RxPG News : Inflammatory Bowel Disease

Demographic profile suggests environmental role in etiology of Crohn's Disease

Sat, 06 Feb 2010 12:58:24 PST

( from http://www.rxpgnews.com ) Although inflammatory bowel disease (IBD) [comprising mainly Crohn's disease (CD) and ulcerative colitis (UC)] is thought to affect about 150 000 people in the United Kingdom, the prevalence of severe IBD is not known. Mortality following hospitalization for IBD is significant but little has been reported on long-term follow-up.

A research article to be published on January 28, 2010 in the World Journal of Gastroenterology addresses this question. The research team from United Kingdom determined the hospitalized prevalence of severe IBD and subsequent 5-year mortality in Wales, and investigated associations between severe IBD and social deprivation, distance travelled to hospital, and other socio-demographic characteristics.

They found that hospitalization for severe CD was more common among women than men and it peaked among younger people aged 16󈞉 years. UC was similar among men and women and was more common among older people. There was no link between social deprivation and UC, but CD was more common among more deprived social groups.

The differing demographic profiles between CD and UC, suggest that environmental factors play a more significant role in the etiology of CD. The findings of this large population-based study on the prevalence and mortality of IBD are also important for service planning and provision.

Crohn's disease or gastrointestinal endometriosis?

Fri, 22 Feb 2008 08:02:46 PST

( from http://www.rxpgnews.com ) Endometriosis is a condition of unknown etiology in which endometrial tissue occurs at extra-uterine sites, including ovaries, fallopian tubes, and gastrointestinal tract. It usually occurs between 30 and 40 years of age. Four to 17% of menstruating women develop endometriosis. When the disease involves the small bowel, it usually has a benign course, but in rare circumstances, it may present as abdominal emergency. Invasive bowel endometriosis can present as bowel obstruction. The major cause of obstruction is stricture formation and adhesions, which occasionally mimic Crohn's disease or a malignancy in its clinical presentation.

Gastrointestinal endometriosis is suggested by dysmenorrhea, menorrhagia or perimenstrual symptoms. Frank intestinal symptoms are usually associated with intestinal obstruction. While intestinal symptoms may occur during or be exacerbated by the menses, this association may not always be present. The symptoms coincide with menstruation in only 18-40% of the cases. A recurring crampy lower or mid-abdominal pain is the most common presenting symptom for both intestinal endometriosis and Crohn's disease. Other symptoms which may occur in both entities include diarrhea, constipation, nausea, vomiting, fever, anorexia, and weight loss.

A case report published on January 7, 2008 in the World Journal of Gastroenterology describes a desperate patient who presented to Dr. Zafer Teke of Pamukkale University Hospital, Turkey, in 2006. This patient was quite a challenge for Dr. Teke. She was 31 years old with perimenstrual lower and mid-abdominal pain irradiating to the back, and lower abdominal fullness for 3 years, at first monthly, but later continuous, and gradually increasing in severity. She gave a history of moderate dysmenorrhea and menorrhagia, but no dyspareunia. Her only medication was an oral contraceptive. She had delivered a healthy baby.

Her gynecologist at a women's health clinic had diagnosed her with small bowel endometriosis, based on interviews and her clinical course. As only oral contraceptive therapy was started, the symptoms due to partial mechanical bowel obstruction had gradually improved. The lack of response to oral contraceptive therapy had encouraged her gynecologist to perform an exploratory laparotomy. The gynecologist was only able to perform a biopsy from the highly inflamed areas. Biopsy results were non-specific inflammation. The patient was then referred to Dr. Teke's institution to identify the underlying pathology.

In an effort to improve the condition of the patient, Dr. Teke initially decided to treat the patient with conservative measures, and the patient responded to this treatment. However, after ingesting a small amount of food she again complained of abdominal pain, and plain abdominal radiography once more showed mechanical bowel obstruction. After improvement with conservative management and obtaining adequate informed consent, the patient was operated on by Dr. Teke. The operative appearance was thought to indicate Crohn's disease, but in view of the close relationship of the ovaries, tubes and uterus, an immediate gynecological opinion was obtained. The on-call gynecology registrar did not consider the appearance to be due to primary gynecological pathology. An approximately 40 cm segment of distal small bowel had four strictures and three internal fistulas. Histopathological examination of the resected specimen was consistent with Crohn's disease. The surgical treatment led to rapid resolution of the symptoms.

The differential diagnosis of Crohn's disease with intestinal endometriosis may be difficult pre-operatively. Dr. Teke noted that even lower gastrointestinal flexible endoscopy may show no findings suggestive of Crohn's disease, as in his patient. Indeed, there may be a similarity between the two entities in terms of clinical presentation, symptomatology, radiological appearances, surgical and pathological findings. Due to a relatively high percentage of endometriosis among the female population of child-bearing age globally, and the unavailability of a precise test differentiating Crohn's disease from bowel endometriosis, this case reported by Dr. Teke is surely worth the attention of both doctors and women at large.

Alternative strategy better for Crohn's Disease

Fri, 22 Feb 2008 06:52:36 PST

( from http://www.rxpgnews.com ) An international research study, published in The Lancet, has thrown into question the current method of treating Crohn’s disease – opening the door to a safer and more effective treatment option for sufferers of the chronic disease.

“Our study clearly demonstrated that this alternative treatment method was more effective at inducing disease remission than the conventional method,” said Dr. Brian Feagan, Director of Robarts Clinical Trials at Robarts Research Institute at The University of Western Ontario. Dr. Feagan coordinated the research trial and is an author on the study. “Not only were patients more likely to get their disease under control, but they were also spared exposure to steroids – the extended use of which is linked with metabolic disease and even increased mortality. It’s simply a safer, more effective treatment method.”

Called a "step-up" approach, the conventional treatment for Crohn’s disease involves first administering steroids in order to control the patient’s symptoms (abdominal pain and bloody diarrhea); the next step involves administering immune-suppressing drugs, which prepare the body to receive the third medication – an antibody that curbs the inflammatory response at the root of the disease.

The alternative strategy, called "top-down" therapy, employs early use of immune-suppressing drugs combined with an antibody in order to address the disease from the start. Symptom-treating steroids may never even be needed.

The two-year study was conducted at research centres in Belgium, Holland, and Germany and involved 129 subjects with active Crohn’s disease. 64 patients received the conventional step-up treatment and 65 the combined immune-suppressing method (top-down). 60% of the top-down subjects were symptom-free by the 26th week of the study, compared to only 36% of the step-up subjects.

“This study is a milestone in the management of Crohn’s disease,” said lead author Dr. Geert D’Haens, of the Imelda GI Clinical Research Centre at the Imelda Hospital in Bonheiden, Belgium. “It does not look at the effects of single drug intervention but at strategies to alter the natural history of this chronic destructive condition. All ‘classic’ paradigms for the management of Crohn’s disease need to be questioned.”

The impact of the study goes beyond Crohn’s disease. “We’ve seen similar results in top-down, step-up studies of rheumatoid arthritis,” said Dr. Feagan, “suggesting that the top-down approach could be the best treatment method for other chronic auto-immune diseases such as ulcerative colitis.”

New prevention, treatment methods for patients with painful bowel inflammation

Mon, 21 May 2007 03:59:37 PST

( from http://www.rxpgnews.com ) Inflammatory bowel disease, or IBD, is an umbrella term referring to a group of disorders that cause inflammation of the intestines, including ulcerative colitis, diverticular disease and perianal fistula.

Nearly one million Americans experience some form of IBD every year, which is often chronic or recurring. Research presented today at Digestive Disease Week? 2007 (DDW?) looks at preventative measures and potential treatment options for these painful and debilitating conditions. DDW is the largest international gathering of physicians and researchers in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.

Inflammatory bowel diseases are serious and complex diseases with varied preventative and treatment options, and we are pleased to see more attention directed toward improving the lives of people suffering from these conditions, said Marí¡ Abreu, M.D., Director, Inflammatory Bowel Disease Center, Associate Professor of Medicine, Mount Sinai School of Medicine. The studies presented today provide evidence that scientists are beginning to capitalize on previous research to better understand, prevent and treat intestinal inflammation.

Adalimumab is an effective treatment for refractory Crohn's disease

Tue, 01 May 2007 11:26:31 PST

( from http://www.rxpgnews.com ) A study led by Mayo Clinic found that adalimumab (HUMIRA®)) is an effective treatment for adults with Crohn's disease who do not respond to infliximab (REMICADE®) therapy. These findings were published online today by Annals of Internal Medicine.

Crohn's disease is an inflammatory disorder of the gastrointestinal tract that affects an estimated 500,000 people in the United States. Symptoms include abdominal pain, fever, nausea, vomiting, weight loss and diarrhea. Crohn's disease has no known medical cure. One common therapy is a series of intravenous infusions of infliximab, which blocks tumor necrosis factor, an important cause of inflammation in Crohn's disease.

"Approximately 50 percent of Crohn's disease patients who receive repeated administration of infliximab will eventually develop an allergic reaction, need higher doses, or completely stop responding to the therapy," says William J. Sandborn, M.D., the lead author and a gastroenterologist at Mayo Clinic. "Our goal with this study was to determine if adalimumab was a safe and effective alternative for these patients."

Like infliximab, adalimumab is a human monoclonal antibody that blocks tumor necrosis factor. However, it is administered via a series of subcutaneous injections, rather than intravenously.

The study included 325 patients at 52 sites with moderate to severe Crohn's disease who continued to have symptoms despite infliximab therapy or who could not take infliximab due to an allergic reaction. Researchers found that 21 percent of patients who received adalimumab achieved remission after four weeks, while just 7 percent of patients who received a placebo achieved remission in the same period. Fifty-two percent of patients who received adalimumab achieved an improvement in their clinical symptoms as compared with 34 percent of patients who received a placebo.

"This study demonstrates that in the short term, adalimumab can be safely administered to Crohn's disease patients who are intolerant of infliximab," says Dr. Sandborn. "For those patients, this new therapy is a second chance at remission and a significant improvement in quality of life."

Patients in this study were recruited from tertiary care centers, academic medical institutions and independent research organizations in the United States, Canada and Europe.

Each year, physicians at Mayo Clinic's campuses in Arizona, Florida and Minnesota treat approximately 2,000 patients who have Crohn's disease. For more information on the treatment of Crohn's disease at Mayo Clinic, visit www.mayoclinic.org/crohns/.

This research was funded by Abbott Laboratories. Mayo Clinic receives consulting fees from Abbott Laboratories and Centocor, Inc. for work performed by Dr. Sandborn. Humira (adalimumab) is a product of Abbott Laboratories. Remicade (infliximab) is a product of Centocor, Inc.
http://www.mayoclinic.org/news2007-rst/4047.html?src=email-release

Why smokers rarely suffer from ulcerative colitis

Tue, 20 Dec 2005 00:15:38 PST

( from http://www.rxpgnews.com ) Doctors have long known that smokers rarely suffer from a common form of inflammatory bowel disease (IBD) called ulcerative colitis, but they didn't know why. A new study in the December 19 issue of The Journal of Experimental Medicine might help explain this apparent resistance. Scott Plevy and his colleagues at the University of Pittsburgh now show that carbon monoxide (CO), a component of cigarette smoke, helps shut down the intestinal inflammation that causes ulcerative colitis.

CO is best known as a toxic air pollutant, but small amounts of this gas are also produced in the human body as a normal byproduct of metabolism, suggesting that the effects of CO must not be all bad. High dose CO gas is lethal, because it robs the body of life-sustaining oxygen. It is this asphyxiant property of CO that has earned it a bad reputation. But recent scientific studies have shown that CO -- at least at low concentrations -- has a redeeming quality: it acts as an anti-inflammatory agent.

It is this quality, according to Plevy and colleagues, that allowed CO to ease the symptoms of IBD in mice. The group traced the action of inhaled CO to a protein that is produced by immune cells called interleukin (IL)-12. IL-12 is normally produced during infection and helps activate the immune cells that fight off the invading pathogens. But chronic production of IL-12 in the gut also drives the inflammation that causes ulcerative colitis. Inhaled CO inhibited the production of IL-12, short-circuiting the disease-causing inflammation.

The researchers are now trying to unravel the specific cellular components that are required for CO to inhibit IL-12. In the meantime, Plevy thinks that inhaled CO might provide some relief for patients with ulcerative colitis. But non-smokers with IBD shouldn't necessarily break out the Marlboros, as cigarette smoking is a risk factor not only for heart disease and cancer but also for Crohn's disease, another form of IBD.

Probiotic bacteria mixture VSL#3 ease ulcerative colitis pain

Tue, 26 Jul 2005 01:04:38 PST

( from http://www.rxpgnews.com ) A mixture of bacteria developed in part by University of Alberta researchers has been proven highly effective in treating people suffering from ulcerative colitis.

The findings, published in the July, 2005 issue of American Journal of Gastroenterology showed that the majority of patients taking a probiotic mixture of 8 bacteria (VSL#3) for 6 weeks improved their ulcerative colitis. Probiotics are preparations of living microbial cells that, when ingested, are thought to positively influence the composition of microbes in the gut and improve the health of the intestine.

While "bad" bacteria have been flagged as potential culprits in the cause of inflammatory diseases of the bowel, in this case, the ingestion of supplemental "good" bacteria (probiotics) to the intestine proved beneficial in treating ulcerative colitis, said Dr. Richard Fedorak, a professor of gastroenterology at the University of Alberta. The joint study included researchers from the University of Bologna in Italy and the University of North Carolina.

In this open label clinical trial, 86 per cent of those treated with probiotic bacteria mixture VSL#3 experienced relief of their mild to moderate ulcerative colitis. The mixture of eight lactic acid bacterial species is believed to be effective by mechanisms that include (1) reducing the number of "bad" bacteria, (2) reducing the amount of inflammation (3) increasing the mucus layer in the gut, and (4) increasing the amount of anti-inflammatory molecules in the intestine.

Ulcerative colitis is an inflammatory bowel disease that affects the large intestine (colon) and causes acute bloody diarrhea, sever stomach pain, urgency, anemia and fatigue. In its most severe form, ulcerative colitis that does not respond to medical treatment will require surgical removal of the colon.

The VSL#3 was administered over a six-week period to 30 patients who ranged in age from 18 to 65. Remission of the colitis was achieved in 63 per cent of the patients, while another 23 per cent responded with improvement in their symptoms and with healing of the colon's lining. There were no adverse effects to the medication.

The VSL#3 can be considered an important potential treatment for those patients who don't respond to conventional therapy such as mesalamine or 5ASA, Dr. Fedorak said.