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Nutrients in the Prevention of Osteoporosis in Patients with Inflammatory Bowel Diseases.
Ratajczak, AE, Rychter, AM, Zawada, A, Dobrowolska, A, Krela-Kaźmierczak, I
Nutrients. 2020;(6)
Abstract
The chronic character of inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis, results in various complications. One of them is osteoporosis, manifested by low bone mineral density, which leads to an increased risk of fractures. The aetiology of low bone mineral density is multifactorial and includes both diet and nutritional status. Calcium and vitamin D are the most often discussed nutrients with regard to bone mineral density. Moreover, vitamins A, K, C, B12; folic acid; calcium; phosphorus; magnesium; sodium; zinc; copper; and selenium are also involved in the formation of bone mass. Patients suffering from inflammatory bowel diseases frequently consume inadequate amounts of the aforementioned minerals and vitamins or their absorption is disturbed, resulting innutritional deficiency and an increased risk of osteoporosis. Thus, nutritional guidelines for inflammatory bowel disease patients should comprise information concerning the prevention of osteoporosis.
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Thiopurines in Pediatric Inflammatory Bowel Disease: Current and Future Place.
van Hoeve, K, Vermeire, S
Paediatric drugs. 2020;(5):449-461
Abstract
Thiopurines have been widely used to maintain steroid-free remission in children with inflammatory bowel disease (IBD). However, within the expanding treatment armamentarium, the role of these non-selective immunomodulators has been questioned, especially in pediatric patients, who often present with a more aggressive disease course, which can impact growth and development. The less favorable safety but also inferior efficacy profile associated with thiopurines, in contrast to the newer biological therapies, has interfered with their use. The future place of thiopurines in the management of childhood IBD, therefore, needs revisiting. This review provides a practical overview on the historical and current use of thiopurines in pediatric IBD with specific attention for thiopurine S-methyltransferase testing and monitoring of thiopurine metabolite levels as an approach to improve outcomes. We also give a personal expert opinion on the future role of these drugs in childhood IBD.
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The Rundown of Dietary Supplements and Their Effects on Inflammatory Bowel Disease-A Review.
Malinowski, B, Wiciński, M, Sokołowska, MM, Hill, NA, Szambelan, M
Nutrients. 2020;(5)
Abstract
Inflammatory bowel diseases, including Crohn's disease and ulcerative colitis, are a life-long, chronic, and relapsing problem affecting 11.2 million people worldwide. To date, there is pharmacological therapy to treat symptoms such as diarrhea, constipation, and abdominal cramping/pain. These medications also help to alleviate everyday discomfort; however, there are no curative therapies. Recent studies have investigated the combination of pharmacological treatment along with nutritional interventions to improve quality of life and risk of disease relapse. Dietary supplements, specifically probiotics, polyphenols, fibers, fatty acids and low fermentable oligosaccharide, disaccharide, monosaccharide, and polyol diets (FODMAP diets), have been closely looked at to determine their effect, if any, on the development of inflammatory bowel disease and its course of progression. Approximately 30 studies were carefully reviewed and analyzed to appreciate the value of these above-mentioned supplements and their influence on this gastrointestinal disease. After analysis, it has been demonstrated that by implementing fibers, polyphenols, and fatty acids, as well as keeping a low-saccharide diet for those patients with Crohn's disease and ulcerative colitis can improve quality of life and invoke clinical remission. Some polyphenols, specifically curcumin and resveratrol, have proved to decrease disease activity in studies reviewed. Although these studies have become a topic of recent interest, it would be of great value to doctors and patients alike, to continue in this direction of research and to improve the findings for best treatment substances and dosages. This would lead to increased quality of life and disease control leading to fewer complications in the future.
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Synergic interactions between polyphenols and gut microbiota in mitigating inflammatory bowel diseases.
Li, H, Christman, LM, Li, R, Gu, L
Food & function. 2020;(6):4878-4891
Abstract
Inflammatory bowel diseases (IBD) are a group of chronic and recurring inflammatory conditions in the colon and intestine. Their etiology is not fully understood but involves the combination of gut dysbiosis, genetics, immune functions, and environmental factors including diet. Polyphenols from plant-based food synergistically interact with gut microbiota to suppress inflammation and alleviate symptoms of IBD. Polyphenols increase the diversity of gut microbiota, improve the relative abundance of beneficial bacteria, and inhibit the pathogenic species. Polyphenols not absorbed in the small intestine are catabolized in the colon by microbiota into microbial metabolites, many of which have higher anti-inflammatory activity and bioavailability than their precursors. The polyphenols and their microbial metabolites alleviate IBD through reduction of oxidative stress, inhibition of inflammatory cytokines secretion (TNF-α, IL-6, IL-8, and IL-1β), suppression of NF-κB, upregulation of Nrf2, gut barrier protection, and modulation of immune function. Future studies are needed to discover unknown microbial metabolites of polyphenols and correlate specific gut microbes with microbial metabolites and IBD mitigating activity. A better knowledge of the synergistic interactions between polyphenols and gut microbiota will help to devise more effective prevention strategies for IBD. This review focuses on the role of polyphenols, gut microbiota and their synergistic interactions on the alleviation of IBD as well as current trends and future directions of IBD management.
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Inflammatory bowel diseases in pregnancy.
Andrášová, M, Pařízek, A, Lukáš, K
Ceska gynekologie. 2020;(2):144-148
Abstract
OBJECTIVE To bring actual summary of pre and perinatal care of women with Crohn's disease and ulcerative colitis. DESIGN Review. SETTING Department of Gynaecology and Obstetrics, General Faculty Hospital and 1st Faculty of Medicine, Prague. METHODS Review of articles. CONCLUSION Care of women with inflammatory bowel diseases should be placed in a specialised centre and management of pregnancy should be discussed by a multidisciplinary team included obstetrician, gastroenterologist, surgeon and nutritional specialist. All the possibilities in treatment of these women (except a few of them) are safe during the pregnancy and in the puerperium both for mother and fetus.
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Enhancing treatment success in inflammatory bowel disease: Optimising the use of anti-TNF agents and utilising their biosimilars in clinical practice.
Armuzzi, A, Bouhnik, Y, Cummings, F, Bettey, M, Pieper, B, Kang, T
Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver. 2020;(11):1259-1265
Abstract
Anti-tumour necrosis factor (TNF) agents such as infliximab and adalimumab have greatly altered the treatment landscape in inflammatory bowel disease (IBD). However, there are remaining unmet needs and opportunities to optimise their use. Recent data suggest that proactive therapeutic drug monitoring may lead to more efficient usage of these agents, with potential for higher rates of corticosteroid-free clinical remission than with reactive monitoring. Expanded application of faecal calprotectin measurements may also be valuable, given the ease of use of the assay and its proven effectiveness as a diagnostic tool and predictor of relapse risk. From a practical viewpoint, improved multidisciplinary working may be essential to optimise patient care, with IBD nurse specialists playing an increasingly central role within this model. Finally, the availability of biosimilars of the anti-TNF agents allow drug costs to be reduced without compromising safety or efficacy - thereby providing opportunities to improve accessibility. Alongside extensive data on originator to biosimilar infliximab switch, new studies are beginning to demonstrate the safety of biosimilar to biosimilar switch, as well as adalimumab biosimilar transitions. The risk of a nocebo effect when switching to a biosimilar can be reduced through improved patient education and preparation.
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The Treatment of Pediatric Inflammatory Bowel Disease with Biologic Therapies.
Conrad, MA, Kelsen, JR
Current gastroenterology reports. 2020;(8):36
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Abstract
PURPOSE OF REVIEW Biologics for the treatment of inflammatory bowel disease (IBD) have been transformative to the therapeutic goals in the pediatric population. We review the biologics used to treat IBD, highlighting the importance of patient selection, dosing considerations, and therapeutic drug monitoring in children. RECENT FINDINGS Infliximab is well-established as a safe and efficacious therapy for Crohn's disease and ulcerative colitis. Both dose escalation strategies and therapeutic drug monitoring increase the likelihood of response to anti-TNFα therapies. Early real-world experience of vedolizumab and ustekinumab in pediatric IBD shows promising results, including clinical response rates comparable to what is seen in adults, but there are limited data using them as first-line therapies. Biologic therapies have improved outcomes in pediatric IBD, including achieving mucosal healing as well as improved growth and pubertal development. Therapeutic drug monitoring improves likelihood of response to anti-TNFα therapies, but further studies for vedolizumab and ustekinumab are necessary.
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Nutritional Interventions Using Functional Foods and Nutraceuticals to Improve Inflammatory Bowel Disease.
Shin, DW, Lim, BO
Journal of medicinal food. 2020;(11):1136-1145
Abstract
The gastrointestinal tract, the second largest organ in the body, plays an important role in nutrient and mineral intake through the intestinal barrier. Dysfunction of intestinal permeability and related disorders commonly occur in patients with inflammatory bowel disease (IBD), one of the health problems in the Western societies that are considered to be mainly due to the Western diet. Although the exact etiology of IBD has not been elucidated, environmental and genetic factors may be involved in its pathogenesis. Many synthetic or biological drugs, such as 5-aminosalicylic acid corticosteroids as anti-inflammatory drugs, have been used clinically to treat IBD. However, their long-term use exhibits some adverse health consequences. Therefore, many researchers have devised alternative therapies to overcome this problem. Many studies have revealed that some functional nutrients in nature can relieve gastrointestinal inflammation by controlling proinflammatory cytokines. In this study, we review the ability of functional nutraceuticals such as phytochemicals, fatty acids, and bioactive peptides in improving IBD by regulating its underlying pathogenic mechanisms.
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Nutrition and inflammatory bowel disease.
Forbes, A
Current opinion in clinical nutrition and metabolic care. 2020;(5):350-354
Abstract
PURPOSE OF REVIEW Patients with inflammatory bowel disease (IBD) are always interested in the effects of diet on their disease and are often puzzled by the apparent lack of concern in this regard expressed by their doctors. This lack of concern too often reflects the lack of knowledge but it must be recognized that the evidence base for nutritional interventions is weak and compares poorly with that underlying the use of modern biologic drugs. RECENT FINDINGS The past year has had its usual collection of personal and systematic reviews of the topic and a regrettably large number of poor quality publications on nutrition in IBD. The present contribution aims to highlight some of the more original articles of the past year and to identify areas where useful progress is being made both in cause (sugar perhaps less important than was thought) and habitual diet (where more fruit and less red meat are cautiously promoted). With regard to specific interventions, there is a swing back toward an exclusion diet in children with Crohn's disease and to dietary management of persistent symptoms in IBD patients in whom objective evidence of disease activity is absent or very low. SUMMARY The quality of articles in the field is slowly improving and it is encouraging to find several pertinent publications in the highest caliber journals. Hopefully, this will encourage improvement in clinical practice and further investment in research.
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Autologous fecal microbiota transplantation for the treatment of inflammatory bowel disease.
Basson, AR, Zhou, Y, Seo, B, Rodriguez-Palacios, A, Cominelli, F
Translational research : the journal of laboratory and clinical medicine. 2020;:1-11
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Abstract
The term autologous fecal microbiota transplantation (a-FMT) refers herein to the use of one's feces during a healthy state for later use to restore gut microbial communities after perturbations. Generally, heterologous fecal microbiota transplantation (h-FMT), where feces from a ``healthy" donor is transplanted into a person with illness, has been used to treat infectious diseases such as recurrent Clostridioides difficile infection (CDI), with cure rates of up to 90%. In humans, due to limited response to medicines, h-FMT has become a hallmark intervention to treat CDI. Extrapolating the benefits from CDI, h-FMT has been attempted in various diseases, including inflammatory bowel disease (IBD), but clinical response has been variable and less effective (ranging between 24% and 50%). Differences in h-FMT clinical response could be because CDI is caused by a Clostridial infection, whereas IBD is a complex, microbiome-driven immunological inflammatory disorder that presents predominantly within the gut wall of genetically-susceptible hosts. FMT response variability could also be due to differences in microbiome composition between donors, recipients, and within individuals, which vary with diet, and environments, across regions. While donor selection has emerged as a key factor in FMT success, the use of heterologous donor stool still places the recipient at risk of exposure to infectious/pathogenic microorganisms. As an implementable solution, herein we review the available literature on a-FMT, and list some considerations on the benefits of a-FMT for IBD.