various types of diarrhoea (135 patients) or from non-diarrhoeal controls (23 acute medical patients, 23 inflammatory bowel disease in remission) were investigated using a colony-blot DNA hybridization assay for the presence of Verocytotoxin-producing (VTEC), enteroaggregative (EAggEC) and diffusely adherent (DAEC) Escherichia coli. Twelve patients had probe-positive EAggEC in the stool and 8 of these had diarrhoea, 6 following recent travel. Eight patients had DAEC, 7 of whom had travellers' diarrhoea. Six of 10 (60%) travellers with gastroenteritis, but without a recognized enteric pathogen, were positive for EAggEC (4) or DAEC (2). Five of 10 (50%) travellers with gastroenteritis related to a recognized enteric pathogen also had DAEC identified in their stool. Of the 23 acute medical control patients 11 had been abroad, 4 of these were immigrants and had EAggEC. VTEC were not found and, with one exception, immunoassays for antibodies to E. coli O 157 and O 2 lipopolysaccharides were negative.