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Ghusn W, Loftus EV, Johnson AM. Reviewing the impact of obesity on inflammatory bowel disease and considerations for optimizing management. Curr Opin Gastroenterol 2024; 40:268-275. [PMID: 38662340 DOI: 10.1097/mog.0000000000001025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
PURPOSE OF REVIEW This review examines the complex relationship between obesity and inflammatory bowel disease (IBD), encompassing their potentially shared pathogenesis, the impact of obesity on the natural history and treatment outcomes of IBD, and the management of obesity in the patient with IBD. RECENT FINDINGS Obesity represents a state of chronic inflammation that may not only contribute to IBD pathogenesis, but also influence disease progression, complications, and response to treatment. Increased visceral adiposity may carry negative prognostic implications for disease and treatment-specific outcomes. Antiobesity medications, endoscopic bariatric therapies, and even bariatric surgery may be effective and well tolerated in selected patients with IBD. SUMMARY The intersection of obesity and IBD presents a significant clinical challenge, with obesity influencing the natural history of IBD and potentially affecting treatment efficacy. As obesity prevalence among IBD patients rises, a tailored approach to management is crucial, taking into account the individualized risks and benefits of various treatment strategies, including lifestyle interventions, pharmacotherapy, endoscopic procedures, and bariatric surgery.
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Affiliation(s)
- Wissam Ghusn
- Department of Internal Medicine, Boston Medical Center, Boston, Massachusetts
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Amanda M Johnson
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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Alsakarneh S, Hassan K, Jaber F, Mintz M, Zulqarnian M, Obeid A, Ghoz H, Hashash JG, Farraye FA. The national burden of inflammatory bowel disease in the United States from 1990-2019: results from the Global Burden of Disease study database. Ann Gastroenterol 2024; 37:427-435. [PMID: 38974084 PMCID: PMC11226748 DOI: 10.20524/aog.2024.0894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/04/2024] [Indexed: 07/09/2024] Open
Abstract
Background Inflammatory bowel disease (IBD) epidemiology has changed rapidly in recent years. We aimed to provide a systematic report of the burden of IBD at a state level in the United States (US), and to study the age- and sex-specific trends of incidence, prevalence and mortality rates for the past 3 decades. Methods Using the Global Burden of Disease (GBD) 2019 Study Database, we examined the incidence, prevalence and mortality rate, and the disability-adjusted life-years from GBD 2019 at national and state level from 1990-2019. Results There was an overall decrease in incidence and prevalence rates of IBD in the US from 1990-2019, while a simultaneous increase in the overall mortality rates was identified. However, a distinct trend of increasing incidence and prevalence rates emerged starting in 2000, with incidence rates rising from 21 cases per 100,000 persons in 2000 to 23 cases per 100,000 persons in 2019. From 1990-2019, incidence and prevalence decreased in males at a higher rate than in females. However, mortality rates increased more in females than males. Incidence rates were highest in Midwestern and Eastern states, and were lowest across the northern Great Plains and Western states, with the highest incidence noted in Michigan (31 cases per 100,000 persons). California had the greatest decrease in incidence rates from 1990-2019 (-63.3%). Conclusion Our results concerning recent trends and geographic variations in IBD offer policymakers crucial insights for informed decision-making in policy, research, and investment, facilitating more effective strategies and allocation of resources.
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Affiliation(s)
- Saqr Alsakarneh
- Department of Medicine, University of Missouri–Kansas City, Kansas City, MO (Saqr Alsakarneh, Fouad Jaber)
| | - Kamal Hassan
- Department of Gastroenterology and Hepatology, Weill Cornell University, NY (Kamal Hassan, Micheal Mintz)
| | - Fouad Jaber
- Department of Medicine, University of Missouri–Kansas City, Kansas City, MO (Saqr Alsakarneh, Fouad Jaber)
| | - Micheal Mintz
- Department of Gastroenterology and Hepatology, Weill Cornell University, NY (Kamal Hassan, Micheal Mintz)
| | - Mir Zulqarnian
- Department of Gastroenterology and Hepatology, University of Missouri-Kansas City, MO (Mir Zulqarnian, Hassan Ghoz)
| | - Ayah Obeid
- Department of Medicine, St. Luke’s University Health Network, Bethlehem, Pennsylvania (Ayah Obied)
| | - Hassan Ghoz
- Department of Gastroenterology and Hepatology, University of Missouri-Kansas City, MO (Mir Zulqarnian, Hassan Ghoz)
| | - Jana G. Hashash
- Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL (Jana G. Hashash, Francis A. Farraye), USA
| | - Francis A. Farraye
- Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL (Jana G. Hashash, Francis A. Farraye), USA
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Mahmoud M, Syn WK. Impact of Obesity and Metabolic Syndrome on IBD Outcomes. Dig Dis Sci 2024:10.1007/s10620-024-08504-8. [PMID: 38864929 DOI: 10.1007/s10620-024-08504-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 05/14/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE OF REVIEW The recent surge in inflammatory bowel disease (IBD) cases has paralleled a significant rise in obesity and metabolic comorbidities rates. In this article, we explore the potential influence of obesity and associated metabolic comorbidities on disease progression, complications, treatment response, surgical outcomes, health economics, and the potential impact of obesity treatment on the course of IBD. FINDINGS Contrary to visceral adiposity, obesity does not consistently result in an increased risk of IBD-related complications. Patients with IBD have a higher risk of acute arterial events, likely linked to systemic inflammation. Substantial evidence suggests that obesity has a negative impact on the response to IBD treatment, with this effect being most thoroughly studied in biologics and immunomodulators. The rates of overall complications and post-operative infections are higher in patients who are obese. There are limited but promising data regarding the impact of weight loss techniques, including exercise, medications, and bariatric interventions, on the outcomes in IBD. Both obesity and diabetes have adverse effects on the overall quality of life and place an increased financial burden on the IBD population. A growing body of evidence indicates a connection between obesity and associated metabolic comorbidities and negative outcomes in IBD, yet further efforts are required to fully understand this relationship.
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Affiliation(s)
- Maya Mahmoud
- Department of Internal Medicine, Saint Louis University, St Louis, MO, USA
| | - Wing-Kin Syn
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, Saint Louis University, St. Louis, MO, USA.
- Department of Physiology, Faculty of Medicine and Nursing, University of Basque Country UPV/EHU, Vizcaya, Spain.
- James F. King Chair in Gastroenterology, Division of Gastroenterology and Hepatology, Liver Center, Metabolic & Nutrition Institute, Research Track Fellowship, Saint Louis University School of Medicine, St. Louis, MO, USA.
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4
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Sun SP, Chen JJ, Zheng MX, Fan YH, Lv B. Progress in research of exercise intervention in inflammatory bowel disease. WORLD CHINESE JOURNAL OF DIGESTOLOGY 2024; 32:339-346. [DOI: 10.11569/wcjd.v32.i5.339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
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García-Mateo S, Martínez-Domínguez SJ, Gargallo-Puyuelo CJ, Gallego B, Alfambra E, Aso MC, Martinez-Micaelo N, Amigó N, Martínez-García J, Baptista PM, Sanz B, Ballesta S, Espinosa J, Tejero C, Gomollón F. Cardiovascular risk assessment in inflammatory bowel disease with metabolic dysfunction-associated steatotic liver disease. Med Clin (Barc) 2024; 162:409-416. [PMID: 38423940 DOI: 10.1016/j.medcli.2023.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/26/2023] [Accepted: 11/28/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND AND AIMS Inflammatory bowel disease (IBD) has been reported to increase the risk of early atherosclerosis even in young patients. Moreover, metabolic dysfunction-associated steatotic liver disease (MASLD), which has been linked to IBD, is a well-recognized but underdiagnosis entity related to cardiovascular risk. We analyze the impact of MASLD in IBD patients' cardiovascular risk through both advanced lipoprotein profile sorted by nuclear magnetic resonance spectroscopy, and carotid artery intima-media thickness (CIMT). METHODS Cross-sectional cohort study which involves 941 IBD adult outpatients. Of them, 50 patients with IBD who met criteria for MASLD and 50 with IBD without MASLD, matched by sex and age were included. Alterations in CIMT were evaluated considering abnormal measures above the 75th percentile adjusted for sex and age. Specific advanced lipoprotein profile was also carried out. RESULTS Most of the patients had an abnormal CIMT (58%). MASLD (OR=5.05, CI 95%=1.71-14.92) and female sex (OR=3.32, CI 95%=1.03-10) were significantly associated with CIMT alterations. Dense LDL particles (with high cholesterol composition in general cohort (OR=3.62, 95% CI=1.07-12.19) and high triglycerides density in young subgroup (OR=6.25, 95% CI=1.04-50) but not total LDL cholesterol were associated with CIMT alterations. CONCLUSIONS MASLD and female sex are associated with early atherosclerosis in IBD patients. Dense LDL particle in combination with vascular imaging findings should be evaluated as non-invasive tools in the management of cardiovascular risk in IBD patients.
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Affiliation(s)
- Sandra García-Mateo
- Department of Gastroenterology, "Lozano Blesa" University Clinical Hospital, 50009 Zaragoza, Spain; Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain.
| | - Samuel J Martínez-Domínguez
- Department of Gastroenterology, "Lozano Blesa" University Clinical Hospital, 50009 Zaragoza, Spain; Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain
| | - Carla J Gargallo-Puyuelo
- Department of Gastroenterology, "Lozano Blesa" University Clinical Hospital, 50009 Zaragoza, Spain; Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain
| | - Beatriz Gallego
- Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain
| | - Erika Alfambra
- Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain
| | - María C Aso
- Department of Gastroenterology, "Lozano Blesa" University Clinical Hospital, 50009 Zaragoza, Spain; Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain
| | | | - Nuria Amigó
- School of Medicine, University of Zaragoza, 50009 Zaragoza, Spain; Biosfer Teslab, Plaça del Prim 10, 2on 5a, 43201 Reus, Spain
| | - Javier Martínez-García
- Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain; University of Zaragoza, Department of Multiscale in Mechanical and Biological Engineering, Spain
| | - Pedro M Baptista
- Aragón Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain; CIBER Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
| | - Borja Sanz
- Department of Endocrinology, Manises Hospital, 46940 Valencia, Spain
| | - Sara Ballesta
- Department of Neurology, Lozano Blesa University Hospital, 50009 Zaragoza, Spain
| | - Judith Espinosa
- Department of Neurology, Lozano Blesa University Hospital, 50009 Zaragoza, Spain
| | - Carlos Tejero
- Department of Neurology, Lozano Blesa University Hospital, 50009 Zaragoza, Spain
| | - Fernando Gomollón
- Department of Gastroenterology, "Lozano Blesa" University Clinical Hospital, 50009 Zaragoza, Spain; School of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
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Gravina AG, Pellegrino R, Palladino G, Imperio G, Ventura A, Cipullo M, Coppola A, Federico A. Profiling the patient with inflammatory bowel disease in the relationship between physical activity and partner/social network status: A post hoc patient-tailored analysis of the "BE-FIT-IBD" study. GASTROENTEROLOGIA Y HEPATOLOGIA 2024:S0210-5705(24)00161-4. [PMID: 38723769 DOI: 10.1016/j.gastrohep.2024.502203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 06/02/2024]
Abstract
INTRODUCTION Normal quality of life is an ultimate target in the therapeutic approach to inflammatory bowel diseases (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC) in the context of which regular physical activity (PA) is often a chimeric parameter that is not standardized in terms of quality/quantity. The study aimed to profile a sample of IBD patients about the relationship between PA-partner status and social network support. PATIENTS AND METHODS A post hoc analysis of the "BE-FIT-IBD" study was set up by stratifying the data of PA with that of partner status and the support that the patient's social network (i.e., relatives, friends) provided in inciting the patient to practice regular PA. RESULTS In the 219 patients included, there was a greater tendency for patients with stable partners to view the risk of reactivation/worsening of IBD as a barrier to conducting regular PA (p<0.0001). Single patients considered PA more as a protective factor (p=0.045). Patients without a PA-supporting social network retained IBD-related treatment as a PA barrier (p=0.016) and PA as a risk for IBD complications (p=0.01), with less confidence that PA could improve the course of IBD (p<0.001). Rectal syndrome was an IBD-related barrier more represented in patients with PA-deterring social network (p<0.0001). CONCLUSIONS These factors are potential targets for recovering the IBD patient's adherence to regular PA.
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Affiliation(s)
- Antonietta Gerarda Gravina
- Hepatogastroenterology Division, Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80138, Via Luigi de Crecchio, Naples, Italy
| | - Raffaele Pellegrino
- Hepatogastroenterology Division, Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80138, Via Luigi de Crecchio, Naples, Italy.
| | - Giovanna Palladino
- Hepatogastroenterology Division, Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80138, Via Luigi de Crecchio, Naples, Italy
| | - Giuseppe Imperio
- Hepatogastroenterology Division, Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80138, Via Luigi de Crecchio, Naples, Italy
| | - Andrea Ventura
- Hepatogastroenterology Division, Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80138, Via Luigi de Crecchio, Naples, Italy
| | - Marina Cipullo
- Hepatogastroenterology Division, Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80138, Via Luigi de Crecchio, Naples, Italy
| | - Annachiara Coppola
- Hepatogastroenterology Division, Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80138, Via Luigi de Crecchio, Naples, Italy
| | - Alessandro Federico
- Hepatogastroenterology Division, Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80138, Via Luigi de Crecchio, Naples, Italy
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Neal WN, Pekmezi D, Motl RW. Physical Activity Levels and Social Cognitive Theory Correlates among Adults with Crohn's Disease: Preliminary Results from a Cross-Sectional Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:462. [PMID: 38673373 PMCID: PMC11050289 DOI: 10.3390/ijerph21040462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/07/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024]
Abstract
There is increasing research and clinical interest in physical activity (PA) as an adjuvant therapy for improving health outcomes among persons with Crohn's disease. To date, little is known regarding PA behavior and its cognitive and behavioral correlates in Crohn's disease. Thus, we assessed self-reported PA and its social cognitive theory (SCT) correlates in a sample of persons with Crohn's disease. Data on demographic and clinical characteristics, disease activity, leisure-time PA, and SCT variables were collected from 30 participants with Crohn's disease (90% White, 60% female) through an online survey. SCT variables assessed included exercise self-efficacy, social support, outcome expectations, goal setting, and planning. Analyses involved comparing PA levels and SCT survey scores using independent sample t-tests and non-parametric bivariate correlations. The majority of participants were in clinical remission (60%) and over half (57%) were classified as physically active, yet the mean PA level was lower than normative values for adults. Females (n = 18) and participants who reported previous surgery for Crohn's disease (n = 18) were almost twice as physically active as male participants and those without a history of Crohn's disease-related surgery, respectively (p's < 0.05). Overall, participants who reported greater exercise goal setting behaviors had higher levels of PA (rs = 0.34; p < 0.05). These findings highlight lower overall levels of PA in persons with Crohn's disease, and exercise goal setting represents a potential target of behavior change interventions for increasing PA in this population.
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Affiliation(s)
- Whitney N. Neal
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Dorothy Pekmezi
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Robert W. Motl
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL 61820, USA;
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Hao F, Tian M, Wang H, Li S, Wang X, Jin X, Wang Y, Jiao Y, Tian M. Exercise-induced β-hydroxybutyrate promotes Treg cell differentiation to ameliorate colitis in mice. FASEB J 2024; 38:e23487. [PMID: 38345808 DOI: 10.1096/fj.202301686rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/21/2024] [Accepted: 01/30/2024] [Indexed: 02/15/2024]
Abstract
Increasing attention is being paid to the mechanistic investigation of exercise-associated chronic inflammatory disease improvement. Ulcerative colitis (UC) is one type of chronic inflammatory bowel disease with increasing incidence and prevalence worldwide. It is known that regular moderate aerobic exercise (RMAE) reduces the incidence or risk of UC, and attenuates disease progression in UC patients. However, the mechanisms of this RMAE's benefit are still under investigation. Here, we revealed that β-hydroxybutyrate (β-HB), a metabolite upon prolonged aerobic exercise, could contribute to RMAE preconditioning in retarding dextran sulfate sodium (DSS)-induced mouse colitis. When blocking β-HB production, RMAE preconditioning-induced colitis amelioration was compromised, whereas supplementation of β-HB significantly rescued impaired β-HB production-associated defects. Meanwhile, we found that RMAE preconditioning significantly caused decreased colonic Th17/Treg ratio, which is considered to be important for colitis mitigation; and the downregulated Th17/Treg ratio was associated with β-HB. We further demonstrated that β-HB can directly promote the differentiation of Treg cell rather than inhibit Th17 cell generation. Furthermore, β-HB increased forkhead box protein P3 (Foxp3) expression, the core transcriptional factor for Treg cell, by enhancing histone H3 acetylation in the promoter and conserved noncoding sequences of the Foxp3 locus. In addition, fatty acid oxidation, the key metabolic pathway required for Treg cell differentiation, was enhanced by β-HB treatment. Lastly, administration of β-HB without exercise significantly boosted colonic Treg cell and alleviated colitis in mice. Together, we unveiled a previously unappreciated role for exercise metabolite β-HB in the promotion of Treg cell generation and RMAE preconditioning-associated colitis attenuation.
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Affiliation(s)
- Fengqi Hao
- School of Physical Education, Northeast Normal University, Changchun, Jilin, China
- Key Laboratory of Molecular Epigenetics of the Ministry of Education (MOE), Northeast Normal University, Changchun, Jilin, China
| | - Miaomiao Tian
- Key Laboratory of Molecular Epigenetics of the Ministry of Education (MOE), Northeast Normal University, Changchun, Jilin, China
| | - Huiyue Wang
- Key Laboratory of Molecular Epigenetics of the Ministry of Education (MOE), Northeast Normal University, Changchun, Jilin, China
| | - Shuo Li
- Key Laboratory of Molecular Epigenetics of the Ministry of Education (MOE), Northeast Normal University, Changchun, Jilin, China
| | - Xinyu Wang
- Key Laboratory of Molecular Epigenetics of the Ministry of Education (MOE), Northeast Normal University, Changchun, Jilin, China
| | - Xin Jin
- Key Laboratory of Molecular Epigenetics of the Ministry of Education (MOE), Northeast Normal University, Changchun, Jilin, China
| | - Yang Wang
- Key Laboratory of Molecular Epigenetics of the Ministry of Education (MOE), Northeast Normal University, Changchun, Jilin, China
| | - Yang Jiao
- School of Physical Education, Northeast Normal University, Changchun, Jilin, China
| | - Meihong Tian
- School of Physical Education, Northeast Normal University, Changchun, Jilin, China
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Derbey L, Charlois AL, Buisson A, Roblin X, Mathieu N, Danion P, Gay C, Nancey S, Boschetti G. Physical Activity and IBD: State of Art and Knowledge, Patients and Healthcare Professionals Points of View, A French Multicenter Cross Sectional Study. Inflamm Bowel Dis 2024:izae009. [PMID: 38330214 DOI: 10.1093/ibd/izae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND Several studies have reported low levels of physical activity (PA) in patients with inflammatory bowel diseases (IBD), possibly related to a lack of information and support, despite the many recognized benefits such as cardiovascular prevention or quality of life (QoL) improvement. METHODS The purpose of our study was to identify challenges faced by patients and to evaluate IBD impact on PA and QoL by using the International Physical Activity Questionnaire short form and the 32-item Inflammatory Bowel Disease Questionnaire (IBDQ-32) questionnaire, respectively. We also assessed the expectations and knowledge of patients and healthcare professionals using the MICI-Active questionnaire that we developed. RESULTS We included 298 IBD patients in 4 French hospitals, with a mean age of 38 years. We found a decrease in training frequency since IBD diagnosis, regardless of age, gender, symptom intensity, or type of disease. Moreover, there was an increase in low intensity activities like walking and a decrease in competitions and sports club registrations. Intensity of symptoms has a negative impact on QoL, as evidenced by the worsening of IBDQ score. Conversely, a higher PA intensity was correlated with a higher IBDQ score, regardless of symptoms intensity. The main barrier to PA was fatigue (56%), and the main fear was diarrhea (42%). Furthermore, 75% of patients did not feel sufficiently informed, and 61% were interested in coaching. A total of 112 healthcare professionals were interviewed, 62.5% said they had already discussed of PA with their patients, but 98% felt that they lacked knowledge. CONCLUSIONS Inflammatory bowel disease constraints and symptoms have a strong impact on PA. Work needs to be done to better train practitioners to improve IBD patient management, who have much to gain from better PA.
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Affiliation(s)
- Lea Derbey
- Department of Gastroenterology and Nutrition, Lyon-Sud hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Anne Laure Charlois
- Department of Gastroenterology and Nutrition, Lyon-Sud hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Anthony Buisson
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastroentérologie, Clermont-Ferrand, France
| | - Xavier Roblin
- Department of Gastroenterology, University hospital of Saint-Etienne, Saint-Etienne, France
| | - Nicolas Mathieu
- University Clinic of Hepato-Gastroenterology, University Hospital, Grenoble, France
| | - Pauline Danion
- Department of Gastroenterology and Nutrition, Lyon-Sud hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Claire Gay
- Department of Gastroenterology and Nutrition, Lyon-Sud hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Stéphane Nancey
- Department of Gastroenterology and Nutrition, Lyon-Sud hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- INSERM U1111, Centre International de Recherche en Infectiologie, Lyon, France
| | - Gilles Boschetti
- Department of Gastroenterology and Nutrition, Lyon-Sud hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- INSERM U1111, Centre International de Recherche en Infectiologie, Lyon, France
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Khan S, Sebastian SA, Parmar MP, Ghadge N, Padda I, Keshta AS, Minhaz N, Patel A. Factors influencing the quality of life in inflammatory bowel disease: A comprehensive review. Dis Mon 2024; 70:101672. [PMID: 38143196 DOI: 10.1016/j.disamonth.2023.101672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
Inflammatory bowel disease (IBD) is a group of chronic relapsing disorders, including Crohn's disease (CD) and ulcerative colitis (UC), which affects an increasing number of people worldwide. In the last few decades, the scientific world has witnessed many developments in IBD management by controlling debilitating symptoms and remaining in remission for more protracted periods. Even so, we still have a large population suffering from active IBD. An individual's quality of life (QoL) can be severely affected by IBD, like any other chronic illness. In this article, we have reviewed factors influencing the QoL in IBD patients, including chronic pain, diet, physical activity, and psychological factors like depression, anxiety, and stress symptoms. We also discussed the mechanisms of diet-microbial-immune system interaction, currently available dietary therapies for active CD and UC, and early psycho-social interventions that can reduce the disease burden and improve QoL in IBD patients.
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Affiliation(s)
- Samina Khan
- University of Alberta Hospital, Edmonton, Alberta, Canada
| | | | | | - Nitin Ghadge
- Independent Researcher, Albany, NY, United States of America
| | - Inderbir Padda
- Richmond University Medical Center/Mount Sinai, Staten Island, NY, United States of America
| | | | - Naofel Minhaz
- Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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Lund K, Knudsen T, Kjeldsen J, Nielsen RG, Juhl CB, Nørgård BM. The IBD-FITT study - moderate-intensity exercise for patients with inflammatory bowel disease with moderate disease activity: an open-label randomized controlled trial. Trials 2023; 24:742. [PMID: 37986021 PMCID: PMC10659067 DOI: 10.1186/s13063-023-07781-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 11/06/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD), Crohn's disease, and ulcerative colitis are chronic autoimmune lifelong diseases with fluctuating activity over time. The treatment includes medical therapy and surgery, however, there is no definite cure. Therefore, the quest for new and supplementary treatment options is imperative to improve patients' general health and quality of life. Physical activity and exercise have been suggested to be elements in both the prevention and supplementary treatment of IBD; however, this is based on limited underpowered trials. Thus, the role of exercise as a treatment option still has to be settled. We aim to investigate the effect of a 12-week exercise intervention in adult patients with moderately active IBD on three categories of outcomes (1) disease-specific health-related quality of life (IBDQ); (2) general health status of the patients, i.e., waist circumference, disease activity by clinical scorings systems (Harvey Bradshaw Index, Simple Clinical Colitis Activity Index), blood pressure, blood lipids, and non-disease specific quality of life (EQ5D) scores; and (3) explorative outcomes on biomarkers (C-reactive protein and fecal calprotectin) plus different biomarkers of immunology (cytokine panel). METHODS We will apply a superiority design in this open-label randomized clinical trial including 150 patients equally allocated to intervention and usual care. The intervention will be based on a 12-week aerobic exercise program and will include two supervised exercise sessions of 60 min per week, combined with one weekly home training session. We have defined a moderate exercise level as 60-80% of patients' maximum heart rate. The patients in the intervention group will also be offered an online video lesson of 15-25 min on lifestyle guidance, and the same online video lesson will be offered in the comparator group. Questionnaires on quality of life will be forwarded electronically both at inclusion and at the end of the study, and the patients will have blood samples, and fecal samples for calprotectin at baseline, weeks 4 and 8, as well as after 12 weeks (study end). DISCUSSION This will be a clinical trial investigating the effect of exercise on patients with Crohn's disease and ulcerative colitis. This trial will add to the evidence on the possible effect of exercise and might clarify whether exercise can benefit as a supplementary treatment addendum. Thus, the trial may provide a new patient-active disease management approach. TRIAL REGISTRATION ClinicalTrials.gov NCT04816812. Date of first registration: March 23, 2021.
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Affiliation(s)
- Ken Lund
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark.
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Torben Knudsen
- Department of Medicine, Hospital of Southwest Jutland, Esbjerg, Denmark
- Department of Regional Health Science, Center Southwest Jutland, University of Southern Denmark, Esbjerg, Denmark
| | - Jens Kjeldsen
- Department of Medical Gastroenterology S, Odense University Hospital, Odense, Denmark
- Research Unit of Medical Gastroenterology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rasmus Gaardskær Nielsen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
- Research Unit of Pediatrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Carsten Bogh Juhl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Physiotherapy and Occupational Therapy, University of Copenhagen, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Bente Mertz Nørgård
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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12
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Nishida Y, Hosomi S, Kobayashi Y, Nakata R, Ominami M, Nadatani Y, Fukunaga S, Otani K, Tanaka F, Nagami Y, Taira K, Kamata N, Fujiwara Y. Impact of the COVID-19 Pandemic on the Lifestyle and Psychosocial Behavior of Patients with Inflammatory Bowel Diseases: A Narrative Review. Healthcare (Basel) 2023; 11:2642. [PMID: 37830679 PMCID: PMC10572197 DOI: 10.3390/healthcare11192642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023] Open
Abstract
The coronavirus disease (COVID-19) pandemic has had a considerable impact on the global healthcare system and potentially the clinical course of patients with inflammatory bowel disease (IBD). Although IBD is a chronic disease, its therapy (except steroid therapy) does not increase the risk of contracting or aggravating COVID-19. However, the clinical course of patients is significantly influenced by environmental factors. Social restrictions due to the pandemic or the fear of contracting the virus have influenced lifestyle and psychosocial behaviors that may worsen the clinical course of patients with IBD. This narrative literature review summarizes the current evidence on the impact of the COVID-19 pandemic on the lifestyle and psychosocial behaviors of patients with IBD. The COVID-19 pandemic negatively affected the lifestyle and psychosocial behaviors of patients with IBD. Furthermore, patients with IBD failed to maintain medication adherence, thus affecting the clinical course of their condition.
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Affiliation(s)
| | - Shuhei Hosomi
- Department of Gastroenterology, Graduate School of Medicine, Osaka Metropolitan University Osaka, Osaka 530-0001, Japan
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13
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Matsuoka K, Yamazaki H, Nagahori M, Kobayashi T, Omori T, Mikami Y, Fujii T, Shinzaki S, Saruta M, Matsuura M, Yamamoto T, Motoya S, Hibi T, Watanabe M, Fernandez J, Fukuhara S, Hisamatsu T. Association of ulcerative colitis symptom severity and proctocolectomy with multidimensional patient-reported outcomes: a cross-sectional study. J Gastroenterol 2023; 58:751-765. [PMID: 37351647 PMCID: PMC10366259 DOI: 10.1007/s00535-023-02005-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/01/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND The YOu and Ulcerative colitis: Registry and Social network (YOURS) is a large-scale, multicenter, patient-focused registry investigating the effects of lifestyle, psychological factors, and clinical practice patterns on patient-reported outcomes in patients with ulcerative colitis in Japan. In this initial cross-sectional baseline analysis, we comprehensively explored impacts of symptom severity or proctocolectomy on nine patient-reported outcomes. METHODS Patients receiving tertiary care at medical institutions were consecutively enrolled in the YOURS registry. The patients completed validated questionnaires on lifestyle, psychosocial factors, and disease-related symptoms. Severity of symptoms was classified with self-graded stool frequency and rectal bleeding scores (categories: remission, active disease [mild, moderate, severe]). The effects of symptom severity or proctocolectomy on nine scales for quality of life, fatigue, anxiety/depression, work productivity, and sleep were assessed by comparing standardized mean differences of the patient-reported outcome scores. RESULTS Of the 1971 survey responses analyzed, 1346 (68.3%) patients were in remission, 583 (29.6%) had active disease, and 42 (2.1%) had undergone proctocolectomy. A linear relationship between increasing symptom severity and worsening quality of life, fatigue, anxiety, depression, and work productivity was observed. Patients with even mild symptoms had worse scores than patients in remission. Patients who had undergone proctocolectomy also had worse scores than patients in remission. CONCLUSIONS Ulcerative colitis was associated with reduced mood, quality of life, fatigue, and work productivity even in patients with mild symptoms, suggesting that management of active ulcerative colitis may improve patient-reported outcomes irrespective of disease severity. (UMIN Clinical Trials Registry: UMIN000031995, https://www.umin.ac.jp/ctr/index-j.htm ).
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Affiliation(s)
- Katsuyoshi Matsuoka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan.
| | - Hajime Yamazaki
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masakazu Nagahori
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taku Kobayashi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Teppei Omori
- Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yohei Mikami
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Toshimitsu Fujii
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinichiro Shinzaki
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, Hyogo, Japan
| | - Masayuki Saruta
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Minoru Matsuura
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Takayuki Yamamoto
- Inflammatory Bowel Disease Center and Department of Surgery, Yokkaichi Hazu Medical Center, Mie, Japan
| | - Satoshi Motoya
- Inflammatory Bowel Disease Center, Sapporo Kosei General Hospital, Hokkaido, Japan
| | - Toshifumi Hibi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Mamoru Watanabe
- Advanced Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Jovelle Fernandez
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Shunichi Fukuhara
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Health Policy Management, Johns Hopkins Bloomberg School of Public Health, Maryland, USA
| | - Tadakazu Hisamatsu
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
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14
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Festő B, Njers S, Dávid A, Horvát B, Sallay V, Molnár T, Rafael B, Martos T. [Health goals amongst patients with Crohn's disease.]. Orv Hetil 2023; 164:1102-1110. [PMID: 37454328 DOI: 10.1556/650.2023.32801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/03/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Inflammatory bowel diseases, including Crohn's disease, have a significant impact on patients' lifestyle, requiring lifelong attention to health behavior. OBJECTIVE The aim of our study was to investigate health-related goals, emotions related to health goals, the use of infocommunication tools and their associations. METHOD 79 patients with Crohn's disease (59.5% female, mean age 40.7 years, SD = 11.89) participated in the study. They answered demographic and health behaviour questions and completed the Personal Health Plans Questionnaire, which assessed their personal health goals, positive and negative emotions about health goal(s), support for personal health goals from their physician, negative and positive effects (barriers/support) of achieving health goals, and digital technology and internet use. RESULTS 70% of patients had at least 1 health goal. The health goals were classified into four categories: physical activity (43.6%), stress management (25.4%), nutrition (18%) and smoking cessation (7%). 71% of participants experienced at least average levels of positive emotions related to the health goal, but about 50% also experienced negative emotions. 51% of those with a health goal regularly use the internet and apps on smartphones. Infocommunication device use showed a medium-strength correlation with perceived health goal-related barrier/support (ρ = 0.55, p<0.01), support from the person's doctor (ρ = 0.45, p<0.05) and physical activity (ρ = 0.40, p<0.01). DISCUSSION More than two-thirds of patients had a health goal; most of the goals were related to health behaviours that are also relevant to Crohn's disease, but few had healthy eating and smoking cessation as health goals. Half of those with a health goal regularly use the internet and apps on smartphones. Among health behaviours, physical activity was associated with infocommunication device use. CONCLUSION It is recommended to investigate patients' health goals and infocommunication device use in the care of patients with Crohn's disease. This would allow the development of specific interventions to improve their health behaviour, which could increase the quality of life and disease prognosis. Orv Hetil. 2023; 164(28): 1102-1110.
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Affiliation(s)
- Blanka Festő
- 1 Szegedi Tudományegyetem, Egészségtudományi és Szociális Képzési Kar Szeged, Bal fasor 39-45., 6726 Magyarország
| | - Sanela Njers
- 2 Szegedi Tudományegyetem, Bölcsészet- és Társadalomtudományi Kar, Pszichológiai Intézet Szeged Magyarország
| | - Anett Dávid
- 3 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Belgyógyászati Klinika Szeged Magyarország
| | - Barbara Horvát
- 2 Szegedi Tudományegyetem, Bölcsészet- és Társadalomtudományi Kar, Pszichológiai Intézet Szeged Magyarország
| | - Viola Sallay
- 2 Szegedi Tudományegyetem, Bölcsészet- és Társadalomtudományi Kar, Pszichológiai Intézet Szeged Magyarország
| | - Tamás Molnár
- 3 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Belgyógyászati Klinika Szeged Magyarország
| | - Beatrix Rafael
- 4 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Preventív Medicina Tanszék Szeged Magyarország
| | - Tamás Martos
- 2 Szegedi Tudományegyetem, Bölcsészet- és Társadalomtudományi Kar, Pszichológiai Intézet Szeged Magyarország
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15
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Kolahi Z, Yaghoubi A, Rezaeian N, Khazaei M. Exercise Improves Clinical Symptoms, Pathological Changes and Oxidative/Antioxidative Balance in Animal Model of Colitis. Int J Prev Med 2023; 14:46. [PMID: 37351030 PMCID: PMC10284199 DOI: 10.4103/ijpvm.ijpvm_162_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 10/27/2022] [Indexed: 06/24/2023] Open
Abstract
Background Ulcerative colitis is one of the major phenotypic forms of inflammatory bowel diseases. The present study aimed to investigate the effect of force swimming exercise on clinical symptoms (disease activity index; DAI), colon histopathology, inflammation and fibrosis, and oxidant/antioxidant balance in dextran sulfate sodium (DSS)-induced colitis mice. Methods Male C57BL6 mice were randomly divided into five groups (n = 6 each): control, exercise, colitis, colitis + sulfasalazine, and colitis + exercise. Exercise was performed by forced swimming six weeks before and during the experiment. Colitis was induced by 1.5% DSS in drinking water. The animals were evaluated for body weight changes and DAI (including changes of body weight, stool consistency, rectal bleeding, and prolapse) during the induction of colitis and treatment. At the end of experiment, colons and spleens were evaluated by H and E and Masson Trichrome stainings. Oxidant (Malon dialdehyde; MDA), and antioxidant markers [total thiol groups, superoxide dismutase (SOD), and catalase activity] were also measured in colon tissue. Results Results indicated that exercise in colitis mice significantly improved DAI, colon length, spleen weight, and histological injury score and alleviated fibrotic changes in colon tissue that were comparable to sulfasalazine group. Exercise also restored the oxidant/antioxidant balance in colitis mice by reducing MDA and increasing antioxidative markers including total thiol groups, SOD, and catalase activity. Conclusions Taken together, aerobic exercise could improve clinical symptoms and colonic inflammation through, at least, the balancing the oxidative stress markers. Thus, it can be considered in management of colitis patients as effective method.
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Affiliation(s)
- Zohreh Kolahi
- Department of Physical Education and Sport Science, Bojnourd Branch, Islamic Azad University, Bojnourd, Iran
| | - Ali Yaghoubi
- Department of Physical Education and Sport Science, Bojnourd Branch, Islamic Azad University, Bojnourd, Iran
| | - Najmeh Rezaeian
- Department of Physical Education and Sport Science, Bojnourd Branch, Islamic Azad University, Bojnourd, Iran
| | - Majid Khazaei
- Department of Physiology, Mashhad University of Medical Sciences, Mashhad, Iran
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16
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Kim JH, Oh CM, Yoo JH. Obesity and novel management of inflammatory bowel disease. World J Gastroenterol 2023; 29:1779-1794. [PMID: 37032724 PMCID: PMC10080699 DOI: 10.3748/wjg.v29.i12.1779] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 01/13/2023] [Accepted: 03/14/2023] [Indexed: 03/28/2023] Open
Abstract
Obesity is prevalent within the inflammatory bowel disease (IBD) population, particularly in newly developed countries. Several epidemiological studies have suggested that 15%-40% of IBD patients are obese, and there is a potential role of obesity in the pathogenesis of IBD. The dysfunction of mesenteric fat worsens the inflammatory course of Crohn’s disease and may induce formation of strictures or fistulas. Furthermore, obesity may affect the disease course or treatment response of IBD. Given the increasing data supporting the pathophysiologic and epidemiologic relationship between obesity and IBD, obesity control is being suggested as a novel management for IBD. Therefore, this review aimed to describe the influence of obesity on the outcomes of IBD treatment and to present the current status of pharmacologic or surgical anti-obesity treatments in IBD patients.
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Affiliation(s)
- Jee Hyun Kim
- Department of Gastroenterology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, South Korea
| | - Chang-Myung Oh
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju 62465, South Korea
| | - Jun Hwan Yoo
- Department of Gastroenterology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, South Korea
- Institute of Basic Medical Sciences, CHA University School of Medicine, Seongnam 13496, South Korea
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17
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Ordille AJ, Phadtare S. Intensity-specific considerations for exercise for patients with inflammatory bowel disease. Gastroenterol Rep (Oxf) 2023; 11:goad004. [PMID: 36814502 PMCID: PMC9940700 DOI: 10.1093/gastro/goad004] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/02/2022] [Accepted: 12/22/2022] [Indexed: 02/22/2023] Open
Abstract
The rising prevalence of inflammatory bowel disease (IBD) necessitates that patients be given increased access to cost-effective interventions to manage the disease. Exercise is a non-pharmacologic intervention that advantageously affects clinical aspects of IBD, including disease activity, immune competency, inflammation, quality of life, fatigue, and psychological factors. It is well established that exercise performed at low-to-moderate intensity across different modalities manifests many of these diseased-related benefits while also ensuring patient safety. Much less is known about higher-intensity exercise. The aim of this review is to summarize findings on the relationship between strenuous exercise and IBD-related outcomes. In healthy adults, prolonged strenuous exercise may unfavorably alter a variety of gastrointestinal (GI) parameters including permeability, blood flow, motility, and neuro-endocrine changes. These intensity- and gut-specific changes are hypothesized to worsen IBD-related clinical presentations such as diarrhea, GI bleeding, and colonic inflammation. Despite this, there also exists the evidence that higher-intensity exercise may positively influence microbiome as well as alter the inflammatory and immunomodulatory changes seen with IBD. Our findings recognize that safety for IBD patients doing prolonged strenuous exercise is no more compromised than those doing lower-intensity work. Safety with prolonged, strenuous exercise may be achieved with adjustments including adequate hydration, nutrition, drug avoidance, and careful attention to patient history and symptomatology. Future work is needed to better understand this intensity-dependent relationship so that guidelines can be created for IBD patients wishing to participate in high-intensity exercise or sport.
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Affiliation(s)
- Andrew J Ordille
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Sangita Phadtare
- Corresponding author. Department of Biomedical Sciences, Cooper Medical School of Rowan University, 401 S Broadway, Camden, NJ 08103, USA.
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18
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Bullard BM, VanderVeen BN, McDonald SJ, Cardaci TD, Murphy EA. Cross talk between the gut microbiome and host immune response in ulcerative colitis: nonpharmacological strategies to improve homeostasis. Am J Physiol Gastrointest Liver Physiol 2022; 323:G554-G561. [PMID: 36283090 PMCID: PMC9678428 DOI: 10.1152/ajpgi.00210.2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/12/2022] [Accepted: 10/18/2022] [Indexed: 01/31/2023]
Abstract
Ulcerative colitis (UC) is a chronic disease that is characterized by diffuse inflammation of the colonic and rectal mucosa. The burden of UC is rising globally with significant disparities in levels and trends of disease in different countries. The pathogenesis of UC involves the presence of pathogenic factors including genetic, environmental, autoimmune, and immune-mediated components. Evidence suggests that disturbed interactions between the host immune system and gut microbiome contribute to the origin and development of UC. Current medications for UC include antibiotics, corticosteroids, and biological drugs, which can have deleterious off-target effects on the gut microbiome, contributing to increased susceptibility to severe infections and chronic immunosuppression. Alternative, nonpharmacological, and behavioral interventions have been proposed as safe and effective treatments to alleviate UC, while also holding the potential to improve overall life quality. This mini-review will discuss the interactions between the immune system and the gut microbiome in the case of UC. In addition, we suggest nonpharmacological and behavioral strategies aimed at restoring a proper microbial-immune relationship.
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Affiliation(s)
- Brooke M Bullard
- Department of Pathology, Microbiology, and Immunology, School of Medicine, University of South Carolina, Columbia, South Carolina
| | - Brandon N VanderVeen
- Department of Pathology, Microbiology, and Immunology, School of Medicine, University of South Carolina, Columbia, South Carolina
| | - Sierra J McDonald
- Department of Pathology, Microbiology, and Immunology, School of Medicine, University of South Carolina, Columbia, South Carolina
| | - Thomas D Cardaci
- Department of Pathology, Microbiology, and Immunology, School of Medicine, University of South Carolina, Columbia, South Carolina
| | - E Angela Murphy
- Department of Pathology, Microbiology, and Immunology, School of Medicine, University of South Carolina, Columbia, South Carolina
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19
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Lamers CR, de Roos NM, Heerink HH, van de Worp-Kalter LA, Witteman BJM. Lower Impact of Disease on Daily Life and Less Fatigue in Patients With Inflammatory Bowel Disease Following a Lifestyle Intervention. Inflamm Bowel Dis 2022; 28:1791-1799. [PMID: 35212382 DOI: 10.1093/ibd/izac027] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Despite the potential benefits of diet and physical activity, evidence for beneficial effects of a combined lifestyle intervention is lacking in patients with inflammatory bowel disease (IBD). Therefore, we assessed its effects on impact of disease on daily life, clinical disease activity, fatigue, and health-related quality of life (HRQoL) in patients with IBD. METHODS A 6-month single-arm intervention study was performed in adult IBD patients in remission or with mildly active disease. Participants received personal dietary and physical activity advice from a dietician and a physiotherapist in 6 consults. At baseline and over time, questionnaires on diet quality, physical activity, and disease-related outcomes were completed and fecal calprotectin was determined. Data were analyzed by linear mixed models. RESULTS During the intervention, diet quality significantly increased (P < .001), but the level of physical activity remained the same. Over time, impact of the disease on daily life reduced (P = .009) and fatigue decreased (P = .001), while clinical disease activity, HRQoL, and fecal calprotectin did not change. Improvement in diet quality was significantly associated with a lower impact of disease on daily life (β = 0.09; 95% confidence interval [CI], 0.03 to 0.15; P = .003) and less fatigue (β = -0.13; 95% CI, -0.20 to -0.07; P < .001) but not with clinical disease activity, HRQoL, and fecal calprotectin. No associations were found with physical activity. CONCLUSIONS This combined lifestyle intervention significantly improved diet quality, and this improvement was associated with a reduction in the impact of disease on daily life and fatigue in patients with IBD in remission or with mildly active disease.
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Affiliation(s)
- Carlijn R Lamers
- Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede, the Netherlands.,Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Nicole M de Roos
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Henrike H Heerink
- Department of Dietetics, Hospital Gelderse Vallei, Ede, the Netherlands
| | | | - Ben J M Witteman
- Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede, the Netherlands.,Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
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Dipasquale V, Romano C. Genes vs environment in inflammatory bowel disease: an update. Expert Rev Clin Immunol 2022; 18:1005-1013. [PMID: 35912838 DOI: 10.1080/1744666x.2022.2108407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Inflammatory bowel diseases (IBDs) are known to be caused by a combination of genetic and environmental factors that vary in their influence on the development of the disease. Environmental exposures seem to influence IBD susceptibility, whereas genetic background is thought to modulate the impact of the environment on disease course and phenotype. AREAS COVERED A broad review of the involvement of genes and the environment in IBD pathogenesis was performed, and information regarding the main genetic and environmental factors - categorized into lifestyle factors, drugs, diet, and microbes - was updated. Monogenic very early onset IBD (VEO-IBD) was also discussed. EXPERT OPINION In the upcoming years, better understanding of gene-environment interactions will contribute to the possibility of a better prediction of disease course, response to therapy, and therapy-related adverse events with the final goal of personalized and more efficient patient management.
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Affiliation(s)
- Valeria Dipasquale
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
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21
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Ananthakrishnan AN, Kaplan GG, Bernstein CN, Burke KE, Lochhead PJ, Sasson AN, Agrawal M, Tiong JHT, Steinberg J, Kruis W, Steinwurz F, Ahuja V, Ng SC, Rubin DT, Colombel JF, Gearry R. Lifestyle, behaviour, and environmental modification for the management of patients with inflammatory bowel diseases: an International Organization for Study of Inflammatory Bowel Diseases consensus. Lancet Gastroenterol Hepatol 2022; 7:666-678. [PMID: 35487235 DOI: 10.1016/s2468-1253(22)00021-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 06/14/2023]
Abstract
Environmental and lifestyle factors play an important role in the natural history of Crohn's disease and ulcerative colitis. A group of international experts from the International Organization for the Study of Inflammatory Bowel Diseases voted on a series of consensus statements to inform the management of inflammatory bowel disease (IBD). The recommendations include avoiding traditional cigarette smoking in patients with Crohn's disease or ulcerative colitis, screening for symptoms of depression, anxiety, and psychosocial stressors at diagnosis and during flares (with referral to mental health professionals when appropriate), and encouraging regular physical activity as tolerated. Patients using dietary approaches for treatment of their IBD should be encouraged to adopt diets that are best supported by evidence and involve monitoring for the objective resolution of inflammation. We recommend formal assessment for obesity and nutritional deficiencies, and patients should be encouraged to maintain a normal body-mass index. A shared decision-making approach to contraception should include the consideration of IBD-related factors, and risk factors for venous thromboembolism. Long-term or frequent use of high-dose non-steroidal anti-inflammatory drugs should be avoided. For primary prevention of disease in the offspring of patients with IBD, we recommend avoiding passive exposure to tobacco, using antibiotics judiciously, and considering breastfeeding when able.
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Affiliation(s)
- Ashwin N Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Gilaad G Kaplan
- Division of Gastroenterology & Hepatology, University of Calgary, Calgary, AB, Canada
| | - Charles N Bernstein
- Section of Gastroenterology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Kristin E Burke
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Paul J Lochhead
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Alexa N Sasson
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Manasi Agrawal
- Dr Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Clinical Medicine, Center for Molecular Prediction of Inflammatory Bowel Disease (PREDICT), Aalborg University, Copenhagen, Denmark
| | - Jimmy Ho Tuan Tiong
- Department of Gastroenterology, Christchurch Hospital, Christchurch, New Zealand
| | - Joshua Steinberg
- Department of Gastroenterology, Hepatology, and Nutrition, Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA
| | - Wolfgang Kruis
- Department of Internal Medicine, University of Cologne, Cologne, Germany
| | - Flavio Steinwurz
- Department of Gastroenterology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Vineet Ahuja
- Department of Gastroenterology & Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Siew C Ng
- Department of Medicine and Therapeutics, LKS Institute of Health Science and Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - David T Rubin
- Department of Gastroenterology, Hepatology, and Nutrition, Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA
| | - Jean-Frederic Colombel
- Dr Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Richard Gearry
- Department of Gastroenterology, Christchurch Hospital, Christchurch, New Zealand
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22
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Raman M, Rajagopalan V, Kaur S, Reimer RA, Ma C, Ghosh S, Vallance J. Physical Activity in Patients With Inflammatory Bowel Disease: A Narrative Review. Inflamm Bowel Dis 2022; 28:1100-1111. [PMID: 34605548 DOI: 10.1093/ibd/izab218] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite advancement in the treatment of inflammatory bowel disease (IBD), induction and maintenance of remission remain challenging to achieve in many patients and a significant proportion of patients with IBD experience mental health conditions, including anxiety, depression, and fatigue, which impair their quality of life (QoL). We aim to describe the available evidence regarding the effects of physical activity (PA) on the onset of IBD, its disease course, and important patient-reported outcome measures (PROMs), such as QoL, fatigue, and mental health. METHODS A literature search was performed using electronic databases to identify original articles that assessed the effects of PA in patients with IBD using PROMs. RESULTS Prospective cohort and case-control studies demonstrate inverse relationships between PA and new-onset IBD in Crohn's disease but not in ulcerative colitis; however, they have small sample sizes and caution must be taken in considering associations versus causation. Small randomized controlled trials suggest promise for PA and beneficial outcomes, such as maintenance of clinical remission and improvement in QoL, fatigue, depression, and anxiety. However, these studies were small and underpowered, and limited by outcome measurements and durations of follow-up. CONCLUSIONS Physicians may consider discussing PA interventions with their patients on an individual basis, especially if they report impaired QoL, fatigue, depression, or anxiety, until disease-specific guidelines are available. Including PA as part of a primary prevention strategy in high-risk patients could be considered.
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Affiliation(s)
- Maitreyi Raman
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, ABCanada
| | - Vidya Rajagopalan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, ABCanada
| | - Sandeep Kaur
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, ABCanada
| | | | - Christopher Ma
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, ABCanada
| | - Subrata Ghosh
- College of Medicine and Health, University College Cork, Cork, Ireland
| | - Jeff Vallance
- Faculty of Health Disciplines, Athabasca University, Athabasca, Canada
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23
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Neal WN, Jones CD, Pekmezi D, Motl RW. Physical Activity in Adults With Crohn's Disease: A Scoping Review. CROHN'S & COLITIS 360 2022; 4:otac022. [PMID: 36777047 PMCID: PMC9802416 DOI: 10.1093/crocol/otac022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background As it becomes increasing clear that managing Crohn's disease (CD) requires more than medical treatment alone, further research to identify second-line approaches for managing CD and its symptoms such as physical activity (PA) are necessary to address this public health concern. Methods We conducted a scoping review of descriptive, cross-sectional, and experimental studies to synthesize evidence regarding PA rates, determinants, health consequences, and interventions specifically in adults with CD. Adhering to the Preferred Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines, published literature was searched to identify articles that examined PA or exercise in adults with CD. Results Twenty-eight articles met inclusion criteria: 13 included a cross-sectional design, 4 a case-control design, 2 cohort designs, and 9 intervention designs. Adults with CD appear to be similar to somewhat less physically active than the general population, though self-report and objective rates of PA vary widely by geographical location. PA may be associated with the reduced risk of future active disease in adults with CD in clinical remission, as well as improve health-related quality of life, fatigue, cardiorespiratory fitness, and depression. Preliminary findings from interventional studies demonstrate that moderate-intensity PA is feasible, safe, and may have beneficial effects on disease activity. Conclusions Overall, the benefits that can be accrued from regular PA are quite diverse; however, a substantially larger body of evidence is needed to provide firmer conclusions on the health benefits of PA that might underlie exercise-related changes in function and disease activity in adults with CD.
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Affiliation(s)
- Whitney N Neal
- Address correspondence to: Whitney N. Neal, MA, Department of Health Behavior, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL 35233, USA ()
| | - C Danielle Jones
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Dorothy Pekmezi
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, Illinois, USA
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24
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Abstract
Complementary and alternative medicine (CAM) is a growing entity within inflammatory bowel disease (IBD). CAM includes mind-based therapies, body-based therapies, supplements, vitamins, and probiotics. Limitations currently exist for health care providers as it pertains to IBD and CAM that stem from knowledge gaps, conflicting reports, limited oversight, and a lack of well-organized clinical data. Even without well-described data, patients are turning to these forms of therapy at increasing rates. It is imperative that the ongoing review of CAM therapies is performed, and future trials are performed to better understand efficacy as well as adverse effects related to these therapies.
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25
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Watanabe J, Furukawa S, Yagi S, Shiraishi K, Hanayama M, Tange K, Hashimoto Y, Kitahata S, Mori K, Ninomiya T, Suzuki S, Shibata N, Murakami H, Ohashi K, Hasebe A, Tomida H, Yamamoto Y, Takeshita E, Ikeda Y, Hiasa Y. Time spent per day in strenuous activity and total physical activity are inversely associated with mucosal healing but not with clinical remission in patients with ulcerative colitis. Ann Gastroenterol 2021; 34:796-801. [PMID: 34815645 PMCID: PMC8596212 DOI: 10.20524/aog.2021.0663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/13/2021] [Indexed: 11/23/2022] Open
Abstract
Background Epidemiological evidence on the association between physical activity (PA) and ulcerative colitis (UC) is limited, and the effect of PA on the prognosis of UC is currently unknown. We evaluated the association between PA and clinical outcomes, including clinical remission and mucosal healing (MH), in Japanese patients with UC. Methods The study subjects were 327 Japanese patients with UC. Subjects were asked about the average time spent per day on 4 types of PA (sedentary, standing, walking, and strenuous activity) and metabolic equivalents (METs) using a validated questionnaire. Clinical outcomes were complete MH, MH, and clinical remission. The association between PA, including hours spent on each type of PA and average daily METs, and clinical outcomes was assessed by multivariate logistic regression. Results Plentiful strenuous activity was significantly inversely associated with MH and complete MH after adjustment (MH: adjusted odds ratio [OR] 0.45, 95% confidence interval [CI] 0.23-0.89; complete MH: adjusted OR 0.24, 95%CI 0.07-0.62; P for trend=0.008). A very high daily MET total was significantly inversely associated with complete MH after adjustment (adjusted OR 0.37, 95%CI 0.16-0.80; P for trend=0.010). In contrast, no association between PA and clinical remission was found (plentiful strenuous activity: adjusted OR 1.10, 95%CI 0.55-2.23; very high daily total METs: adjusted OR 0.74, 95%CI 0.37-1.46). Conclusion In Japanese patients with UC, time spent per day on strenuous activity and total PA per day may be significantly inversely associated with complete MH, but not with clinical remission.
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Affiliation(s)
- Junichi Watanabe
- Department of Rehabilitation, Ehime Prefectural Central Hospital, Matsuyama (Junichi Watanabe)
| | | | - Sen Yagi
- Department of Internal Medicine, Saiseikai Matsuyama Hospital, Matsuyama, Ehime (Sen Yagi, Hidehiro Murakami)
| | - Kana Shiraishi
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine (Kana Shiraishi, Masakazu Hanayama, Kazuhiro Tange, Yu Hashimoto, Shogo Kitahata, Yoichi Hiasa)
| | - Masakazu Hanayama
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine (Kana Shiraishi, Masakazu Hanayama, Kazuhiro Tange, Yu Hashimoto, Shogo Kitahata, Yoichi Hiasa)
| | - Kazuhiro Tange
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine (Kana Shiraishi, Masakazu Hanayama, Kazuhiro Tange, Yu Hashimoto, Shogo Kitahata, Yoichi Hiasa)
| | - Yu Hashimoto
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine (Kana Shiraishi, Masakazu Hanayama, Kazuhiro Tange, Yu Hashimoto, Shogo Kitahata, Yoichi Hiasa)
| | - Shogo Kitahata
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine (Kana Shiraishi, Masakazu Hanayama, Kazuhiro Tange, Yu Hashimoto, Shogo Kitahata, Yoichi Hiasa)
| | - Kenichirou Mori
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Matsuyama (Kenichirou Mori, Tomoyuki Ninomiya)
| | - Tomoyuki Ninomiya
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Matsuyama (Kenichirou Mori, Tomoyuki Ninomiya)
| | - Seiyuu Suzuki
- Department of Gastroenterology, Sumitomo Besshi Hospital, Niihama (Seiyuu Suzuki)
| | - Naozumi Shibata
- Department of Gastroenterology, Ehime Prefectural Niihama Hospital, Niihama (Naozumi Shibata)
| | - Hidehiro Murakami
- Department of Internal Medicine, Saiseikai Matsuyama Hospital, Matsuyama, Ehime (Sen Yagi, Hidehiro Murakami)
| | - Katsuhisa Ohashi
- Ohashi Clinic participate in Gastro-Enterology and Ano-Proctology, Niihama, Ehime (Katsuhisa Ohashi)
| | - Aki Hasebe
- Department of Gastroenterology, Shikoku Cancer Center, Matsuyama, Ehime (Aki Hasebe)
| | - Hideomi Tomida
- Department of Inflammatory Bowel Diseases and Therapeutics, Ehime University Graduate School of Medicine (Hideomi Tomida, Eiji Takeshita)
| | - Yasunori Yamamoto
- Endoscopy Center, Ehime University Hospital (Yasunori Yamamoto, Yoshio Ikeda), Japan
| | - Eiji Takeshita
- Department of Inflammatory Bowel Diseases and Therapeutics, Ehime University Graduate School of Medicine (Hideomi Tomida, Eiji Takeshita)
| | - Yoshio Ikeda
- Endoscopy Center, Ehime University Hospital (Yasunori Yamamoto, Yoshio Ikeda), Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine (Kana Shiraishi, Masakazu Hanayama, Kazuhiro Tange, Yu Hashimoto, Shogo Kitahata, Yoichi Hiasa)
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26
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Koutouratsas T, Philippou A, Kolios G, Koutsilieris M, Gazouli M. Role of exercise in preventing and restoring gut dysbiosis in patients with inflammatory bowel diseases: A review. World J Gastroenterol 2021; 27:5037-5046. [PMID: 34497433 PMCID: PMC8384738 DOI: 10.3748/wjg.v27.i30.5037] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/19/2021] [Accepted: 07/12/2021] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel diseases (IBD) include a spectrum of chronic inflammatory disorders of the gastrointestinal tract whose pathogenesis is yet to be elucidated. The intestinal microbiome has been studied as a causal component, with certain microbiotic alterations having been observed in subtypes of IBD. Physical exercise is a modulator of the intestinal microbiome, causing shifts in its composition that are partially corrective of those observed in IBD; furthermore, physical exercise may be beneficial in patients with certain IBD subtypes. This review studies the effects of physical exercise on the human gut microbiome while investigating pathophysiologic mechanisms that could explain physical activity’s clinical effects on patients with IBD.
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Affiliation(s)
- Tilemachos Koutouratsas
- Department of Basic Medical Sciences, Laboratory of Biology, Medical School, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Anastassios Philippou
- Department of Basic Medical Sciences, Laboratory of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - George Kolios
- Department of Medicine, Laboratory of Pharmacology, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Michael Koutsilieris
- Department of Basic Medical Sciences, Laboratory of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Maria Gazouli
- Department of Basic Medical Sciences, Laboratory of Biology, Medical School, National and Kapodistrian University of Athens, Athens 11527, Greece
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27
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McGing JJ, Radford SJ, Francis ST, Serres S, Greenhaff PL, Moran GW. Review article: The aetiology of fatigue in inflammatory bowel disease and potential therapeutic management strategies. Aliment Pharmacol Ther 2021; 54:368-387. [PMID: 34228817 DOI: 10.1111/apt.16465] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 09/30/2020] [Accepted: 05/20/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fatigue is the inability to achieve or maintain an expected work output resulting from central or peripheral mechanisms. The prevalence of inflammatory bowel disease (IBD) fatigue can reach 86% in active disease, persisting in 50%-52% of patients with mild to inactive disease. Fatigue is the commonest reason for work absence in IBD, and patients often report fatigue burden to be greater than that of primary disease symptoms. Relatively few evidence-based treatment options exist, and the aetiology is poorly understood. AIM To review the available data and suggest a possible aetiology of IBD fatigue and to consider the efficacy of existing management strategies and highlight potential future interventions. METHODS We reviewed fatigue-related literature in IBD using PubMed database. RESULTS Disease related factors such as inflammation and pharmacological treatments negatively impact skeletal muscle and brain physiology, likely contributing to fatigue symptoms. Secondary factors such as malnutrition, anaemia, sleep disturbance and psychological comorbidity are potential determinants. Immune profile, faecal microbiota composition and physical fitness differ significantly between fatigued and non-fatigued patients, suggesting these may be aetiological factors. Solution-focused therapy, high-dosage thiamine supplementation and biological therapy may reduce fatigue perception in IBD. The effect of physical activity interventions is inconclusive. CONCLUSIONS A multimodal approach is likely required to treat IBD fatigue. Established reversible factors like anaemia, micronutrient deficiencies and active disease should initially be resolved. Psychosocial intervention shows potential efficacy in reducing fatigue perception in quiescent disease. Restoring physical deconditioning by exercise training intervention may further improve fatigue burden.
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Affiliation(s)
- Jordan J McGing
- School of Medicine, University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| | - Shellie Jean Radford
- School of Medicine, University of Nottingham, Nottingham, UK.,National Institute of Health Research Nottingham Biomedical Research Centre (NIHR), Nottingham University Hospitals and University of Nottingham, Nottingham, UK
| | - Susan T Francis
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK.,National Institute of Health Research Nottingham Biomedical Research Centre (NIHR), Nottingham University Hospitals and University of Nottingham, Nottingham, UK
| | - Sébastien Serres
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Paul L Greenhaff
- National Institute of Health Research Nottingham Biomedical Research Centre (NIHR), Nottingham University Hospitals and University of Nottingham, Nottingham, UK.,MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Gordon W Moran
- School of Medicine, University of Nottingham, Nottingham, UK.,National Institute of Health Research Nottingham Biomedical Research Centre (NIHR), Nottingham University Hospitals and University of Nottingham, Nottingham, UK
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28
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Madison AA, Kiecolt-Glaser JK. The gut microbiota and nervous system: Age-defined and age-defying. Semin Cell Dev Biol 2021; 116:98-107. [PMID: 33422403 PMCID: PMC8257779 DOI: 10.1016/j.semcdb.2020.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/01/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023]
Abstract
Even healthy older adults experience gastrointestinal (GI) and neurological changes. In fact, the aging process of these two systems are interrelated due the extensive, multifaceted communication network connecting them, termed the gut-brain axis. Age-related modification of the GI environment can influence the bacterial species that survive and thrive there. Additionally, the lifestyle common to older adults in the West, including sedentariness, polypharmacy, and a poor diet, can compound the effect of aging on the GI tract, gut microbiota, and nervous system. Emerging animal and human findings suggest that GI organisms play a major role in gut-brain communication, ultimately shaping neurological aging trajectories by either helping to maintain nervous system function into late life or promoting pathology. Aging and age-related behaviors help to define the gut microbiota's composition and function, but, conversely, the gut microbiota may help to determine late-life functionality and may be harnessed to limit the prevalence of steep neurological decline and diseases. Focusing primarily on clinical research, this review first defines the gut-brain axis, then details age-related GI and nervous system changes, and discusses the impact of age-related lifestyle factors on the GI and nervous systems. The remainder of this review describes cutting-edge research that positions the gut microbiota as an arbiter of age-related neurological decline.
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Affiliation(s)
- Annelise A Madison
- The Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, USA; Department of Psychology, The Ohio State University, USA
| | - Janice K Kiecolt-Glaser
- The Institute for Behavioral Medicine Research, The Ohio State University College of Medicine, USA; Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, USA.
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29
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Johnson AM, Loftus EV. Obesity in inflammatory bowel disease: A review of its role in the pathogenesis, natural history, and treatment of IBD. Saudi J Gastroenterol 2021; 27:183-190. [PMID: 34169900 PMCID: PMC8448008 DOI: 10.4103/sjg.sjg_30_21] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
In contrast to previous perceptions that inflammatory bowel disease (IBD) patients are generally malnourished and underweight, there is mounting evidence to suggest that rates of obesity in IBD now mirror that of the general population. IBD is an immune-mediated condition that appears to develop in individuals who have not only a genetic predisposition to immune dysregulation but also likely exposure to various environmental factors which further potentiate this risk. With the surge in obesity alongside the rising incidence of IBD, particularly in developing nations, the role that obesity may play, not only in the pathogenesis but also in the natural history of disease has become a topic of growing interest. Currently available data exploring obesity's impact on the natural history of IBD are largely conflicting, potentially limited by the use of body mass index as a surrogate measure of obesity at varying time points throughout the disease course. While there are pharmacokinetic data to suggest possible detrimental effects that obesity may have on the response to medical therapy, results in this realm are also inconsistent. Moreover, not only is it unclear whether weight loss improves IBD outcomes, little is known about the safety and efficacy of available weight-loss strategies in this population. For these reasons, it becomes increasingly important to further understand the nature of any interaction between obesity and IBD.
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Affiliation(s)
- Amanda M. Johnson
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, MN, USA,Address for correspondence: Dr. Amanda M. Johnson, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, MN - 55905, USA. E-mail:
| | - Edward V. Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, MN, USA
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30
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Lamers CR, de Roos NM, Koppelman LJM, Hopman MTE, Witteman BJM. Patient experiences with the role of physical activity in inflammatory bowel disease: results from a survey and interviews. BMC Gastroenterol 2021; 21:172. [PMID: 33853535 PMCID: PMC8046271 DOI: 10.1186/s12876-021-01739-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/29/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Physical activity may affect disease activity in patients with inflammatory bowel disease. We used a survey to investigate this association and performed interviews to get a better understanding of patient experiences, and therefore the nature of this association. METHODS Patients with Crohn's disease (CD, n = 176) and ulcerative colitis (UC, n = 162) completed the short Crohn's Disease Activity (sCDAI) or Patient Simple Clinical Colitis Activity Index (P-SCCAI) and the Short Questionnaire to Assess Health-enhancing physical activity (SQUASH). Associations were investigated by multiple linear regression. Semi-structured interviews (7 CD, 7 UC) were conducted to assess patient experiences with the role of physical activity in their disease. RESULTS The majority of survey participants were in remission (70%) and adhered to the Dutch physical activity guidelines (61%). In Crohn's disease, the total physical activity score was inversely associated with disease activity, even after adjustment for confounders (β = - 0.375; p = 0.013). No association between physical activity and disease activity was found in ulcerative colitis. Of the interviewees, 86% experienced beneficial effects of physical activity, such as improved general fitness, quality of life and self-image. However, during periods of active disease they struggled to find the motivation and perseverance to be physically active due to physical barriers. CONCLUSIONS Crohn's disease participants with a higher physical activity level had a lower disease activity. This inverse association was not found in ulcerative colitis. Interviews revealed that IBD patients generally experience beneficial effects from physical activity, although the barriers caused by active disease may put them off to be physically active.
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Affiliation(s)
- Carlijn R Lamers
- Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands. .,Division of Human Nutrition and Health, Wageningen University and Research (WUR), Stippeneng 4, 6708 WE, Wageningen, The Netherlands.
| | - Nicole M de Roos
- Division of Human Nutrition and Health, Wageningen University and Research (WUR), Stippeneng 4, 6708 WE, Wageningen, The Netherlands
| | - Lola J M Koppelman
- Division of Human Nutrition and Health, Wageningen University and Research (WUR), Stippeneng 4, 6708 WE, Wageningen, The Netherlands
| | - Maria T E Hopman
- Department of Physiology, Radboud University Medical Center, Philips Van Leydenlaan 15, 6500 HB, Nijmegen, The Netherlands
| | - Ben J M Witteman
- Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands.,Division of Human Nutrition and Health, Wageningen University and Research (WUR), Stippeneng 4, 6708 WE, Wageningen, The Netherlands
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31
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van der Sloot KWJ, Geertsema P, Rijkmans HC, Voskuil MD, van Dullemen HM, Visschedijk MC, Festen EAM, Weersma RK, Alizadeh BZ, Dijkstra G. Environmental factors associated with biological use and surgery in inflammatory bowel disease. J Gastroenterol Hepatol 2021; 36:1022-1034. [PMID: 32839987 PMCID: PMC8247347 DOI: 10.1111/jgh.15223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/30/2020] [Accepted: 08/16/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIM While major efforts were made studying the complex etiology of inflammatory bowel disease (IBD) including environmental factors, less is known about underlying causes leading to the heterogeneous and highly variable course of disease. As cigarette smoking cessation is the best-known environmental factor with beneficial effect in Crohn's disease (CD), more exposome factors are likely involved. Further insights into the role of the exposome in heterogeneity of disease might not only further knowledge of underlying pathways, but also allow for better risk stratification. METHODS Seven hundred twenty-eight IBD patients completed the validated Groningen IBD Environmental Questionnaire, collecting exposome data for 93 exposome factors. Associations with disease course, that is, for need for surgery or biological therapy, were evaluated using univariate and multivariate-adjusted logistic regression modeling. RESULTS No significant associations were seen after Bonferroni correction. However, 11 novel exposome factors were identified with P < 0.05. Two factors were associated with course of CD and ulcerative colitis (UC): beer (CD OR0.3/UC OR0.3) and cannabis (0.5/2.2). While in CD, carpet flooring (0.5) was associated with biological use, and four factors were associated with surgery: working shifts (1.8), appendectomy (2.4), frequent tooth brushing (2.8), and large household size (0.1). For UC, migrants more often required biologicals (10.2). Childhood underweight (3.4), amphetamine use (6.2), and cocaine use (4.8) were associated with surgery. Five factors were replicated. CONCLUSIONS We identified 16 environmental factors nominally associated with biological use and surgery in established IBD. These new insights form an important stepping stone to guide research on biological pathways involved, risk stratification, tailor-made interventions, and preventive strategies in IBD.
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Affiliation(s)
- Kimberley W J van der Sloot
- Department of Gastroenterology and Hepatology, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands,Department of Epidemiology, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Paul Geertsema
- Department of Gastroenterology and Hepatology, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Hanneke C Rijkmans
- Department of Gastroenterology and Hepatology, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Michiel D Voskuil
- Department of Epidemiology, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Hendrik M van Dullemen
- Department of Gastroenterology and Hepatology, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Marijn C Visschedijk
- Department of Gastroenterology and Hepatology, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Eleonora A M Festen
- Department of Gastroenterology and Hepatology, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Rinse K Weersma
- Department of Gastroenterology and Hepatology, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Behrooz Z Alizadeh
- Department of Epidemiology, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Gerard Dijkstra
- Department of Gastroenterology and Hepatology, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
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Spijkerman R, Hesselink L, Bertinetto C, Bongers CCWG, Hietbrink F, Vrisekoop N, Leenen LPH, Hopman MTE, Jansen JJ, Koenderman L. Refractory neutrophils and monocytes in patients with inflammatory bowel disease after repeated bouts of prolonged exercise. CYTOMETRY PART B-CLINICAL CYTOMETRY 2021; 100:676-682. [PMID: 33683008 PMCID: PMC9291995 DOI: 10.1002/cyto.b.21996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/09/2021] [Accepted: 02/23/2021] [Indexed: 12/12/2022]
Abstract
Background Neutrophils and monocytes are key immune effector cells in inflammatory bowel disease (IBD) that is associated with chronic inflammation in the gut. Patients with stable IBD who perform exercise have significantly fewer flare‐ups of the disease, but no underlying mechanism has been identified. Therefore, the aim of this study was to compare the responsiveness/refractoriness of these innate immune cells after repeated bouts of prolonged exercise in IBD patients and controls. Methods Patients with IBD and age‐ and gender‐matched healthy controls were recruited from a cohort of walkers participating in a 4‐day walking event. Blood analysis was performed at baseline and after 3 days of walking. Responsiveness to the bacterial/mitochondrial‐stimulus N‐Formylmethionine‐leucyl‐phenylalanine (fMLF) was tested in granulocytes and monocytes by measuring the expression of activation markers after adding this stimulus to whole blood. Results In total 38 participants (54 ± 12 years) were included in this study: 19 walkers with and 19 walkers without IBD. After 3 days of prolonged exercise, a significant increase in responsiveness to fMLF was observed in all participants irrespective of disease. However, IBD patients showed significantly less responsiveness in neutrophils and monocytes, compared with non‐IBD walkers. Conclusions Increased responsiveness of neutrophils and monocyte to fMLF was demonstrated after repetitive bouts of prolonged exercise. Interestingly, this exercise was associated with relative refractoriness of both neutrophils and monocytes in IBD patients. These refractory cells might create a lower inflammatory state in the intestine providing a putative mechanism for the decrease in flare‐ups in IBD patients after repeated exercise.
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Affiliation(s)
- Roy Spijkerman
- Department of Trauma SurgeryUniversity Medical Center UtrechtUtrechtCXThe Netherlands
- Center for Translational Immunology (CTI)University Medical Center UtrechtUtrechtCXThe Netherlands
- Department of Respiratory MedicineUniversity Medical Center UtrechtUtrechtCXThe Netherlands
| | - Lillian Hesselink
- Department of Trauma SurgeryUniversity Medical Center UtrechtUtrechtCXThe Netherlands
- Center for Translational Immunology (CTI)University Medical Center UtrechtUtrechtCXThe Netherlands
| | - Carlo Bertinetto
- Institute for Molecules and Materials (Analytical Chemistry)Radboud UniversityNijmegenAJThe Netherlands
| | - Coen C. W. G. Bongers
- Department of Physiology Radboud Institute for Health Sciences (RIHS)Radboud university medical centerNijmegenGAThe Netherlands
| | - Falco Hietbrink
- Department of Trauma SurgeryUniversity Medical Center UtrechtUtrechtCXThe Netherlands
| | - Nienke Vrisekoop
- Center for Translational Immunology (CTI)University Medical Center UtrechtUtrechtCXThe Netherlands
- Department of Respiratory MedicineUniversity Medical Center UtrechtUtrechtCXThe Netherlands
| | - Luke P. H. Leenen
- Department of Trauma SurgeryUniversity Medical Center UtrechtUtrechtCXThe Netherlands
| | - Maria T. E. Hopman
- Department of Physiology Radboud Institute for Health Sciences (RIHS)Radboud university medical centerNijmegenGAThe Netherlands
| | - Jeroen J. Jansen
- Institute for Molecules and Materials (Analytical Chemistry)Radboud UniversityNijmegenAJThe Netherlands
| | - Leo Koenderman
- Center for Translational Immunology (CTI)University Medical Center UtrechtUtrechtCXThe Netherlands
- Department of Respiratory MedicineUniversity Medical Center UtrechtUtrechtCXThe Netherlands
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Fagan G, Osborne H, Schultz M. Physical Activity in Patients with Inflammatory Bowel Disease: A Cross-Sectional Study. Inflamm Intest Dis 2021; 6:61-69. [PMID: 34124177 DOI: 10.1159/000511212] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/27/2020] [Indexed: 01/17/2023] Open
Abstract
Introduction and Objective Despite the known benefits of physical activity in the management of chronic diseases, the use of exercise as a treatment is relatively underemployed, with many patients reporting their disease to be a barrier. This study aimed to assess physical activity levels, attitudes, and barriers towards exercise in a cohort of patients with inflammatory bowel disease (IBD). In addition, this study aimed to assess possible relationships between physical well-being, psychological well-being, and sociodemographic factors. Methods 306 patients >18 years with diagnosed IBD in Dunedin, New Zealand, were approached to participate in this study. Participants who consented completed questionnaires regarding exercise preferences and attitudes, physical activity levels, and psychological well-being. Results Seventy-seven patients participated in the study (77/308 = 25%). Sixty-six percent of participants met physical activity guidelines and the median metabolic equivalent minutes/week of 1,027.5 (505.5-2,339.5). Walking was the most preferred activity (30%) followed by water-based exercise (20%). Two-thirds of participants reported their disease limited the amount of physical activity undertaken. Common barriers to participating in physical activity included fatigue (34%) and abdominal pain (20%). Patients with active disease reported higher levels of barriers than those in remission (80 vs. 54%, p = 0.018). Higher physical activity levels were correlated with lower levels of fatigue (p = 0.022-0.046). Conclusions While patients with IBD in Dunedin, New Zealand, are physically active, reducing real and perceived barriers is crucial to further increase physical activity in patients with IBD who are in remission or with active disease.
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Affiliation(s)
- Georgina Fagan
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Hamish Osborne
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Michael Schultz
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.,Gastroenterology Department, Southern District Health Board, Dunedin, New Zealand
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Intestinal Alkaline Phosphatase Combined with Voluntary Physical Activity Alleviates Experimental Colitis in Obese Mice. Involvement of Oxidative Stress, Myokines, Adipokines and Proinflammatory Biomarkers. Antioxidants (Basel) 2021; 10:antiox10020240. [PMID: 33557311 PMCID: PMC7914798 DOI: 10.3390/antiox10020240] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/20/2021] [Accepted: 01/29/2021] [Indexed: 01/01/2023] Open
Abstract
Intestinal alkaline phosphatase (IAP) is an essential mucosal defense factor involved in the process of maintenance of gut homeostasis. We determined the effect of moderate exercise (voluntary wheel running) with or without treatment with IAP on the course of experimental murine 2,4,6-trinitrobenzenesulfonic acid (TNBS) colitis by assessing disease activity index (DAI), colonic blood flow (CBF), plasma myokine irisin levels and the colonic and adipose tissue expression of proinflammatory cytokines, markers of oxidative stress (SOD2, GPx) and adipokines in mice fed a standard diet (SD) or high-fat diet (HFD). Macroscopic and microscopic colitis in sedentary SD mice was accompanied by a significant decrease in CBF, and a significant increase in the colonic expression of tumor necrosis factor-alpha (TNF-α), IL-6, IL-1β and leptin mRNAs and decrease in the mRNA expression of adiponectin. These effects were aggravated in sedentary HFD mice but reduced in exercising animals, potentiated by concomitant treatment with IAP, especially in obese mice. Exercising HFD mice demonstrated a substantial increase in the mRNA for adiponectin and a decrease in mRNA leptin expression in intestinal mucosa and mesenteric fat as compared to sedentary animals. The expression of SOD2 and GPx mRNAs was significantly decreased in adipose tissue in HFD mice, but these effects were reversed in exercising mice with IAP administration. Our study shows for the first time that the combination of voluntary exercise and oral IAP treatment synergistically favored healing of intestinal inflammation, strengthened the antioxidant defense and ameliorated the course of experimental colitis; thus, IAP may represent a novel adjuvant therapy to alleviate inflammatory bowel disease (IBD) in humans.
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Davis SP, Crane PB, Bolin LP, Johnson LA. An integrative review of physical activity in adults with inflammatory bowel disease. Intest Res 2021; 20:43-52. [PMID: 33472342 PMCID: PMC8831770 DOI: 10.5217/ir.2020.00049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 12/12/2020] [Indexed: 11/17/2022] Open
Abstract
Adults with inflammatory bowel disease (IBD) search for self-management strategies to manage their symptoms and improve their quality of life (QOL). Physical activity (PA) is one of the self-management strategies widely adopted by adults with IBD. This integrative review aimed to synthesize the evidence on health outcomes of PA in adults with IBD as well as to identify the barriers to engaging in PA. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), published literature was searched to identify the articles that addressed PA in adults with IBD. Twenty-eight articles met the inclusion criteria. Many of the reviewed studies used the terms of PA and exercise interchangeably. Walking was the most common PA reported in the studies. The findings from the majority of the reviewed studies supported the benefits of moderate-intensity exercise/PA among adults with IBD. The reviewed studies noted the following positive health outcomes of PA: improvement in QOL, mental health, sleep quality, gastrointestinal symptoms, fatigue and cardiorespiratory fitness. More importantly, participation in PA reduced the risk for development of IBD and the risk for future active disease. The findings from the reviewed studies highlighted the following barriers to engage in PA: fatigue, joint pain, abdominal pain, bowel urgency, active disease and depression.
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Lamers CR, de Roos NM, Bongers CCWG, Ten Haaf DSM, Hartman YAW, Witteman BJM, Hopman MTE. Repeated prolonged moderate-intensity walking exercise does not appear to have harmful effects on inflammatory markers in patients with inflammatory bowel disease. Scand J Gastroenterol 2021; 56:30-37. [PMID: 33211989 DOI: 10.1080/00365521.2020.1845791] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVES The role of exercise in the management of inflammatory bowel disease (IBD) is inconclusive as most research focused on short or low-intensity exercise bouts and subjective outcomes. We assessed the effects of repeated prolonged moderate-intensity exercise on objective inflammatory markers in IBD patients. METHODS In this study, IBD patients (IBD walkers, n = 18), and a control group (non-IBD walkers, n = 19), completed a 30, 40 or 50 km walking exercise on four consecutive days. Blood samples were taken at baseline and every day post-exercise to test for the effect of disease on exercise-induced changes in cytokine concentrations. A second control group of IBD patients who did not take part in the exercise, IBD non-walkers (n = 19), was used to test for the effect of exercise on faecal calprotectin. Both IBD groups also completed a clinical disease activity questionnaire. RESULTS Changes in cytokine concentrations were similar for IBD walkers and non-IBD walkers (IL-6 p = .95; IL-8 p = .07; IL-10 p = .40; IL-1β p = .28; TNF-α p = .45), with a temporary significant increase in IL-6 (p < .001) and IL-10 (p = .006) from baseline to post-exercise day 1. Faecal calprotectin was not affected by exercise (p = .48). Clinical disease activity did not change in the IBD walkers with ulcerative colitis (p = .92), but did increase in the IBD walkers with Crohn's disease (p = .024). CONCLUSION Repeated prolonged moderate-intensity walking exercise led to similar cytokine responses in participants with or without IBD, and it did not affect faecal calprotectin concentrations, suggesting that IBD patients can safely perform this type of exercise.
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Affiliation(s)
- Carlijn R Lamers
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands.,Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Nicole M de Roos
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Coen C W G Bongers
- Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Yvonne A W Hartman
- Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ben J M Witteman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands.,Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Maria T E Hopman
- Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
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Clinical Remission and Psychological Management are Major Issues for the Quality of Life in Pediatric Crohn Disease. J Pediatr Gastroenterol Nutr 2021; 72:74-79. [PMID: 32740538 DOI: 10.1097/mpg.0000000000002865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Crohn disease (CD) can affect patient's quality of life (QOL) with physical, social, and psychological impacts. This study aimed to investigate the QOL of children with CD and its relationship with patient and disease characteristics. METHODS Children ages from 10 to 17 years with diagnosed CD for more than 6 months were eligible to this cross-sectional study conducted in 35 French pediatric centers. QOL was assessed by the IMPACT-III questionnaire. Patient and disease characteristics were collected. RESULTS A total of 218 children (42% of girls) were included at a median age of 14 years (interquartile range [IQR]: 13--16). Median duration of CD was 3.2 years (IQR: 1.7-5.1) and 63% of children were in clinical remission assessed by wPCDAI. Total IMPACT-III score was 62.8 (±11.0). The lowest score was in "emotional functioning" subdomain (mean: 42.8 ± 11.2). Clinical remission was the main independent factor associated with QOL of children with CD (5.74 points higher compared with those "with active disease", 95% confidence interval [CI] 2.77--8.70, P < 0.001). Age of patient at the evaluation was found negatively correlated with QOL (-0.76 per year, 95% CI: -1.47 to -0.06, P = 0.009). Presence of psychological disorders was associated with a lower QOL (-9.6 points lower to those without, 95% CI: -13.34 to -5.86, P < 0.0001). Total IMPACT-III and its subdomains scores were not related to sex, disease duration, or treatments. CONCLUSIONS These results not only confirm that clinical remission is a major issue for the QOL of patients, but also highlights the importance of psychological care.
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Lucca FDA, Malaguti C, Chebli LA, Reboredo MM, Pinheiro BV, Ribeiro TCDR, Azevedo FMD, Corrêa JODA, Gaburri PD, Chebli JMF. Infliximab-induced remission improves physical activity in patients with active Crohn's disease. Rev Assoc Med Bras (1992) 2020; 66:1566-1572. [PMID: 33295411 DOI: 10.1590/1806-9282.66.11.1566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/11/2020] [Indexed: 01/04/2023] Open
Abstract
AIM To compare the level of physical activity (PA), exercise capacity, and body composition before and after infliximab-induced clinical remission in patients with Crohn's disease (CD). METHODS This prospective longitudinal study evaluated 44 adult outpatients with active CD before infliximab administration and 24 weeks after infliximab therapy. The patients were evaluated for PA in daily life, exercise capacity, muscle strength, and body composition. RESULTS 38 (86.4%) patients achieved infliximab-induced remission at 24 weeks and presented an increment in the number of steps taken of 1092 (7440±2980 vs. 6348±3177, respectively; p=0.006). The inactive time was reduced when compared to the baseline value (454.2±106.3 vs. 427.9±97.8, respectively; p=0.033). There was no difference in the distance walked before and after infliximab therapy, while there was an increase in the fat mass index in responders to infliximab compared to the baseline (19.1±7.6 vs. 14.9±5.8; p=0.001). CONCLUSIONS Infliximab-induced remission was shown to be effective for increasing physical activity by improving the number of steps and reducing inactive time. The maintenance of clinical remission associated with incentives to regular PA may contribute to making these patients reach an ideal level of PA.
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Affiliation(s)
- Fernando de Azevedo Lucca
- Unidade de Gastroenterologia, Departamento de Medicina, Centro de Doenças Inflamatórias Intestinais, Hospital Universitário da Universidade Federal de Juiz de Fora, Faculdade de Medicina da Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - Carla Malaguti
- Programa de Pós-Graduação em Ciências da Reabilitação e Desempenho Físico-Funcional da Universidade Federal de Juiz de Fora, Faculdade de Medicina da Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - Liliana Andrade Chebli
- Unidade de Gastroenterologia, Departamento de Medicina, Centro de Doenças Inflamatórias Intestinais, Hospital Universitário da Universidade Federal de Juiz de Fora, Faculdade de Medicina da Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - Maycon Moura Reboredo
- Laboratório de Investigação Pulmonar, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil.,Programa de Pós-Graduação em Ciências da Reabilitação e Desempenho Físico-Funcional da Universidade Federal de Juiz de Fora, Faculdade de Medicina da Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - Bruno Valle Pinheiro
- Laboratório de Investigação Pulmonar, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - Tarsila Campanha da Rocha Ribeiro
- Unidade de Gastroenterologia, Departamento de Medicina, Centro de Doenças Inflamatórias Intestinais, Hospital Universitário da Universidade Federal de Juiz de Fora, Faculdade de Medicina da Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - Felipe Meirelles de Azevedo
- Programa de Pós-Graduação em Ciências da Reabilitação e Desempenho Físico-Funcional da Universidade Federal de Juiz de Fora, Faculdade de Medicina da Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - José Otávio do Amaral Corrêa
- Unidade de Gastroenterologia, Departamento de Medicina, Centro de Doenças Inflamatórias Intestinais, Hospital Universitário da Universidade Federal de Juiz de Fora, Faculdade de Medicina da Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - Pedro Duarte Gaburri
- Unidade de Gastroenterologia, Departamento de Medicina, Centro de Doenças Inflamatórias Intestinais, Hospital Universitário da Universidade Federal de Juiz de Fora, Faculdade de Medicina da Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
| | - Julio Maria Fonseca Chebli
- Unidade de Gastroenterologia, Departamento de Medicina, Centro de Doenças Inflamatórias Intestinais, Hospital Universitário da Universidade Federal de Juiz de Fora, Faculdade de Medicina da Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil
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Nicolaides S, Vasudevan A, Long T, van Langenberg D. The impact of tobacco smoking on treatment choice and efficacy in inflammatory bowel disease. Intest Res 2020; 19:158-170. [PMID: 33040518 PMCID: PMC8100381 DOI: 10.5217/ir.2020.00008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/22/2020] [Indexed: 12/18/2022] Open
Abstract
Smoking significantly increases the risk of developing and worsens Crohn's disease (CD), yet protects against the development and reduces the severity of ulcerative colitis. It is less clear whether smoking impacts the efficacy of therapeutics in inflammatory bowel disease (IBD). We review the literature regarding the relationship between smoking and the efficacy of medical and surgical therapy in IBD. Smoking is associated with alterations in thiopurine metabolism and may affect time to disease relapse. The outcomes of anti-tumor necrosis factor therapy in active smokers appear neutral with data lacking for newer biologics. Smoking increases the risk of postoperative recurrence in those requiring resection for CD, likely attributable to perturbations of the gut microbiota although further implications of these for disease onset/progression and treatment efficacy remain unclear. Multiple lifestyle and psychosocial confounders are likely under-recognized cofactors in the association between smoking and IBD. Despite the widely promulgated risks associated with cigarette smoking in CD, more incisive data are required to further elucidate the actual relationship between smoking and disease pathways, while accounting for the several negative cofactors prevalent in smokers which cast uncertainty on the magnitude of the direct effect of smoking on disease pathophysiology and the efficacy of therapy.
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Affiliation(s)
- Steven Nicolaides
- Department of Gastroenterology, Eastern Health, Box Hill Hospital, Box Hill, Australia
| | - Abhinav Vasudevan
- Department of Gastroenterology, Eastern Health, Box Hill Hospital, Box Hill, Australia
| | - Tony Long
- Department of Gastroenterology, Eastern Health, Box Hill Hospital, Box Hill, Australia
| | - Daniel van Langenberg
- Department of Gastroenterology, Eastern Health, Box Hill Hospital, Box Hill, Australia
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Pino J, Gómez S, Olivares M, Quera R, Simian D, Escaffi MJ, Ibáñez P. EFECTOS DEL EJERCICIO EN ENFERMEDADES DEL TUBO DIGESTIVO. REVISTA MÉDICA CLÍNICA LAS CONDES 2020. [DOI: 10.1016/j.rmclc.2020.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Opening a Window on Attention: Adjuvant Therapies for Inflammatory Bowel Disease. Can J Gastroenterol Hepatol 2020; 2020:7397523. [PMID: 32850517 PMCID: PMC7441453 DOI: 10.1155/2020/7397523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 01/17/2020] [Accepted: 01/27/2020] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel disease (IBD), most commonly known as Crohn's disease (CD) and ulcerative disease (UC), is a chronic and relapsing intestinal disease which cannot be cured completely. The prevalence of IBD in Europe and in North America has increased over the past 20 years. As most IBD patients are young at onset, their quality of life (QOL) can be influenced to varying degrees. Thus, current treatment goals are typically focused on preventing complications, including maintaining clinical remission and improving the QOL. Adjuvant therapies have been widely concerned as an effective treatment in alleviating IBD symptoms, including dietary intervention, traditional Chinese medicine, smoking, alcohol, and physical activities. This review focuses on different ancillary therapies for IBD treatments, in particular the mechanism of reducing inflammation based on the actual data from research studies. Moreover, comparing the latest data, this review also presented potential future prospect for adjuvant therapies.
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Seeger WA, Thieringer J, Esters P, Allmendinger B, Stein J, Schulze H, Dignass A. Moderate endurance and muscle training is beneficial and safe in patients with quiescent or mildly active Crohn's disease. United European Gastroenterol J 2020; 8:804-813. [PMID: 32580666 DOI: 10.1177/2050640620936383] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND AIMS Physical activity is beneficial in several chronic disorders including Crohn's disease, but the preferred type of exercise is unknown. Our study aimed to examine and compare the safety, feasibility and potential beneficial effects of individual moderate endurance and moderate muscle training in patients with Crohn's disease. METHODS Quiescent or mildly active (Crohn's disease activity index <220) patients with Crohn's disease were randomly allocated to either a control, endurance, or muscle training group. Participants exercised individually for 3 months three times per week. Endpoints included dropout rate, disease activity, inflammatory parameters including faecal calprotectin, anthropometric data, quality of life, physical activity and strength. RESULTS A total of 45 patients with Crohn's disease were randomly allocated. In the endurance group (n = 17), the dropout rate was significantly higher (47% vs. 13%) compared with the muscle group (n = 15). In both groups the maximal and average strength in the upper and lower extremities increased significantly (all P < 0.04). In the endurance group emotional function was significantly improved (P = 0.03). Statistically significant changes of disease activity and other outcome parameters were not observed in this pilot cohort. CONCLUSION Both individual moderate endurance and muscle training can be safely performed in patients with mild or quiescent Crohn's disease. Muscle training appears more feasible and may be favoured. Both forms of exercise have beneficial effects on strength. Quality of life increased in both intervention groups, although statistical significance was only reached in one subgroup.
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Affiliation(s)
- Wolfgang Alexander Seeger
- Department of Medicine I, Agaplesion Markus Hospital, Frankfurt, Germany.,Medical Department I (Gastroenterology, Infectiology, and Rheumatology), Charité - Universitätsmedizin Berlin, Germany
| | - Juliane Thieringer
- Department of Medicine I, Agaplesion Markus Hospital, Frankfurt, Germany
| | - Philip Esters
- Department of Medicine I, Agaplesion Markus Hospital, Frankfurt, Germany
| | | | - Jürgen Stein
- Department of Gastroenterology and Clinical Nutrition, Interdisziplinäres Crohn Colitis Centrum, Frankfurt, Germany
| | - Hermann Schulze
- Department of Medicine I, Agaplesion Markus Hospital, Frankfurt, Germany
| | - Axel Dignass
- Department of Medicine I, Agaplesion Markus Hospital, Frankfurt, Germany.,Medical Department I (Gastroenterology, Infectiology, and Rheumatology), Charité - Universitätsmedizin Berlin, Germany
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Abstract
Various lifestyle factors including physical activity and obesity, stress, sleep, and smoking may modify the risk of developing inflammatory bowel diseases (IBDs). In patients with established IBD, these lifestyle factors may significantly impact the natural history and clinical outcomes. Recreational exercise decreases the risk of flare and fatigue in patients with IBD. In contrast, obesity increases the risk of relapse and is associated with higher anxiety, depression, fatigue, and pain and higher health care utilization. Obesity also modifies pharmacokinetics of biologic agents unfavorably and is associated with a higher risk of treatment failure. Sleep disturbance is highly prevalent in patients with IBD, independent of disease activity, and increases the risk of relapse and chronic fatigue. Similarly, stress, particularly perceived stress rather than major life events, may trigger symptomatic flare in patients with IBD, although its impact on inflammation is unclear. Cigarette smoking is associated with unfavorable outcomes including the risk of corticosteroid dependence, surgery, and disease progression in patients with Crohn's disease; in contrast, smoking does not significantly impact outcomes in patients with ulcerative colitis, although some studies suggest that it may be associated with a lower risk of flare. The effect of alcohol and cannabis use in patients with IBD is inconsistent, with some studies suggesting that cannabis may decrease chronic pain in patients with IBD, without a significant effect of biological remission. Although these lifestyle factors are potentially modifiable, only a few interventional studies have been conducted. Trials of structured exercise and psychological therapy including mindfulness-based therapies such as meditation and yoga and gut-directed hypnotherapy have not consistently demonstrated benefit in clinical and/or endoscopic disease activity in IBD, although may improve overall quality of life.
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Cabalzar AL, Azevedo FMD, Lucca FDA, Reboredo MDM, Malaguti C, Chebli JMF. PHYSICAL ACTIVITY IN DAILY LIFE, EXERCISE CAPACITY AND QUALITY OF LIFE IN PATIENTS WITH CROHN'S DISEASE ON INFLIXIMAB-INDUCED REMISSION: A PRELIMINARY STUDY. ARQUIVOS DE GASTROENTEROLOGIA 2020; 56:351-356. [PMID: 31618395 DOI: 10.1590/s0004-2803.201900000-65] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 07/23/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Physical activity in daily life and exercise capacity have not been assessed in patients with Crohn's disease to date. OBJECTIVE To evaluate the physical activity in daily life, exercise capacity, quality of life, and prevalence of mood disorders in patients with moderate-to-severe Crohn's disease on infliximab-induced remission and the possible associations among variables. METHODS A cross-sectional preliminary study was conducted. Twenty-six patients with Crohn's disease and 20 controls were selected. Participants underwent evaluation of physical activity in daily life (triaxial accelerometer), exercise capacity (shuttle walk test), handgrip strength, quality of life, and presence of mood disorders. RESULTS The number of steps taken (7446±3081 vs 7898±2487), active time (80.6±42 vs 89.7±24.3min), shuttle walk test distance [665 (405) vs 710 (409) m] and handgrip strength [31 (15) vs 29 (20) kgf did not show any difference between the patients with Crohn's disease and the controls. The time spent lying down [95.8 (68.8) vs 60.9 (74.7) min] was greater and some domains of the quality of life were superior in the patients with Crohn's disease. No correlation was observed between the physical activity in daily life and quality of life or presence of mood disorders in patients with Crohn's disease. CONCLUSION Patients with Crohn's disease on infliximab-induced remission, despite to more time spent lying down, they have the same level of physical activity in daily life and exercise capacity min compared with the controls.
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Affiliation(s)
- Andrea Lemos Cabalzar
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Departamento de Gastroenterologia, Hospital Universitário, Centro de Doenças Inflamatórias Intestinais, Juiz de Fora, MG, Brasil
| | - Felipe Meirelles de Azevedo
- Universidade Federal de Juiz de Fora, Faculdade de Fisioterapia, Programa de Pós-Graduação Ciências da Reabilitação e Desempenho Físico-Funcional, Juiz de Fora, MG, Brasil
| | - Fernando de Azevedo Lucca
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Departamento de Gastroenterologia, Hospital Universitário, Centro de Doenças Inflamatórias Intestinais, Juiz de Fora, MG, Brasil
| | - Maycon de Moura Reboredo
- Universidade Federal de Juiz de Fora, Faculdade de Fisioterapia, Programa de Pós-Graduação Ciências da Reabilitação e Desempenho Físico-Funcional, Juiz de Fora, MG, Brasil
| | - Carla Malaguti
- Universidade Federal de Juiz de Fora, Faculdade de Fisioterapia, Programa de Pós-Graduação Ciências da Reabilitação e Desempenho Físico-Funcional, Juiz de Fora, MG, Brasil
| | - Júlio Maria Fonseca Chebli
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Departamento de Gastroenterologia, Hospital Universitário, Centro de Doenças Inflamatórias Intestinais, Juiz de Fora, MG, Brasil
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Barnes EL, Long MD, Kappelman MD, Martin CF, Sandler RS. High Patient Activation Is Associated With Remission in Patients With Inflammatory Bowel Disease. Inflamm Bowel Dis 2019; 25:1248-1254. [PMID: 30590700 PMCID: PMC6939681 DOI: 10.1093/ibd/izy378] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND High levels of patient activation (having the knowledge, skills, and confidence to effectively manage one's care), have been associated with improved outcomes in many chronic conditions. There have been few studies of the effects of activation in patients with inflammatory bowel disease (IBD). We performed a large, prospective Internet-based study to assess the relationship between patient activation level and clinical remission in patients with Crohn's disease or ulcerative colitis. METHODS We administered the Patient Activation Measure (Insignia Health) to 1486 cohort participants. Patients completed a follow-up survey within 13 months (median, 189 days). We collected demographic and clinical data; anxiety and depression were assessed using Patient-Reported Outcomes Measurement Information System instruments. We used bivariate analyses and multivariable logistic regression to identify characteristics associated with low or high patient activation and to evaluate the association between levels of patient activation and subsequent disease activity. RESULTS Higher anxiety (adjusted odds ratio [aOR], 0.32; 95% confidence interval [CI], 0.29-0.36) and depression (aOR, 0.33; 95% CI, 0.29-0.37) scores were associated with a decreased odds of high patient activation. After we adjusted for education status, smoking, medication use, and other confounders, we found that patients with high activation at baseline were more likely to be in clinical remission during the follow-up period (aOR, 1.71; 95% CI, 1.20-2.45). CONCLUSIONS In a large, prospective Internet-based cohort of patients with IBD, we found a strong association between patient activation and clinical remission. These findings suggest that patient activation affects disease outcomes.
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Affiliation(s)
- Edward L Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Address correspondence to: Edward L. Barnes, MD, MPH, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, 130 Mason Farm Road, Bioinformatics Building, CB #7080, Chapel Hill, NC 27599-7080 ()
| | - Millie D Long
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michael D Kappelman
- Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Division of Pediatric Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Christopher F Martin
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Robert S Sandler
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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46
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Beyond pregnancy, women's health in inflammatory bowel disease. Curr Opin Gastroenterol 2019; 35:288-295. [PMID: 33216483 DOI: 10.1097/mog.0000000000000552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
PURPOSE OF REVIEW Women's health includes comprehensive physical, mental and preventive care. This section will provide an overview of some of the most common disorders that can impact the health and quality of life (QOL) of women with inflammatory bowel diseases (IBDs). RECENT FINDINGS Women with IBD are at higher risk for cervical dysplasia compared to healthy controls with most cases preventable with vaccination. Current rates of cervical cancer screening and human papilloma virus vaccination remain low. Irritable bowel syndrome is highly prevalent among women with IBD and may present with similar symptoms. In addition, gastrointestinal symptoms may worsen during the menstrual cycle. Evaluation for active inflammation and infection should be undertaken prior to changing IBD medications. Fecal incontinence is prevalent but highly underreported in women with IBD. Further, sexual dysfunction is ubiquitous in women with IBD. Many aspects of IBD impact sexual function, including side-effects of medications, changes in body image and surgical interventions. SUMMARY Understanding other disorders that may cause symptoms in women with IBD is important for providers to obtain a clear history, provide the appropriate treatment and improve QOL. Caring for women with IBD involves more comprehensive care beyond the treatment of active luminal inflammation.
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Holik D, Včev A, Milostić-Srb A, Salinger Ž, Ivanišević Z, Včev I, Miškulin M. THE EFFECT OF DAILY PHYSICAL ACTIVITY ON THE ACTIVITY OF INFLAMMATORY BOWEL DISEASES IN THERAPY-FREE PATIENTS. Acta Clin Croat 2019; 58:202-212. [PMID: 31819315 PMCID: PMC6884387 DOI: 10.20471/acc.2019.58.02.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
It has been suggested that various environmental factors play a very important role in the etiology of inflammatory bowel diseases (IBDs) and that they have a significant effect on the course of these diseases. The aim of this study was to investigate the effect of daily physical activity on the activity of IBDs in therapy-free patients. This cross-sectional population based study was conducted in eastern Croatia from January to June 2016. The study included 312 patients, mean age 49.9±15.0 years, 53.2% of males and 46.8% of females; there were 63.4% of ulcerative colitis (UC) and 36.6% of Crohn’s disease (CD) patients. Sociodemographic characteristics of patients, data on their daily physical activity and type of therapy taken were collected through a specifically designed and validated questionnaire, while the activity of UC and CD was evaluated using the Mayo index and Harvey-Bradshaw index. The study showed that 24.0% of patients were not taking therapy. Daily physical activity was connected to IBD in study patients when taking both diseases collectively (Fisher exact test; p<0.001), as well as to the inactivity of CD (Fisher exact test; p=0.001) and UC (Fisher exact test; p=0.006), when observing each disease separately. Daily physical activity was connected to the inactivity of IBDs in patients not taking therapy. It is necessary to educate all IBD patients about the importance of physical activity in order to control their disease.
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Affiliation(s)
| | - Aleksandar Včev
- 1Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Mathematics, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4University of Zadar, Zadar, Croatia
| | - Andrea Milostić-Srb
- 1Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Mathematics, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4University of Zadar, Zadar, Croatia
| | - Željka Salinger
- 1Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Mathematics, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4University of Zadar, Zadar, Croatia
| | - Zrinka Ivanišević
- 1Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Mathematics, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4University of Zadar, Zadar, Croatia
| | - Ivan Včev
- 1Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Mathematics, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4University of Zadar, Zadar, Croatia
| | - Maja Miškulin
- 1Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Department of Mathematics, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 4University of Zadar, Zadar, Croatia
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Torres J, Ellul P, Langhorst J, Mikocka-Walus A, Barreiro-de Acosta M, Basnayake C, Ding NJS, Gilardi D, Katsanos K, Moser G, Opheim R, Palmela C, Pellino G, Van der Marel S, Vavricka SR. European Crohn's and Colitis Organisation Topical Review on Complementary Medicine and Psychotherapy in Inflammatory Bowel Disease. J Crohns Colitis 2019; 13:673-685e. [PMID: 30820529 DOI: 10.1093/ecco-jcc/jjz051] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 02/26/2019] [Indexed: 12/11/2022]
Abstract
Patients with inflammatory bowel disease [IBD] increasingly use alternative and complementary therapies, for which appropriate evidence is often lacking. It is estimated that up to half of all patients with IBD use various forms of complementary and alternative medicine during some point in their disease course. Considering the frequent use of such therapies, it is crucial that physicians and patients are informed about their efficacy and safety in order to provide guidance and evidence-based advice. Additionally, increasing evidence suggests that some psychotherapies and mind-body interventions may be beneficial in the management of IBD, but their best use remains a matter of research. Herein, we provide a comprehensive review of some of the most commonly used complementary, alternative and psychotherapy interventions in IBD.
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Affiliation(s)
- Joana Torres
- Department of Gastroenterology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Pierre Ellul
- Department of Medicine, Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | - Jost Langhorst
- Department of Internal Medicine and Integrative Gastroenterology, Kliniken Essen-Mitte and Chair for Integrative Medicine and Translational Gastroenterology, Klinikum Bamberg, University Duisburg-Essen, Germany
| | | | - Manuel Barreiro-de Acosta
- Department of Gastroenterology, IBD Unit, University Hospital Santiago De Compostela (CHUS), Santiago De Compostela, Spain
| | - Chamara Basnayake
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Fitzroy, Melbourne, Australia
| | - Nik John Sheng Ding
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Fitzroy, Melbourne, Australia
| | - Daniela Gilardi
- IBD Centre, Department of Gastroenterology, Humanitas Clinical and Research Institute, Rozzano, Milan, Italy
| | - Konstantinos Katsanos
- Department of Gastroenterology and Hepatology, Division of Internal Medicine, University and Medical School of Ioannina, Ioannina, Greece
| | - Gabriele Moser
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Randi Opheim
- Department of Gastroenterology, Oslo University Hospital, and Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Carolina Palmela
- Department of Gastroenterology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Sander Van der Marel
- Department of Gastroenterology and Internal Medicine, Haaglanden Medisch Centrum, The Hague, The Netherlands
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49
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Gatt K, Schembri J, Katsanos KH, Christodoulou D, Karmiris K, Kopylov U, Pontas C, Koutroubakis IE, Foteinogiannopoulou K, Fabian A, Molnar T, Zammit D, Fragaki M, Balomenos D, Zingboim N, Ben Horin S, Mantzaris GJ, Ellul P. Inflammatory Bowel Disease [IBD] and Physical Activity: A Study on the Impact of Diagnosis on the Level of Exercise Amongst Patients With IBD. J Crohns Colitis 2019; 13:686-692. [PMID: 30561568 DOI: 10.1093/ecco-jcc/jjy214] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/28/2018] [Accepted: 12/12/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Inflammatory bowel disease [IBD] can impair patients' functional capacity with significant negative effects on their quality of life. Our aim was to determine the impact of IBD diagnosis on fitness levels and to assess the levels of engagement in physical activity and fatigue in IBD patient before and after diagnosis. METHODS A prospective multi-centre cross-sectional study was performed. Patients diagnosed with IBD in the previous 18 months were recruited. Inclusion criteria included clinical remission and/or no treatment changes within the previous 6 months. Physical exercise levels were assessed by the Godin score and fatigue levels was assessed by the functional assessment of chronic illness therapy [FACIT] score. RESULTS In total, 158 patients (100 Crohn's disease [CD]) were recruited. Mean age was 35.1 years (95% confidence interval [CI] ± 2.0). Gender distribution was approximately equal [51.3% male]. The Mean Harvey Bradshaw and Simple Clinical Colitis Activity indices were 2.25 [95% CI ± 0.40] and 1.64 [95% CI ± 0.49], respectively. The mean Godin score difference before and after IBD diagnosis was 6.94 [p = 0.002]. Patients with ulcerative colitis [UC] [41.8%] were more likely than patients with CD [23.0%] to reduce their exercise levels [p = 0.04]. FACIT scores were lower in patients who had experienced relapses [p = 0.012] and had severe disease [p = 0.011]. Approximately one-third of patients reduced their activity level following IBD diagnosis. CONCLUSIONS Patients were significantly less physically active after a diagnosis of IBD and this was more apparent in UC. Identification of the risk factors associated with loss of fitness levels would help to address the reduced patient quality of life.
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Affiliation(s)
- K Gatt
- Division of Gastroenterology, Mater Dei Hospital, Malta
| | - J Schembri
- Division of Gastroenterology, Mater Dei Hospital, Malta
| | - K H Katsanos
- Department of Gastroenterology and Hepatology, Medical School and University Hospital of Ioannina, Greece
| | - D Christodoulou
- Department of Gastroenterology and Hepatology, Medical School and University Hospital of Ioannina, Greece
| | - K Karmiris
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece
| | - U Kopylov
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
| | - C Pontas
- Department of Gastroenterology, Evangelismos Hospital, Athens, Greece
| | - I E Koutroubakis
- Department of Gastroenterology, University Hospital Heraklion, Crete, Greece
| | | | - A Fabian
- University of Szeged, First Department of Internal Medicine, Szeged, Hungary
| | - T Molnar
- University of Szeged, First Department of Internal Medicine, Szeged, Hungary
| | - D Zammit
- Division of Gastroenterology, Mater Dei Hospital, Malta
| | - M Fragaki
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece
| | - D Balomenos
- Department of Gastroenterology and Hepatology, Medical School and University Hospital of Ioannina, Greece
| | - N Zingboim
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
| | - S Ben Horin
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
| | - G J Mantzaris
- Department of Gastroenterology, Evangelismos Hospital, Athens, Greece
| | - P Ellul
- Division of Gastroenterology, Mater Dei Hospital, Malta
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50
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Bilski J, Mazur-Bialy A, Wojcik D, Magierowski M, Surmiak M, Kwiecien S, Magierowska K, Hubalewska-Mazgaj M, Sliwowski Z, Brzozowski T. Effect of Forced Physical Activity on the Severity of Experimental Colitis in Normal Weight and Obese Mice. Involvement of Oxidative Stress and Proinflammatory Biomarkers. Nutrients 2019; 11:nu11051127. [PMID: 31117199 PMCID: PMC6567060 DOI: 10.3390/nu11051127] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/16/2019] [Accepted: 05/17/2019] [Indexed: 12/16/2022] Open
Abstract
Inflammatory bowel diseases are a heterogeneous group of disorders represented by two major phenotypic forms, Crohn’s disease and ulcerative colitis. Cross talk between adipokines and myokines, as well as changes in intestinal microcirculation, was proposed in pathogenesis of these disorders. C57BL/6 male mice were fed ad libitum for 12 weeks a standard (SD) or high-fat diet (HFD). After the adaptation period, two groups of animals fed SD or HFD were subjected to 6 weeks of the forced treadmill exercise and the experimental colitis was induced in both groups of sedentary and exercising mice fed SD and HFD by intra-colonic administration of 2,4,6-trinitrobenzenesulfonic acid. The disease activity index (DAI), colonic blood flow (CBF), the weight of animals, caloric intake, the mesenteric fad pad, the colonic oxidative stress markers malondialdehyde (MDA), reduced glutathione (GSH), and superoxide dismutase (SOD) activity and intestinal expression and protein content of proinflammatory markers were evaluated. Macroscopic and microscopic colitis in sedentary SD mice was accompanied by a significant fall in CBF and exacerbated in those fed a HFD. The contents of MDA, GSH, and SOD activity were significantly increased in both SD and HFD fed mice with treadmill exercise as compared with sedentary mice. In sedentary HFD mice a significant increase in the intestinal oxidative stress parameters and mucosal expression of IL-1β, TNF-α, IL-17, IFNγ, IL-6, and IL-10 protein were observed and these effects were aggravated in mice subjected to forced treadmill exercise. The mucosal expression of mRNA for TNF-α, IL-1β, iNOS, COX-2, SOD-1, SOD-2, GPx mRNAs, and the hypoxia inducible factor (HIF)-1α protein expression were upregulated in colonic mucosa of treadmill exercising HFD mice with colitis compared with those without exercise. We conclude that forced treadmill running exacerbates the severity of colonic damage in obese mice due to a fall in colonic microcirculation, an increase in oxidative stress, and the rise in expression and activity of proinflammatory biomarkers.
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Affiliation(s)
- Jan Bilski
- Department of Ergonomics and Exercise Physiology, Faculty of Health Sciences, Jagiellonian University Medical College, 20 Grzegorzecka Street, 31-531 Cracow, Poland.
| | - Agnieszka Mazur-Bialy
- Department of Ergonomics and Exercise Physiology, Faculty of Health Sciences, Jagiellonian University Medical College, 20 Grzegorzecka Street, 31-531 Cracow, Poland.
| | - Dagmara Wojcik
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, 16 Grzegorzecka Street, 31-531 Cracow, Poland.
| | - Marcin Magierowski
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, 16 Grzegorzecka Street, 31-531 Cracow, Poland.
| | - Marcin Surmiak
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, 16 Grzegorzecka Street, 31-531 Cracow, Poland.
| | - Slawomir Kwiecien
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, 16 Grzegorzecka Street, 31-531 Cracow, Poland.
| | - Katarzyna Magierowska
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, 16 Grzegorzecka Street, 31-531 Cracow, Poland.
| | - Magdalena Hubalewska-Mazgaj
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, 16 Grzegorzecka Street, 31-531 Cracow, Poland.
| | - Zbigniew Sliwowski
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, 16 Grzegorzecka Street, 31-531 Cracow, Poland.
| | - Tomasz Brzozowski
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, 16 Grzegorzecka Street, 31-531 Cracow, Poland.
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