Episodes Of Inflammatory Bowel Disease Research Articles

Use of Proton Pump Inhibitors Increases the Number of Episodes of Inflammatory Bowel Disease

Use of Proton Pump Inhibitors Increases the Number of Episodes of Inflammatory Bowel Disease

Revisiting the "starved gut" hypothesis in inflammatory bowel disease.

Active episodes of inflammatory bowel disease (IBD), which include ulcerative colitis and Crohn's disease, coincide with profound shifts in the composition of the microbiota and host metabolic energy demand. Intestinal epithelial cells (IEC) that line the small intestine and colon serve as an initial point for contact for the microbiota and play a central role in innate immunity. In the 1980s, Roediger et al proposed the hypothesis that IBD represented a disease of diminished mucosal nutrition and energy deficiency ("starved gut") that strongly coincided with the degree of inflammation. These studies informed the scientific community about the important contribution of microbial-derived metabolites, particularly short-chain fatty acids (SCFA) such as butyrate, to overall energy homeostasis. Decades later, it is appreciated that disease-associated shifts in the microbiota, termed dysbiosis, places inordinate demands on energy acquisition within the mucosa, particularly during active inflammation. Here, we review the topic of tissue energetics in mucosal health and disease from the original perspective of that proposed by the starved gut hypothesis.

Clostridium difficile infection in Polish pediatric outpatients with inflammatory bowel disease

The prevalence of Clostridium difficile infection (CDI) in pediatric patients with inflammatory bowel disease (IBD) is still not sufficiently recognized. We assessed the prevalence of CDI and recurrences in outpatients with IBD. In addition, the influence of IBD therapy on CDI and antimicrobial susceptibility of the potentially causative C. difficile strains was assessed. This was a prospective, single-center, observational study. All specimens were obtained between January 2005 and January 2007 from the IBD outpatient service and screened for C. difficile and its toxins. C. difficile isolates were genotyped by PCR ribotyping. Diagnosis of Crohn’s disease (CD) and ulcerative colitis (UC) was based on Porto criteria. Severity of disease was assessed using the Hyams scale (for Crohn’s disease) and the Truelove–Witts scale (for ulcerative colitis). One hundred and forty-three fecal samples from 58 pediatric IBD patients (21 with Crohn’s disease and 37 with ulcerative colitis) were screened. The risk of C. difficile infection was 60% and was independent of disease type (CD or UC) (χ2 = 2.5821, df = 3, p = 0.4606). About 17% of pediatric IBD patients experienced a recurrence of CDI. All C. difficile strains were susceptible to metronidazole, vancomycin and rifampin. A high prevalence of C. difficile infection and recurrences in pediatric outpatients with IBD was observed, independent of disease type. There was no significant correlation between C. difficile infection and IBD therapy. PCR ribotyping revealed C. difficile re-infection and relapses during episodes of IBD in pediatric outpatients.

Preoperative Steroid Use and Risk of Postoperative Complications in Patients With Inflammatory Bowel Disease Undergoing Abdominal Surgery

Corticosteroids are the mainstay of medical therapies to induce remission in acute episodes of inflammatory bowel disease (IBD). However, evidence suggests that this may increase the risk of postoperative complications among patients with IBD who go on to have abdominal surgery. To estimate the risk of postoperative complications following abdominal surgery in patients with IBD on steroids at the time of abdominal surgery. Meta-analysis of observational studies. We searched medical electronic databases for full journal articles published after 1965 reporting on postoperative complications in patients with IBD undergoing abdominal surgery provided they compared patients treated with steroids with those not on steroids. We hand searched the reference lists of all retrieved articles. Two independent reviewers extracted data from studies meeting the inclusion criteria and any discrepancies were resolved by discussion. We carried out fixed effects meta-analysis, funnel plot and sensitivity analyses. A total of seven observational studies involving 1,532 patients met the inclusion criteria for risk of total complications, and five observational studies involving 1,714 patients met the inclusion criteria for risk of infectious complications. Pooled analysis showed an increased risk of all postoperative complications (OR 1.41, 95% confidence interval 1.07-1.87), as well as an increased risk of postoperative infectious complications (OR 1.68, 95% confidence interval 1.24-2.28) among patients on steroids. Patients who received higher doses of perioperative oral steroids (>40 mg) had a higher risk of total complications (OR 2.04 (95% CI 1.28-3.26). There is an increased risk of total as well as infectious complications following the use of steroids in patients with IBD.

Depression and anxiety levels in therapy-naïve patients with inflammatory bowel disease and cancer of the colon

To assess whether depression and anxiety are more expressed in patients with the first episode of inflammatory bowel disease (IBD) than in individuals with newly discovered cancer of the colon (CCa). A total of 32 patients with IBD including 13 males and 19 females, aged 27 to 74, and 30 patients with CCa including 20 males and 10 females, aged 39-78, underwent a structured interview, which comprised Hamilton's Depression Rating Inventory, Hamilton's Anxiety Rating Inventory and Paykel's Stressful Events Rating Scale. Patients of the IBD group expressed both depression and anxiety. Depressive mood, sense of guilt, psychomotor retardation and somatic anxiety were also more pronounced in IBD patients. The discriminant function analysis revealed the total depressive score was of high importance for the classification of a newly diagnosed patient into one of the groups. Newly diagnosed patients with IBD have higher levels of depression and anxiety. Moreover, a psychiatrist in the treatment team is advisable from the beginning.

Upregulation of Interleukin-12 and -17 in Active Inflammatory Bowel Disease

Background: Cytokines are essential mediators of the intestinal inflammation during active episodes of inflammatory bowel disease (IBD). Interleukin (IL)-12 and IL-17 are potent immunoregulatory cytokines whose roles in the pathogenesis of IBD are unknown. The aim of this study was to evaluate the colonic expression of IL-12 and IL-17 genes in IBD. Methods: Fifty-one patients (22 with ulcerative colitis (UC), 17 with Crohn disease (CD), and 12 controls) who underwent colonoscopy were included. IBD disease activity was determined using a clinical grading scale. The degree of inflammation, as well as the content of CD4+ T cells (synthesizing IL-17) and CD68+ macrophages (synthesizing IL-12) in colonic biopsies, was determined. The amounts of IL-12 and IL-17 mRNA were assessed by RT-PCR, using GAPDH as an internal standard. Results: In colonic specimens, IL-17 mRNA expression was increased in moderately and severely active UC (P = 0.03) and in all degrees of activity in CD (P < 0.04). Levels of IL-12 mRNA were upregulated in both active UC and active CD compared to controls (P < 0.02). In cases of remission, IL-12 mRNA expression was similar to that found in control samples. Compared to controls, histological examination showed significant differences in signs of chronic and acute inflammation in UC (P < 0.01) and CD (P < 0.02), revealing a high correlation between clinical disease activity and histological scoring (r 2 = 0.92, P < 0.005). Whereas CD4+ T cells were observed in lymphocyte aggregates located profound in the lamina propria, CD68+ macrophages were primarily found just underneath the surface epithelium. The density of CD4+ and CD68+ cells correlated significantly with the amounts of IL-17 and IL-12 mRNA, respectively (P < 0.05). Conclusion: The expression of both IL-12 and IL-17 mRNA is induced in active UC and CD and may thus be involved in sustaining the intestinal inflammation in IBD. Inhibition of IL-12 or IL-17 might be future therapeutic targets in IBD.

Lag Time between Stress Events and Risk of Recurrent Episodes of Inflammatory Bowel Disease

We followed a cohort of 124 subjects with a history of inflammatory bowel disease to ascertain risk estimates for clinically active disease associated with exposure to recent stress events. We calculated risk estimates for three lag models (-1, 0, + 1 month). The data indicated a strong association between stress exposures and new clinical episodes of disease (RR = 2.9, 95% Cl: 2.0-4.1), most apparent in the immediate period (lag = 0). Risk estimates were also elevated for extended episodes of disease in subjects under stress compared with unexposed subjects. These results underscore the importance of monitoring stress exposures in prevention and treatment of recurrent disease.