Nutrition support in inflammatory bowel disease

A case of plummer-vinson syndrome associated with Crohn's disease

Plummer-Vinson syndrome manifests as cervical dysphagia, iron deficiency anemia, an upper esophageal web, and atrophic glossitis. The cause of the esophageal web is thought to be iron deficiency anemia; however, the cause of Plummer-Vinson syndrome has not been established. Crohn's disease is usually accompanied by malnutrition and iron deficiency anemia; however, no case of concomitant Crohn's disease and Plummer-Vinson syndrome with aggravated malnutrition and anemia has been previously reported. Here, we report on a rare case of Plummer-Vinson syndrome in a Crohn's disease patient, which caused malnutrition and constipation.

Mechanisms and management of growth impairment in children affected by inflammatory bowel disease

Growth failure is a typical complication of pediatric inflammatory bowel disease. Factors responsible for stunting are multiple, and proinflammatory cytokines such as TNF-α and IL-6 play a pivotal role. Other determinants are disease severity and location, malnutrition, increased nutritional needs, genetics and drugs. The achievement of optimal linear growth and the remission of gastrointestinal symptoms are the principal targets of pediatric inflammatory bowel disease treatment. Thus, it is very important to assess and monitor linear growth at diagnosis and during follow-up of disease until final adult height achievement. The main strategies for management or prevention of growth impairment in these children are aimed to ensure optimal nutrition, obtain a rapid and complete remission of the disease avoiding or minimizing steroid usage and consider surgical resection, in particular in case of localized ileo or ileocecal disease, to achieve remission in early or mid-puberty. In the last few years, some authors have evaluated the effects of recombinant human growth hormone treatment in children and adolescents with inflammatory bowel disease. However, further studies are needed to better assess its efficacy.

Probable inflammatory bowel disease in a child: assessment and conservative management

OBJECTIVE

This case presentation describes a method of evaluation and a conservative management plan for a child with probable inflammatory bowel disease (Crohn's Disease). Possible causes for this clinical presentation and a brief review of the literature are offered.

CLINICAL FEATURES

A 9-year-old female had a history of headaches, stomach ache, foulsmelling soft stools, canker and cold sores, dry skin, stuffy nose with postnasal drip, difficulty concentrating in school, mood swings and growing pains with leg cramps. She also had a trace of fecal blood. A Urine OrganiX Profile and the Food Antibody Assessment was ordered demonstrating metabolic changes and food sensitivities.

INTERVENTION AND OUTCOME

In this case, following a clinical laboratory assessment, treatment was initiated using nutrients and dietary changes. Fourteen months after consultation, the patient was symptom-free and her final laboratory assessment was essentially negative. She learned to work with her diet and the consequences resulting from breaking it.

CONCLUSIONS

There is the need for a conservative approach to evaluation and treatment of inflammatory bowel disease before considering other more aggressive and potentially hazardous approaches. The patient's signs and symptoms responded to a unique method of evaluation and conservative management when other approaches had failed.

Testing strategies to reduce diarrhea in persons with HIV using traditional Chinese medicine: acupuncture and moxibustion

Diarrhea affects more than 60% of persons living with HIV/AIDS. Diarrhea can be caused by pathogens, neoplastic diseases, side effects of medications, malabsorption, and/or enteropathy. Activities of daily living and quality of life are often affected by HIV/AIDS-related diarrhea. Traditional Chinese medical interventions such as acupuncture and moxibustion show promise in the area of gastrointestinal symptom management. The purposes of this study were to (a) determine the influence of acupuncture and moxibustion in reducing the frequency of diarrhea and increasing stool consistency in HIV-infected men with chronic diarrhea (defined as three or more episodes of watery, liquid, or loose stools in a 24-hour period for 3 weeks or more), (b) ascertain the feasibility of the methodology for a future prospective randomized controlled trial, and (c) determine sample size estimate for a prospective randomized controlled trial. Using a time-series design, 15 HIV-positive men with chronic diarrhea received the same acupuncture/moxibustion treatment for six sessions over a 3-week period. Each participant maintained a daily stool frequency/consistency and medication diary. All treatments were administered by a licensed acupuncturist trained in traditional Chinese medicine. Based on the intent to treat analysis comparing the change in stool frequency from baseline (Week 1) to Week 3 and Week 4, stool frequency reduced approximately one episode per day (Week 3: p < .001; Week 4: p < .005). Stool consistency also improved, from baseline to Week 3 and Week 4, by more than 1 point on Hansen's stool consistency scale. Acupuncture and moxibustion are promising modalities for the symptom management of chronic diarrhea in HIV/AIDS. The results of this pilot study also establish the feasibility of a larger study and provide the empirical basis to serve as preliminary data from which to estimate statistical power and sample size for a larger efficacy study, inclusive of women as well as men.

Comparison of micronutrients in patients having had panproctocolectomy and either ileal pouch anal anastomosis or Brooke ileostomy for chronic ulcerative colitis (UC)

OBJECTIVE

Patients having panproctocolectomy undergo major metabolic changes. A recent study suggested that patients who have had a panproctocolectomy and ileal pouch-anal anastomosis (IPAA) may be trace element-deficient, while other recent evidence has suggested a gradual decrease in vitamin B12. This study was undertaken to compare patients who had a panproctocolectomy for UC in combination with either an IPAA or a Brooke ileostomy (BI), and to determine whether the type of surgery post-proctocolectomy influences the absorption of trace elements, as well as comparing the levels after both operations with the normal population values.

PATIENTS AND METHODS

One hundred randomly selected patients who had had a panproctocolectomy for UC (50 IPAA, 50 BI) were invited to take part in the study by letter. The patients who consented had blood taken for haemoglobin, serum iron, ferritin, serum folate, red cell folate, vitamin B12, insulin-like growth factor-1 (IGF-1), albumin, and the trace elements copper, magnesium, manganese, selenium, and zinc.

RESULTS

Of the 100 patients, 46 consented to participate in the study (23 IPAA, 23 BI). The age of the BI group was significantly higher than those of the IPAA group (mean age IPAA 44 years, BI 52 years, P < 0.05). There was no significant difference between the two groups with respect to time since operation, mean levels of haemoglobin, iron indices, albumin, serum and red cell folate, vitamin B12, or any of the trace elements examined. Plasma IGF-1 was higher in the IPAA group, but this was no longer significant when adjusted for age.

CONCLUSION

No difference was found in trace element status in patients who had had a panproctocolectomy for UC with either an IPAA or BI. Furthermore, no difference existed between these two groups.

Nutritional issues in inflammatory bowel disease

Malnutrition is a very common problem in patients with chronic inflammatory bowel diseases. This article discusses the incidence, causes, and clinical consequences of malnutrition in these patient groups. The role of nutritional support administered enterally or parenterally either as primary or adjunctive therapy is highlighted, based on past and more recent controlled studies. Additional attention is given to the roles of glutamine, short-chain fatty acids, fish oil, and alternative nutritional therapy.

Diarrhea and human immunodeficiency virus: Western and Eastern perspectives [corrected]

Sixty percent of patients with human immunodeficiency virus (HIV) in the United States and 90% throughout the world will have diarrhea at some point in their illness. This article provides an introductory exploration and discussion of Western and Eastern perspectives of chronic diarrhea in patients with HIV. Western etiologies and treatment approaches, as well as Eastern views from traditional Chinese medicine pathogenesis and treatment principles involving acupuncture and moxibustion are presented. Whereas their interpretations of the causes of diarrhea are different, both the East and West have something to offer patients with this distressing symptom. Further exploration and clinical research is needed in this area.

Nutritional support of the hospitalized patient

Comprehensive care of patients in hospitals includes assessment of nutritional status and provision of appropriate support. This approach is facilitated by knowledge of the essential differences in metabolism between starved and stressed states. Nutritional assessment and care of patients in a hospital are based on answers to the following questions: Who gets it? When do they get it? How much do they get? What route is used to administer it? What kind do they get? What are common complications of enteral and parenteral support? What nutritional aspects are pertinent to common diseases?

[What is the role of nutrition in ulcerative colitis? A contribution to the current status of diet therapy in treatment of inflammatory bowel diseases]

Nutritional therapy for ulcerative colitis (UC) is controversial. Studies are usually designed to investigate total parenteral (TPN) or total enteral nutrition (TEN), and before these can be compared it is necessary to differentiate between the different therapeutic aims. The aims of artificial nutritional support in patients with UC are the readjustment of the nutritional status, possible remission of disease activity, and decrease in the incidence of surgical intervention or postoperative complication. Owing to the heterogeneity of the results published so far, it is still difficult to compare studies. Nevertheless, they indicate that the extent and severity of the colitis and the patient selection are of paramount importance in the implementation of nutritional therapy. Positive effects of TPN reported from non-controlled studies were not confirmed by controlled trials. Moreover, TPN was no more effective than an oral diet. Regarding remission rates or operative interventions needed, TPN had more side effects than and no defined advantages over TEN. TEN seems to be useful for certain patients. In some patients with UC, it seems to be accompanied by fewer postoperative complications. However, a definitive conclusion on the effects of TEN or TPN is not yet possible. In this context, certain fatty acids may have an important role in the treatment of UC. In prospective, randomized and controlled studies omega-3 fatty acids were found to be therapeutically useful. A reduction of the steroid doses needed is particularly important. Another therapeutic approach in distal UC is seen in the rectal administration of short chain fatty acids.