Inflammatory Bowel Disease - A Holistic Perspective

The IBS Miracle

Today to Discover: My unique holistic system to immediately get symptomatic relief and completely cure your condition within 3 to 8 weeks using my powerful 100% natural system. The horrible truth about conventional Ibs treatments. A list of the original hidden research papers (together with all the details you need to locate them yourself) published by scientists and MDs reporting how they cured Ibs using natural methods so you'll see that my system is backed by scientific evidence! 78 different scientific sources to be exact! How simple over the counter products will immediately reduce cramps and abdominal pain. The dietary changes you should make to live an Ibs-free life. How to make your body combat Ibs and re-balance itself. The link between lifestyle and Ibs. The specific foods that trigger Ibs symptoms. Foods that are marketed as being ery healthy that will actually cause your Ibs to get worse. Herbs that are extremely potent in stopping diarrhea, constipation and gas. Simple alternative treatments that will cure your Ibs faster than you ever thought possible. I will show you step by step how to do this. The food items you have to include in your diet if you want to get rid of your Ibs fast. The food items you should limit if you want to get rid of Ibs. Convenient printable charts that will tell you exactly the foods to avoid and the foods to include. The secret 100% natural remedies that you should use, and are guaranteed to make a dramatic impact on your Ibs condition in just a few days! Read more here...

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Spectrum of Inflammatory Bowel Disease

The spectrum of inflammatory bowel disease results in major differences with respect to quality of life among patients with ulcerative colitis compared to those with Crohn's disease. In ulcerative colitis, only the colon and rectum is involved, the sphincters are spared and there is no small-bowel involvement. Although many of these patients present with acute fulminating colitis requiring an emergency colecto-my, a high proportion of these patients can today be reassured that the stoma might be temporary and that there is an 80-95 chance of full continence, albeit with some diarrhoea after colorectal excision and pouch construction. There is of course a risk of malignancy and there is the risk that conventional surgery may be associated with complications resulting in a permanent stoma.

The Role of IL10 in the Regulation of Inflammatory Bowel Disease

Inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis, is the major chronic inflammatory disease of the intestinal tract. Although the etiology of IBD is unknown, the intestinal flora is believed to play an important role in its pathogenesis. This is perhaps best illustrated in experimental models of the disease e.g., the IL-10 7 mouse model

Descriptie Epidemiology

Inflammatory bowel diseases (IBD) are a collection of diseases affecting the bowel, the most common of which are ulcerative colitis and Crohn's disease. Whereas UC is characterised by a continuous distribution of mucosal submucosal inflammation within the colon, CD may result in focal areas of disease in any part of the gastrointestinal tract from the mouth to the anus the inflammation is transmural and almost inevitably progresses over time, often leading to structuring or fistulising complications. Extraintestinal complications affecting eyes, skin and joints occur in both illnesses. Although inflammatory bowel disease is not common or highly fatal, it is important to public health because its highest incidence is early in life, its therapy involves major surgery including a curative colectomy for ulcerative colitis, and having the disease increases the risk of developing colon cancer. The Multicenter European Collaborative Study on Inflammatory Bowel Disease (EC-IBD) reported...

The Mediators Expressed by Mast Cells and Their Role in the Inflammatory Response

Mast cells have been incriminated in such diverse diseases as allergy, asthma, rheumatoid arthritis, atherosclerosis, interstitial cystitis, inflammatory bowel disease, progressive systemic sclerosis, chronic graft-vs-host disease, fibrotic diseases, sarcoidosis, asbestosis, ischemic heart disease, keloid scars, and malignancy (3). The mediators released by mast cells can independently and, in synergy with macrophage- and T-cell-derived cytokines, induce much of the inflammatory pathology observed in inflammation and serve to orchestrate a complex immune response. Histamine, LTB4, LTC4, PAF, and PGD2 may have multiple effects on inflammatory cell recruitment (eosinophils), smooth muscle hyperplasia, and vascular dilatation (80,81). Tryptase, chymase, and TNF-a from mast cells activate fibroblasts, leading to collagen deposition and fibrosis. Mast cell-derived TNF-a regulates NF-KB-dependent induction of endothelial adhesion molecule expression on endothelial cells in vivo (49). Mast...

Human In Vitro Studies

Selective impairments in tachykinin and CGRP-mediated colonic motility are manifest in inflammatory bowel disease In Vitro 48 . Data show a reduction in motility in patients with active disease. In Vitro, there is evidence of impaired contractility of smooth muscle from UC patients, suggesting the physiological release of an inhibitory neurotransmitter 36 . There is a large neural inhibitory component to responses from inflamed tissue and these responses could be blocked through the inhibition of nitric oxide synthase (NOS), implicating nitric oxide (NO) as the mediator 49 . The role of NO in the patho-physiology of IBD is controversial. An immunoblot of biopsies revealed significant elevation of nitric oxide synthase isoform (iNOS) in active UC compared to uninflamed sites 50, 51 , whereas in patients with CD, no significant changes were detected 52 .

Noninfectious inflammatory disorders

Seronegative spondyloarthropathies may be the most common causes of chronic inflammatory monarthritis. Important clinical clues include the presence of low-back or buttock pains with morning stiffness reflecting spinal involvement or inflammation of the sacroiliac joints extraarticular features, such as pitting of the nails or a scaling skin rash (psoriasis) characteristic skin lesions, such as keratoderma blennorrhagicum or circinate balanitis, associated with urethritis and conjunctivitis (Reiter's disease) a history consistent with inflammatory bowel disease (ulcerative colitis or Crohn's disease) or a history of uveitis.

Crystalinduced disease

Sarcoidosis presents as a periarthritis or polyarthritis associated with hilar adenopathy, erythema nodosum, and fever (Lofgren syndrome). A similar disorder can occur without adenopathy and can be due to infections (streptococci, TB, coccy), inflammatory bowel disease, and drug reactions.

Differential diagnosis

Seronegative spondyloarthropathies characteristically present with asymmetric inflammatory disease of the large joints of the lower extremities, often with low-back disease and telltale manifestations such as psoriasis, urethritis, uveitis, or inflammatory bowel disease.

The Efficacy of Surveillance

There is evidence showing that colonoscopic surveillance may detect precancerous dysplasia and early treatable cancer. Thus, some studies indicate that patients with cancers detected by surveillance tend to be at a curable stage while patients not adhering to surveillance are most likely to die from cancer 23 . Other studies, however, are less convincing 24 , showing evidence that only very few of the malignancies found were treatable cancers detected by true surveillance colonoscopy and with only a marginally better success rate. There seems in fact to be no direct evidence that endoscopic surveillance reduces cancer mortality in inflammatory bowel disease 25 , and a review reported on in the Cochrane Central Register of Controlled Trials presents a similar message 18 . Although cancers tend to be detected at an earlier stage and has a correspondingly better prognosis in

Pathogenic and Protective T Cells

Distinguishing CD4+CD25+ cells from recently activated CD4+ T cells is Foxp3, a transcription factor that is required for CD4+CD25+ cell development and is sufficient for their suppressive function (102-104). Foxp3+ CD4+CD25+ cells play an important role in preventing the induction of several autoimmune diseases, such as the autoimmune syndrome induced by day-3 thymectomy in genetically susceptible mice (100), inflammatory bowel disease (105), T1D in thymectomized rats (106), and in NOD mice (9,107). CD4+CD25+ cells are reduced in NOD compared to other mouse strains and this reduction could be a factor in their susceptibility to T1D (9,10). Mice with a defect in Foxp3, required for the generation and activity of regulatory T cells, exhibit massive lymphoproliferation and severe inflammatory infiltration of multiple organs, in particular the lungs, liver, and skin (103). This phenotype is influenced by an additional defect in central tolerance induction, generated by either crossing in...

IntroductionTo Cut is not to Cure

The challenge of inflammatory bowel disease (IBD) is formidable. For the patient, there are the symptoms of the disease, causing personal suffering and interference with physical and social activities. For the clinician, the problems are just as challenging the patho-genesis is yet obscure, and the diagnosis, especially for Crohn's disease, can prove frustrating, as the disease may be diffuse and latent in parts of the bowel that appears normal. The surgeon can be particularly frustrated by the knowledge that he or she can never claim to be able to cure the patient's problem.

Inflammation and the development of cancer

The association between inflammation and cancer has been recognised for many years. One clearly established example is the correlation between inflammatory bowel disease and colorectal cancer. The mechanisms behind this association are unclear. The ''landscape theory'' suggests that abnormal cells from stromal tissues, influenced by factors in the local environment, cause susceptibility to malignant transformation in epithelial cells. These environmental factors include those that favour genomic changes (resulting in the loss of tumour suppressor function or activation of oncogenes) or enhanced growth, thus providing transformed cells the opportunity to proliferate.

The Pneig System a Cybernetic Array is Closely Related to the Bowel

The large bowel controls (and is controlled by) the P (psycho), N (neuro), E (endocrine) and I (immune) system. The altered balance between bacteria and cytokine may initiate the inflammatory bowel disease (IBD) process. IBD patients need a holistic approach, taking care of the whole psyche-body-enteric nervous system Fig. 1. The large bowel controls (and is controlled by) the P (psycho), N (neuro), E (endocrine) and I (immune) system. The altered balance between bacteria and cytokine may initiate the inflammatory bowel disease (IBD) process. IBD patients need a holistic approach, taking care of the whole psyche-body-enteric nervous system

AGlucosidase Inhibitors

The a-glucosidase inhibitors are contraindicated in patients with a hypersensitivity to the drug, diabetic ketoacidosis, cirrhosis, inflammatory bowel disease, colonic ulceration, partial intestinal obstruction or predisposition to intestinal obstruction, or chronic intestinal diseases. Acarbose and miglitol are used cautiously in patients with renal impairment or pre-existing gastrointestinal (GI) problems such as irritable

Contraindications Precautions And Interactions

The glucocorticoids are administered with caution to patients with renal or hepatic disease, hypothyroidism, ulcerative colitis, diverticulitis, peptic ulcer disease, inflammatory bowel disease, hypertension, osteoporosis, convulsive disorders, or diabetes. The glucocorticoids

Biobehavioral Disorders

This group of disorders with clearly identified pathophysiologic origins and effects have been traditionally understood to have significant psychoemotional components. Examples include asthma, migraine, encopresis, Tourette's Syndrome, and inflammatory bowel disease, all of which are known to include psychological stress as just one stimulus which may 'trigger' exacerbations or promote difficulties with the disease. Teaching self-hypnosis as an integral component of a comprehensive

Gastrointestinal Tract Infection

Inguinal Colostomy

INFLAMMATORY BOWEL DISEASE Two similar diseases are included under the heading of inflammatory bowel disease (IBD) Crohn disease and ulcerative colitis, both of which occur mainly in adolescents and young adults. Crohn disease is a chronic inflammation of segments of the intestinal wall, usually in the ileum, causing pain, diarrhea, abscess, and often formation of an abnormal passageway, or fistula. Ulcerative colitis involves a continuous inflammation of the lining of the colon and usually the rectum.

Treatment of Chronic Pouchitis

More recently, 44 patients with refractory pouchi-tis received metronidazole 800 mg - 1 g day and ciprofloxacin 1 g day for 28 days. Symptomatic, endoscopic and histological evaluations were undertaken before and after the antibiotic therapy, according to the PDAI score, and the related quality of life was assessed with the inflammatory bowel disease questionnaire (IBDQ). Thirty-six patients (82 ) went into remission the median PDAI scores before and after therapy were 12 and 3 respectively (p

Definition and Classification of Dysplasia in Ulcerative Colitis

In most centres in Europe, the term cancer, in regards to the colon, is given only when there is invasion through the biological basement membrane of the colonic epithelium, i.e. the muscularis mucosa. Malignant tumours confined to the mucosa have practically no metastatic potential and therefore we prefer not to use such a term. In 1993, the Research Committee on Inflammatory Bowel Disease of the Ministry of Health and Welfare of Japan 9 proposed a variation of the classification of Riddell et al. (Table 2) however, it was not universally used. Riddell's classification of dysplasia remained unchanged until 2000 when a group of gastrointestinal pathologists from Europe, Japan and North America gathered in Vienna to propose a new classification to bridge the huge gap between the terminologies used by the various groups. The Vienna classification categorises epithelial dysplasia, found any where in the gastrointestinal tract including the colon, as negative...

Hull T.l.1996 Work On Ileostomy

Kodner IJ (1997) Perianal Crohn's disease. In Allan RN, Rhodes JM, Hanauer SB et al (eds) Inflammatory bowel diseases, 3rd edn. Churchill Livingstone, New York, p 863 31. Jeffery PJ, Ritchie JK, Parks AG (1977) Treatment of haemorrhoids in patients with inflammatory bowel disease. Lancet 1 1084-1085 39. Richards ME, Rickert RR, Nance FC (1989) Crohn's disease associated carcinoma a poorly recognized complication of inflammatory bowel disease. Ann Surg 209 764-773 41. Lavery IC, Jagelman DG (1982) Cancer in the excluded rectum following surgery for inflammatory bowel disease. Dis Colon Rectum 25 522-524 52. Sandborn WJ, Hanauer SB (1999) Antitumor necrosis factor therapy for inflammatory bowel disease a review of agents, pharmacology, clinical results, and safety. Inflamm Bowel Dis 5 119-133

Differential Diagnosis Of Delayed Puberty

A thorough medical history should note the symptoms and signs of anorexia nervosa, the intensity of athletic training, and the timing of puberty of both parents (see Fig. 5). In boys with constitutional delay of puberty, one parent often developed late as well. A history of chronic illness, such as celiac disease or inflammatory bowel disease, suggests a temporary or secondary delay of puberty. Stature and height velocity should be evaluated using appropriate growth charts. Height velocity is usually reduced in patients with constitutional delay but is normal in patients with isolated hypogo-

Pathological Considerations

Paneth cell metaplasia together with pseudo-pyloric metaplasia (cells of the ulcer-associated cell lineage) appears in epithelium, which has been subjected to chronic insults, but their diagnostic value is unclear. Paneth cells can be seen in colonic crypts in inflammatory bowel disease however, one should be wary of the fact that Paneth cells can be a normal finding in biopsies from the caecum and ascending colon 92 .

Preoperative and definitive radiation therapy

Good candidates for bladder conservation. The bladder function has to be adequate to be worthwhile preserving. The second issue is the technical ability to deliver an adequate dose of radiation to the tumour. The factors to consider as contra-indications to radiation treatment include the presence of active inflammatory bowel disease, prior pelvic surgery, prior pelvic infections, and the technical ability to control the disease is the size of radiation field that is required, presence of tumour of diverticulum, etc. The other factors relevant to patient selection are related to the potential for achieving lasting local control and therefore bladder conservation. To define this, we should examine the local control rates and survival data in patients with muscle-invasive bladder cancer treated with radiation therapy. One should remember that the information on the use of RT was gathered in the 1970s and 1980s, when the disease extent was defined clinically. Neither CT scans nor MRIs...

Epidemiology and Pathogenesis

Genetic factors have been shown to play an important part in the causation of both UC and CD and they have a stronger link to the latter. The relative risk to a sibling of a patient with Crohn's disease is 13-36 and for ulcerative colitis it is 7-17 18 . Additionally, it is estimated that between 6 and 32 of patients with inflammatory bowel disease have an affected first or second-degree relative 19 . Numerous candidate genes have been analysed in inflammatory bowel disease, especially genes related to the HLA system 20 . A gene, located on chromosome 16, named NOD2 (encodes a protein which has a nucleotide-binding oligomerisation domain) with a locus designated IBD1, has recently been shown to be linked with CD 21, 22 , and it has been shown that persons who are homozygous for variant NOD2 may have a 20-fold increase tendency for CD with a predominantly ileal involvement 23 . Additionally, it has been shown that possession of the DRB1*103 and DRB1*12 alleles are associated with UC...

Clinical Studies on Artificial Nutrition in Crohns Disease

Artificial nutrition (enteral and parenteral) represents a widespread approach to many gastrointestinal disorders such as intestinal failure and chronic intestinal pseudo-obstruction, inflammatory bowel disease (IBD), severe exocrine pancreatic insufficiency due to cystic fibrosis, enteric and pancreatic fistulas, swallowing disorders, and other conditions secondary to other severe gastrointestinal disease or major digestive surgery leading to malnutrition. The availability of different enteral nutritional formulas, improvements in assessing nutritional status and its relationships with the digestive tract, as well as the progress in the management of artificial nutrition

A CD4CD25 Subpopulation of T cells Negatively Regulates Immune Responses

Investigators first described T cell populations that could suppress immune responses during the early 1970s. These cells were called suppressor T cells (Ts) and were believed to be CD8+ T cells. However, the cellular and molecular basis of the observed suppression remained obscure, and eventually great doubt was cast on the existence of CD8+ suppressor T cells. Recent research has shown that there are indeed T cells that suppress immune responses. Unexpectedly, these cells have turned out to be CD4+ rather than CD8+ T cells. Within the population of CD4+CD25+ T cells, there are regulatory T cells that can inhibit the proliferation of other T cell populations in vitro. Animal studies show that members of the CD4+CD25+ population inhibit the development of autoimmune diseases such as experimentally induced inflammatory bowel disease, experimental allergic encephalitis, and autoimmune diabetes. The suppression by these regulatory cells is antigen specific because it depends upon...

Screening and Treatment Options of Patients with Dysplasia Associated IBD

The British Society of Gastroenterology and the Association of Coloproctology have suggested guidelines for the screening of asymptomatic colorectal cancer in patients with inflammatory bowel disease. These guidelines suggest that colonoscopy surveillance with four random biopsies every 10 cm should commence after the patient has endured the condition for a minimum of 8 years. The risk of CRC is relatively low during the first decade of the disease. As a result, the surveillance protocols recommend three yearly colonoscopies for the first 12 years, then biannual endoscopies for the next 10 years, followed indefinitely with annual colonoscopy 48 . This is at variance with the recommendation originally suggested by Riddell et al. in their classic paper in 1983 (see Table 1) In high risk groups such as those patients with positive family histories of CRC at a young age or primary sclerosing cholangitis, annual colonoscopy is recommended 49 .

Human Laparoscopic Colorectal Surgery

Initially, the beginner in laparoscopic colorectal surgery should choose simple, uncomplicated cases (such as diagnostic laparoscopy, biopsy, or loop ileostomy, or colostomy) in thin patients who have not undergone previous abdominal surgery. Next, the surgeon should proceed to limited resections for benign disease with or without intra-peritoneal mesenteric dissection or anastomosis. More demanding procedures, such as resection for inflammatory bowel disease (such patients often have a thickened mesentery and inflamed fragile tissue) or oncologic resections, should be performed only if the surgeon is very comfortable with laparoscopic colorectal techniques.

Summary and Conclusion

Our data indicate that an imbalance between IL-10 and TNFa IFNy might contribute to the persistence of bacteria in ReA, an imbalance which can be overcome by exogenous IL-12. We could clearly show that IL-10 is not only produced by monocytes macrophages but also by T cells. These T cells might play a central role in the regulation of the immune response. The contribution of IL-10 for the ongoing immune response in AS is less clear. Some of the ReA patients move on to AS in the course of their disease, however other factors such as inflammatory bowel disease with interactions between immune cells and gut bacteria seems to be at least as important as an earlier bacterial infection. Thus, the chronic interaction between the host's immune system and bacteria are probably most relevant for the development and

Regulatory Role of IL10 in Infectious Diseases Results from Experimental Mouse Models

In general, the patho-physiological effects of a particular cytokine can be investigated by modulating its levels through (a) exogenous administration of the cytokine, blocking cytokine activity by anti-cytokine or anti-cytokine receptor antibodies, or (b) through selectively disrupting (knock-out models) or over-expressing (transgenic models) the cytokine gene. The global immunosuppressive effects of IL-10 have been demonstrated by employing both IL-10 knock out (IL-10 KO) and IL-10 transgenic mice (IL-10 Tg). IL-10 KO mice demonstrate a state of chronic inflammation characterized by an overexpression of Th1 cytokines.9,10 These mice are growth-retarded, anemic, and feature a form of enterocolitis which is similar to human inflammatory bowel disease. This condition can be partially ameliorated by exogenous administration of IL-10.10 IL-10 Tg mice, on the other hand, exhibit impaired cell-mediated and humoral immune responses to a number of intracellular pathogens including...

Exercise Can Modify the Rate of Gastric Emptying and Intestinal Absorption

Blood flow to the gut decreases in proportion to exercise intensity, as sympathetic vasoconstrictor tone rises. Water, electrolyte, and glucose absorption may be slowed in parallel, and acute diarrhea is common in endurance athletes during competition. However, these effects are transient, and malabsorption as a consequence of acute or chronic exercise does not occur in healthy people. While exercise may not improve symptoms or disease progression in inflammatory bowel disease, there is some evidence that repetitive dynamic exercise may reduce the risk for this illness. Although exercise is often recommended as treatment for postsurgical ileus, uncomplicated constipation, or irritable bowel syndrome, little is known in these areas. However, chronic dynamic exercise does substantially decrease the risk for colon cancer, possibly via increases in food and fiber intake, with consequent acceleration of colonic transit.

Epidemiologic and genetic considerations

Axial involvement is more frequent in Crohn's disease (5 to 22 ) than in ulcerative colitis (2 to 6 ). There is no male predominance, as there is in ankylosing spondylitis, and only 50 to 70 of patients are positive for HLA-B27. In fact, the presence of ankylosing spondylitis in patients negative for HLA-B27 should predict inflammatory bowel disease or psoriatic arthritis.

Mercaptopurine and Azathioprine

These drugs are among the few agents that have demonstrated efficacy in fistulizing CD in controlled clinical trials. Although these agents are discussed interchangeably, there have been uncontrolled trials directly comparing these medications in the treatment of inflammatory bowel disease. We can conclude that AZA 6-mercaptopurine is effective both in healing and maintaining fistula closure. Furthermore, there is evidence of long-term safety in terms of neoplasia of super-infections. Adverse events are reported to occur in 9-15 of patients receiving AZA or 6-MP for inflammatory bowel disease. The most serious adverse events are pancreatitis (3 ), allergic reactions (2 ) and drug induced hepatitis (0.3 ). A small percentage of patients who are thiopurine methyltransferase deficient may also develop leukopenia (2 ) 29 . These drugs have also been proven to be safe when taken during pregnancy, since they did not increase the number of fetal damage or abortions 30 .

Complement Activation By Doxil And Other Liposomal Drugs

Who reported 16 to 19 decrease of plasma C3, C4, and factor B in the blood of a patient developing HSR to Tc-99m-labeled, HYNIC-PE containing pegylated liposomes applied for the scintigraphic detection of infection and inflammation (63). The fact that both C4 and factor B were involved in the consumption of C suggest that C activation proceeded on both the classical and alternative pathways. In a subsequent study by the same group, it was reported that three out of nine patients reacted to pegylated HYNIC liposomes (62). Despite clear benefits in imaging inflammatory bowel disease, the presence of HSRs was considered as unacceptable from a diagnostic agent and the Dutch team temporarily abandoned human trials with pegylated HYNIC liposomes until the hypersensitivity issue could get resolved.

Prevention and Treatment of Colorectal Cancer

Ease extent also correlates with an increased risk of cancer, with the risk being most significant in patients with pancolitis 24 . Another two independent risk factors for CRC in UC patients are family history of CRC 25, 26 and primary sclerosing cholangitis (PSC) 27 . Common practice is to start an annual or biannual surveillance colonoscopy, as cancer risk increases over that of the background population. This would usually mean 8-12 years after disease onset for patients with pancolitis or upon diagnosis of concomitant PSC. Confirmed precancerous lesions, such as high-grade dysplasia or dysplasia-associated lesion or mass (DALM) would be an indication for proctocolectomy 28, 29 . In most inflammatory bowel disease (IBD) referral centres, confirmed low-grade dysplasia would also be an indication for surgery 30 although strict follow-up is an optional alternative suggested by others 31 .

IL10 and IL10 Receptor Polymorphisms in Psoriasis

Effects of IL-10 on the T-helper (Th)1 Th2 dysbalance in psoriasis.18 An immune deviation towards a type 1 cytokine aptetrn is a typical finding in several indications such as psoriasis, rheumatoid arthrism, inflammatory bowel disease, transplant rejection, multiple sclerosis. IL-10 reverses the Th1 cytokine pattern present. It promotes the development of a type 2 cytokine pattern by inhibiting the IFN-y production ofT lymphocytes particularly via the suppression of IL-12 synthesis in accessory cells. Moreover it inhibits MHC class II and costimulatory molecule expression. Figure 1. Effects of IL-10 on the T-helper (Th)1 Th2 dysbalance in psoriasis.18 An immune deviation towards a type 1 cytokine aptetrn is a typical finding in several indications such as psoriasis, rheumatoid arthrism, inflammatory bowel disease, transplant rejection, multiple sclerosis. IL-10 reverses the Th1 cytokine pattern present. It promotes the development of a type 2 cytokine pattern by inhibiting...

Noninfectious inflammatory conditions

Enteropathic arthritis usually presents as an asymmetric polyarthritis of the lower extremities, which can predate known inflammatory bowel disease by months to years. It is typically nonerosive, and the peripheral joint inflammation usually responds to therapy of the underlying bowel disease. The axial arthritis may not respond as well. Clues to the diagnosis include abdominal pain, abnormal bowel movements, erythema nodosum, or pyoderma gangrenosum associated with a spondylitic presentation (see Ch.a.pie.L3.4.).

Oral Iron Medication

Coexistent disease that interferes with absorption or utilization of iron (e.g., infection, inflammatory bowel disease, malignant disease, hepatic or renal disease, or concomitant deficiencies of, for instance, vitamin B12, folic acid, thyroid, associated lead poisoning)

Colonoscopy

Colonoscopy is an important aid in diagnosis and management of patients with inflammatory bowel disease (IBD). This procedure, with multiple biopsies, is indicated when adequate data are not available from clinical, sigmoidoscopic or radiologic studiesand there is strong clinical suspicion of IBD. However, colonoscopy carries an increased risk of perforation when the bowel wall is inflamed and presents with ulcers and fistulae. Known or suspected severe inflammation is a relative contraindication to colonoscopy. Toxic megacolon is an absolute contraindication to endoscopy if performed only for diagnostic purpose because of the weakness of the colonic wall, which is paper thin 10 . Endoscopy monitoring to assess response to therapy has been evaluated by a randomised study in which patients were treated with steroids. In one group, steroid tapering was decided on following clinical remission in the other group, the decision was based on endo-scopic findings. The conclusion was that...

Tr1 Cells

In addition to natural arising cells with suppressor activity, it has been shown clearly that other types of regulatory T cells can develop under specific (but yet not completely defined) conditions. Tr1 represent probably the most widely investigated population of this genre. Upon TCR-mediated activation, these cells produce high levels of IL-10 and TGF-P, IFN-y, and IL-5 (a unique pattern of cytokine production). Tr1 cells were defined initially as able to prevent inflammatory bowel disease in vivo (46). They can be generated in vitro by activation (e.g., interaction with allogeneic monocytes) in the presence of exogenous IL-10 that causes the development of long-lasting, Ag-specific anergic cells. Tr1 cells exert their suppressive function partially via IL-10 and TGF-P, but other mechanisms, including cell-cell contact-dependent mechanisms have been suggested (47,48). As with Treg, no specific membrane marker has been identified that allows unequivocal isolation of Tr1, but this...

Painful mouth

Soreness of the lips, tongue or buccal mucosa has a wide variety of causcs. including iron, folate or vitamin Bl2 deficiency, dermatological disorders, chemotherapy, aphthous ulceration and infective stomatitis (Table 5.2). Gastrointestinal disorders particularly associated with mouth uleers include inflammatory bowel disease and gluten enteropathy. A history of recurrent painful tiny mouth ulcers with its onset at the menarche, exacerbations during menstruation and a family history of mouth ulcers suggests idiopathic aphthous ulceration.

Haemorrhage

Although we had no patients with massive bleeding in our hospital in the last 7 years to treat, this issue is worth mentioning. Severe bleeding occurs in 0-6 of patients with inflammatory bowel disease with most series quoting a 2-3 incidence 42-44 . As compared with ulcerative colitis, where bleeding may diffuse from large areas of ulcerated mucosa, in Crohn's disease the bleeding is often from a localised source. It is important to rule out a gastroduodenal source prior to bowel resection. Robert et al. 43 found that nearly 30 of patients with Crohn's disease treated for significant gastrointestinal bleeding had a bleeding duodenal ulcer as its source. In Crohn's disease, it is important to localise the source of bleeding pre-operatively. If gastroscopy and colonoscopy are not successful, the use of angiography may be considered, but only if patient stability is obtained. Other methods include the use of a nuclear medicine known as red cell scan.

Osteoporosis

For patients with IBD and low BMD, it is possible that calcium and Vitamin D supplementation alone may be sufficient unless the patient is also receiving corticosteroids or has a history of fragility fractures. . . . Combination antiresorptive therapy (typically a bisphosphonate combined with oestrogen or ralox-ifene) may produce greater gains in bone mass than either agent alone, but the use of two antiresorptive agents is not recommended because the benefit on fracture risk has not been demonstrated and there is increased cost and side effects 16 . Bernstein and Leslie suggested that to date, there remains no therapy proven to be efficacious in inflammatory bowel disease-related osteoporosis however, calcium and vitamin D supplementation and bisphosphonates have their roles 16 .

Kevin J Maloy

Although the etiology of human inflammatory bowel disease (IBD) has not yet been completely defined, the current prevailing hypothesis is that it is caused by aberrant immune responses, or loss of tolerance, toward components of the intestinal bacterial microflora. During the past decade, several animal models of IBD have been developed that reproduce many features of the human disease. This article will outline one of the best characterized murine IBD models, the T-cell transfer model where colitis rapidly develops following adoptive transfer of na ve CD4+CD45RBhlgh T cells into immunodeficient scid or RAG - mice. This model has also been instrumental in characterizing the potent suppressive activities of CD4+CD25+ regulatory T cells that prevent the development of IBD when cotransferred with the na ve CD4+ T cells. The T cell transfer model of IBD is reproducible and easily manipulated and therefore provides an excellent system for the study of immunopathology and immune regulation...

Leukotrienes

The leukotrienes are involved in allergic responses and inflammatory processes. An antigen-antibody reaction can result in the release of compounds such as histamine (see page 379) or materials termed slow reacting substance of anaphylaxis (SRSA). These substances are then mediators of hypersensitive reactions such as hay fever and asthma. Structural studies have identified SRSA as a mixture of LTC4, LTD4 and LTE4. These cysteine-containing leukotrienes are powerful bronchoconstrictors and vasoconstrictors, and induce mucus secretion, the typical symptoms of asthma. LTE4 is some 10-100-fold less active than LTD4, so that degradation of the peptide side-chain represents a means of eliminating leukotriene function. LTB4 appears to facilitate migration of leukocytes in inflammation, and is implicated in the pathology of psoriasis, inflammatory bowel disease, and arthritis. The biological effects of leukotrienes are being actively researched to define the cellular processes involved. This...

Altered bowel habit

The normal bowel habit varies between several evacuations per day to one every 3 days or so. Changes in bowel habit may be the first symptom of serious underlying disease. Constipation may be used by the patient to describe hard pellety stools, infrequent defecation or excessive straining at stool with difficulty in evacuation (dyschezia). Similarly, diarrhoea may be used to describe frequent defecation, loose or fluid stools, urgency of defecation, Ihe persistent desire to defecate or faecal incontinence. Tenesmus, the feeling of incomplete rectal evacuation with a persistent desire to defecate, is common in infective colitis, rectal carcinoma, rectal prolapse and the irritable bowel syndrome. The irritable bowel syndrome is a common cause of altered bowel function in patients under the age of 50 years. The principal symptoms include episodic constipation and diarrhoea associated with abdominal distension, intermittent abdominal pain relieved by defecation and often accompanied by...

Balloon Dilatation

The stenosis of the small intestine is one of the typical symptoms of CD. The standard treatment should be strictureplasty or resection of the affected part 34 . The less common clinical manifestation is large-intestine stricture, which is diagnosed when a colonoscope of a standard diameter (13-13.6 mm) cannot be inserted through the affected part of the intestine. The clinical manifestations of the stricture include flatulence, tenesmus (when the stricture is localised near the rectum), constipation, abdominal pain, ileus or subileus 34 . The exacerbation and severity of symptoms depend on the diameter of the narrowing. An intestinal diameter greater than 13 mm usually suffices for correct passage. When the diameter of the stricture falls below 9 mm, it leads to increased symptoms of obstruction 35 . This type of changes is observed usually in neoplastic tumours of the large intestine. When neoplastic etiology is excluded, the most frequent causes are the healing complications of the...

Bone Disease in IBD

Reduced bone mineral density (BMD) is frequently associated with Crohn's disease (CD). Early studies have described a high prevalence of osteopenia (a T-score of -1 or lower) and osteoporosis (a T-score of -2.5 or lower) in inflammatory bowel disease (IBD). Uncontrolled studies gave a prevalence of severe demineralisation determined by dual-energy absorp-tiometry (Z-score of lower than -2 or T-score of lower than -2.5) that ranged from 18 to 42 , while larger studies with a healthy control group showed prevalence rates of only 2-16 87 . It is important to notice that these studies are prone to selection bias as they are conducted in specialised IBD centres. In Onset of inflammatory bowel disease. A recent analysis of premenopausal adult women with early onset IBD did not provide evidence that an early onset of disease is a major risk factor for early onset osteoporosis 94 .

Toxic Colitis

Toxic colitis, with or without megacolon, is an emergent life-threatening complication of inflammatory bowel disease. Its overall incidence in patients with ulcerative colitis is about 10 27 . Although in the past, toxic colitis was thought to be a rare complication of Crohn's disease compared with ulcerative colitis, recent studies have shown that Crohn's colitis is the etiology in approximately 50 of the cases 28 . The overall incidence of complicated Crohn's disease is about 6 , with an increasing number occurring in Crohn's colitis 29 . The presentation of toxic fulminant colitis includes fever, an abrupt onset of bloody diarrhoea, abdominal tenderness, colicky pain, and anorexia 30 . Toxic megacolon is present if, in addition to toxic colitis, either total or segmental dilatation of the colon occurs 31, 32 . Once the diagnosis of toxic colitis is suspected, aggressive medical therapy is initiated. A team approach is required involving both gastroenterologists and surgeons. Prompt...

Alpha Defensins

Mucosa is inversely correlated to the incidence of HPV infection and cervical cancer incidence (Buck et al. 2006). HNP1-4 have antiviral effects against many viruses including HIV1 (Klotman and Chang 2006). Furthermore, deficiencies in these alpha defensins are also associated with an increased incidence of inflammatory bowel disease (IBD) (Wehkamp and Stange 2006). We have found alpha defensins to be chemotactic for the subset of CD4+ CD45+ RA+-naive T cells, some CD8+ T cells, and immature DCs (Chertov et al. 1996 Yang et al. 2000, 2004a). Although this chemotactic effect is PTx inhibitable, the specific HNP receptor has not been identified. Alpha defensins also activate immature DCs (iDCs) to mature into mDCs. This is characterized by phenotypic changes such as increased expression of CD80, CD83, CD86, CD40, and MHC class II, increased production of inflammatory cytokines, and loss of receptor expression such as CCR1 and 5 but an increase in the expression of CCR7. Mature DCs also...

Laparoscopy

The final role of laparoscopic surgery for the management of inflammatory bowel disease is still under evaluation, but it is attractive. Since it is well known that development of laparoscopic techniques is not reserved for university centres or high volume hospitals, minimal invasive procedures can also be applied in peripheral hospitals. Certainly, laparoscopy is not the first choice approach in the emergency treatment of our patients with inflammatory bowel disease, but we do not hesitate to perform a diagnostic laparoscopy in patients with known inflammatory bowel disease which present with unclear acute abdominal complaints. In this way, we managed a cecal perforation in a patient with Crohn's disease and cecal carcinoma by direct closure of the perforation and peritoneal lavage and drainage. Laparoscopic ileocolic resection is a feasible procedure for skilled surgeons. When compared with an open approach, laparoscopic ileocolic resection led to lower 5-year small-bowel...

Endocrine disease

Inflammatory bowel disease, an occasional accompaniment to rheumatic disease, poses nutritional problems and also increases the risk for postoperative ileus. Preoperative dietary consultation should be obtained if such patients continue appropriate medications. Postoperatively, the resumption of the patient's oral intake should be careful and slow.

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