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King JW, Bennett ASW, Wood HM, Baker CC, Alsaadi H, Topley M, Vanner SA, Reed DE, Lomax AE. Expression and function of transient receptor potential melastatin 3 in the spinal afferent innervation of the mouse colon. Am J Physiol Gastrointest Liver Physiol 2024; 326:G176-G186. [PMID: 38084411 DOI: 10.1152/ajpgi.00230.2023] [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: 10/11/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 01/27/2024]
Abstract
Abdominal pain is a cardinal symptom of inflammatory bowel disease (IBD). Transient receptor potential (TRP) channels contribute to abdominal pain in preclinical models of IBD, and TRP melastatin 3 (TRPM3) has recently been implicated in inflammatory bladder and joint pain in rodents. We hypothesized that TRPM3 is involved in colonic sensation and is sensitized during colitis. We used immunohistochemistry, ratiometric Ca2+ imaging, and colonic afferent nerve recordings in mice to evaluate TRPM3 protein expression in colon-projecting dorsal root ganglion (DRG) neurons, as well as functional activity in DRG neurons and colonic afferent nerves. Colitis was induced using dextran sulfate sodium (DSS) in drinking water. TRPM3 protein expression was observed in 76% of colon-projecting DRG neurons and was often colocalized with calcitonin gene-related peptide. The magnitudes of intracellular Ca2+ transients in DRG neurons in response to the TRPM3 agonists CIM-0216 and pregnenolone sulfate sodium were significantly greater in neurons from mice with colitis compared with controls. In addition, the percentage of DRG neurons from mice with colitis that responded to CIM-0216 was significantly increased. CIM-0216 also increased the firing rate of colonic afferent nerves from control and mice with colitis. The TRPM3 inhibitor isosakuranetin inhibited the mechanosensitive response to distension of wide dynamic range afferent nerve units from mice with colitis but had no effect in control mice. Thus, TRPM3 contributes to colonic sensory transduction and may be a potential target for treating pain in IBD.NEW & NOTEWORTHY This is the first study to characterize TRPM3 protein expression and function in colon-projecting DRG neurons. A TRPM3 agonist excited DRG neurons and colonic afferent nerves from healthy mice. TRPM3 agonist responses in DRG neurons were elevated during colitis. Inhibiting TRPM3 reduced the firing of wide dynamic range afferent nerves from mice with colitis but had no effect in control mice.
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Affiliation(s)
- James W King
- Gastrointestinal Diseases Research Unit, Queen's University, Kingston, Ontario, Canada
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Aidan S W Bennett
- Gastrointestinal Diseases Research Unit, Queen's University, Kingston, Ontario, Canada
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Hannah M Wood
- Gastrointestinal Diseases Research Unit, Queen's University, Kingston, Ontario, Canada
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Corey C Baker
- Gastrointestinal Diseases Research Unit, Queen's University, Kingston, Ontario, Canada
| | - Hanin Alsaadi
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Max Topley
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Stephen A Vanner
- Gastrointestinal Diseases Research Unit, Queen's University, Kingston, Ontario, Canada
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - David E Reed
- Gastrointestinal Diseases Research Unit, Queen's University, Kingston, Ontario, Canada
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Alan E Lomax
- Gastrointestinal Diseases Research Unit, Queen's University, Kingston, Ontario, Canada
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
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Baillie S, Norton C, Saxena S, Pollok R. Chronic abdominal pain in inflammatory bowel disease: a practical guide. Frontline Gastroenterol 2023; 15:144-153. [PMID: 38420131 PMCID: PMC10897648 DOI: 10.1136/flgastro-2023-102471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/12/2023] [Indexed: 03/02/2024] Open
Abstract
Pain is common in inflammatory bowel disease (IBD), yet many patients feel their pain is not addressed by healthcare professionals. Listening to a patient's concerns about pain, assessing symptoms and acknowledging the impact these have on daily life remain crucial steps in addressing pain in IBD. While acute pain may be effectively controlled by pain medication, chronic pain is more complex and often pharmacological therapies, particularly opioids, are ineffective. Low-dose tricyclic antidepressants and psychological approaches, including cognitive-behavioural therapy, have shown some promise in offering effective pain management while lifestyle changes such as a trial of low-fermentable oligosaccharides, disaccharides, monosaccharides and polyols diet in those with overlapping irritable bowel syndrome may also reduce pain. Patients benefit from a long-term, trusting relationship with their healthcare professional to allow a holistic approach combining pharmacological, psychological, lifestyle and dietary approaches to chronic pain. We present a practical review to facilitate management of chronic abdominal pain in IBD.
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Affiliation(s)
- Samantha Baillie
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Christine Norton
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Sonia Saxena
- Primary Care and Public Health, Imperial College London, London, UK
| | - Richard Pollok
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
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Trieschmann K, Chang L, Park S, Naliboff B, Joshi S, Labus JS, Sauk JS, Limketkai BN, Mayer EA. The visceral sensitivity index: A novel tool for measuring GI-symptom-specific anxiety in inflammatory bowel disease. Neurogastroenterol Motil 2022; 34:e14384. [PMID: 35478469 PMCID: PMC9427691 DOI: 10.1111/nmo.14384] [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: 09/02/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are chronic gastrointestinal (GI) disorders. GI symptom-specific anxiety (GSA) is the cognitive, affective, and behavioral response stemming from fear of GI symptoms. The Visceral Sensitivity Index (VSI) measures GSA and is validated in IBS and may be useful in IBD. METHODS We compared VSI scores in IBD participants to IBS participants and healthy controls (HCs). Using validated questionnaires, we assessed the VSI's correlation with anxiety, health-related quality of life (HRQOL), and IBD activity. KEY RESULTS We recruited 222 age- and sex-matched participants (74 IBD [23 Crohn's disease; 51 ulcerative colitis], 74 IBS, and 74 HCs). IBD and IBS participants had higher VSI scores compared with HCs (IBD = 26.62 ± 16.64, IBS = 38.83 ± 15.06; HCs = 3.42±5.06; all p's < 0.001). VSI scores were lower in IBD vs IBS (p < 0.001). In IBD, VSI modestly correlated with current anxiety (R = 0.35, p = 0.002) and the physical component of HRQOL (R = -0.45, p = 0.0001) but less with the mental component of HRQOL (R = -0.23, p = 0.05). CONCLUSIONS & INFERENCES Our findings suggest the VSI is a useful measure in IBD. The VSI in IBD is related to general anxiety but is measuring a different construct and is not affected by the presence of trait anxiety. IBD patients have GSA that is associated with decreased HRQOL, which can negatively affect treatment compliance and other long-term disease outcomes. Future studies are needed to further validate the VSI in IBD and to assess its correlation with disease activity.
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Affiliation(s)
- Kimberly Trieschmann
- UCLA Division of Pediatric Gastroenterology, Hepatology, and Nutrition, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Lin Chang
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Disease, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Sarah Park
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Disease, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Bruce Naliboff
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Disease, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Swapna Joshi
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Disease, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jennifer S. Labus
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Disease, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jenny S. Sauk
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Berkeley N. Limketkai
- UCLA Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Emeran A. Mayer
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Disease, David Geffen School of Medicine at UCLA, Los Angeles, California
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Ceballos D, Hernández-Camba A, Ramos L. Diet and microbiome in the beginning of the sequence of gut inflammation. World J Clin Cases 2021; 9:11122-11147. [PMID: 35071544 PMCID: PMC8717522 DOI: 10.12998/wjcc.v9.i36.11122] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 08/26/2021] [Accepted: 11/18/2021] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic inflammatory condition of the gastrointestinal tract due, at least partially, to an aberrant and excessive mucosal immune response to gut bacteria in genetically-predisposed individuals under certain environmental factors. The incidence of IBD is rising in western and newly industrialized countries, paralleling the increase of westernized dietary patterns, through new antigens, epithelial function and permeability, epigenetic mechanisms (e.g., DNA methylation), and alteration of the gut microbiome. Alteration in the composition and functionality of the gut microbiome (including bacteria, viruses and fungi) seems to be a nuclear pathogenic factor. The microbiome itself is dynamic, and the changes in food quality, dietary habits, living conditions and hygiene of these western societies, could interact in a complex manner as modulators of dysbiosis, thereby influencing the activation of immune cells' promoting inflammation. The microbiome produces diverse small molecules via several metabolic ways, with the fiber-derived short-chain fatty acids (i.e., butyrate) as main elements and having anti-inflammatory effects. These metabolites and some micronutrients of the diet (i.e., vitamins, folic acid, beta carotene and trace elements) are regulators of innate and adaptive intestinal immune homeostasis. An excessive and unhealthy consumption of sugar, animal fat and a low-vegetable and -fiber diet are risk factors for IBD appearance. Furthermore, metabolism of nutrients in intestinal epithelium and in gut microbiota is altered by inflammation, changing the demand for nutrients needed for homeostasis. This role of food and a reduced gut microbial diversity in causing IBD might also have a prophylactic or therapeutic role for IBD. The relationship between dietary intake, symptoms, and bowel inflammation could lead to dietary and lifestyle recommendations, including diets with abundant fruits, vegetables, olive oil and oily fish, which have anti-inflammatory effects and could prevent dysbiosis and IBD. Dietary modulation and appropriate exclusion diets might be a new complementary management for treatment at disease flares and in refractory patients, even reducing complications, hospitalizations and surgery, through modifying the luminal intestinal environment.
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Affiliation(s)
- Daniel Ceballos
- Department of Gastroenterology, Hospital Universitario de Gran Canaria Doctor Negrin, Las Palmas 35019, Canarias, Spain
| | - A Hernández-Camba
- Department of Gastroenterology, Hospital Universitario Nuestra Señora de La Candelaria, Santa Cruz de Tenerife 38010, Canarias, Spain
| | - Laura Ramos
- Department of Gastroenterology, Hospital Universitario de Canarias, San Cristóbal de La Laguna 38320, Canarias, Spain
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Midenfjord I, Grinsvall C, Koj P, Carnerup I, Törnblom H, Simrén M. Central sensitization and severity of gastrointestinal symptoms in irritable bowel syndrome, chronic pain syndromes, and inflammatory bowel disease. Neurogastroenterol Motil 2021; 33:e14156. [PMID: 33860970 DOI: 10.1111/nmo.14156] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/25/2021] [Accepted: 03/23/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Central sensitization has been suggested as an explanation of the wide range of gastrointestinal and extraintestinal symptoms commonly seen in irritable bowel syndrome (IBS). In this study, the presence and level of central sensitization, and its association to gastrointestinal (GI) symptoms were explored in IBS in comparison with control groups. METHODS We investigated patients with IBS (n = 215), chronic pain disorders (n = 36), and inflammatory bowel disease (IBD) (n = 40) and volunteers without chronic diseases (n = 112). The Central Sensitization Inventory (CSI) was translated and validated in Swedish and used together with the Highly Sensitive Person (HSP) scale to measure the presence and level of central sensitization. Furthermore, severity of GI symptoms (GSRS-IBS and IBS-SSS), and anxiety and depression (HAD) were determined. KEY RESULTS The Swedish translation of CSI demonstrated excellent validity. Central sensitization, defined by validated cut-off levels for CSI and HSP, was common in the whole cohort (40% and 28%) and in IBS (57% and 35%). Study participants with central sensitization had more severe GI symptoms, anxiety and depression, than participants without central sensitization. Strong associations were seen between CSI and GI symptom severity in the whole cohort (GSRS-IBS: partial η2 = 0.455, p < 0.001; IBS-SSS: partial η2 = 0.408, p < 0.001), with decreasing strength in patients with chronic pain, IBD, IBS, and volunteers. CONCLUSION AND INFERENCES Central sensitization was common in IBS and associated with GI symptom severity, but with stronger associations in chronic pain disorders and IBD. This implies that other mechanisms may be of equal or greater importance for GI symptom severity in IBS.
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Affiliation(s)
- Irina Midenfjord
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Cecilia Grinsvall
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Koj
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ida Carnerup
- Pain Rehabilitation, Skane University Hospital, Lund, Sweden
| | - Hans Törnblom
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Magnus Simrén
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, NC, USA
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6
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Friedman AB, Asthana A, Knowles SR, Robbins A, Gibson PR. Effect of point-of-care gastrointestinal ultrasound on decision-making and management in inflammatory bowel disease. Aliment Pharmacol Ther 2021; 54:652-666. [PMID: 34157157 DOI: 10.1111/apt.16452] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/30/2020] [Accepted: 05/15/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Gastrointestinal ultrasound is increasingly used for point of care assessment of inflammatory bowel disease. AIMS To explore the utility of gastrointestinal ultrasound as a point-of-care assessment tool from the perspectives of the clinician and patient. METHODS A prospective, observational cohort study was designed utilising routine outpatient consultations. Adult patients with inflammatory bowel disease were allocated to receive gastrointestinal ultrasound or not at the discretion of their treating clinician. Patients completed self-reported session experience questionnaires at study entry, immediately after their consultation, and 4 and 16 weeks later. Clinicians reported disease activity status, therapeutic decisions and clinical management. RESULTS Of 259 participants, mean age 40 (SD: 13) years, 54% male, 73 (28%) underwent ultrasound. Time since diagnosis was 9.2 (8.5) years (ultrasound) and 11.3 (9.2) years (no ultrasound). Immediately after ultrasound, patients who self-reported active disease reported better understanding of all aspects of their disease and disease symptoms were more confident in their ability to make informed decisions about managing their disease and had improved knowledge domain scores compared with the non-ultrasound group (all P < 0.05). Ultrasound had no influence over the patients' ability to manage their own healthcare but tended to be associated with transient improvement in medication adherence. After the ultrasound, the clinician's assessment of patient's disease activity changed in 22% (16/73) and management was altered in 56% (41/73) with anti-inflammatory therapy escalated in 33. About 47% (23/49) patients with Crohn's disease had their medication changed in the ultrasound group, compared to only 22% (25/112) in the nonultrasound group (P = 0.002). For patients with ulcerative colitis, medications were altered in 68% (15/22) compared to 26% (24/70) in the nonultrasound group (P = 0.005) When stratified for disease activity, medication change was more likely in those having ultrasound (P = 0.024). CONCLUSIONS Point-of-care gastrointestinal ultrasound has the potential to enhance the clinical management of inflammatory bowel disease by contributing to clinician decision-making and education of patients regarding their disease.
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Affiliation(s)
- Antony B Friedman
- Department of Gastroenterology, Alfred Hospital and Monash University, Melbourne, Vic., Australia
| | - Anil Asthana
- Department of Gastroenterology, Alfred Hospital and Monash University, Melbourne, Vic., Australia.,Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Vic., Australia
| | - Simon R Knowles
- Department of Gastroenterology, Alfred Hospital and Monash University, Melbourne, Vic., Australia.,Department of Psychology, Swinburne University of Technology, Melbourne, Vic., Australia
| | | | - Peter R Gibson
- Department of Gastroenterology, Alfred Hospital and Monash University, Melbourne, Vic., Australia
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Ahola Kohut S, Martincevic I, Turrell SL, Church PC, Walters TD, Weiser N, Iuliano A. Online Acceptance and Commitment Therapy and Nutrition Workshop for Parents of Children with Inflammatory Bowel Disease: Feasibility, Acceptability, and Initial Effectiveness. CHILDREN-BASEL 2021; 8:children8050396. [PMID: 34069305 PMCID: PMC8156170 DOI: 10.3390/children8050396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/09/2021] [Accepted: 05/11/2021] [Indexed: 11/29/2022]
Abstract
Parents of children with inflammatory bowel disease (IBD) are important members of their healthcare team and influence their child’s adaptation to disease. The primary aim of this research was to test the feasibility and acceptability of a three-session online parent workshop based on acceptance and commitment therapy (ACT) and address concerns about eating well and nutrition in IBD. The secondary aim was to explore the initial effectiveness of this workshop in parent reported psychological flexibility, mindfulness, experiential avoidance, cognitive fusion, valued living, and symptoms of depression, anxiety, and stress. We used a single arm pragmatic prospective study design with parents of children attending the IBD program at a tertiary pediatric healthcare centre in Canada. Mixed methods patient reported outcomes were measured at baseline, immediate post participation, and 3 months post participation in the workshop. Thirty-seven parents enrolled in the study and feasibility and acceptability goals were largely met. Parents qualitatively described changes to their parenting, what aspects of the workshop were most helpful, and targeted feedback on how to improve workshop. Findings suggest that providing parents of children with IBD a brief online ACT workshop including nutrition guidance is feasible and leads to changes in parenting behaviours.
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Affiliation(s)
- Sara Ahola Kohut
- Department of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (P.C.C.); (T.D.W.)
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON M5G 1X8, Canada; (N.W.); (A.I.)
- Department of Psychiatry, University of Toronto, Toronto, ON M5G 1X8, Canada
- Correspondence:
| | - Inez Martincevic
- Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
| | | | - Peter C. Church
- Department of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (P.C.C.); (T.D.W.)
- Department of Paediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Thomas D. Walters
- Department of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (P.C.C.); (T.D.W.)
- Department of Paediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Natalie Weiser
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON M5G 1X8, Canada; (N.W.); (A.I.)
| | - Armanda Iuliano
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON M5G 1X8, Canada; (N.W.); (A.I.)
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Caio G, Lungaro L, Caputo F, Zoli E, Giancola F, Chiarioni G, De Giorgio R, Zoli G. Nutritional Treatment in Crohn's Disease. Nutrients 2021; 13:nu13051628. [PMID: 34066229 PMCID: PMC8151495 DOI: 10.3390/nu13051628] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 12/12/2022] Open
Abstract
Crohn's disease (CD) is a chronic inflammatory bowel disease (IBD) which can affect any part of the whole gastrointestinal tract (from mouth to anus). Malnutrition affects 65-75% of CD patients, and it is now well acknowledged that diet is of paramount importance in the management of the disease. In this review, we would like to highlight the most recent findings in the field of nutrition for the treatment of CD. Our analysis will cover a wide range of topics, from the well-established diets to the new nutritional theories, along with the recent progress in emerging research fields, such as nutrigenomics.
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Affiliation(s)
- Giacomo Caio
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (L.L.); (F.C.); (E.Z.); (F.G.); (R.D.G.)
- Center for the Study and Treatment of Chronic Inflammatory Intestinal Diseases (IBD) and Gastroenterological Manifestations of Rare Diseases, Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
- Center for the Study and Treatment of Alcohol-Related Diseases, Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital-Harvard Medical School, Boston, MA 02114, USA
- Correspondence: (G.C.); (G.Z.); Tel.: +39-0532-236823 (G.C.); +39-051-6838307 (G.Z.)
| | - Lisa Lungaro
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (L.L.); (F.C.); (E.Z.); (F.G.); (R.D.G.)
- Department of Internal Medicine, Santissima Annunziata Hospital, Cento (Ferrara), University of Ferrara, 44042 Ferrara, Italy
| | - Fabio Caputo
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (L.L.); (F.C.); (E.Z.); (F.G.); (R.D.G.)
- Center for the Study and Treatment of Chronic Inflammatory Intestinal Diseases (IBD) and Gastroenterological Manifestations of Rare Diseases, Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
- Center for the Study and Treatment of Alcohol-Related Diseases, Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
- Department of Internal Medicine, Santissima Annunziata Hospital, Cento (Ferrara), University of Ferrara, 44042 Ferrara, Italy
| | - Eleonora Zoli
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (L.L.); (F.C.); (E.Z.); (F.G.); (R.D.G.)
- Department of Internal Medicine, Santissima Annunziata Hospital, Cento (Ferrara), University of Ferrara, 44042 Ferrara, Italy
| | - Fiorella Giancola
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (L.L.); (F.C.); (E.Z.); (F.G.); (R.D.G.)
| | - Giuseppe Chiarioni
- Division of Gastroenterology of the University of Verona, A.O.U.I. Verona, 37126 Verona, Italy;
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7080, USA
| | - Roberto De Giorgio
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (L.L.); (F.C.); (E.Z.); (F.G.); (R.D.G.)
- Center for the Study and Treatment of Chronic Inflammatory Intestinal Diseases (IBD) and Gastroenterological Manifestations of Rare Diseases, Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
- Center for the Study and Treatment of Alcohol-Related Diseases, Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Giorgio Zoli
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (L.L.); (F.C.); (E.Z.); (F.G.); (R.D.G.)
- Center for the Study and Treatment of Chronic Inflammatory Intestinal Diseases (IBD) and Gastroenterological Manifestations of Rare Diseases, Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
- Center for the Study and Treatment of Alcohol-Related Diseases, Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
- Department of Internal Medicine, Santissima Annunziata Hospital, Cento (Ferrara), University of Ferrara, 44042 Ferrara, Italy
- Correspondence: (G.C.); (G.Z.); Tel.: +39-0532-236823 (G.C.); +39-051-6838307 (G.Z.)
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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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10
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Feasibility and Acceptability of a Mindfulness-Based Group Intervention for Adolescents with Inflammatory Bowel Disease. J Clin Psychol Med Settings 2021; 27:68-78. [PMID: 31065861 DOI: 10.1007/s10880-019-09622-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The aim of the study is to explore the feasibility and initial outcomes of a mindfulness-based group intervention (MBI) for adolescents with inflammatory bowel disease (IBD). A mixed-methods uncontrolled study using an adapted 8-week group MBI for adolescents with IBD was conducted at a pediatric tertiary hospital. Primary outcomes focused on feasibility. Secondary outcomes focused on preliminary efficacy via quality of life, mindfulness, and symptoms of anxiety and depression. Of a total of 44 adolescents invited to participate, 16 adolescents completed the study. Group attendance and home meditation practice was satisfactory. There were significant differences in emotional functioning relative to IBD following MBI-A participation. Qualitative analysis rendered two themes: (1) personal interpretation and application of mindfulness and (2) the benefits of IBD-specific peer support. Several key adaptations are needed to increase feasibility of group MBIs prior to randomized controlled trials. Findings can be generalized to inform group-based therapies for adolescents with IBD.
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11
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Peppas S, Pansieri C, Piovani D, Danese S, Peyrin-Biroulet L, Tsantes AG, Brunetta E, Tsantes AE, Bonovas S. The Brain-Gut Axis: Psychological Functioning and Inflammatory Bowel Diseases. J Clin Med 2021; 10:377. [PMID: 33498197 PMCID: PMC7863941 DOI: 10.3390/jcm10030377] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/11/2021] [Accepted: 01/18/2021] [Indexed: 02/07/2023] Open
Abstract
The brain-gut axis represents a complex bi-directional system comprising multiple interconnections between the neuroendocrine pathways, the autonomous nervous system and the gastrointestinal tract. Inflammatory bowel disease (IBD), comprising Crohn's disease and ulcerative colitis, is a chronic, relapsing-remitting inflammatory disorder of the gastrointestinal tract with a multifactorial etiology. Depression and anxiety are prevalent among patients with chronic disorders characterized by a strong immune component, such as diabetes mellitus, cancer, multiple sclerosis, rheumatoid arthritis and IBD. Although psychological problems are an important aspect of morbidity and of impaired quality of life in patients with IBD, depression and anxiety continue to be under-diagnosed. There is lack of evidence regarding the exact mechanisms by which depression, anxiety and cognitive dysfunction may occur in these patients, and whether psychological disorders are the result of disease activity or determinants of the IBD occurrence. In this comprehensive review, we summarize the role of the brain-gut axis in the psychological functioning of patients with IBD, and discuss current preclinical and clinical data on the topic and therapeutic strategies potentially useful for the clinical management of these patients. Personalized pathways of psychological supports are needed to improve the quality of life in patients with IBD.
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Affiliation(s)
- Spyros Peppas
- Department of Gastroenterology, Athens Naval Hospital, 11521 Athens, Greece;
| | - Claudia Pansieri
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (C.P.); (S.D.); (E.B.)
- Humanitas Clinical and Research Center–IRCCS, 20089 Milan, Italy
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (C.P.); (S.D.); (E.B.)
- Humanitas Clinical and Research Center–IRCCS, 20089 Milan, Italy
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (C.P.); (S.D.); (E.B.)
- Humanitas Clinical and Research Center–IRCCS, 20089 Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Inserm U1256 NGERE, Nancy University Hospital, Lorraine University, 54500 Vandoeuvre-les-Nancy, France;
| | - Andreas G. Tsantes
- Attiko Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.G.T.); (A.E.T.)
| | - Enrico Brunetta
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (C.P.); (S.D.); (E.B.)
- Humanitas Clinical and Research Center–IRCCS, 20089 Milan, Italy
| | - Argirios E. Tsantes
- Attiko Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.G.T.); (A.E.T.)
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (C.P.); (S.D.); (E.B.)
- Humanitas Clinical and Research Center–IRCCS, 20089 Milan, Italy
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12
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Szałwińska P, Włodarczyk J, Spinelli A, Fichna J, Włodarczyk M. IBS-Symptoms in IBD Patients-Manifestation of Concomitant or Different Entities. J Clin Med 2020; 10:jcm10010031. [PMID: 33374388 PMCID: PMC7794700 DOI: 10.3390/jcm10010031] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/14/2020] [Accepted: 12/22/2020] [Indexed: 12/12/2022] Open
Abstract
Irritable bowel syndrome (IBS) is a functional heterogenous disease with a multifactorial pathogenesis. It is characterized by abdominal pain, discomfort, and alteration in gut motility. The occurrence of similar symptoms was observed in patients in clinical remission of inflammatory bowel diseases (IBD) that is Crohn's disease (CD) and ulcerative colitis (UC), which pathogenesis is also not fully understood. Hence, arose the question if these symptoms are "true IBS" imposed on IBD, or is it a subclinical form of IBD or even pre-IBD? In this article, based on a narrative overview of the literature, we try to find an answer to this query by discussing the pathogenesis and overlaps between these conditions.
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Affiliation(s)
- Patrycja Szałwińska
- Department of Biochemistry, Medical University of Lodz, Mazowiecka 6/8, 92-215 Lodz, Poland; (P.S.); (J.W.); (J.F.)
| | - Jakub Włodarczyk
- Department of Biochemistry, Medical University of Lodz, Mazowiecka 6/8, 92-215 Lodz, Poland; (P.S.); (J.W.); (J.F.)
- Department of General and Colorectal Surgery, Medical University of Lodz, Haller Square 1, 90-624 Lodz, Poland
| | - Antonino Spinelli
- Colon and Rectal Surgery Division, Humanitas Clinical and Research Center IRCCS, Rozzano, 20089 Milano, Italy;
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milano, Italy
| | - Jakub Fichna
- Department of Biochemistry, Medical University of Lodz, Mazowiecka 6/8, 92-215 Lodz, Poland; (P.S.); (J.W.); (J.F.)
| | - Marcin Włodarczyk
- Department of General and Colorectal Surgery, Medical University of Lodz, Haller Square 1, 90-624 Lodz, Poland
- Correspondence:
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13
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Pagoldh J, Lundgren D, Suhr OB, Karling P. Irritable bowel syndrome-like symptoms in treated microscopic colitis patients compared with controls: a cross-sectional study. Gastroenterol Rep (Oxf) 2020; 8:374-380. [PMID: 33163193 PMCID: PMC7603863 DOI: 10.1093/gastro/goz069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/04/2019] [Accepted: 11/30/2019] [Indexed: 12/12/2022] Open
Abstract
Background The prevalence of irritable bowel syndrome (IBS)-like symptoms is high in untreated patients with microscopic colitis (MC), but there is uncertainty of the prevalence of IBS-like symptoms in treated patients. We assessed the degree of IBS-like symptoms in patients with MC in comparison to control subjects, and investigated the association between IBS-like symptoms and faecal calprotectin (FC) in MC patients. Methods Patients with an established MC diagnosis (n = 57) were compared to sex- and age-matched controls (n = 138) for scores in the GSRS-IBS (Gastrointestinal Symptom Rating Scale for Irritable Bowel Syndrome) and HADS (Hospital Anxiety Depression Scale). In MC patients, an FC level was simultaneously analysed. Results The median interval from MC diagnoses to the time the subjects participated in the study was 5.5 years (25th–75th percentiles; 4.5–9.5 years). The total GSRS-IBS score, subscores for abdominal pain, bloating, and diarrhoea were significantly higher in MC patients compared to controls (all P < 0.001). There was a significant correlation between FC levels and reported bowel frequency (P = 0.023), but there was no correlation between FC levels and GSRS-IBS scores. Patients with MC had significantly higher scores on anxiety (HADS-A) (P < 0.001) and used more selective serotonin-reuptake-inhibitor drugs (P = 0.016) than the control subjects. However, only the control subjects (not the patients with MC) showed significant correlations between GSRS-IBS scores and HADS scores. Conclusions Patients with MC reported more IBS-like symptoms and anxiety than control subjects but neither FC levels nor symptoms of affectivity were significantly correlated with IBS-like symptoms.
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Affiliation(s)
- Jenny Pagoldh
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - David Lundgren
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Ole B Suhr
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Pontus Karling
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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14
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Song JH, Kim JW, Oh CH, Kim HJ, Lee CK, Kang WS. Depression, Anxiety, Related Risk Factors and Cognitive Distortion in Korean Patients with Inflammatory Bowel Disease. Psychiatry Investig 2020; 17:1126-1136. [PMID: 33115188 PMCID: PMC7711122 DOI: 10.30773/pi.2020.0299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/08/2020] [Accepted: 10/13/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To evaluate the severity of depression, anxiety, associated risk factors, and cognitive distortion in Korean patients with ulcerative colitis (UC) and Crohn's disease (CD). METHODS This study included 369 patients with inflammatory bowel disease. The severity of depression and anxiety was examined using Patient Health Questionnaire-9 and Hospital Anxiety and Depression Scale. The Anxious Thoughts and Tendencies scale was used to measure catastrophizing tendency. Multivariate regression analyses were performed. RESULTS The predictors of depression were marital status, anti-tumor necrosis factor-α (TNF-α) agent use, age, and body mass index in UC patients and marital status, disease activity, alcohol use, and employment status in CD patients. For anxiety, sex and marital status were the associated factors in UC patients, whereas steroid use was the only significant predictor in CD patients. Comparing the cognitive distortion level, there were no significant differences between UC and CD patients although there was an increasing tendency according to the severity of depression or anxiety. CONCLUSION If patients are accompanied by high levels of depression or anxiety and their associated risk factors including TNF-α agent or steroid use, it is recommended that not only symptoms are treated but also cognitive approach and evaluation be performed.
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Affiliation(s)
- Jun Ho Song
- Department of Psychiatry, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Jong Woo Kim
- Department of Psychiatry, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Chi Hyuk Oh
- Center for Crohn’s and Colitis, Department of Gastroenterology, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Hyo Jong Kim
- Center for Crohn’s and Colitis, Department of Gastroenterology, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Chang Kyun Lee
- Center for Crohn’s and Colitis, Department of Gastroenterology, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Won Sub Kang
- Department of Psychiatry, Kyung Hee University College of Medicine, Seoul, Republic of Korea
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15
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Supraspinal Mechanisms of Intestinal Hypersensitivity. Cell Mol Neurobiol 2020; 42:389-417. [PMID: 33030712 DOI: 10.1007/s10571-020-00967-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/22/2020] [Indexed: 12/13/2022]
Abstract
Gut inflammation or injury causes intestinal hypersensitivity (IHS) and hyperalgesia, which can persist after the initiating pathology resolves, are often referred to somatic regions and exacerbated by psychological stress, anxiety or depression, suggesting the involvement of both the spinal cord and the brain. The supraspinal mechanisms of IHS remain to be fully elucidated, however, over the last decades the series of intestinal pathology-associated neuroplastic changes in the brain has been revealed, being potentially responsible for the phenomenon. This paper reviews current clinical and experimental data, including the authors' own findings, on these functional, structural, and neurochemical/molecular changes within cortical, subcortical and brainstem regions processing and modulating sensory signals from the gut. As concluded in the review, IHS can develop and maintain due to the bowel inflammation/injury-induced persistent hyperexcitability of viscerosensory brainstem and thalamic nuclei and sensitization of hypothalamic, amygdala, hippocampal, anterior insular, and anterior cingulate cortical areas implicated in the neuroendocrine, emotional and cognitive modulation of visceral sensation and pain. An additional contribution may come from the pathology-triggered dysfunction of the brainstem structures inhibiting nociception. The mechanism underlying IHS-associated regional hyperexcitability is enhanced NMDA-, AMPA- and group I metabotropic receptor-mediated glutamatergic neurotransmission in association with altered neuropeptide Y, corticotropin-releasing factor, and cannabinoid 1 receptor signaling. These alterations are at least partially mediated by brain microglia and local production of cytokines, especially tumor necrosis factor α. Studying the IHS-related brain neuroplasticity in greater depth may enable the development of new therapeutic approaches against chronic abdominal pain in inflammatory bowel disease.
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16
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Larussa T, Flauti D, Abenavoli L, Boccuto L, Suraci E, Marasco R, Imeneo M, Luzza F. The Reality of Patient-Reported Outcomes of Health-Related Quality of Life in an Italian Cohort of Patients with Inflammatory Bowel Disease: Results from a Cross-Sectional Study. J Clin Med 2020; 9:jcm9082416. [PMID: 32731482 PMCID: PMC7464775 DOI: 10.3390/jcm9082416] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023] Open
Abstract
Inflammatory bowel disease (IBD) has a negative impact on patients’ physical and psychological well-being, social performance, and working capacity, thereby worsening their health-related quality of life (HRQoL). Clinicians should take care of the patients’ global health, including the psychological, social, and emotional spheres. We aimed to investigate the reality of patient-reported outcomes of HRQoL in a series of IBD patients. Consecutive Crohn´s disease (CD) and ulcerative colitis (UC) patients in clinical remission were recruited. The survey consisted of the Short Inflammatory Bowel Disease Questionnaire (S-IBDQ), the Hospital Anxiety and Depression Scale (HADS), the Brief Illness Perception Questionnaire (B-IPQ), and a questionnaire dealing with impact of IBD on patients’ lives. Demographic and clinical characteristics were recorded. Of 202 participants (29% CD and 71% UC; 54% male; median age 48 years; mean disease duration 14 ± 11 years), 52% had poor HRQoL, 45% anxiety/depression, and 35% sleep disturbance and a high perception of disease (mean score 42.8 ± 14.3). In the multivariate analysis, a low HRQoL was rather associated with UC than CD (p = 0.037), IBD surgery (p = 0.010), disease duration (p = 0.01), sleep disturbance (p = 0.014), anxiety/depression (p = 0.042), and high illness perception (p = 0.006). IBD affected working performance and social activities in 62% and 74% of patients, respectively. Satisfaction regarding quality of care, biologics, and surgery approach were claimed in 73%, 69%, and 76% of patients, respectively. Although 84% of patients trusted their gastroenterologist, only 66% of them discussed IBD impact on HRQoL during visit. In a series of IBD patients in remission, the low HRQoL was significantly associated with surgery, disease duration, sleep disturbance, anxiety/depression, and high illness perception. Even though patients were satisfied with the quality of their care, it appears that clinicians should pay more attention to patients’ emotional status.
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Affiliation(s)
- Tiziana Larussa
- Department of Health Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (T.L.); (D.F.); (L.A.); (E.S.); (R.M.); (M.I.)
| | - Danilo Flauti
- Department of Health Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (T.L.); (D.F.); (L.A.); (E.S.); (R.M.); (M.I.)
| | - Ludovico Abenavoli
- Department of Health Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (T.L.); (D.F.); (L.A.); (E.S.); (R.M.); (M.I.)
| | - Luigi Boccuto
- Greenwood Genetic Center, Greenwood, Clemson University, Clemson, SC 29631, USA;
| | - Evelina Suraci
- Department of Health Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (T.L.); (D.F.); (L.A.); (E.S.); (R.M.); (M.I.)
| | - Raffaella Marasco
- Department of Health Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (T.L.); (D.F.); (L.A.); (E.S.); (R.M.); (M.I.)
| | - Maria Imeneo
- Department of Health Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (T.L.); (D.F.); (L.A.); (E.S.); (R.M.); (M.I.)
| | - Francesco Luzza
- Department of Health Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (T.L.); (D.F.); (L.A.); (E.S.); (R.M.); (M.I.)
- Correspondence: ; Tel.: +39-0961-3647-113
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17
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Nazarian A, Bishay K, Gholami R, Scaffidi MA, Khan R, Cohen-Lyons D, Griller N, Satchwell JB, Baker JP, Grover SC, Irvine EJ. Factors Associated with Poor Quality of Life in a Canadian Cohort of Patients with Inflammatory Bowel Disease: A Cross-sectional Study. J Can Assoc Gastroenterol 2020; 4:91-96. [PMID: 33855267 PMCID: PMC8023811 DOI: 10.1093/jcag/gwaa014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 04/05/2020] [Indexed: 12/22/2022] Open
Abstract
Background Health-related quality of life (QoL) is often adversely affected in patients with inflammatory bowel disease (IBD). We aimed to identify factors associated with poor QoL among Canadian patients with IBD in clinical remission. Methods We enrolled patients at a single academic tertiary care center with inactive IBD. All eligible patients completed a series of questionnaires that included questions on demographics, disease activity, anxiety, depression and the presence of irritable bowel syndrome (IBS) symptoms. Stool sample for fecal calprotectin (FC) was also collected to assess for subclinical inflammation. The primary outcome measure was QoL assessed by the short inflammatory bowel disease questionnaire (SIBDQ), with planned subgroup comparisons for fatigue, anxiety, depression and IBS symptoms. Results Ninety-three patients were eligible for inclusion in this study. The median SIBDQ scores were lower in patients with anxiety (P < 0.001), depression (P = 0.004), IBS symptoms (P < 0.001) and fatigue (P = 0.018). Elevated FC in patients in clinical remission did not impact QoL. These findings were consistent on multivariate linear regression. Conclusions Anxiety, depression, fatigue and IBS symptoms are all independently associated with lower QoL in patients with inactive IBD. Clinicians are encouraged to screen for these important factors as they may detrimentally impact QoL in IBD patients even in clinical remission.
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Affiliation(s)
- Amir Nazarian
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Kirles Bishay
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Reza Gholami
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michael A Scaffidi
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Rishad Khan
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Daniel Cohen-Lyons
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Nadia Griller
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Joshua B Satchwell
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Jeffrey P Baker
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Samir C Grover
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada
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18
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Ozer M, Bengi G, Colak R, Cengiz O, Akpinar H. Prevalence of irritable bowel syndrome-like symptoms using Rome IV criteria in patients with inactive inflammatory bowel disease and relation with quality of life. Medicine (Baltimore) 2020; 99:e20067. [PMID: 32384473 PMCID: PMC7220554 DOI: 10.1097/md.0000000000020067] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Irritable bowel syndrome (IBS)-like symptoms tend to be common in inflammatory bowel disease (IBD) patients even during the long-standing remission phase, and quality of life (QOL) seem to reduce in IBD patients with such symptoms. Thus, the aim of this study was to define the prevalence of IBS-like symptoms in inactive IBD patients using Rome IV criteria and evaluate the effect of IBS-like symptoms on QOL.Total 137 patients with IBD (56 with ulcerative colitis (UC) and 81 with Crohn disease (CD), who had been in long-standing remission according to the clinical scoring system and 123 control participants were included. These patients completed questionnaires to evaluate IBS-like symptoms according to Rome IV criteria, and the impact of these symptoms on the QOL of inactive IBD patients was compared with and without IBS-like symptoms according to disease-specific inflammatory bowel disease questionnaire (IBDQ).Depending on our research, IBS-like symptoms were found in 32% (18/56) of patients with inactive UC, 35% (29/81) of patients with inactive CD, and 13.8% (17/123) of control participants (P < .001). The QOL seemed to be significantly lower in both inactive UC and CD patients with IBS-like symptoms than in those without such symptoms (P < .001).In conclusion, we defined that the prevalence of IBS-like symptoms in IBD patients in remission is 2 to 3 times higher than that in healthy control participants, and significantly lower IBDQ scores showed QOL was reduced in inactive IBD patients with IBS-like symptoms as compared with patients without IBS-like symptoms.
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Affiliation(s)
- Muhammet Ozer
- Dokuz Eylul University, Department of Internal Medicine, Izmir, Turkey
- Capital Health Regional Medical Center, Department of Internal Medicine, Trenton, NJ, USA
| | - Goksel Bengi
- Dokuz Eylul University, Division of Gastroenterology, Izmir, Turkey
| | - Rumeysa Colak
- Dokuz Eylul University, Department of Internal Medicine, Izmir, Turkey
| | - Ozan Cengiz
- Dokuz Eylul University, Division of Gastroenterology, Izmir, Turkey
| | - Hale Akpinar
- Dokuz Eylul University, Division of Gastroenterology, Izmir, Turkey
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19
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Theofanous SA, Florens MV, Appeltans I, Denadai Souza A, Wood JN, Wouters MM, Boeckxstaens GE. Ephrin-B2 signaling in the spinal cord as a player in post-inflammatory and stress-induced visceral hypersensitivity. Neurogastroenterol Motil 2020; 32:e13782. [PMID: 32004400 DOI: 10.1111/nmo.13782] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 11/07/2019] [Accepted: 11/27/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Ephrin-B2/EphB receptor signaling contributes to persistent pain states such as postinflammatory and neuropathic pain. Visceral hypersensitivity (VHS) is a major mechanism underlying abdominal pain in patients with irritable bowel syndrome (IBS) and inflammatory bowel diseases (IBD) in remission, but the underlying pathophysiology remains unclear. Here, we evaluated the spinal ephrin-B2/EphB pathway in VHS in 2 murine models of VHS, that is, postinflammatory TNBS colitis and maternal separation (MS). METHODS Wild-type (WT) mice and mice lacking ephrin-B2 in Nav 1.8 nociceptive neurons (cKO) were studied. VHS was induced by: 1. intracolonic instillation of TNBS or 2. water avoidance stress (WAS) in mice that underwent maternal separation (MS). VHS was assessed by quantifying the visceromotor response (VMRs) during colorectal distention. Colonic tissue and spinal cord were collected for histology, gene, and protein expression evaluation. KEY RESULTS In WT mice, but not cKO mice, TNBS induced VHS at day 14 after instillation, which returned to baseline perception from day 28 onwards. In MS WT mice, WAS induced VHS for up to 4 weeks. In cKO however, visceral pain perception returned to basal level by week 4. The development of VHS in WT mice was associated with significant upregulation of spinal ephrin-B2 and EphB1 mRNA expression or protein levels in the TNBS model and upregulation of spinal ephrin-B2 protein in the MS model. No changes were observed in cKO mice. VHS was not associated with persistent intestinal inflammation. CONCLUSIONS AND INFERENCES Overall, our data indicate that the ephrin-B2/EphB1 spinal signaling pathway is involved in VHS and may represent a novel therapeutic target.
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Affiliation(s)
| | - Morgane V Florens
- Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Iris Appeltans
- Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | | | - John N Wood
- Molecular Nociception Group, Wolfson Institute for Biomedical Research (WIBR), University College London (UCL), London, UK
| | - Mira M Wouters
- Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Guy E Boeckxstaens
- Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
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20
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Ko CY, Yang YB, Chou D, Xu JH. The Ventrolateral Periaqueductal Gray Contributes to Depressive-Like Behaviors in Recovery of Inflammatory Bowel Disease Rat Model. Front Neurosci 2020; 14:254. [PMID: 32265648 PMCID: PMC7105903 DOI: 10.3389/fnins.2020.00254] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/06/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) experience depression, even in the remission phase of IBD symptoms. Although mapping depression-associated brain regions through the gut-brain axis can contribute to understanding the process, the mechanisms remain unclear. Our previous results support the idea that glutamatergic transmission in the ventrolateral periaqueductal gray (vlPAG) mediates stress-induced depression-like behaviors. Thus, we hypothesize that the vlPAG plays a role in regulating depression during remission of IBD. METHODS We used dextran sulfate sodium (DSS)-induced visceral pain model to evoke depression-like behaviors, assessed by tail suspension test (TST) and sucrose preference test (SPT), and electrophysiological recordings from vlPAG. RESULTS Symptoms of animals modeling IBD were relieved by replacing DSS solution with normal drinking water, but their depression-like behaviors sustained. Moreover, the impairment of glutamatergic neurotransmission in vlPAG was sustained as well. Pharmacologically, microinfusion of the glutamate receptor 1 (GluR1) antagonist NASPM into vlPAG mimicked the depression-like behaviors. Furthermore, intra-vlPAG application of AMPA and AMPA receptor-mediated antidepressant (2R,6R)-hydroxynorketamine [(2R,6R)-HNK] reversed the DSS-induced depression-like behaviors in the remission phase of visceral abnormalities. CONCLUSION Our results suggest that vlPAG glutamatergic transmission mediates depression-like behaviors during remission of DSS-induced visceral pain, suggesting that vlPAG mapping to the gut-brain axis contributes to depression during remission of IBD.
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Affiliation(s)
- Chih-Yuan Ko
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
- Department of Clinical Nutrition, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
- Respiratory Medicine Center of Fujian Province, Quanzhou, China
- The Sleep Medicine Key Laboratory of Fujian Medical Universities, Fujian Province University, Quanzhou, China
| | - Ya-Bi Yang
- Physical Examination Center, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
| | - Dylan Chou
- Department of Physiology, Zunyi Medical University, Zhuhai, China
| | - Jian-Hua Xu
- Department of Tumor Surgery, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
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21
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Khera AJ, Chase JW, Salzberg M, Thompson AJV, Kamm MA. Systematic review: Pelvic floor muscle training for functional bowel symptoms in inflammatory bowel disease. JGH Open 2019; 3:494-507. [PMID: 31832550 PMCID: PMC6891014 DOI: 10.1002/jgh3.12207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/04/2019] [Accepted: 03/29/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM Large bowel functional symptoms are common in patients with inflammatory bowel disease (IBD) who are in disease remission. The efficacy of pelvic floor muscle training for symptoms of evacuation difficulty or fecal incontinence is well established in patients without organic bowel disease but is unknown in these patients. This study aimed to systematically evaluate the published evidence in this group of patients. METHODS A systematic review was conducted of articles evaluating pelvic floor muscle training, with or without biofeedback, to improve bowel function in patients with quiescent IBD, including those with an ileoanal pouch. The outcome of interest was improved bowel function measured by bowel diary, patient report, or validated questionnaire in randomized controlled studies, cohort studies, or case series. RESULTS Two randomized controlled trials, four retrospective case series, and one prospective study met eligibility criteria. Pelvic floor muscle training for patients with quiescent IBD improved symptoms in 51 of 76 (68%) patients with evacuation difficulty and 20 of 25 (80%) patients with fecal incontinence. Pelvic floor muscle training for patients with an ileoanal pouch, prior to stoma closure, did not appear to reduce the risk or severity of fecal incontinence following stoma closure. Studies were limited by small numbers, study design, methodological quality, and lack of long-term follow-up. CONCLUSION Pelvic floor muscle training appears to be of therapeutic value in some patients with quiescent IBD and evacuation difficulty or fecal incontinence. The effectiveness of this approach warrants further investigation.
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Affiliation(s)
- Angela J Khera
- Department of GastroenterologySt Vincent's HospitalAustralia
- Department of Medicine, University of MelbourneMelbourneVictoriaAustralia
| | - Janet W Chase
- Department of GastroenterologySt Vincent's HospitalAustralia
| | | | - Alexander J V Thompson
- Department of GastroenterologySt Vincent's HospitalAustralia
- Department of Medicine, University of MelbourneMelbourneVictoriaAustralia
| | - Michael A Kamm
- Department of GastroenterologySt Vincent's HospitalAustralia
- Department of Medicine, University of MelbourneMelbourneVictoriaAustralia
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22
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Gallo G, Sammarco G. Functional Assessment on IBD Patients: Is It A Must or Is It A Dust? J INVEST SURG 2019; 34:554-555. [PMID: 31661329 DOI: 10.1080/08941939.2019.1679294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Giuseppe Sammarco
- Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
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23
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El-Salhy M, Gilja OH, Hatlebakk JG. Overlapping of irritable bowel syndrome with erosive esophagitis and the performance of Rome criteria in diagnosing IBS in a clinical setting. Mol Med Rep 2019; 20:787-794. [PMID: 31180516 PMCID: PMC6580027 DOI: 10.3892/mmr.2019.10284] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 05/15/2019] [Indexed: 02/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) and gastroesophageal reflux disease (GERD) overlap. It is not clear whether GERD is caused by non-erosive esophagitis, or erosive esophagitis. The Rome criteria are not widely used for the diagnosis of IBS in the clinic. In total, 1,489 IBS patients without red flags were included in the present retrospective study. They comprised of 1,331 females and 158 males with a mean age of 51 years. The diagnosis of IBS was verified by endoscopic and histopathological examinations. Whereas erosive esophagitis occurred in 97% of patients, only 66% had GERD symptoms. Endoscopy and histopathological examinations revealed that 1.4% of the IBS patients with diarrhea as the predominant symptom had other organic gastrointestinal diseases: 0.3% with celiac disease, 0.2% with Crohn's disease, 0.07% with ulcerative colitis, 0.6% with microscopic colitis, and 0.2% with colon cancer. Applying the Rome III criteria produced a sensitivity of 100% [95% confidence intervals (CI)=99.8–100.0%] a specificity of 98.7% (95% CI=98.0–99.2%), a positive likelihood ratio of 76.9%, and a negative likelihood ratio of 0%. IBS is associated with erosive esophagitis. Applying Rome III criteria without red flags and history, was effective in diagnosing IBS. Celiac disease and microscopic colitis should be considered as alternative diagnoses.
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Affiliation(s)
- Magdy El-Salhy
- Section for Gastroenterology, Department of Medicine, Stord Hospital, 5416 Stord, Norway
| | - Odd Helge Gilja
- Department of Clinical Medicine, University of Bergen, 5007 Bergen, Norway
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24
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Wu Y, Wang Y, Wang J, Fan Q, Zhu J, Yang L, Rong W. TLR4 mediates upregulation and sensitization of TRPV1 in primary afferent neurons in 2,4,6-trinitrobenzene sulfate-induced colitis. Mol Pain 2019; 15:1744806919830018. [PMID: 30672380 PMCID: PMC6378437 DOI: 10.1177/1744806919830018] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Elevated excitability of primary afferent neurons underlies chronic pain in patients with functional or inflammatory bowel diseases. Recent studies have established an essential role for an enhanced transient receptor potential vanilloid subtype 1 (TRPV1) signaling in mediating peripheral hyperalgesia in inflammatory conditions. Since colocalization of Toll-like receptor 4 (TLR4) and TRPV1 has been observed in primary afferents including the trigeminal sensory neurons and the dorsal root ganglion neurons, we test the hypothesis that TLR4 might regulate the expression and function of TRPV1 in primary afferent neurons in 2,4,6-trinitrobenzene sulfate (TNBS)-induced colitis using the TLR4-deficient and the wild-type C57 mice. Despite having a higher disease activity index following administration of 2,4,6-trinitrobenzene sulfate, the TLR4-deficient mice showed less inflammatory infiltration in the colon than the wild-type mice. Increased expression of TLR4 and TRPV1 as well as increased density of capsaicin-induced TRPV1 current was observed in L4–S2 dorsal root ganglion neurons of the wild-type colitis mice till two weeks post 2,4,6-trinitrobenzene sulfate treatment. In comparison, the TLR4-deficient colitis mice had lower TRPV1 expression and TRPV1 current density in dorsal root ganglion neurons with lower abdominal withdrawal response scores during noxious colonic distensions. In the wild type but not in the TLR4-deficient dorsal root ganglion neurons, acute administration of the TLR4 agonist lipopolysaccharide increased the capsaicin-evoked TRPV1 current. In addition, we found that the canonical signaling downstream of TLR4 was activated in 2,4,6-trinitrobenzene sulfate-induced colitis in the wild type but not in the TLR4-deficient mice. These results indicate that TLR4 may play a major role in regulation of TRPV1 signaling and peripheral hyperalgesia in inflammatory conditions.
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Affiliation(s)
- Yingwei Wu
- 1 Department of Anatomy and Physiology, Shanghai Jiaotong University School of Medicine, Shanghai, China.,2 Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yingping Wang
- 1 Department of Anatomy and Physiology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Juan Wang
- 1 Department of Anatomy and Physiology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qi Fan
- 2 Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jinyu Zhu
- 2 Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Liu Yang
- 3 Core Laboratory, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weifang Rong
- 1 Department of Anatomy and Physiology, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Csekő K, Beckers B, Keszthelyi D, Helyes Z. Role of TRPV1 and TRPA1 Ion Channels in Inflammatory Bowel Diseases: Potential Therapeutic Targets? Pharmaceuticals (Basel) 2019; 12:E48. [PMID: 30935063 PMCID: PMC6630403 DOI: 10.3390/ph12020048] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 12/20/2022] Open
Abstract
Inflammatory bowel diseases (IBD) have long been recognized to be accompanied by pain resulting in high morbidity. Transient receptor potential vanilloid 1 (TRPV1) and ankyrin 1 (TRPA1) ion channels located predominantly on the capsaicin-sensitive sensory neurons play a complex role in hyperalgesia and neurogenic inflammation. This review provides an overview of their expression and role in intestinal inflammation, in particular colitis, that appears to be virtually inconsistent based on the thorough investigations of the last twenty years. However, preclinical results with pharmacological interventions, as well as scarcely available human studies, more convincingly point out the potential therapeutic value of TRPV1 and TRPA1 antagonists in colitis and visceral hypersensitivity providing future therapeutical perspectives through a complex, unique mechanism of action for drug development in IBD.
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Affiliation(s)
- Kata Csekő
- Department of Pharmacology and Pharmacotherapy, Medical School and Molecular Pharmacology Research Group, Szentágothai Research Centre, University of Pécs, H-7624 Pécs, Hungary.
| | - Bram Beckers
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center (MUMC+), 6202 AZ Maastricht, The Netherlands.
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, 6202 AZ Maastricht, The Netherlands.
| | - Daniel Keszthelyi
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center (MUMC+), 6202 AZ Maastricht, The Netherlands.
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University, 6202 AZ Maastricht, The Netherlands.
| | - Zsuzsanna Helyes
- Department of Pharmacology and Pharmacotherapy, Medical School and Molecular Pharmacology Research Group, Szentágothai Research Centre, University of Pécs, H-7624 Pécs, Hungary.
- PharmInVivo Ltd., H-7629 Pécs, Hungary.
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Yoon JW, Ahn SI, Jhoo JW, Kim GY. Antioxidant Activity of Yogurt Fermented at Low Temperature and Its Anti-inflammatory Effect on DSS-induced Colitis in Mice. Food Sci Anim Resour 2019; 39:162-176. [PMID: 30882084 PMCID: PMC6411250 DOI: 10.5851/kosfa.2019.e13] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 02/18/2019] [Accepted: 02/19/2019] [Indexed: 01/01/2023] Open
Abstract
This study was performed to evaluate the antioxidant activity of yogurt fermented
at low temperature and the anti-inflammatory effect it has on induced colitis
with 2.5% dextran sodium sulfate (DSS) in Balb/c mice. Yogurt premix were
fermented with a commercial starter culture containing Lactobacillus
acidophilus, Bifidobacterium lactis,
Streptococcus thermophilus, and Lactobacillus
delbrueckii subsp. bulgaricus at different
temperatures: 22°C (low fermentation temperature) for 27 h and
37°C (general fermentation temperature) for 12 h. To measure antioxidant
activity of yogurt samples, DPPH, ABTS+ and ferric reducing
antioxidant potential (FRAP) assays were conducted. For animal experiments,
inflammation was induced with 2.5% DSS in Balb/c mice. Yogurt fermented
at low temperature showed higher antioxidant activity than that of the yogurt
fermented at general temperature. In the inflammatory study, IL-6 (interleukin
6) was decreased and IL-4 and IL-10 increased significantly in DSS group with
yogurt fermented at general temperature (DYG) and that with yogurt fermented at
low temperature (DYL) compared to that in DSS-induced colitic mice (DC),
especially DYL had higher concentration of cytokines IL-4, and IL-10 than DYG.
MPO (myeloperoxidase) tended to decrease more in treatments with yogurt than DC.
Additionally, yogurt fermented at low temperature had anti-inflammatory
activity, although there was no significant difference with general
temperature-fermented yogurt (p>0.05).
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Affiliation(s)
- Ji-Woo Yoon
- Department of Applied Animal Science, College of Animal Life Sciences, Kangwon National University, Chuncheon 24341, Korea
| | - Sung-Il Ahn
- Department of Applied Animal Science, College of Animal Life Sciences, Kangwon National University, Chuncheon 24341, Korea
| | - Jin-Woo Jhoo
- Department of Applied Animal Science, College of Animal Life Sciences, Kangwon National University, Chuncheon 24341, Korea
| | - Gur-Yoo Kim
- Department of Applied Animal Science, College of Animal Life Sciences, Kangwon National University, Chuncheon 24341, Korea
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27
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Chitnavis MV, Baray M, Northup PG, Tuskey AG, Behm BW. Opioid use and misuse in ulcerative colitis. World J Gastrointest Pharmacol Ther 2019; 10:22-28. [PMID: 30697446 PMCID: PMC6347648 DOI: 10.4292/wjgpt.v10.i1.22] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/24/2018] [Accepted: 01/09/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with ulcerative colitis (UC) may be exposed to opioids over their disease duration. The use of such medications carries significant risk, including intestinal dysmotility and potential for addiction. However, the rates of narcotic use and misuse in patients with UC have not been studied extensively. Functional gastrointestinal disorders (FGID) are prevalent in patients with UC, and have been shown to increase the risk of narcotic use and misuse in patients with Crohn’s disease. We hypothesized that patients with UC and a concurrent diagnosis of FGID would have increased rates of both opioid use and misuse in our patient cohort.
AIM To evaluate the prevalence of chronic opioid use and misuse in UC.
METHODS A retrospective chart review of UC patients seen at the University of Virginia Digestive Health Center was performed on all patients evaluated between 2006 and 2011. Patient demographics, medical, surgical, and medication histories were obtained from the electronic medical record. Concomitant diagnosis of FGID was also noted at the time. The electronic prescription monitoring program was accessed to obtain prescription opioid filling histories. Prescription opioid misuse was defined as opioid prescriptions filled from four or more prescribers and four or more different pharmacies in a 12-mo period.
RESULTS A total of 497 patients with UC were included. Patients with UC and FGID were more likely to be female, but no other demographic variables were associated with FGID. Of the UC patients who had FGID, a greater proportion were found to be using opioids chronically (36% with FGID vs 9% without FGID, P < 0.0001) and were misusing prescription opioids (12.8% vs 1.3%, P < 0.001). Multivariate logistic regression demonstrated a significant association with FGID and chronic opioid use (OR = 4.50; 95%CI: 1.91-10.59) and opioid misuse (OR = 5.19; 95%CI 1.04-25.76). Tobacco use (OR 2.53; 95%CI: 1.06-6.08) and anxiety (OR 3.17; 95%CI: 1.08-9.26) were other variables associated with an increased risk of chronic narcotic use.
CONCLUSION FGID was associated with a 4.5-fold increase in chronic opioid use and a 5-fold increased risk of opioid misuse in this patient cohort with UC.
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Affiliation(s)
- Maithili V Chitnavis
- Division of Gastroenterology and Hepatology, Virginia Tech Carilion School of Medicine, Roanoke, VA 24016, United States
| | - Merwise Baray
- University of Virginia School of Medicine, Charlottesville, VA 22908, United States
| | - Patrick G Northup
- Division of Gastroenterology and Hepatology, University of Virginia School of Medicine, Charlottesville, VA 22908, United States
| | - Anne G Tuskey
- Division of Gastroenterology and Hepatology, University of Virginia School of Medicine, Charlottesville, VA 22908, United States
| | - Brian W Behm
- Division of Gastroenterology and Hepatology, University of Virginia School of Medicine, Charlottesville, VA 22908, United States
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Sugihara K, Morhardt TL, Kamada N. The Role of Dietary Nutrients in Inflammatory Bowel Disease. Front Immunol 2019; 9:3183. [PMID: 30697218 PMCID: PMC6340967 DOI: 10.3389/fimmu.2018.03183] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 12/27/2018] [Indexed: 12/22/2022] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic and relapsing inflammatory disease of the gastrointestinal tract. Although the precise etiology of IBD remains incompletely understood, accumulating evidence suggests that various environmental factors, including dietary nutrients, contribute to its pathogenesis. Dietary nutrients are known to have an impact on host physiology and diseases. The interactions between dietary nutrients and intestinal immunity are complex. Dietary nutrients directly regulate the immuno-modulatory function of gut-resident immune cells. Likewise, dietary nutrients shape the composition of the gut microbiota. Therefore, a well-balanced diet is crucial for good health. In contrast, the relationships among dietary nutrients, host immunity and/or the gut microbiota may be perturbed in the context of IBD. Genetic predispositions and gut dysbiosis may affect the utilization of dietary nutrients. Moreover, the metabolism of nutrients in host cells and the gut microbiota may be altered by intestinal inflammation, thereby increasing or decreasing the demand for certain nutrients necessary for the maintenance of immune and microbial homeostasis. Herein, we review the current knowledge of the role dietary nutrients play in the development and the treatment of IBD, focusing on the interplay among dietary nutrients, the gut microbiota and host immune cells. We also discuss alterations in the nutritional metabolism of the gut microbiota and host cells in IBD that can influence the outcome of nutritional intervention. A better understanding of the diet-host-microbiota interactions may lead to new therapeutic approaches for the treatment of IBD.
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Affiliation(s)
- Kohei Sugihara
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Tina L Morhardt
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States.,Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Nobuhiko Kamada
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
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Intake of Lutein and Zeaxanthin as a Possible Factor Influencing Gastrointestinal Symptoms in Caucasian Individuals with Ulcerative Colitis in Remission Phase. J Clin Med 2019; 8:jcm8010077. [PMID: 30641888 PMCID: PMC6352032 DOI: 10.3390/jcm8010077] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/08/2019] [Accepted: 01/09/2019] [Indexed: 12/22/2022] Open
Abstract
The vitamin A deficiencies are commonly observed in the case of ulcerative colitis individuals. The decreased antioxidant defence may influence the intestine, inducing higher susceptibility to oxidative damage of tissues and altering the symptoms and course of disease. Intestinal symptoms, ranging from diarrhea to constipation, occur more commonly in remission ulcerative colitis individuals than in general population. The aim of the study was to analyze the association between retinoid intake and gastrointestinal symptoms in Caucasian individuals in the remission phase of ulcerative colitis. Reitnoid (total vitamin A, retinol, β-carotene, α-carotene, β-cryptoxanthin, lycopene, as well as lutein and zeaxanthin) intakes were analyzed on the basis of three-day dietary records. Gastrointestinal symptoms (daily number of bowel movements, and the presence of painful tenesmus, flatulence, and constipation) were self-reported. The study was conducted in a group of 56 ulcerative colitis remission individuals, stratified by the gastrointestinal symptoms. One in every seven individuals reported recurring constipation. Higher intake of lutein and zeaxanthin (median 1386.2 µg, 289.0–13221.3 µg vs. median 639.0 µg, 432.7–1309.0 µg) may lower the incidence of constipation (p = 0.013). The intake of retinoids other than lutein and zeaxanthin was not associated with the incidence of constipation or other gastrointestinal symptoms.
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Nigam GB, Limdi JK, Vasant DH. Current perspectives on the diagnosis and management of functional anorectal disorders in patients with inflammatory bowel disease. Therap Adv Gastroenterol 2018; 11:1756284818816956. [PMID: 30574193 PMCID: PMC6295686 DOI: 10.1177/1756284818816956] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 11/13/2018] [Indexed: 02/04/2023] Open
Abstract
Despite advances in inflammatory bowel disease (IBD) therapies, a significant proportion of patients with quiescent disease experience persistent, debilitating symptoms of faecal incontinence (FI), urgency and defaecatory disorders due to anorectal dysfunction. Such symptoms are often underreported or misdiagnosed and can lead to potentially premature treatment 'escalation' and under-utilisation of pelvic floor investigations. In this review article, we consider putative pathophysiological post-inflammatory changes resulting in altered anorectal sensitivity, motility and neuromuscular coordination and how this may drive symptoms in quiescent IBD. Finally, we discuss a pragmatic approach to investigating and managing anorectal dysfunction and highlight areas for future research for this often-neglected group of patients.
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Affiliation(s)
| | - Jimmy K. Limdi
- Pennine Acute Hospitals NHS Trust, Greater Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, The University of Manchester, Manchester, UK
| | - Dipesh H. Vasant
- Honorary Senior Lecturer, Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester University NHS Foundation Trust, Neurogastroenterology Unit, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT, UK
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31
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Goichon A, Bahlouli W, Ghouzali I, Chan P, Vaudry D, Déchelotte P, Ducrotté P, Coëffier M. Colonic Proteome Signature in Immunoproteasome-Deficient Stressed Mice and Its Relevance for Irritable Bowel Syndrome. J Proteome Res 2018; 18:478-492. [DOI: 10.1021/acs.jproteome.8b00793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Alexis Goichon
- INSERM unit 1073, Normandie University, UNIROUEN, 22 boulevard Gambetta, Rouen, F-76183, France
- Institute for Research and Innovation in Biomedicine (IRIB), Normandie University, UNIROUEN, Rouen, F-76183, France
| | - Wafa Bahlouli
- INSERM unit 1073, Normandie University, UNIROUEN, 22 boulevard Gambetta, Rouen, F-76183, France
- Institute for Research and Innovation in Biomedicine (IRIB), Normandie University, UNIROUEN, Rouen, F-76183, France
| | - Ibtissem Ghouzali
- INSERM unit 1073, Normandie University, UNIROUEN, 22 boulevard Gambetta, Rouen, F-76183, France
- Institute for Research and Innovation in Biomedicine (IRIB), Normandie University, UNIROUEN, Rouen, F-76183, France
| | - Philippe Chan
- Institute for Research and Innovation in Biomedicine (IRIB), Normandie University, UNIROUEN, Rouen, F-76183, France
- Platform in proteomics PISSARO, Normandie University, UNIROUEN, Rouen, F-76821, France
| | - David Vaudry
- Institute for Research and Innovation in Biomedicine (IRIB), Normandie University, UNIROUEN, Rouen, F-76183, France
- Platform in proteomics PISSARO, Normandie University, UNIROUEN, Rouen, F-76821, France
- INSERM unit 1239, Normandie University, UNIROUEN, Rouen, F-76821, France
| | - Pierre Déchelotte
- INSERM unit 1073, Normandie University, UNIROUEN, 22 boulevard Gambetta, Rouen, F-76183, France
- Institute for Research and Innovation in Biomedicine (IRIB), Normandie University, UNIROUEN, Rouen, F-76183, France
- Nutrition Department, Rouen University Hospital, Rouen, F-76031, France
| | - Philippe Ducrotté
- INSERM unit 1073, Normandie University, UNIROUEN, 22 boulevard Gambetta, Rouen, F-76183, France
- Institute for Research and Innovation in Biomedicine (IRIB), Normandie University, UNIROUEN, Rouen, F-76183, France
- Gastroenterology Department, Rouen University Hospital, Rouen, F-76031, France
| | - Moïse Coëffier
- INSERM unit 1073, Normandie University, UNIROUEN, 22 boulevard Gambetta, Rouen, F-76183, France
- Institute for Research and Innovation in Biomedicine (IRIB), Normandie University, UNIROUEN, Rouen, F-76183, France
- Nutrition Department, Rouen University Hospital, Rouen, F-76031, France
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Leung Y, Shim HH, Wilkens R, Tanyingoh D, Afshar EE, Sharifi N, Pauls M, Novak KL, Kaplan GG, Panaccione R, Wilson SR, Seow CH. The Role of Bowel Ultrasound in Detecting Subclinical Inflammation in Pregnant Women with Crohn's Disease. J Can Assoc Gastroenterol 2018; 2:153-160. [PMID: 31616856 PMCID: PMC6785691 DOI: 10.1093/jcag/gwy062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 10/05/2018] [Indexed: 12/16/2022] Open
Abstract
Background and Aims Maintaining disease remission improves outcomes for pregnant women with Crohn’s disease (CD). As symptoms may correlate poorly with disease activity in the gravid state, we investigated the utility of bowel sonography during pregnancy to assess disease activity. Methods We conducted a prospective observational cohort study of pregnant women with CD undergoing bowel sonography between July 1, 2012, and December 1, 2016. Clinically active disease was defined using standardized clinical indices (Harvey Bradshaw Index >4 for active disease). Sonographic findings were graded as inactive (normal, mild) or active (moderate, severe) by expert radiologists. Results There were 91 pregnancies in 82 CD patients. Symptoms were present in 12 pregnancies; however, eight (67%) had sonographic findings of inactive disease, and escalation of therapy was not initiated. Conversely, sonographically active disease in seven asymptomatic pregnancies resulted in four women escalating therapy. The remaining three women declined escalation of therapy, one had a miscarriage, and the other two women had persistently active disease on sonography and endoscopy at one-year postpartum. Conclusions Bowel ultrasound may detect subclinical inflammation in asymptomatic pregnant women with CD and stratify CD activity in symptomatic patients. Therefore, bowel sonography should be considered as a useful adjunct for the assessment of the pregnant woman with Crohn’s disease.
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Affiliation(s)
- Yvette Leung
- Division of Gastroenterology and Hepatology, Department of Medicine, University of British Columbia, British Columbia, Canada.,Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Alberta, Canada
| | - Hang Hock Shim
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Alberta, Canada.,Department of Gastroenterology and Hepatology, Singapore General Hospital, Bukit Merah, Singapore
| | - Rune Wilkens
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Hospital, Silkeborg, Denmark.,Department of Radiology and Division of Gastroenterology, Department of Medicine, University of Calgary, Alberta, Canada
| | | | - Elnaz Ehteshami Afshar
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Alberta, Canada
| | - Nastaran Sharifi
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Alberta, Canada
| | - Mehrnoosh Pauls
- Department of Medicine, Dalhousie University and Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Kerri L Novak
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Alberta, Canada
| | - Gilaad G Kaplan
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Alberta, Canada
| | - Remo Panaccione
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Alberta, Canada
| | - Stephanie R Wilson
- Department of Radiology and Division of Gastroenterology, Department of Medicine, University of Calgary, Alberta, Canada
| | - Cynthia H Seow
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Alberta, Canada
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Predictors of Impaired Mental Health and Support Seeking in Adults With Inflammatory Bowel Disease: An Online Survey. Gastroenterol Nurs 2018; 41:38-46. [PMID: 29373354 DOI: 10.1097/sga.0000000000000251] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
This study explored the possible factors associated with psychological distress in adults with inflammatory bowel disease (IBD) and also engagement in mental health services (MHS) in those reporting distress in a large Australian cohort. Participants with IBD completed an online survey assessing perceived IBD activity (Manitoba Index; MI), mental health status (K10), demographic details, and engagement with MHS for IBD-associated issues. Of 336 participants, 76.5% perceived themselves as having active disease over the past 6 months, and on K10 scores, 51.8% had a mental health issue. Of participants with a mental health issue, only 21.3% were currently receiving mental health support. A stepwise logistic regression analysis correctly classified 78.7% of the status of receiving mental health support, with lower income (<$60,000 per annum) the only significant predictor. Paradoxically, the degree of psychological distress did not correlate with seeking mental health support. The data show that in individuals with ongoing symptoms attributed to active IBD, mental health issues are highly prevalent, with older age and higher income being additional drivers of mental health issues. The greater challenge, however, seems not to be identifying mental health issues, but in getting those in need to engage in MHS.
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Duff W, Haskey N, Potter G, Alcorn J, Hunter P, Fowler S. Non-pharmacological therapies for inflammatory bowel disease: Recommendations for self-care and physician guidance. World J Gastroenterol 2018; 24:3055-3070. [PMID: 30065553 PMCID: PMC6064965 DOI: 10.3748/wjg.v24.i28.3055] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/23/2018] [Accepted: 06/01/2018] [Indexed: 02/06/2023] Open
Abstract
We performed a scoping review on sought-after complementary therapies for patients with inflammatory bowel disease (IBD), specifically diet, physical activity and exercise (PA/E), and psychotherapy. We aim to update patients with IBD on therapies for self-care and provide physicians with guidance on how to direct their patients for the management of IBD. A search of MEDLINE, EMBASE, and PUBMED was completed in Sept 2016. Studies on diet, PA/E, or psychotherapy in patients with IBD were included. Medical Subject Heading terms and Boolean operators were used. The search was limited to full-text English articles describing an adult population. This review included 67 studies: Diet (n = 19); PA/E (n = 19); and psychotherapy (n = 29). We have made the following recommendations: (1) Diet: Consumption of diets rich in vegetables, fruit and soluble fiber may be beneficial in IBD. A trial of a low FODMAP diet can be considered in those patients with functional gastrointestinal symptoms. Restrictive diets are lacking in evidence and should be avoided; (2) PA/E: Regular low-moderate intensity activity, including cardiovascular and resistance exercise, has been shown to improve quality of life (QOL) and may improve inflammation; and (3) psychotherapy: Therapies such as cognitive-behavioural interventions, mindfulness, hypnosis, and stress management have been shown to improve QOL, but evidence is limited on their impact on anxiety, depression, and disease activity. Overall, these complementary therapies are promising and should be used to treat patients with IBD from a more holistic perspective.
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Affiliation(s)
- Whitney Duff
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5B2, Canada
| | - Natasha Haskey
- Irving K Barber School of Arts and Science, University of British Columbia-Okanagan, Kelowna, British Columbia V1V 1V7, Canada
| | - Gillian Potter
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5A5, Canada
| | - Jane Alcorn
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5E5, Canada
| | - Paulette Hunter
- St Thomas More College, University of Saskatchewan, Saskatoon, SK S7N 0W6, Canada
| | - Sharyle Fowler
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan S7N 0W8, Canada
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Cohen ER, Melmed GY. Making a Case for Patient-Reported Outcomes in Clinical Inflammatory Bowel Disease Practice. Clin Gastroenterol Hepatol 2018; 16:603-607. [PMID: 29678238 DOI: 10.1016/j.cgh.2017.12.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Erica R Cohen
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California
| | - Gil Y Melmed
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California.
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36
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Bryant RV, Friedman AB, Wright EK, Taylor KM, Begun J, Maconi G, Maaser C, Novak KL, Kucharzik T, Atkinson NSS, Asthana A, Gibson PR. Gastrointestinal ultrasound in inflammatory bowel disease: an underused resource with potential paradigm-changing application. Gut 2018; 67:973-985. [PMID: 29437914 DOI: 10.1136/gutjnl-2017-315655] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 12/13/2017] [Accepted: 12/14/2017] [Indexed: 12/20/2022]
Abstract
Evolution of treatment targets in IBD has increased the need for objective monitoring of disease activity to guide therapeutic strategy. Although mucosal healing is the current target of therapy in IBD, endoscopy is invasive, expensive and unappealing to patients. GI ultrasound (GIUS) represents a non-invasive modality to assess disease activity in IBD. It is accurate, cost-effective and reproducible. GIUS can be performed at the point of care without specific patient preparation so as to facilitate clinical decision-making. As compared with ileocolonoscopy and other imaging modalities (CT and MRI), GIUS is accurate in diagnosing IBD, detecting complications of disease including fistulae, strictures and abscesses, monitoring disease activity and detecting postoperative disease recurrence. International groups increasingly recognise GIUS as a valuable tool with paradigm-changing application in the management of IBD; however, uptake outside parts of continental Europe has been slow and GIUS is underused in many countries. The aim of this review is to present a pragmatic guide to the positioning of GIUS in IBD clinical practice, providing evidence for use, algorithms for integration into practice, training pathways and a strategic implementation framework.
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Affiliation(s)
- Robert Venning Bryant
- Department of Gastroenterology, The Queen Elizabeth Hospital, Adelaide, Australia.,Faculty of Health Sciences, School of Medicine, University of Adelaide, Adelaide, Australia
| | - Antony B Friedman
- Department of Gastroenterology, Alfred Hospital, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Emily Kate Wright
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Kirstin M Taylor
- Department of Gastroenterology, Alfred Hospital, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Jakob Begun
- Department of Gastroenterology, Mater Hospital, Brisbane, Australia.,Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Giovanni Maconi
- Department of Gastroenterology, Luigi Sacco University Hospital, Milan, Italy
| | - Christian Maaser
- Department of General Internal Medicine and Gastroenterology, University Teaching Hospital Lueneburg, Lueneburg, Germany
| | - Kerri L Novak
- Division of Gastroenterology, University of Calgary, Calgary, Canada
| | - Torsten Kucharzik
- Department of General Internal Medicine and Gastroenterology, University Teaching Hospital Lueneburg, Lueneburg, Germany
| | | | - Anil Asthana
- Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Australia
| | - Peter R Gibson
- Department of Gastroenterology, Alfred Hospital, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
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Bhandari S, Larson ME, Kumar N, Stein D. Association of Inflammatory Bowel Disease (IBD) with Depressive Symptoms in the United States Population and Independent Predictors of Depressive Symptoms in an IBD Population: A NHANES Study. Gut Liver 2018; 11:512-519. [PMID: 28395506 PMCID: PMC5491086 DOI: 10.5009/gnl16347] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/04/2016] [Accepted: 11/02/2016] [Indexed: 12/25/2022] Open
Abstract
Background/Aims There is a paucity of population-based studies on the association between inflammatory bowel disease (IBD) and depression in the U.S. population. We sought to study this association using the National Health and Nutrition Examination Survey (NHANES) database. Methods We used NHANES data from 2009 to 2010. Our study included 190,269,933 U.S. adults without IBD and 2,325,226 with IBD. We sought to determine whether IBD is an independent risk factor for depressive symptoms (DS) in the U.S. population and studied the independent predictors of DS in IBD population. Results DS was present in 49% of the IBD population versus 23% of the non-IBD population (p<0.001). During the multivariate analysis, we found that IBD was independently associated with DS in the U.S. population (p=0.002). The independent predictors of DS in the IBD population were older age (p=0.048) and divorced/separated/widowed status (p=0.005). There was nonsignificant increase in suicidal risk in IBD population with DS versus that in non-IBD population with DS (27% vs 12%, respectively, p=0.080). Only 36% of IBD individuals with DS visited mental health professional or psychiatrist within the past year. Conclusions IBD is independently associated with DS in the U.S. population. Further research is warranted on risk stratification, screening and management of those with IBD who are at risk of depression.
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Affiliation(s)
- Sanjay Bhandari
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael E Larson
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nilay Kumar
- Division of Gastroenterology and Hepatology, Aurora St. Luke's Medical Center, Milwaukee, WI, USA
| | - Daniel Stein
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA
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Wickbom A, Bohr J, Nyhlin N, Eriksson A, Lapidus A, Münch A, Ung KA, Vigren L, Öst Å, Tysk C. Microscopic colitis in patients with ulcerative colitis or Crohn's disease: a retrospective observational study and review of the literature. Scand J Gastroenterol 2018; 53:410-416. [PMID: 29546806 DOI: 10.1080/00365521.2018.1430252] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Onset of microscopic colitis (MC) in patients with ulcerative colitis (UC) or Crohn's disease (CD), or vice versa, has been reported occasionally but the subject is not well described. We therefore report a retrospective observational study of such patients and review the literature. METHODS Forty-six Swedish gastroenterology clinics were contacted about patients with diagnoses of both inflammatory bowel disease (IBD) and MC. Publications were searched on PubMed. RESULTS We identified 31 patients with onset of MC after a median (range) of 20 (2-52) years after diagnosis of IBD, or vice versa; 21 UC patients developed collagenous colitis (CC) (n = 16) or lymphocytic colitis (LC) (n = 5); nine CD patients developed CC (n = 5) or LC (n = 4); one CC patient developed CD. Of the 21 UC patients, 18 had extensive disease, whereas no consistent phenotype occurred in CD. Literature review revealed 27 comprehensive case reports of patients with diagnoses of both IBD and MC. Thirteen MC patients developed IBD, of which four required colectomy. Fourteen IBD patients later developed MC. There were incomplete clinical data in 115 additional reported patients. CONCLUSIONS Altogether 173 patients with occurrence of both IBD and MC were found. The most common finding in our patients was onset of CC in a patient with UC. Although these are likely random associations of two different disorders, MC should be considered in the patient with UC or CD if there is onset of chronic watery diarrhoea without endoscopic relapse of IBD.
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Affiliation(s)
- Anna Wickbom
- a Department of Gastroenterology, Faculty of Medicine and Health , Örebro University , Örebro , Sweden
| | - Johan Bohr
- a Department of Gastroenterology, Faculty of Medicine and Health , Örebro University , Örebro , Sweden
| | - Nils Nyhlin
- a Department of Gastroenterology, Faculty of Medicine and Health , Örebro University , Örebro , Sweden
| | - Anders Eriksson
- b Department of Medicine, Emergency and Geriatrics , Sahlgrenska University Hospital/East Hospital , Gothenburg , Sweden
| | - Annika Lapidus
- c Department of Gastroenterology , Ersta Hospital , Stockholm , Sweden
| | - Andreas Münch
- d Department of Clinical and Experimental Medicine, Division of Gastroenterology and Hepatology, Faculty of Health Sciences , Linköping University , Linköping , Sweden
| | - Kjell-Arne Ung
- e Department of Internal Medicine , Sahlgrenska University Hospital/Mölndal , Gothenburg , Sweden
| | - Lina Vigren
- f Department of Medicine , Trelleborg Hospital , Trelleborg , Sweden
| | - Åke Öst
- g Department of Pathology and Cytology , Aleris Medilab , Täby , Sweden
| | - Curt Tysk
- a Department of Gastroenterology, Faculty of Medicine and Health , Örebro University , Örebro , Sweden
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Henriksen M, Høivik ML, Jelsness-Jørgensen LP, Moum B. Irritable Bowel-like Symptoms in Ulcerative Colitis are as Common in Patients in Deep Remission as in Inflammation: Results From a Population-based Study [the IBSEN Study]. J Crohns Colitis 2018; 12:389-393. [PMID: 29186372 DOI: 10.1093/ecco-jcc/jjx152] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 11/26/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS An increased prevalence of irritable bowel syndrome [IBS]-like symptoms has been reported in patients with ulcerative colitis [UC]. Whether ongoing inflammation increases the prevalence of such symptoms is unknown. The aims of this study were to determine the prevalence of IBS-like symptoms in a population-based cohort of UC patients 20 years after diagnosis, and to assess the possible association between such symptoms and ongoing inflammation. METHODS Patients diagnosed with UC between 1990 and 1994, in a geographically well-defined area, were included in a prospective follow-up study, and IBS symptoms according to Rome III criteria were recorded 20 years after diagnosis. The patients underwent colonoscopy with biopsies and/or the level of faecal calprotectin was analysed. RESULTS A total of 260 patients answered the Rome III questionnaire. The overall prevalence of IBS-like symptoms was 27%. In patients who had no signs of inflammation in colonic biopsies [n = 96] [deep remission], the prevalence was 29%. No difference in prevalence of IBS-like symptoms was found between patients with ongoing inflammation and patients in deep remission. CONCLUSIONS IBS-like symptoms in UC patients are frequent after 20 years of disease. Deep remission did not change the frequency of IBS-like symptoms.
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Affiliation(s)
- Magne Henriksen
- Østfold Hospital Trust, Department of Gastroenterology, Grålum, Norway
| | - Marte Lie Høivik
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Lars-Petter Jelsness-Jørgensen
- Østfold Hospital Trust, Department of Gastroenterology, Grålum, Norway.,Østfold University College, Department of Health Science, Halden, Norway
| | - Bjørn Moum
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Lazaridis N, Germanidis G. Current insights into the innate immune system dysfunction in irritable bowel syndrome. Ann Gastroenterol 2018; 31:171-187. [PMID: 29507464 PMCID: PMC5825947 DOI: 10.20524/aog.2018.0229] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/22/2017] [Indexed: 12/12/2022] Open
Abstract
Irritable bowel syndrome (IBS) is a functional bowel disorder associated with abdominal pain and alterations in bowel habits. The presence of IBS greatly impairs patients' quality of life and imposes a high economic burden on the community; thus, there is intense pressure to reveal its elusive pathogenesis. Many etiological mechanisms have been implicated, but the pathophysiology of the syndrome remains unclear. As a result, novel drug development has been slow and no pharmacological intervention is universally accepted. A growing evidence implicates the role of low-grade inflammation and innate immune system dysfunction, although contradictory results have frequently been presented. Mast cells (MC), eosinophils and other key immune cells together with their mediators seem to play an important role, at least in subgroups of IBS patients. Cytokine imbalance in the systematic circulation and in the intestinal mucosa may also characterize IBS presentation. Toll-like receptors and their emerging role in pathogen recognition have also been highlighted recently, as dysregulation has been reported to occur in patients with IBS. This review summarizes the current knowledge regarding the involvement of any immunological alteration in the development of IBS. There is substantial evidence to support innate immune system dysfunction in several IBS phenotypes, but additional studies are required to better clarify the underlying pathogenetic pathways. IBS heterogeneity could potentially be attributed to multiple causes that lead to different disease phenotypes, thus explaining the variability found between study results.
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Affiliation(s)
- Nikolaos Lazaridis
- Gastroenterology Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Georgios Germanidis
- Gastroenterology Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki, Greece
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Cox SR, Prince AC, Myers CE, Irving PM, Lindsay JO, Lomer MC, Whelan K. Fermentable Carbohydrates [FODMAPs] Exacerbate Functional Gastrointestinal Symptoms in Patients With Inflammatory Bowel Disease: A Randomised, Double-blind, Placebo-controlled, Cross-over, Re-challenge Trial. J Crohns Colitis 2017; 11:1420-1429. [PMID: 28525543 DOI: 10.1093/ecco-jcc/jjx073] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 05/18/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Preliminary evidence suggests that fermentable carbohydrate restriction might ameliorate functional gastrointestinal symptoms [FGS] in inflammatory bowel disease [IBD]. Our aim was to determine whether fermentable carbohydrates exacerbate FGS in IBD using a randomised, double-blinded, placebo-controlled, re-challenge trial. METHODS Patients with quiescent IBD and FGS responsive to a low FODMAP diet were allocated to a series of 3-day [d] fermentable carbohydrate challenges in random order [fructan, 12 g/d; galacto-oligosaccharides [GOS] 6 g/d; sorbitol, 6 g/d; and glucose placebo, 12 g/d], each separated by a washout period. Symptoms and stool output were measured daily during the challenges. RESULTS Thirty-two patients with IBD, fulfilling criteria for irritable bowel syndrome, functional bloating, or functional diarrhoea, were recruited and data were available for 29 patients completing all arms [12 Crohn's disease, 17 ulcerative colitis]. Significantly fewer patients reported adequate relief of FGS on the final day day of the fructan challenge [18/29, 62.1%] compared with glucose [26/29, 89.7%] [p = 0.033]. There was greater severity of pain [1.1 vs 0.5, p = 0.004], bloating [1.3 vs 0.6, p = 0.002], flatulence [1.5 vs 0.7, p = 0.004], and faecal urgency [0.9 vs 0.4, p = 0.014] on the final day of fructan challenge compared with glucose. CONCLUSIONS At the relatively high doses used, fructans, but not GOS or sorbitol, exacerbated FGS in quiescent IBD. Further research is required to determine whether a low FODMAP diet reduces FGS in IBD and the degree of FODMAP restriction required for symptom improvement.
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Affiliation(s)
- Selina R Cox
- King's College London, Diabetes and Nutritional Sciences Division, UK
| | - Alexis C Prince
- King's College London, Diabetes and Nutritional Sciences Division, UK.,King's College Hospital NHS Foundation Trust, Department of Nutrition and Dietetics, UK
| | - Clio E Myers
- King's College London, Diabetes and Nutritional Sciences Division, UK.,Royal Surrey County Hospital NHS Trust, Department of Nutrition and Dietetics, UK
| | - Peter M Irving
- King's College London, Diabetes and Nutritional Sciences Division, UK.,Guy's and St Thomas' NHS Foundation Trust, Department of Gastroenterology, UK
| | - James O Lindsay
- Barts Health NHS Trust, Department of Gastroenterology, Royal London Hospital, UK.,Queen Mary University of London, Blizard Institute, UK
| | - Miranda C Lomer
- King's College London, Diabetes and Nutritional Sciences Division, UK.,Guy's and St Thomas' NHS Foundation Trust, Department of Gastroenterology, UK
| | - Kevin Whelan
- King's College London, Diabetes and Nutritional Sciences Division, UK
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Abstract
There are many mechanisms to explain how food may drive and ameliorate inflammation. Although there are no consistent macronutrient associations inflammatory bowel disease (IBD) development, many exclusion diets have been described: IgG-4 guided exclusion diet; semivegetarian diet; low-fat, fiber-limited exclusion diet; Paleolithic diet; Maker's diet; vegan diet; Life without Bread diet; exclusive enteral nutrition (EEN), the Specific Carbohydrate Diet (SCD) and the low FODMAP diet. The literature on diet and IBD is reviewed with a particular focus on EEN, SCD, and low FODMAP diets. Lessons learned from the existing observations and strengths and shortcomings of existing data are presented.
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Calloway A, Dalal R, Beaulieu DB, Duley C, Annis K, Gaines L, Slaughter C, Schwartz DA, Horst S. Depressive Symptoms Predict Anti-tumor Necrosis Factor Therapy Noncompliance in Patients with Inflammatory Bowel Disease. Dig Dis Sci 2017; 62:3563-3567. [PMID: 29052816 DOI: 10.1007/s10620-017-4800-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 10/10/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Noncompliance in use of anti-tumor necrosis factor (anti-TNF) therapy in patients with moderate-to-severe inflammatory bowel disease (IBD) can be a factor in medication failure. Few studies have evaluated the contribution of depressive symptoms to medication noncompliance in anti-TNF therapies. METHODS A retrospective chart review was performed in a single-center tertiary care IBD center for patients with Crohn's disease and ulcerative colitis starting anti-TNF therapy over a 2-year period. Medication noncompliance was defined as interruption of medication (not filling anti-TNF prescription if injectable or not getting infliximab infusion for 30 days beyond needed date for continuation) due to patient-driven circumstances. Depressive symptoms were evaluated at baseline using the well-validated Patient Health Questionnaire-9 (PHQ-9), with PHQ-9 ≥ 10 indicative of at least moderate depressive symptoms. Statistical analysis was performed using Cox proportional hazards regression controlling for age, sex, psychiatric history, and disease. RESULTS A total of 246 patients (75 with ulcerative colitis, 171 with Crohn's disease) were started on anti-TNF therapy. Seventy-nine patients (32%) had a prior psychiatric diagnosis reported in the medical record. Thirty-three patients (13%) were noncompliant in follow-up. Sixty patients (24%) had at least moderate depressive symptoms at baseline (PHQ ≥ 10). Depressive symptoms at baseline were significantly associated with noncompliance in follow-up (hazards ratio 2.28, CI 1.1-4.6, p < 0.05). CONCLUSION Depressive symptoms at baseline were associated with medication noncompliance of anti-TNF therapies at follow-up when controlling for age, sex, disease type, and history of psychiatric disease.
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Affiliation(s)
| | - Robin Dalal
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, 1211 21st Ave South, Medical Arts Building Suite 220, Nashville, TN, 37232, USA
| | - Dawn B Beaulieu
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, 1211 21st Ave South, Medical Arts Building Suite 220, Nashville, TN, 37232, USA
| | - Caroline Duley
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, 1211 21st Ave South, Medical Arts Building Suite 220, Nashville, TN, 37232, USA
| | - Kimberly Annis
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, 1211 21st Ave South, Medical Arts Building Suite 220, Nashville, TN, 37232, USA
| | - Lawrence Gaines
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, 1211 21st Ave South, Medical Arts Building Suite 220, Nashville, TN, 37232, USA
| | - Chris Slaughter
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, 1211 21st Ave South, Medical Arts Building Suite 220, Nashville, TN, 37232, USA
| | - David A Schwartz
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, 1211 21st Ave South, Medical Arts Building Suite 220, Nashville, TN, 37232, USA
| | - Sara Horst
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, 1211 21st Ave South, Medical Arts Building Suite 220, Nashville, TN, 37232, USA.
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Rapid Fecal Calprotectin Test and Symptom Index in Monitoring the Disease Activity in Colonic Inflammatory Bowel Disease. Dig Dis Sci 2017; 62:3123-3130. [PMID: 28948412 DOI: 10.1007/s10620-017-4770-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 09/16/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fecal calprotectin is a reliable surrogate marker for inflammatory activity in inflammatory bowel disease (IBD). AIMS For the noninvasive monitoring of the activity of colonic inflammation, we validated a symptom index suitable for ulcerative colitis and colonic Crohn's disease. By combining the symptom index with a rapid semi-quantitative calprotectin test, we constructed a new activity index based on the highest AUCs, using histological remission as a reference. We also evaluated the correlation of the patient-reported influence of the IBD in the daily life, measured by a VAS, with the inflammation activity. METHODS The disease activity of 72 patients with IBD of the colon was determined by endoscopic activity scores (SES-CD/UCEIS). The patients provided stool samples for determination of calprotectin and filled in a questionnaire about their symptoms during the last week. RESULTS The results of the symptom index demonstrated a statistically significant correlation with the rapid calprotectin test, histological inflammation activity, and the VAS. No correlations were found between the VAS and calprotectin or the histological inflammation activity. The sensitivity of the combination index to detect active inflammation was slightly superior to fecal calprotectin alone. CONCLUSION The new symptom index and the combination index are simple, noninvasive means for distinguishing remission from active inflammation in colonic IBD. With the VAS, we can pick up patients who need psychosocial support because of the disease burden, even if their IBD is in remission.
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Allen PB, Gower-Rousseau C, Danese S, Peyrin-Biroulet L. Preventing disability in inflammatory bowel disease. Therap Adv Gastroenterol 2017; 10:865-876. [PMID: 29147137 PMCID: PMC5673018 DOI: 10.1177/1756283x17732720] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 08/29/2017] [Indexed: 02/04/2023] Open
Abstract
Disability is a common worldwide health challenge and it has been increasing over the past 3 decades. The treatment paradigm has changed dramatically in inflammatory bowel diseases (IBDs) from control of symptoms towards full control of disease (clinical and endoscopic remission) with the goal of preventing organ damage and disability. These aims are broadly similar to rheumatoid arthritis and multiple sclerosis. Since the 1990s, our attention has focused on quality of life in IBD, which is a subjective measure. However, as an objective end-point in clinical trials and population studies, measures of disability in IBD have been proposed. Disability is defined as '…any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being.' Recently, after 10 years of an international collaborative effort with the World Health Organization (WHO), a disability index was developed and validated. This index ideally would assist with the assessment of disease progression in IBD. In this review, we will provide the evidence to support the use of disability in IBD patients, including experience from rheumatoid arthritis and multiple sclerosis. New treatment strategies, and validation studies that have underpinned the interest and quantification of disability in IBD, will be discussed.
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Affiliation(s)
- Patrick B. Allen
- Department of Medicine and Gastroenterology, SE Trust, Belfast N. Ireland, UK
| | - Corinne Gower-Rousseau
- Public Health Unit, Epimad Registry, Maison Régionale de la Recherche Clinique, Lille University Hospital, France INSERM UMR 995, LIRIC, Team 5: From epidemiology to functional analysis, Lille University, France
| | - Silvio Danese
- Department of Gastroenterology, IBD Center, Istituto Clinico Humanitas, Humanitas University, Milan, Italy
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Fecal Calprotectin: A Reliable Predictor of Mucosal Healing after Treatment for Active Ulcerative Colitis. Gastroenterol Res Pract 2017; 2017:2098293. [PMID: 29225617 PMCID: PMC5684574 DOI: 10.1155/2017/2098293] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/14/2017] [Accepted: 09/06/2017] [Indexed: 02/07/2023] Open
Abstract
Objectives Mucosal healing has become the new goal of treatment in ulcerative colitis. Fecal calprotectin has been demonstrated to differentiate between mucosal inflammation and mucosal healing. With this project, we investigated whether a reduction in f-calprotectin to <250 μg/g after medical treatment for active ulcerative colitis could predict mucosal healing. Material and Methods After a baseline colonoscopy, 20 patients with active ulcerative colitis were followed with consecutive fecal calprotectin monthly until two measurements of fecal calprotectin < 250 μg/g or a maximum follow-up of 12 months. A flexible sigmoidoscopy was then performed and Mayo endoscopic subscore was used to evaluate degree of inflammation. Simple Clinical Colitis Activity Index was used for evaluation of clinical disease activity. Results A total of 16 patients achieved fecal calprotectin < 250 μg/g during follow-up, and all 16 patients had endoscopic mucosal healing (Mayo endoscopic subscore of ≤1) on the second endoscopy. The remaining four patients had persistently high f-calprotectin levels before the second endoscopy with Mayo endoscopic subscore corresponding to endoscopic mucosal healing in three out of four patients. Conclusions Fecal calprotectin <250 μg/g after medical treatment for active ulcerative colitis is a reliable marker of endoscopic mucosal healing.
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Trindade IA, Ferreira C, Pinto-Gouveia J. The longitudinal effects of emotion regulation on physical and psychological health: A latent growth analysis exploring the role of cognitive fusion in inflammatory bowel disease. Br J Health Psychol 2017; 23:171-185. [DOI: 10.1111/bjhp.12280] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 09/11/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Inês A. Trindade
- CINEICC - Cognitive and Behavioural Centre for Research and Intervention; Faculty of Psychology and Education Sciences; University of Coimbra; Portugal
| | - Cláudia Ferreira
- CINEICC - Cognitive and Behavioural Centre for Research and Intervention; Faculty of Psychology and Education Sciences; University of Coimbra; Portugal
| | - José Pinto-Gouveia
- CINEICC - Cognitive and Behavioural Centre for Research and Intervention; Faculty of Psychology and Education Sciences; University of Coimbra; Portugal
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Agostini A, Ballotta D, Righi S, Moretti M, Bertani A, Scarcelli A, Sartini A, Ercolani M, Nichelli P, Campieri M, Benuzzi F. Stress and brain functional changes in patients with Crohn's disease: A functional magnetic resonance imaging study. Neurogastroenterol Motil 2017; 29:1-10. [PMID: 28560758 DOI: 10.1111/nmo.13108] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 04/17/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND In Crohn's disease (CD) patients, stress is believed to influence symptoms generation. Stress may act via central nervous system pathways to affect visceral sensitivity and motility thus exacerbating gastrointestinal symptoms. The neural substrate underpinning these mechanisms needs to be investigated in CD. We conducted an explorative functional magnetic resonance imaging (fMRI) study in order to investigate potential differences in the brain stress response in CD patients compared to controls. METHODS 17 CD patients and 17 healthy controls underwent a fMRI scan while performing a stressful task consisting in a Stroop color-word interference task designed to induce mental stress in the fMRI environment. KEY RESULTS Compared to controls, in CD patients the stress task elicited greater blood oxygen level dependent (BOLD) signals in the midcingulate cortex (MCC). CONCLUSIONS & INFERENCES The MCC integrate "high" emotional processes with afferent sensory information ascending from the gut. In light of these integrative functions, the stress-evoked MCC hyperactivity in CD patients might represent a plausible neural substrate for the association between stress and symptomatic disease. The MCC dysfunction might be involved in mechanisms of central disinhibition of nociceptive inputs leading to amplify the visceral sensitivity. Finally, the stress-evoked MCC hyperactivity might affect the regulation of intestinal motility resulting in exacerbation of disease symptoms and the autonomic and neuroendocrine regulation of inflammation resulting in enhanced inflammatory activity.
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Affiliation(s)
- A Agostini
- Department of Experimental, Diagnostic, and Specialty Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.,Department of Psychology, University of Bologna, Bologna, Italy
| | - D Ballotta
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - S Righi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - M Moretti
- Department of Experimental, Diagnostic, and Specialty Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - A Bertani
- Department of Gastroenterology, IBD Unit, Policlinico Hospital, Modena, Italy
| | - A Scarcelli
- Department of Gastroenterology, IBD Unit, Policlinico Hospital, Modena, Italy
| | - A Sartini
- Department of Gastroenterology, IBD Unit, Policlinico Hospital, Modena, Italy
| | - M Ercolani
- Department of Experimental, Diagnostic, and Specialty Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.,Department of Psychology, University of Bologna, Bologna, Italy
| | - P Nichelli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - M Campieri
- Department of Clinical Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - F Benuzzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Affiliation(s)
- Sung Chul Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Yoon Tae Jeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Głąbska D, Guzek D, Grudzińska D, Lech G. Influence of dietary isoflavone intake on gastrointestinal symptoms in ulcerative colitis individuals in remission. World J Gastroenterol 2017; 23:5356-5363. [PMID: 28839435 PMCID: PMC5550784 DOI: 10.3748/wjg.v23.i29.5356] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/31/2017] [Accepted: 05/19/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To analyse the association between isoflavone intake and ulcerative colitis motility symptoms in individuals in remission.
METHODS Cross-sectional study was conducted in a group of ulcerative colitis remission individuals, in sub-groups characterised by various intestinal motility and functioning characteristics (abdominal pain, flatulence, constipations, tenesmus). Total of 56 individuals with ulcerative colitis in remission (19 males and 37 females) were recruited for the study. Assessment of diet was based on self-reported data from each patient’s dietary records taken over a period of three typical, random days (2 weekdays and 1 d of the weekend). The daily isoflavone intake (daidzein, genistein, glycitein and total isoflavones) and daily isoflavone intake per 1000 kcal of diet were assessed.
RESULTS No correlations between isoflavone intake levels and number of bowel movements per day were observed both in the case of intake and intake per 1000 kcal of diet. In the group of individuals declaring lack of abdominal pain, the higher intakes of daidzein (P = 0.0075), daidzein per 1000 kcal of diet (P = 0.0358) and total isoflavone (P = 0.0358) were stated, than in the group of individuals declaring abdominal pain. In the group of individuals declaring lack of constipations, the lower intakes of glycitein (P = 0.0213) and glycitein per 1000 kcal of diet (P = 0.0213) were stated, than in the group of individuals declaring presence of constipations. No differences were observed in isoflavone intake between groups of ulcerative colitis individuals declaring lack of flatulence and declaring presence of flatulence, as well as between groups declaring lack of tenesmus and declaring presence of tenesmus.
CONCLUSION The moderate dietary isoflavone intake may be beneficial for individuals with ulcerative colitis in remission, however, before including it into recommendations, further prospective studies are needed.
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