Gastrointestinal Disorders

Editorial

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4 pages, 210 KiB

Open AccessEditorial

Aspects of the Pathogenesis and Management of Inflammatory Bowel Diseases

by Andrew S. Day

Gastrointest. Disord. 2021, 3(3), 96-99; https://doi.org/10.3390/gidisord3030010 - 28 Jul 2021

Viewed by 2500

Abstract

Over the last two decades, inflammatory bowel disease (IBD) has been diagnosed more often in many countries around the world, including in parts of the world where IBD was previously uncommon [...] Full article

(This article belongs to the Special Issue Aspects of the Pathogenesis and Management of the Inflammatory Bowel Diseases)

Research

Jump to: Editorial, Review

12 pages, 1293 KiB

Open AccessCommunication

An Irish Multi-Centre Study of Behaviours, Attitudes and Barriers to Exercise in Inflammatory Bowel Disease, a Survey from the Patient’s Perspective

by N. Gettigan Mc, K. Allen, C. Foley, S. Bennett, C. Lardner, T. Lukose, O. Kelly, A. O’Toole and K. Boland

Gastrointest. Disord. 2022, 4(4), 312-323; https://doi.org/10.3390/gidisord4040029 - 10 Dec 2022

Cited by 1 | Viewed by 1991

Abstract

Background: Physical activity (PA) in inflammatory bowel disease (IBD) has many potential favourable outcomes including anti-inflammatory effects, improvement in quality of life and improvements in patient body composition. It is recognised that patients with IBD have a significantly decreased exercise tolerance. Aim: 1. [...] Read more.

Background: Physical activity (PA) in inflammatory bowel disease (IBD) has many potential favourable outcomes including anti-inflammatory effects, improvement in quality of life and improvements in patient body composition. It is recognised that patients with IBD have a significantly decreased exercise tolerance. Aim: 1. To assess physical activity levels, behaviours and barriers to PA in IBD. 2. To assess the likelihood of patients with IBD to engage in a community-based exercise programme. 3. To examine the presence of body image concerns in IBD. Method: Patient surveys were distributed in Beaumont and Connolly Hospitals between October and December 2021. Descriptive statistics, Chi-squared testing and Pearson’s correlations were completed using Minitab. p < 0.05 denoted statistical significance. Results: Data were recorded for a total of 203 patients. Out of all patients, 62% (n = 126) had Crohn’s disease (CD). Over half of the cohort were male (n = 115). Mean weight among females was 75 kg and 83 kg among males. Exercise behaviours: Out of all patients, 71% exercise regularly, on average for 59 min, 3.2 days/week. Walking was the most common form of PA (74%). A post-diagnosis change in exercise behaviour was found in 66% with three-quarters exercising less. The primary barrier to exercise was fatigue (54%). Female gender (p = 0.007) and age < 45 years (p = 0.02) were associated with body image dissatisfaction reported in 62% of patients. Conclusion: These data demonstrate the patient-reported impact of IBD on patient participation in PA. Concerns regarding body image were common and associated with gender and age. A feasibility study of a physician-derived exercise programme in patients with active IBD is underway in Beaumont Hospital to determine the effect on patient response to therapy, inflammation and body composition outcomes (NCT05174754). Full article

(This article belongs to the Special Issue Aspects of the Pathogenesis and Management of the Inflammatory Bowel Diseases 2.0)

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10 pages, 663 KiB

Open AccessArticle

Fecal Calprotectin, Chitinase 3-Like-1, S100A12 and Osteoprotegerin as Markers of Disease Activity in Children with Crohn’s Disease

by Adriaan G. Volkers, Laura Appleton, Richard B. Gearry, Christopher M. Frampton, Floris A. E. de Voogd, Annemieke M. Peters van Ton, Steven T. Leach, Daniel A. Lemberg and Andrew S. Day

Gastrointest. Disord. 2022, 4(3), 180-189; https://doi.org/10.3390/gidisord4030017 - 4 Aug 2022

Cited by 1 | Viewed by 2882

Abstract

Fecal calprotectin (FC), chitinase 3-like-1 protein (CHI3L1), S100A12 and osteoprotegerin (OPG) are biomarkers of intestinal inflammation. This cross-sectional study aimed to evaluate these biomarkers in a cohort of children with Crohn’s disease (CD) and compare them with other measures of disease activity. Stool [...] Read more.

Fecal calprotectin (FC), chitinase 3-like-1 protein (CHI3L1), S100A12 and osteoprotegerin (OPG) are biomarkers of intestinal inflammation. This cross-sectional study aimed to evaluate these biomarkers in a cohort of children with Crohn’s disease (CD) and compare them with other measures of disease activity. Stool samples from children with CD were used to measure FC, CHI3L1, S100A12 and OPG by enzyme-linked immunosorbent assay. Serum inflammatory markers were measured and pediatric CD disease activity index (PCDAI) scores calculated. The simple endoscopic score for CD (SES-CD) was reported for a subgroup who underwent ileocolonoscopy corresponding with the stool samples. Sixty-five children were recruited. Children in clinical remission had lower FC and CHI3L1 levels than those with active disease (FC: 277 vs. 1648 µg/g, p = 0.012; CHI3L1: 23 vs. 227 ng/g, p = 0.013). FC levels differed between patients with clinically active or inactive isolated ileal CD. Although FC and CHI3L1 levels correlated strongly (r = 0.83), none of the fecal markers correlated well with serum markers. Only FC and OPG correlated with SES-CD scores (r = 0.57 and r = 0.48, respectively). In conclusion, FC correlated with both endoscopic and clinical disease activity and was the only biomarker that differentiated between active and inactive ileal CD. CHI3L1 also predicted clinical disease activity and correlated highly with FC. Further investigation of the role of CHI3L1 is required. Full article

(This article belongs to the Special Issue Aspects of the Pathogenesis and Management of the Inflammatory Bowel Diseases 2.0)

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7 pages, 844 KiB

Open AccessArticle

Response to COVID-19 Vaccination in Patients with Inflammatory Bowel Disease on Biological Treatment

by Giorgia Bodini, Elisabetta Giuliana, Irene Giberti, Giulia Guarona, Federica Benvenuto, Elisa Ferretti, Maria Giulia Demarzo, Giorgio Da Rin, Giancarlo Icardi and Edoardo G. Giannini

Gastrointest. Disord. 2022, 4(2), 77-83; https://doi.org/10.3390/gidisord4020009 - 9 May 2022

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Abstract

Background: The antibody response to coronavirus disease 2019 (COVID-19) vaccination in patients with inflammatory bowel disease (IBD) on biological drugs is still unclear. Aim: To determine the anti-SARS-CoV-2 spike 1 (anti-S1-IgG) response rate and antibody levels following a complete COVID-19 vaccination cycle in [...] Read more.

Background: The antibody response to coronavirus disease 2019 (COVID-19) vaccination in patients with inflammatory bowel disease (IBD) on biological drugs is still unclear. Aim: To determine the anti-SARS-CoV-2 spike 1 (anti-S1-IgG) response rate and antibody levels following a complete COVID-19 vaccination cycle in patients with IBD on biological treatment. Methods: We assessed antibody response to COVID-19 in consecutive patients with IBD on biological drugs and without prior exposure to COVID-19. Sera were prospectively collected at baseline and at 21 days (T₁), 42 days (T₂), and 3 months (T₃) after the first vaccine dose. Results: Among the 42 patients included in the study, the overall response rate at T₃ was 97.6%, with no difference across the various biological drugs. After the first dose (T₁), the response rate was higher in patients receiving anti-tumour necrosis factor (TNF) compared to patients treated with other biologics (p = 0.031). Among the responders, the anti-S1 levels were not significantly different among the various biological drugs at all study timepoints. Concomitant corticosteroids and disease activity had no impact on the response rate at all study timepoints. No unexpected side events were observed. Discussion: The antibody response to vaccination against COVID-19 in patients with IBD on biological drugs is optimal, independently of their mechanism of action. Patients treated with anti-TNF seem to have an earlier response to vaccination, while concomitant low-dose corticosteroids and disease activity does not seem to impact response. This information can be used to program vaccination and inform patients. Full article

(This article belongs to the Special Issue Aspects of the Pathogenesis and Management of the Inflammatory Bowel Diseases 2.0)

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7 pages, 234 KiB

Open AccessArticle

Recall of Care Objectives by Patients with Inflammatory Bowel Diseases

by Aria Zand, Shelley Shi, Dominic Nguyen, Brian Kim, Eric Esrailian and Daniel Hommes

Gastrointest. Disord. 2022, 4(1), 49-55; https://doi.org/10.3390/gidisord4010006 - 14 Mar 2022

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Abstract

The management of IBD is highly complex, given the heterogeneity of treatment plans for an equally diverse patient population. Given the intricacy of treatment, improved health literacy may be associated with better outcomes. Methods: Patients were assessed before and after their endoscopy and [...] Read more.

The management of IBD is highly complex, given the heterogeneity of treatment plans for an equally diverse patient population. Given the intricacy of treatment, improved health literacy may be associated with better outcomes. Methods: Patients were assessed before and after their endoscopy and for their knowledge of their disease status, their correct recall of the endoscopy results, their provider–patient communication, and communication preferences. Results: A total of 37 patients completed both surveys and were included in the final analysis. The median age was 45 years. The median number of years diagnosed with IBD was 13. Most patients correctly recalled the results of their surveillance endoscopy after their procedure (84%). Many patients (65%) felt they were equally involved in the decision making process in regard to their surveillance endoscopies. Most patients (92%) reported having results clearly explained to them. Most patients (76%) preferred receiving an email or patient message with results, and 69% of patients reported receiving results in the way they preferred. Conclusions: Most of the patients with IBD who were surveyed had adequate knowledge of their disease process and could accurately recall the results of their endoscopy. However, the delivery of health information can be optimized, as nearly one-third of our patients did not receive their endoscopy results in their preferred method. Full article

(This article belongs to the Special Issue Aspects of the Pathogenesis and Management of the Inflammatory Bowel Diseases 2.0)

7 pages, 237 KiB

Open AccessCommunication

Evidence of On-Going Disparate Levels of Care for South Asian Patients with Inflammatory Bowel Disease in the United Kingdom during the Quinquennium 2015–2019

by Affifa Farrukh and John F. Mayberry

Gastrointest. Disord. 2022, 4(1), 8-14; https://doi.org/10.3390/gidisord4010002 - 14 Jan 2022

Cited by 3 | Viewed by 2597

Abstract

Over the last decade, there have been a number of studies which have documented disparate levels of care in the management of inflammatory bowel disease amongst various minority communities in the UK. Similar findings had previously been described in the USA, where access [...] Read more.

Over the last decade, there have been a number of studies which have documented disparate levels of care in the management of inflammatory bowel disease amongst various minority communities in the UK. Similar findings had previously been described in the USA, where access to biologics has been an issue. In this study, data on admissions to hospital of South Asian and White British patients with inflammatory bowel disease between 2015 and 2019 were collected from 12 National Health Service (NHS) trusts in England, three Health Boards in Wales and two Scottish health organizations using Freedom of Information requests. The analyses of data were based on the assumption that inflammatory bowel disease (IBD) has the same prevalence in the South Asian community and the White British community in the UK. Comparisons were made between the proportion of hospitalised patients who were South Asian and the proportion who were White British in the local community using a z statistic. In Leicester, Bradford, Croydon and Lothian, the proportion of patients from the South Asian community admitted to hospital was significantly greater than the proportion from the local White British community, which is consistent with the greater frequency and severity of the disease in the South Asian community in the UK. However, in Coventry, Wolverhampton, Walsall, Acute Pennine Trust in the north-west of England, Barking, Havering and Redbridge and Glasgow, South Asian patients were significantly under-represented, indicating significant issues with access to hospital-based healthcare for inflammatory bowel disease. This study provides evidence of on-going evidence of disparate levels of care for patients from a South Asian background, with inflammatory bowel disease being underserved by a number of NHS Trusts, Health Boards and comparable organisations. When there is on-going failure to achieve the objectives of the NHS of achieving equality in the delivery of care, it is critical to introduce effective policies which will alter the in-built inertia to change within such organisations. Full article

(This article belongs to the Special Issue Aspects of the Pathogenesis and Management of the Inflammatory Bowel Diseases 2.0)

6 pages, 385 KiB

Open AccessCommunication

by Laura Appleton and Andrew S. Day

Gastrointest. Disord. 2021, 3(1), 23-28; https://doi.org/10.3390/gidisord3010002 - 14 Jan 2021

Cited by 1 | Viewed by 3716

Abstract

Insufficient disease-related knowledge can be a barrier to the effective management of the unpredictable and lifelong course of inflammatory bowel disease (IBD). Patients with chronic illnesses have high non-adherence rates, with direct clinical consequences. While no single intervention strategy can improve the adherence [...] Read more.

Insufficient disease-related knowledge can be a barrier to the effective management of the unpredictable and lifelong course of inflammatory bowel disease (IBD). Patients with chronic illnesses have high non-adherence rates, with direct clinical consequences. While no single intervention strategy can improve the adherence of all patients, the success of attempts to improve patient adherence depends upon the realistic assessment of patients’ knowledge and their understanding of the regimen. The aim of this study was to assess the disease-specific knowledge of the parents and patients with IBD in the South Island of New Zealand, and identify areas of poor knowledge. Families of children diagnosed with IBD were asked to complete the IBD Knowledge Inventory Device (IBD-KID). Patients 10 years and older were asked to participate along with their parents. Of 110 families, 91 responded, with completed questionnaires received from 153 parents and 66 patients. Overall, parents scored significantly higher (13.64 ± 3.88) than their children (10.03 ± 4.07; p < 0.001). Areas of poor knowledge included aspects of treatment (both conventional and alternative), along with long-term disease outcomes. This study has shown clear areas of concern in this population’s disease-specific knowledge of their disease. This should be addressed through targeted education for both the patient and the parents to improve not only their knowledge, but also their adherence and disease self-management. Full article

(This article belongs to the Special Issue Aspects of the Pathogenesis and Management of the Inflammatory Bowel Diseases)

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12 pages, 2957 KiB

Open AccessArticle

20 kDa PEGylated Adrenomedullin as a New Therapeutic Candidate for Inflammatory Bowel Disease

by Goro Miki, Nobuko Kuroishi, Mariko Tokashiki, Sayaka Nagata, Masaji Tamura, Taku Yoshiya, Kumiko Yoshizawa-Kumagaye, Shinya Ashizuka, Joji Kato, Motoo Yamasaki and Kazuo Kitamura

Gastrointest. Disord. 2020, 2(4), 366-377; https://doi.org/10.3390/gidisord2040033 - 7 Oct 2020

Cited by 2 | Viewed by 3386

Abstract

Human adrenomedullin (AM), a hypotensive peptide, also has anti-colitis activity. We prepared a polyethylene glycol (PEG) ylated form of AM through the conjugation of PEG-AM (1–15) and AM (15–52). Highly pure monomeric 20 kDa PEG-AM (20kPEG-AM) stimulated cyclic adenosine monophosphate production in HEK-293 [...] Read more.

Human adrenomedullin (AM), a hypotensive peptide, also has anti-colitis activity. We prepared a polyethylene glycol (PEG) ylated form of AM through the conjugation of PEG-AM (1–15) and AM (15–52). Highly pure monomeric 20 kDa PEG-AM (20kPEG-AM) stimulated cyclic adenosine monophosphate production in HEK-293 cells stably expressing the type 1 AM receptor in a dose-dependent manner. The half-life of 20kPEG-AM was 7.4 h following subcutaneous administration in mice. We assessed the anti-colitis effect of subcutaneous 20kPEG-AM administration in the dextran sodium sulfate murine colitis model. Single and double subcutaneous injection of 20kPEG-AM significantly reduced total inflammation scores. These results suggest that 20kPEG-AM is a promising therapeutic candidate for the treatment of human inflammatory bowel diseases. Full article

(This article belongs to the Special Issue Aspects of the Pathogenesis and Management of the Inflammatory Bowel Diseases)

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7 pages, 519 KiB

Open AccessArticle

Associations between the Presence of Granulomata and Disease Phenotype and Outcomes in Children Diagnosed with Crohn’s Disease

by Laura Appleton, Euan Watt, Fiona Jagger, Richard Hansen, Richard B. Gearry and Andrew S. Day

Gastrointest. Disord. 2020, 2(2), 164-170; https://doi.org/10.3390/gidisord2020017 - 13 Jun 2020

Cited by 1 | Viewed by 2568

Abstract

Background: The finding of a mucosal granuloma on histological analysis of endoscopically obtained biopsies in children with Crohn’s disease has been suggested to provide prognostic information. The aim of this study was to retrospectively assess the rate of granuloma detection and the impact [...] Read more.

Background: The finding of a mucosal granuloma on histological analysis of endoscopically obtained biopsies in children with Crohn’s disease has been suggested to provide prognostic information. The aim of this study was to retrospectively assess the rate of granuloma detection and the impact of this upon specific disease characteristics and outcomes in children diagnosed with Crohn’s disease. After identification of a group of children previously diagnosed with Crohn’s disease, chart reviews were undertaken to characterise the children as granuloma positive or negative. Disease characteristics at diagnosis (such as disease location and nutritional status) and following diagnosis (such as requirement for immunosuppressive medications and surgical intervention) were noted for each patient. Results: Ninety-four children from two distinct geographical areas were identified. Forty-nine (52.1%) of the children had mucosal granulomata. Children with colonic disease were likely to have granulomata detected (RR = 3.04; p < 0.001). Granulomata were associated with lower weight z-scores at diagnosis (p < 0.05), but not other disease features (e.g., perianal disease or extra-intestinal manifestations). The presence of a granuloma at diagnosis was also associated with increased rates of the subsequent requirement for an immunosuppressive medication (RR = 1.26; p = 0.002). The presence of granulomata on histological assessment of mucosal biopsies at diagnosis of children with Crohn’s disease appears to be associated with specific disease features and outcomes. These findings should be clarified prospectively in a larger cohort of children with Crohn’s disease. Full article

(This article belongs to the Special Issue Aspects of the Pathogenesis and Management of the Inflammatory Bowel Diseases)

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8 pages, 228 KiB

Open AccessCommunication

Apparent Disparities in Hospital Admission and Biologic Use in the Management of Inflammatory Bowel Disease between 2014–2018 in Some Black and Ethnic Minority (BEM) Populations in England

by Affifa Farrukh and John Mayberry

Gastrointest. Disord. 2020, 2(2), 144-151; https://doi.org/10.3390/gidisord2020015 - 29 May 2020

Cited by 8 | Viewed by 2502 | Correction

Abstract

Discrimination in delivery of care to patients with inflammatory bowel disease has been reported in the UK with regards to the South Asian population. This paper explores whether it is also true for Afro-Caribbean and Eastern European migrant workers. Treatment was investigated in [...] Read more.

Discrimination in delivery of care to patients with inflammatory bowel disease has been reported in the UK with regards to the South Asian population. This paper explores whether it is also true for Afro-Caribbean and Eastern European migrant workers. Treatment was investigated in NHS trusts, which served substantial migrant and minority communities, through Freedom of Information requests for data on use of biologics or hospital admissions over a five year period. In Bristol, Nottingham, Derby and Burton, Princess Alexandra Hospital Trust in Harlow, Essex and Kings College Hospital NHS Foundation Trust in South London Afro-Caribbean patients were treated significantly less often than White British patients. Eastern European migrant workers, were admitted significantly less often in Croydon, and the Princess Alexandra Hospital NHS Trust in Essex. However, there was no evidence of barriers to access for these communities in Wye Valley Trust, University Hospitals of Bristol NHS Foundation Trust or Queen Elizabeth Hospital Kings Lynn. In North West Anglia both South Asian and Eastern European patients were significantly less likely to be admitted to hospital than members of the White British community. It is incumbent on all gastroenterologists to consider their own clinical practice and encourage their hospital units to adopt effective policies which remove discriminatory barriers to good quality care. Full article

(This article belongs to the Special Issue Aspects of the Pathogenesis and Management of the Inflammatory Bowel Diseases)

10 pages, 979 KiB

Open AccessArticle

Quality of Life and Eligibility for Specific Financial Assistance for Medical Expenses: A Cross-Sectional Web-Based Survey among Patients with Inflammatory Bowel Disease in Japan

by Huyen Thi Thanh Tran, Shota Saito, Shinichi Noto and Kenji Suzuki

Gastrointest. Disord. 2020, 2(2), 123-133; https://doi.org/10.3390/gidisord2020012 - 3 May 2020

Cited by 1 | Viewed by 2866

Abstract

Specific financial assistance for people with rare and intractable diseases is part of Japan’s public health system. This survey aimed to clarify the relationship between eligibility for this specific financial assistance and quality of life (QOL) among individuals with inflammatory bowel disease (IBD) [...] Read more.

Specific financial assistance for people with rare and intractable diseases is part of Japan’s public health system. This survey aimed to clarify the relationship between eligibility for this specific financial assistance and quality of life (QOL) among individuals with inflammatory bowel disease (IBD) in Japan. A nationwide, web-based survey was conducted in Japan among 300 people with IBD. Questionnaire items covered socioeconomic characteristics and QOL, assessed with the five-dimension, five-level EuroQol (EQ-5D-5L). The percentage of respondents who were ineligible for specific financial assistance was 11.0% among those with Crohn’s disease (CD) and 34.0% among those with ulcerative colitis (UC). For those with CD, the median EQ-5D-5L utility weight did not differ significantly between the non-assistance and assistance groups (p = 0.2222). For those with UC, the median EQ-5D-5L utility weight was significantly higher in the non-assistance group than in the assistance group (p = 0.0034). The present study demonstrated that the revision of the law on intractable and rare diseases has not had a negative influence on the QOL of patients with IBD in Japan. Based on our findings, further research on patient-reported outcomes among individuals with IBD may be necessary to inform health policy makers. Full article

(This article belongs to the Special Issue Aspects of the Pathogenesis and Management of the Inflammatory Bowel Diseases)

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Review

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17 pages, 663 KiB

Open AccessReview

Overview of Self-Management Skills and Associated Assessment Tools for Children with Inflammatory Bowel Disease

by Angharad Vernon-Roberts, Richard B. Gearry and Andrew S. Day

Gastrointest. Disord. 2021, 3(2), 61-77; https://doi.org/10.3390/gidisord3020007 - 30 Mar 2021

Cited by 3 | Viewed by 4881

Abstract

Self-management is a multi-modal approach for managing chronic conditions that encompasses a number of different elements; knowledge, adherence, self-regulation, communication, and cognitive factors. Self-management has been shown to be beneficial for adults with inflammatory bowel disease (IBD), and for children with IBD it [...] Read more.

Self-management is a multi-modal approach for managing chronic conditions that encompasses a number of different elements; knowledge, adherence, self-regulation, communication, and cognitive factors. Self-management has been shown to be beneficial for adults with inflammatory bowel disease (IBD), and for children with IBD it may help them learn to take control of their complex treatment regimens and lead to positive disease outcomes. The development of self-management skills for children with IBD is vital in order to maximize their potential for health autonomy, but it is still an emergent field in this population. This review provides an over-arching view of the self-management elements specific to children with IBD, and highlights outcome measures that may be used to assess skills within each field as well as the efficacy of targeted interventions. Full article

(This article belongs to the Special Issue Aspects of the Pathogenesis and Management of the Inflammatory Bowel Diseases)

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13 pages, 1307 KiB

Open AccessReview

Unfolded Protein Response and Crohn’s Diseases: A Molecular Mechanism of Wound Healing in the Gut

by Chao Li

Gastrointest. Disord. 2021, 3(1), 31-43; https://doi.org/10.3390/gidisord3010004 - 10 Feb 2021

Cited by 4 | Viewed by 4279

Abstract

Endoplasmic reticulum (ER) stress triggers a series of signaling and transcriptional events termed the unfolded protein response (UPR). Severe ER stress is associated with the development of fibrosis in different organs, including lung, liver, kidney, heart, and intestine. ER stress is an essential [...] Read more.

Endoplasmic reticulum (ER) stress triggers a series of signaling and transcriptional events termed the unfolded protein response (UPR). Severe ER stress is associated with the development of fibrosis in different organs, including lung, liver, kidney, heart, and intestine. ER stress is an essential response of epithelial and immune cells in the pathogenesis of Inflammatory Bowel Disease (IBD), including Crohn’s disease (CD). Intestinal epithelial cells are susceptible to ER stress-mediated damage due to secretion of a large amount of proteins that are involved in mucosal defense. In other cells, ER stress is linked to myofibroblast activation, extracellular matrix production, macrophage polarization, and immune cell differentiation. This review focuses on the role of the UPR in the pathogenesis in IBD from an immunologic perspective. The roles of macrophage and mesenchymal cells in the UPR from in vitro and in vivo animal models are discussed. The links between ER stress and other signaling pathways, such as senescence and autophagy, are introduced. Recent advances in the understanding of the epigenetic regulation of the UPR signaling are also updated here. The future directions of development of the UPR research and therapeutic strategies to manipulate ER stress levels are also reviewed. Full article

(This article belongs to the Special Issue Aspects of the Pathogenesis and Management of the Inflammatory Bowel Diseases)

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13 pages, 311 KiB

Open AccessReview

Making Decisions about Dietary Therapy in Inflammatory Bowel Disease

by Sydney Solomon, Eunie Park and Joseph A. Picoraro

Gastrointest. Disord. 2020, 2(4), 353-365; https://doi.org/10.3390/gidisord2040032 - 7 Oct 2020

Cited by 1 | Viewed by 3595

Abstract

Treatment for inflammatory bowel disease (IBD) deserves an informed shared decision-making process between patient and doctor. IBD spans a spectrum of phenotypes that impact each patient uniquely. While treatment has primarily consisted of medical or surgical therapy, dietary approaches have become increasingly relevant. [...] Read more.

Treatment for inflammatory bowel disease (IBD) deserves an informed shared decision-making process between patient and doctor. IBD spans a spectrum of phenotypes that impact each patient uniquely. While treatment has primarily consisted of medical or surgical therapy, dietary approaches have become increasingly relevant. A majority of patients with IBD use some form of dietary modification, and it is common for patients to do this without their physicians’ knowledge. Lack of medical supervision can lead to nutritional deficiencies and a worsening disease state. Some patients work with their medical team to pursue a well-defined exclusion diet as a primary therapy, such as the specific carbohydrate diet, exclusive enteral nutrition, or the Crohn’s disease exclusion diet. The motivations to use dietary therapy for IBD remain unclear and the effectiveness has not been definitively established for many approaches. It is necessary for medical providers to be knowledgeable and to foster open communication with their patients in order to ensure the highest likelihood of remission. This review provides an overview of dietary treatment options, the current knowledge about patient motivations for pursuing dietary therapy, and the roles of patient empowerment and patient activation. We outline areas of improvement for the decision-making process. Full article

(This article belongs to the Special Issue Aspects of the Pathogenesis and Management of the Inflammatory Bowel Diseases)

21 pages, 2936 KiB

Open AccessReview

Intestinal Immune Homeostasis and Inflammatory Bowel Disease: A Perspective on Intracellular Response Mechanisms

by Kishu Ranjan

Gastrointest. Disord. 2020, 2(3), 246-266; https://doi.org/10.3390/gidisord2030024 - 22 Aug 2020

Cited by 4 | Viewed by 4964

Abstract

The pathogenesis of inflammatory bowel disease (IBD) involves perturbation of intestinal immune homeostasis in genetically susceptible individuals. A mutual interplay between intestinal epithelial cells (IECs) and gut resident microbes maintains a homeostatic environment across the gut. An idiopathic gastrointestinal (GI) complication triggers aberrant [...] Read more.

The pathogenesis of inflammatory bowel disease (IBD) involves perturbation of intestinal immune homeostasis in genetically susceptible individuals. A mutual interplay between intestinal epithelial cells (IECs) and gut resident microbes maintains a homeostatic environment across the gut. An idiopathic gastrointestinal (GI) complication triggers aberrant physiological stress in the epithelium and peripheral myeloid cells, leading to a chronic inflammatory condition. Indeed, events in the endoplasmic reticulum (ER) and mitochondria contribute to orchestrating intracellular mechanisms such as the unfolded protein response (UPR) and oxidative stress, respectively, to resolve aberrant cellular stress. This review highlights the signaling cascades encrypted within ER and mitochondria in IECs and/or myeloid cells to dissipate chronic stress in maintaining intestinal homeostasis. Full article

(This article belongs to the Special Issue Aspects of the Pathogenesis and Management of the Inflammatory Bowel Diseases)

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18 pages, 359 KiB

Open AccessReview

Vaccination in Inflammatory Bowel Disease: Utility and Future Perspective

by Giovanni Casella, Fabio Ingravalle, Adriana Ingravalle, Claudio Monti, Fulvio Bonetti, Federica De Salvatore, Vincenzo Villanacci and Aurelio Limonta

Gastrointest. Disord. 2020, 2(2), 175-192; https://doi.org/10.3390/gidisord2020019 - 23 Jun 2020

Cited by 2 | Viewed by 3305

Abstract

Inflammatory bowel disease (IBD) is an immune-mediated disease, which often require lifetime treatment with immunomodulators and immunosuppressive drugs. Both IBD and its treatments are associated with an increased risk of infectious disease and mortality. Several of these diseases are vaccine preventable and could [...] Read more.

Inflammatory bowel disease (IBD) is an immune-mediated disease, which often require lifetime treatment with immunomodulators and immunosuppressive drugs. Both IBD and its treatments are associated with an increased risk of infectious disease and mortality. Several of these diseases are vaccine preventable and could be avoided, reducing morbidity and mortality. However, vaccination rates among patients with IBD are lower than in the general population and both patients and doctors are not fully aware of the problem. Education campaigns and well planned vaccination schemes are necessary to improve vaccination coverage in patients with IBD. Immunomodulators and immunosuppressive drugs may reduce the seroprotection levels. For this reason, new vaccination schemes are being studied in patients with IBD. It is therefore important to understand which and when vaccines can be administrated based on immunocompetence or immunosuppression of patients. Usually, live-attenuated vaccines should be avoided in immunosuppressed patients, so assessing vaccination status and planning vaccination before immunosuppressive treatments are pivotal to reduce infection risk. The aim of this review is to increase the awareness of the problem and provide a quick reference for vaccination plan tailoring, especially for gastroenterologists and primary care physicians, who have the skills and knowledge to implement vaccination strategies. Full article

(This article belongs to the Special Issue Aspects of the Pathogenesis and Management of the Inflammatory Bowel Diseases)

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