关键词： Herbal Medicine   Acupuncture   Exercise   Probiotics  

摘要： Patients and physicians often have many questions regarding the role of complementary and alternative medicines (CAMs), or nonallopathic therapies, for inflammatory bowel diseases (IBDs). CAMs of various forms are used by more than half of patients with IBD during some point in their disease course. We summarize the available evidence for the most commonly used and discussed CAMs. We discuss evidence for the effects of herbs (such as cannabis and curcumin), probiotics, acupuncture, exercise, and mind-body therapy. There have been few controlled studies of these therapies, which have been limited by their small sample sizes;most studies have been uncontrolled. In addition, there has been a lack of quality control for herbal preparations. It has been a challenge to design rigorous, randomized, placebo-controlled trials, in part owing to problems of adequate blinding for psychological interventions, acupuncture, and exercise. These barriers have limited the acceptance of CAMs by physicians. However, such therapies might be used to supplement conventional therapies and help ease patient symptoms. We conclude that physicians should understand the nature of and evidence for CAMs for IBD so that rational advice can be offered to patients who inquire about their use. CAMs have the potential to aid in the treatment of IBD, but further research is needed to validate these approaches.

关键词： beliefs   Crohn's disease   dietary advice   eating patterns   ulcerative colitis  

摘要： BackgroundDiet and body composition play unclear roles in the pathogenesis, activity and symptoms of inflammatory bowel disease (IBD). Evidence-based guidance regarding dietary modification in IBD is lacking. We aimed to determine the attitudes of IBD patients and clinicians to diet. MethodsThe present cross-sectional study comprised an online questionnaire distributed to members of a national IBD patient organisation, assessing demographics, anthropometry, disease phenotype and dietary beliefs. Dietitians, gastroenterologists and surgeons were targeted for a similar questionnaire as a result of membership of national professional bodies. ResultsNine hundred and twenty-eight patients (72.2% female;mean age 39.5 years;age range 5-91 years) responded. Two-thirds of the patients had Crohn's disease. The mean reported body mass index was 24.9 kg m(-2) and was significantly skewed to the right. Patients who had taken >10 courses of steroids were had a greater probability of being overweight or obese, independent of disease complications. Most patients (71%) assumed that their diet affected their IBD;61% considered their IBD specialist disregarded the importance of diet. Of the 136 clinicians who responded, the majority felt that diet was a factor in symptoms and intestinal microbiota. More gastroenterologists (44%) than dietitians (17%) considered that diet had a role in the pathogenesis of IBD (P = 0.003). Twenty-six percent of patients reported receiving dietary advice from their IBD specialist, whereas 98% of gastroenterologists reported advice provision. Patients received diverse advice. Half of the patients followed recommendations provided by a clinician. ConclusionsThe present study demonstrates that IBD patients consider diet to be important in their disease. IBD clinicians from different disciplines have diverse views of the role of diet. Advice given to patients is heterogeneous, often perceived as inadequate and poorly followed.

关键词： Vedolizumab   Sleep   Biologics   Depression   Anxiety  

摘要： Introduction Poor sleep, depression, and anxiety are common in patients with inflammatory bowel diseases (IBD) and associated with increased risk of relapse and poor outcomes. The effectiveness of therapies in improving such psychosocial outcomes is unclear but is an important question to examine with increasing selectivity of therapeutic agents. Methods This prospective cohort enrolled patients with moderate-to-severe CD or UC starting biologic therapy with vedolizumab or anti-tumor necrosis factor α agents (anti-TNF). Sleep quality, depression, and anxiety were measured using validated short-form NIH PROMIS questionnaires assessing sleep and mood quality over the past 7?days. Disease activity was assessed using validated indices. Improvement in sleep and mood scores from baseline was assessed, and regression models were used to identify determinants of sleep quality. Results Our study included 160 patients with IBD (49 anti-TNF, 111 Vedolizumab) among whom half were women and the mean age was 40.2?years. In the combined cohort, we observed a statistically significant and meaningful decrease in mean scores from baseline (52.8) by week 6 (49.8, p?=?0.002). Among vedolizumab users, sleep T-score improved from baseline (53.6) by week 6 (50.7) and persisted through week 54 (46.5, p?=?0.009). Parallel reductions in depression and anxiety were also noted (p? Conclusions Both vedolizumab and anti-TNF biologic therapies were associated with improvement in sleep and mood quality in IBD.

关键词： Prevalence   Paediatrics   Inflammatory bowel disease   Crohn's disease   Ulcerative colitis   Sweden  

摘要： Background: We evaluated the impact of different case definition algorithms on the prevalence of paediatric inflammatory bowel disease (IBD), Crohn's disease (CD) and ulcerative colitis (UC) and to compare the occurrence of certain diseases compared to matched controls. Methods: Paediatric patients (<18 years) were identified via ICD codes for UC and CD in Swedish registers between 1993 and 2010 (n = 1432). Prevalence was defined as >= 2 IBD-related visits. Prevalence of treated children in 2010 was defined as >= 2 IBD-related visits with one visit and >= 1 dispensed IBD-related drug prescription in 2010. To test the robustness of the estimates, prevalence was also calculated according to alternative case definitions. The presence of rheumatic, hepatobiliary, pancreatic, and dermatologic diseases were compared with age-/sex-/county-of-residence- matched general population controls. Results: The IBD prevalence was 75/100,000 (CD: 29/100,000;UC: 30/100,000;patients with IBD-U: 16/100,000). Prevalence of treated disease in 2010 was 62/100,000 (CD: 23/100,000;UC: 25/100,000;patients with IBD-U: 13/100,000). When age restrictions were employed, the prevalence estimate decreased (<17y: 61/100,000, <16y: 49/100,000 and <15y: 38/100,000). Compared to general population controls (n = 8583), children with IBD had a higher prevalence of dermatologic (4.7% vs. 0.6%), hepatobiliary (including primary sclerosing cholangitis) (5.5% vs. 0.1%), pancreatic (1.7% vs. 0%) and rheumatic diseases (7.2% vs. 1.2%;all P < 0.01). Conclusions: The overall prevalence of paediatric IBD in Sweden was similar to that in earlier regional cohorts. IBD patients had a higher prevalence of comorbid conditions than matched general population controls.

关键词： Exome   Sequencing   Ulcerative colitis   Crohn's disease  

摘要： Background: Inflammatory bowel disease (IBD) is a chronic, relapsing inflammatory disease of the gastrointestinal tract which includes ulcerative colitis and Crohn's disease. Genetic risk factors for IBD are not well understood. Methods: We performed a family-based whole exome sequencing (WES) analysis on a core family (Family A) to identify potential causal mutations and then analyzed exome data from a Caucasian pediatric cohort (136 patients and 106 controls) to validate the presence of mutations in the candidate gene, heat shock 70 kDa protein 1-like (HSPA1L). Biochemical assays of the de novo and rare (minor allele frequency, MAF < 0.01) mutation variant proteins further validated the predicted deleterious effects of the identified alleles. Results: In the proband of Family A, we found a heterozygous de novo mutation (c.830C > T;***277Leu) in HSPA1L. Through analysis of WES data of 136 patients, we identified five additional rare HSPA1L mutations (***77Ser, ***172del, ***267Ile, ***268Thr, ***558Asp) in six patients. In contrast, rare HSPA1L mutations were not observed in controls, and were significantly enriched in patients (P = 0.02). Interestingly, we did not find non-synonymous rare mutations in the HSP70 isoforms HSPA1A and HSPA1B. Biochemical assays revealed that all six rare HSPA1L variant proteins showed decreased chaperone activity in vitro. Moreover, three variants demonstrated dominant negative effects on HSPA1L and HSPA1A protein activity. Conclusions: Our results indicate that de novo and rare mutations in HSPA1L are associated with IBD and provide insights into the pathogenesis of IBD, and also expand our understanding of the roles of HSP70s in human disease.

关键词： 小肠   双气囊小肠镜   小肠疾病   诊断   护理  

摘要： 双气囊小肠镜能安全、准确的检查全段小肠,并能对可疑病变取活检,明显的提高了诊断小肠的准确性及阳性率,对小肠疾病有很大的诊断有很大的应用价值;护士的配合及检查前后正确的护理干预有利于小肠镜检查的顺利进行,减少并发症的发生,减轻患者的痛苦,提高患者的满意度及小肠检查的质量.

关键词： epigenetics   forkhead box P3 (FOXP3)   histone methylation   inflammatory bowel disease (IBD)   T helper cells   Crohn’s disease   EZH2   regulatory T cell   transcriptional corepressor  

摘要： Regulatory T (Treg) cells expressing the transcription factor FOXP3 play a pivotal role in maintaining immunologic self-tolerance. We and others have shown previously that EZH2 is recruited to the FOXP3 promoter and its targets in Treg cells. To further address the role for EZH2 in Treg cellular function, we have now generated mice that lack EZH2 specifically in Treg cells (EZH2(Delta/Delta) FOXP3(+)). We find that EZH2 deficiency in FOXP3(+) T cells results in lethal multiorgan autoimmunity. We further demonstrate that EZH2(Delta/Delta)FOXP3(+) T cells lack a regulatory phenotype in vitro and secrete proinflammatory cytokines. Of special interest, EZH2(Delta/Delta)FOXP3(+) mice develop spontaneous inflammatory bowel disease. Guided by these results, we assessed the FOXP3 and EZH2 gene networks by RNA sequencing in isolated intestinal CD4(+) T cells from patients with Crohn's disease. Gene network analysis demonstrates that these CD4(+) T cells display a Th1/Th17-like phenotype with an enrichment of gene targets shared by FOXP3 and EZH2. Combined, these results suggest that the inflammatory milieu found in Crohn's disease could lead to or result from deregulation of FOXP3/EZH2-enforced T cell gene networks contributing to the underlying intestinal inflammation.

关键词： Stem Cells   Intestinal Diseases   In vivo   Inflammatory Bowel Diseases   Inhibitors  

摘要： We report herein the identification of the rhodium(III) complex [Rh(phq)(2)(MOPIP)](+) (1): as a potent and selective ATP-competitive neural precursor cell expressed developmentally down-regulated 8 (NEDD8)-activating enzyme (NAE) inhibitor. Structure-activity relationship analysis indicated that the overall organometallic design of complex 1 was important for anti-inflammatory, activity. Complex 1 showed promising anti-inflammatory activity in vivo for the potential treatment of inflammatory bowel disease.

关键词： Mycobacterium avium subsp paratuberculosis   Inflammatory bowel disease   Crohn's disease   ELISA   IS900 nested PCR   Iran  

摘要： Background: Inflammatory bowel disease (IBD) is described as a relapsing condition with high morbidity and uncertain complex pathogenesis. The association of Mycobacterium avium ssp. paratuberculosis (MAP) with Crohn's disease (CD) in human has been debated for decades, however there is no confirmed data to verify such relations in Iran. The aim of this study was to investigate risk factors and a possible role of MAP in Iranian patients with CD. Methods: Anti-MAP antibodies were detected in serum of IBD patients and subjects without IBD (nIBD) through ELISA;MAP DNA and viable MAP cells were identified in patients' biopsies through nested PCR and direct culture methods, respectively. Principal component analysis (PCA) was used to investigate the risk factors in relation to IBD and MAP infection. Results: Positivity for IS900 PCR was detected in 64% (n = 18) of CD, 33% ( n = 10) of ulcerative colitis (UC) and 9.7% (n = 6) of nIBD samples. Live MAP cells were isolated from biopsies of 2 CD patients only. Among 28 patients with CD, 46% (n = 13) and 39% (n = 11) were positive for antibodies against MAP3865c(133-141) and MAP3865c(125-133) peptides, respectively, whereas much lower seroreactivity was detected in UC subjects accounting for 3% (n = 1) for MAP3865c(133-141) and 16.7% ( n = 5) for MAP3865c(125-133). A high immune reactivity to MAP epitopes among CD patients was positively correlated with consumption of fast food meals and IBD familiarity. For both CD and UC, breastfeeding period and consumption of fruit/vegetables presented negative correlation with the presence of antiMAP antibodies. Conclusions: This study provided evidences that high prevalence of MAP DNA and anti-MAP antibodies in CD patients is significantly associated with the development of CD. Despite the role of several factors contributing to IBD, the presence of MAP DNA and anti-MAP antibodies in Iranian CD patients highlights a possible transmission of MAP from animal-derived products to humans.

关键词： 肛肠术后   腹胀   蒙药热盐包   护理  

摘要： 为探讨蒙药热盐包对防治肛肠疾病术后腹胀的临床疗效,减少腹胀的发生率。将158例肛肠疾病术后腹胀患者按随机数表分为两组,分别为蒙药热盐包热熨法和常规肛肠科护理,三天后观察病人的腹胀、排尿、排便情况。结果显示:两种护理肛肠疾病术后腹胀病人的方法比较,差异有显著统计学意义(P<0.05)。