Strategy For Inflammatory Bowel Disease Research Articles

Blockade of NF- κ B Activation and Donation of Nitric Oxide: New Treatment Options in Inflammatory Bowel Disease?

Background : Inhibition of NF- s B activation has been suggested as an anti-inflammatory treatment strategy in inflammatory bowel disease (IBD). However, NF- s B regulated genes like inducible nitric oxide synthase (iNOS) are also involved in cell survival mechanisms. Methods : Review of the literature on NF- s B activation and iNOS induction in IBD. Results : In patients with IBD the mucosal immune response is derailed. The nuclear transcription factor NF- s B is a key regulator of the inducible expression of many genes involved in immune and inflammatory responses in the gut. Stimuli like oxidative stress, cytokines (IL-1, IL-6, TNF- α ), bacteria and viruses can release NF- s B from their inactive cytoplasmatic form to the nucleus. Drugs like corticosteroids, sulphasalazine, mesalazine and inhibitory cytokines (e.g. IL-10, IL-11) can prevent the activation of NF- s B. New, more potent and selective treatment strategies with antisense p65, proteasome inhibitors and viral I s B α expression vectors aim at the prevention of NF- s B activation in mucosal macrophages and T lymphocytes. However, NF- s B regulated genes are also involved in survival responses of epithelial cells. For example, inhibition of the NF- s B mediated induction of iNOS in epithelial cells could block important anti-apoptotic and anti-microbial survival mechanisms. Nitric oxide may also serve in a negative feedback loop to antagonize prolonged activation of NF- s B, thereby limiting chronic inflammation. Conclusion : Luminal donation of nitric oxide could block NF- s B activation. Selective inhibition of NF- s B activation in inflammatory cells could be a treatment option in IBD.

Nutrition in inflammatory bowel disease

Nutritional derangements are frequent in inflammatory bowel disease. In the past year significant work has been published examining the mechanisms of impaired food intake in animal models of inflammatory bowel disease, which allow a better understanding of these processes. Data from the same laboratory have shed further light on the relative role of underfeeding and inflammation on the growth retardation associated with intestinal inflammation. Other studies have provided further data on the risk factors and predictive biomarkers of bone loss in patients with inflammatory bowel disease. The potential role of enteral nutrition as primary therapy for Crohn's disease is particularly addressed in this review. Recent contributions to the field emphasized the special importance of this modality of therapy in paediatric patients. The possible mechanisms for such a therapeutic action are not well understood. Other nutrients may have a therapeutic potential in inflammatory bowel disease. In particular, recent data on the in-vivo anti-inflammatory actions of butyrate merit special mention. Finally, novel nutritional therapeutic strategies for inflammatory bowel disease, such as transforming growth factor-beta2-enriched enteral feeding, or hydrothermally processed cereals have recently been explored.

Nutrition in inflammatory bowel disease: impact on disease and therapy

Nutritional derangements are frequent in inflammatory bowel disease. In the last year, significant work was published examining the mechanisms of impaired food intake in animal models of inflammatory bowel disease, which allow a better understanding of these processes. These data have shed new light on the relative role of underfeeding and inflammation on the growth retardation associated with intestinal inflammation. Other studies have provided further information on the risk factors and predictive biomarkers of bone loss in patients with inflammatory bowel disease. The potential role of enteral nutrition as primary therapy for Crohn disease is particularly addressed in the present review. Recent contributions emphasized the special importance of this therapeutic modality in pediatric patients, but the possible mechanisms for such therapeutic effect are still not well understood. Other nutrients may have a therapeutic potential in inflammatory bowel disease. In particular, recent data on the in vivo antiinflammatory action of butyrate merit special mention. Finally, novel nutritional therapeutic strategies for inflammatory bowel disease, such as transforming growth factor-beta2-enriched enteral feeding or hydrothermally processed cereals, have recently been explored.

Neoplastic and other complications of inflammatory bowel disease.

Patients with inflammatory bowel disease (IBD) have long been known to be at increased risk of development of colorectal cancer; however, there are many nuances to cancer prevention strategies in IBD that remain unresolved. During the past year, two publications reported on the resection of otherwise typical adenoma-like masses by means of polypectomy, after which these patients were followed with continued endoscopic surveillance, rather than pursuing colectomy. Another concern in IBD is whether there is an increase in the number of other cancers, in particular lymphomas. One issue regarding lymphoma risk is whether immunomodulatory drug use predisposes to this cancer. One study of a large group of 6-mercaptopurine users did not suggest an increased risk for patients with IBD using this drug. There are a variety of nonintestinal problems that patients with IBD may confront. Osteopenia has received considerable attention in the past decade. This year, data have been published that quantify for the first time the risk of fractures in patients with IBD based on population, and these data were compared with a matched control group from the same population. Data on the further exploration of the issue of osteopenia in pediatric IBD have also been reported, as have some of the only studies of therapy for osteopenia in IBD. These and data on other extraintestinal manifestations of IBD have all emerged in the past year.

Book Review: Fabrizio Michelazzi and Jeffrey W. Milsom (Eds), "Operative strategies in inflammatory bowel disease"

Book Review: Fabrizio Michelazzi and Jeffrey W. Milsom (Eds), "Operative strategies in inflammatory bowel disease"