상단 PDF Dietary role in the development and treatment of inflammatory bowel disease

Dietary role in the development and treatment of inflammatory bowel disease

Dietary role in the development and treatment of inflammatory bowel disease

Among the environmental factors, diet appears to play a plausible role in building the physiologic gut microenvironment and contributing to the development of IBD. In a review article, Park at al. described the dietary role as an environmental factor in developing inflammatory bowel disease. 5) Complex carbohy

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Inflammatory bowel disease in Korea: epidemiological, genomic, clinical, and therapeutic characteristics

Inflammatory bowel disease in Korea: epidemiological, genomic, clinical, and therapeutic characteristics

Although IBD occurs worldwide, its epidemiologic and clinical characteristics vary depending upon the geo- graphic location and the ethnicity of the population. Identifying the characteristic features of IBD in pop- ulations living in different geographical locations and with different ethnicities may provide significant clues about its etiology and pathophysiology, which in turn may be helpful in the development of more appro- priate treatment strategies for IBD for these different populations. Therefore, it is important for each country and region to evaluate critically the epidemiology, ge- nomics, and clinical characteristics of IBD among its own population. We have performed a critical review of the recent data in Korea, and describe herein the current epidemiologic and genotypic status, as well as the clinical manifestations and therapeutic responses of IBD that are unique to Korean patients. (Gut Liver 2010;4:1-14)
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Nutritional concerns in pediatric inflammatory bowel disease

Nutritional concerns in pediatric inflammatory bowel disease

Choline and carnitine, which are sufficient in red meat and eggs, comprise major components of cell membrane and have a pivotal role in synthesizing very low density cholesterol in the liver. If their levels become depleted in an obese person, fatty liver disease can easily develop 40) . In a patient of acute ulcerative colitis the intraepithelial choline level is lower than that of re- mission state patients 41) . However, it is still to be determined whether choline deficiency plays a role in the development of experimental colitis and human IBD. It is believed that red meat can alter or aggravate ulcerative colitis. Until now there is no evidence to resist this opinion. Intestinal microbial choline meta- bolism may be linked with IBD. Germ-free mice do not produce increased timethylamine-N-oxide (TMA) when on a high- choline diet. Interestingly, IBD patients are tend to be at increased risk of cardiovascular disease. Recent study showed that IBD is associated with increased levels of urinary TMA, which is indi- cative of enhanced choline metabolism and decreased choline bio-availability 42) . So these patients are recommended to be monitor their intake of this nutrient.
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Prevalence of extraintestinal manifestations in Korean inflammatory bowel disease patients

Prevalence of extraintestinal manifestations in Korean inflammatory bowel disease patients

Age, sex, and medication utilization patterns were significantly different in CD and UC patients, and differences in CD and UC were found for standardized morbidity rate ratios. The medication utilization pattern is likely to be influenced by physician subspecialty. Because musculoskeletal EIMs are the most frequent, it may be expected that there will be differences in the medicines prescribed for patients with IBD depending on whether they are seen by a rheumatologist or a non-rheumatologist. The treatment of severe musculoskeletal EIMs may often involve close collaboration between rheumatologists and gastroenterologists. For exam- ple, when choosing an immunomodulatory agent, rheumatologists tend to prefer methotrexate and gastroenterologists tend to prefer azathioprine. Regarding TNF inhibitors, although eta- nercept has no effect on IBD, as infliximab and adalimumab tend to be preferred by rheuma- tologists. Rheumatologists tend to prescribe more sulfasalazines, while gastroenterologists prefer to use mesalazine in comparison to rheumatologists.
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Comparison of experimental mouse models of inflammatory bowel disease

Comparison of experimental mouse models of inflammatory bowel disease

Pronounced differences between acute vs. chronic DSS-induced colitis. Since IBD is characterized by chronic inflammatory responses and multiple exacerbations during disease progression, a mouse model of chronic colitis is required. The mice with TNBS-induced colitis showed a higher rate of mortality, as shown in Fig. 2D; we therefore used the model of DSS-induced colitis for studying both the acute and chronic forms of the disease. While acute colitis was induced by preparing a 4% DSS solution in drinking water for 5 days, C57BL/6 mice (a highly susceptible strain) were subjected to cyclic treatment with 2% DSS for 30 days to induce chronic inflammation (Fig. 1C). Under these conditions, as shown in Fig. 3A, chronic colitis developed, accompanied by reduced colon length, similar to that observed in DSS-induced acute colitis. Moreover, continuous weight loss was observed, particularly in the 2- to 3-day interval following DSS adminis- tration (Fig. 3B). In accordance with these signs of colitis, mice further exhibited pathological characteristics at the endpoint of the experiment, i.e., they showed necrosis, ulcerations, increase in the number of goblet cells, and infiltration of neutrophils and macrophages into the colonic mucosal and submucosal layers at 30 days post-DSS treatment (Fig. 3C). The colonic mucosal structure of the crypt was broken in both the acute and chronic disease groups, with the occurrence of colonic inflammation, resulting in a clear thickening of the mucosal and muscle layers
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Increasing incidence of inflammatory bowel disease in children and adolescents: significance of environmental factors

Increasing incidence of inflammatory bowel disease in children and adolescents: significance of environmental factors

Diet and microbiota Colonization of the gut begins at birth, and the gut microbiota become more stable and develop adult­like complexity during the first year of life. 41) Various environmental factors, such as diet, are known to contribute to this phenomenon, which begins very early in life. A higher proportion of Bifidobacteria was found in breastfed than formula­fed infants. 42) As previously mentioned, dietary patterns are associated with the pathogenesis of IBD and are related to the intestinal microbiota. In a mouse model, mice fed a high­fat diet demonstrated dysbiosis characterized by an increase in Proteobacteria and decrease in Firmicutes, similar to that observed in CD. 43) A high­fat diet results in the accumulation of secondary bile acids, which in turn can inhibit the growth of the Bacteroidetes and Firmicutes phyla, a common dysbiotic feature found in CD. 44)
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Increasing incidence of inflammatory bowel disease in children and adolescents: significance of environmental factors

Increasing incidence of inflammatory bowel disease in children and adolescents: significance of environmental factors

Diet and microbiota Colonization of the gut begins at birth, and the gut microbiota become more stable and develop adult­like complexity during the first year of life. 41) Various environmental factors, such as diet, are known to contribute to this phenomenon, which begins very early in life. A higher proportion of Bifidobacteria was found in breastfed than formula­fed infants. 42) As previously mentioned, dietary patterns are associated with the pathogenesis of IBD and are related to the intestinal microbiota. In a mouse model, mice fed a high­fat diet demonstrated dysbiosis characterized by an increase in Proteobacteria and decrease in Firmicutes, similar to that observed in CD. 43) A high­fat diet results in the accumulation of secondary bile acids, which in turn can inhibit the growth of the Bacteroidetes and Firmicutes phyla, a common dysbiotic feature found in CD. 44)
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Lung injury as an extra-intestinal manifestation of inflammatory bowel disease

Lung injury as an extra-intestinal manifestation of inflammatory bowel disease

ed in patients with IBD [3,4]. The relationship between EIMs and intestinal disease activity in patients with IBD varies [4,5]. The development of episcleritis or several EIMs, such as pauciarticular arthritis, erythema no- dosum, oral aphthous ulcers, usually implies increased intestinal disease activity. On the other hand, uveitis or ankylosing spondylitis is less likely related to intestinal disease activity.

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Risk of inflammatory bowel disease in patients with chronic obstructive pulmonary disease: A nationwide, population-based study

Risk of inflammatory bowel disease in patients with chronic obstructive pulmonary disease: A nationwide, population-based study

2 Model 2: adjustment for model 1+ place of resident, income, diabetes mellitus, hypertension, dyslipidemia. CD: Crohn’s disease; CI: Confidence interval; COPD: Chronic obstructive pulmonary disease; HR: Hazard ratio; IBD: Inflammatory bowel disease; UC: Ulcerative colitis. weaknesses using administrative data. This limitation is associated with the possibility of overlooking the risk variables that are important for disease development. A well-designed prospective observational cohort study that combine administrative data and actual clinical data including medications and other clinical covariates is needed to reveal more precisely the association between COPD and IBD.
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첨부파일 : The_current_trends_of_therapeutic_agents_for_inflammatory_bowel_disease_and_microbiota

첨부파일 : The_current_trends_of_therapeutic_agents_for_inflammatory_bowel_disease_and_microbiota

Division of Vectors and Parasitic Diseases, Center for Laboratory Control of Infectious Diseases, KCDC Background: Inflammatory bowel disease (IBD) is characterized by chronic inflammation and refers to ulcerative colitis (UC) and Crohn's disease. In Crohn's disease, inflammation occurs in all body parts, from the mouth to the rectum, and UC involves inflammation only in the large intestine. IBD usually involves severe diarrhea, pain, fatigue, and weight loss. Although the etiology of IBD remains unknown, several studies have shown that the development of IBD is caused by genetic or environmental factors.
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The emerging role of resident memory T cells in protective immunity and inflammatory disease.

The emerging role of resident memory T cells in protective immunity and inflammatory disease.

treated with skin-directed rather than systemic therapy, suggests that this approach of local rather than systemic treatment may apply to other tissues as well. Pathologic T rm in non-barrier tissues It has been shown experimentally that accumulation of T RM can also occur in tissues generally considered to be sterile, such as the brain 7 . T RM were identified in the brain after intranasal infection with vesicular stomatitis virus, and CD103+ T RM had a potent effector function after in vitro stimulation. The transcriptional profile of these brain CD8 T RM resembled that of T RM in skin, gut and lung 6,7 . Whether such T RM can form in human brain after viral infection is unknown, and a putative role for these cells in diseases of the CNS requires additional evidence, though recent reports have linked putative pathogenic brain T RM to multiple sclerosis and even schizophrenia. 100,101 While T cell responses in non- barrier tissues may be necessary episodically to deal with a potentially lethal infection, the unintended consequence of such an event may be the generation of long lived T RM and predisposition to potential autoreactive and autoimmune diseases. One hypothesis is that the program to generate T RM exists in all activated T cells, and that a subset those that gain entry into tissue (whether a barrier tissue or a normally sterile tissue) show activation of this program.
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Significant risk and associated factors of active tuberculosis infection in Korean patients with inflammatory bowel disease using anti-TNF agents

Significant risk and associated factors of active tuberculosis infection in Korean patients with inflammatory bowel disease using anti-TNF agents

Guidelines recommend delaying to begin anti-TNF for at least 3 wk when LTBI is confirmed [16,33] . Anti- TNF agents can be started early in some inevitable cases for disease control. Given that LTBI positivity is a significant risk factor for the development of active TB and there seems to be the lack of efficacy of chemoprophylaxis for that, we should consider seriously undertaking the balance between the risk and the benefit before initiating anti-TNF agents in IBD patients with positive result for LTBI. If anti-TNF is used in these patients, more strict and complete anti-TB prophylaxis measures should be followed by rigorous monitoring for the development of active TB.
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Body image, self-esteem, and quality of life in children and adolescents with inflammatory bowel disease in a tertiary hospital in South Korea

Body image, self-esteem, and quality of life in children and adolescents with inflammatory bowel disease in a tertiary hospital in South Korea

In this study, no factors were identified as having a statisti- cally significant influence on body image and self-esteem. The factors that had a statistically significant effect on QOL were height, body weight, hospitalization experiences in the last year, symptoms experienced, and use of oral steroids. First, lower QOL scores for patients with short stature and who were underweight showed statistical significance. The pro- portions of both were high, with 9.2% of participants having short stature and 18.4% being underweight. Such growth dis- orders persist even after the completion of treatment for IBD and are related to delayed puberty and musculoskeletal prob- lems [3]. Interventions such as nutritional supplements and efforts to resolve loss of appetite will be needed in addition to regular checkups on patients' growth status.
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Characteristics and management of patients with inflammatory bowel disease between a secondary and tertiary hospitals: a propensity score analysis

Characteristics and management of patients with inflammatory bowel disease between a secondary and tertiary hospitals: a propensity score analysis

To the best of our knowledge, this is the first study to com- pare the clinical features and management of patients with IBD between a secondary care unit and TRCs using a pro- pensity score matching system. Although IBD is perceived as a condition that usually requires management by gastroen- terology specialists in referral centers, the role of primary or secondary care units is recognized as essential in the long- term care of patients with IBD. 8 Further, issues in the com- munication between health care services for patients with IBD have been highlighted. 9 Therefore, it is imperative to Fig. 2. Kaplan-Meier analysis of cumulative use of treatment after matching. (A) Thiopurine in CD, (B) thiopurine in UC, (C) anti-tumor necrosis factor (anti-TNF) in CD, and (D) anti-TNF in UC. SH, secondary hospital; TRC, tertiary referral centers.
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Pathogenesis and clinical perspectives of extraintestinal manifestations in inflammatory bowel diseases

Pathogenesis and clinical perspectives of extraintestinal manifestations in inflammatory bowel diseases

EIMs. Genetic factors and dysbiosis of gut microbiomes also play an important role in identifying EIMs. Physicians should be careful because specific features of the clinical presenta- tions may signal the possibility of future EIMs. Screening and surveillance of EIMs are difficult for physicians in only one specialty to include in their treatment protocols. Therefore, it is necessary to follow-up with multidisciplinary care. Educat- ing patients on EIMs and their complications will improve the effectiveness of medications and follow-ups. However, re- search has shown that certain EIMs, such as VTEs, PSCs, and nephrolithiasis, may be less emphasized in patient educa- tion. 107 Patients’ perception of thromboembolisms or cardio- vascular EIMs can have a significant impact on the associated morbidity and mortality. VTE has a higher incidence in pa- tients with IBD than in the general population, and IBD dis- ease activity is associated with an increased risk of VTE. 108 However, only 12% of patients were aware that the risk of VTE in the outpatient environment was high and less than half of the patients were convinced that they recognized the signs and symptoms of deep vein thromboses and pulmonary em- bolisms, 107 indicating a need to reconsider the awareness of EIMs in patients with IBD.
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Impact of inflammatory bowel disease on daily life: an online survey by the Korean Association for the Study of Intestinal Diseases

Impact of inflammatory bowel disease on daily life: an online survey by the Korean Association for the Study of Intestinal Diseases

The fluctuations and unpredictable exacerbations of IBD symptoms have a significant psychological impact on the patient’s life. Fears related to the long-term effects of treat- ments, and the progression of the disease can exacerbate anxiety and depression. 11,23-25 In the present study, 37% of the patients reported having felt like committing suicide. Most patients were anxious about their future. The prevalence of anxiety and/or depression in patients with IBD has been reported to be 35% during remission; 24 the prevalence of anxiety and depression during relapse has been reported to be 80% and 60%, respectively. 25 In a recent study, Korean patients with IBD showed higher levels of depression and impaired health-related QOL than those shown by healthy controls. 26 The negative perceptions of IBD among patients and the depressive mood can increase treatment nonadher- ence, leading to a poorer outcome. 19 Integrating psycho- logical interventions with conventional medical treatment seems prudent. 11
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Is fasting beneficial for hospitalized patients with inflammatory bowel diseases?

Is fasting beneficial for hospitalized patients with inflammatory bowel diseases?

In patients with IBD, diet is associated with disease patho- genesis, flare-up, and treatment. 28-30 Several studies have re- ported that diet plays a role in altering the immune system to- gether with the intestinal microbiota in patients with IBD. 31-34 In an etiologic point of view, it is known that Western diets, which consist of refined grains, alcohol, salt, oil, meat, fats, polyunsaturated fatty acids, omega-6 fatty acids, and fructose, and are low in vegetables and fruits, can be considered envi- ronmental factors promoting inflammation in genetically sus- ceptible hosts. 35,36 In addition, Jowett et al. 37 reported that high- er consumption of meat, eggs, protein, and alcohol is related the relapse of UC. Several studies have reported the role of FODMAP (fermentable oligosaccharides, disaccharides and monosaccharides, and polyols), which could increase GI symptoms such as diarrhea, abdominal pain, and bloating in patients with IBD. 38,39 Dietary treatment is often used, such as exclusive and partial EN, specific carbohydrate diet, or gluten- free diet. Exclusive EN is effective, and according to the Euro- pean Society for Clinical Nutrition and Metabolism (ESPEN) guideline, it is recommended as the first-line therapy to induce remission in children and adolescents with acute active CD. 40 However, there is no evidence on the therapeutic benefits of an elimination diet and TPN in patients with UC, 11 and the use of these dietary interventions in adult patients with CD is con- troversial. 41,42 Especially in patients with active IBD, there is no
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Radiologic evaluation of inflammatory bowel disease

Radiologic evaluation of inflammatory bowel disease

대장조영촬영상 장결핵에서 는 Post-evacuat ion 상 이 진단시 가장 도웅이 되었고 Croh n 씨뱅은 이중조영 촬영상에서 아에바성대장엽과 궤양성대장엽은 총만후 촬영상에서 가장 도웅이 되었마... and Bernsteia , C.: Roentgen.[r]

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Nonimmunity against hepatitis B virus infection in patients newly diagnosed with inflammatory bowel disease

Nonimmunity against hepatitis B virus infection in patients newly diagnosed with inflammatory bowel disease

ference. They reported that the reason is that patients with RA are relatively older than patients with SLE. Our study also showed that the anti-HBc-positivity rate increases with age. Our study found that the vaccination effectiveness in the patients newly diagnosed with IBD was significantly lesser than that in the controls. Many studies have presented that immunosuppressant use reduces HBV vaccination effi- cacy. 7-10 However, the patients in this study were newly diag- nosed with and not yet treated for IBD, and the vaccination effectiveness results were similar to those in another study. 18 He et al. 22 opposed that HBV infection in patients with IBD could worsen when treated with immunosuppressants; their finding was concordant with those of this study. We also found that the vaccination effectiveness rate was significant- ly lower in the subgroup of patients newly diagnosed with IBD aged <20 years than in the age-matched controls (IBD, 58.5% vs. control, 75.1%, P=0.045). We did not compare the vaccination rates between the patients and controls; how- ever, we can assume that the vaccination rate of the <20-year subgroup would be higher than that of the other subgroups because of the nationwide vaccination strategy. Therefore, it appears that the lower vaccination effectiveness rate in the patients newly diagnosed with IBD was because of reasons other than the vaccination rate and use of immunosuppres- sants. One possible explanation for this might be a confused immune response. Cellular immune responses initiated by Type 1 helper T cells, cytokines, and regulatory T (Treg) cells effectively protect against and downregulate inflammation in human studies and animal models of CD. 23 HBV infection is also thought to cause an unusual cell-mediated immune response, and it has been proven that Treg cells are an im- portant prognostic factor of HBV infection. 24 However, these hypotheses should be investigated in future research studies;
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Effects of Moxi-tar Herbal Acupuncture of LI11 on inflammatory bowel disease induced by TNBS in mice

Effects of Moxi-tar Herbal Acupuncture of LI11 on inflammatory bowel disease induced by TNBS in mice

여되어야 한다. 관장 후 수일 내에 급성 괴 사와 염증이 생기고 그 후로는 단핵구 침윤 등과 함께 만성 염증 소견을 보인다 34-35) . Chrohn氏 병은 한의학에서는 설사의 범 주에 포함된다 36) . 明의 方賢이 저술한 《奇 效良方·泄瀉門》에서는 “泄者 ,泄漏之义,時 時溏泄,或作 或愈,瀉者 一時水去如注泄”이라 하여 설사를 정의하였다. 病因으로는 外感六 淫 ,飮食不節.勞倦過怠.精神失調로 인해서 脾 胃運化가 실상 되거나 元氣不足과 脾腎虛衰 하게 되어 泄瀉를 일으킨다 하였다 37) . 만성 설사(慢性泄瀉)의 경우는 병세가 완만하고 병정도 비교적 길어져 결국에는 脾腎大腸의 虛寒한 상황이 유발된다. 그래서 健脾調腸 溫腎止瀉하는 치료원칙을 세우고 온열효과 가 있는 애구의 치료를 병행하게 된다. 이와 관련하여 최근에는 60명의 궤양성 대장염 환자를 대상으로 애구요법 비교실험을 통하 여 유의한 효과를 확인하였고 38) , 침구치료가 Bcl-2, Bax, fas and FasL proteins의 발현 을 조절하여 궤양성 대장염의 장점막 세포 의 세포사를 억제한다는 사실이 밝혀지기도 하였다 39) .
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