The role of diet in the prevention and treatment of Inflammatory Bowel Diseases.


Abstract

Inflammatory bowel diseases (IBD) – Crohn’s disease (CD) and ulcerative colitis (UC) – are chronic conditions characterised by relapsing inflammation of the gastrointestinal tract. They represent an increasing public health concern and an aetiological enigma due to unknown causal factors. The current knowledge on the pathogenesis of IBD is that genetically susceptible individuals develop intolerance to a dysregulated gut microflora (dysbiosis) and chronic inflammation develops as a result of environmental triggers. Among the environmental factors associated with IBD, diet plays an important role in modulating the gut microbiome, and, consequently, it could have a therapeutic impact on the disease course.

An overabundance of calories and some macronutrients typical of the Western dietetic pattern increase gut inflammation, whereas several micronutrients characteristic of the Mediterranean Diet have the potential to modulate gut inflammation, according to recent evidence. Immunonutrition has emerged as a new concept putting forward the role of vitamins such as vitamins A, C, E, and D, folic acid, beta carotene and trace elements such as zinc, selenium, manganese and iron. However, when assessed in clinical trials, specific micronutrients showed a limited benefit. Further research is required to evaluate the role of individual food compounds and complex nutritional interventions with the potential to decrease inflammation as a means of prevention and management of IBD.

The current dietary recommendations for disease prevention and management are scarce and non evidence-based. This review summarizes the current knowledge on the complex interaction between diet, microbiome and immune-modulation in IBD, with particular focus to the role of the Mediterranean Diet as a tool for prevention and treatment of the disease.

Saving Steve Jobs


Second Opinions Are Critical: Learn how Steve Jobs fought cancer with the right diagnosis, extending life expectancy when Apple needed him the most.

The trouble with misfits, as Steve Jobs would say, was that they refused to comply. As an entrepreneur who pioneered successive revolutions in personal computing & portable devices, Jobs will always be remembered as an aggressive creator and visionary innovator, who never settled for what the world believed to be a norm.

Of course – we know him as the man who famously put a thousand songs in your pocket and gave the world exceptionally efficient and beautiful gadgets; we have admired his ideas on life and debated endlessly about his arguments. We have smiled at his antics and shed tears at his interpretation of Gandhi. But there is another story – one that runs parallel to his tales of entrepreneurial excellence, and sadly, the one that gets misrepresented the most.

As is the case with volatile urban legends, it is widely speculated that Steve Jobs outlived the general life expectancy of a terminal pancreatic cancer patient. He was diagnosed, after all, in 2003!

Myth: Steve Jobs Had Pancreatic Cancer.

It is common knowledge that Jobs was never too vocal about personal issues. At the helm of a publicly traded computing giant however, he was answerable to his board, shareholders, and members of the Apple tribe. Even so, Steve usually refrained from focusing on the specifics of his diagnosis, which led many to believe that he suffered from pancreatic cancer.

However, there is a general consensus within the medical fraternity that pancreatic cancer (Adenocarcinoma) would have translated into an expedited death, shortly after his diagnosis was confirmed in 2003. What really allowed Jobs to live reasonably well for the next 8 years, was an accurate diagnosis.

Pancreatic Cancer vs Neuroendocrine Cancer

Among a very few instances where Jobs decided to throw some light to his diagnosis, he referred to his affliction as a “hormonal imbalance” as opposed to your regular, run-of-the-mill Pancreatic Cancer.

In a convocation speech at Stanford University in 2005 (now popular, thanks to YouTube), Jobs reflected back on the discovery of a tumor in his pancreas in 2003, and the initial reaction of his doctors who were almost certain at the time, that it was an ‘incurable’ type of cancer, giving him a probable life expectancy of 3 to 6 months.
 

I lived with that diagnosis all day. Later that evening I had a biopsy, where they stuck an endoscope down my throat, through my stomach and into my intestines, put a needle into my pancreas and got a few cells from the tumor. I was sedated, but my wife, who was there, told me that when they viewed the cells under a microscope the doctors started crying because it turned out to be a very rare form of cancer that is curable with surgery. I had the surgery, and I’m fine now.

-Steve Jobs, Stanford Convocation, 2005

It is confirmed today, that Jobs suffered from Neuroendocrine Cancer. Due to a lack of clear public understanding and widespread awareness about the disease (It is reported that as few as 10 cancer specialists in the world fully understood Neuroendocrine Cancer in 2001), its symptoms were often mistaken for Pancreatic Cancer, Irritable Bowel Syndrome or Crohn’s Disease.

While most forms of pancreatic cancer arise from pancreatic cells, neuroendocrine tumors arise from hormone-producing islet cells that happen to be in the pancreas. Unlike regular pancreatic cancer, where patients are likely to die within weeks or months after diagnosis, neuroendocrine cancer grows slow, and can be controlled and contained with an early, accurate diagnosis.

Fact: Steve Jobs Had Access To Specialists.

Following his surgery, Jobs lived for 8 more years, and during this time, administrative responsibilities at Apple were gradually handed down to the right personnel.

It isn’t hard to understand that a man of Jobs’ stature had access to the absolute best that the medicare industry had to offer at the time, and that his diagnosis and subsequent surgery were accelerated by the availability of dedicated on-call specialists whenever required. In other words, Jobs didn’t have to worry about the credibility of the treatment he was receiving.

Sadly, though – misdiagnosis and incorrect treatments result in a huge number of deaths around the world today.

Not everyone can afford to deploy medical resources like Steve Jobs did, and yet – as many as 1,000 patients are diagnosed with Neuroendocrine cancer each year in the United States alone.

With the right push and timely access to specialists, they can be treated well, treated right, and allowed the same life expectancy extensions as Jobs enjoyed, if not more.

Question: Doesn’t limited access make you vulnerable to an incorrect diagnosis?

Plagued by the deplorable condition of state-sponsored and privately-distributed health insurance providers and non-availability of surplus funds, most cancer patients in the world today have their options severely limited to standard-issue procedures for diagnosis and treatment. While rare cases such as Neuroendocrine tumors require special analysis, it is still extremely common to find misinterpretations of its symptoms.

The general population still doesn’t have enough access to specialists. Even if they go to general physicians and hospitals, they get referred to standard procedures such as chemotherapy and radiation therapy. In fact, credible and qualified second opinions were really hard to source, until a new wave of internet-enabled services made it possible to connect patients with specialists and multidisciplinary panels of oncologists.

The Onco.com Advantage

At Onco.com, we offer single consultations with domestic & international oncologists, as well as a tumor-board review for advanced cases, for patients who wish to have their ongoing cancer treatment reviewed. In a reference that Jobs would have probably humored, we are trying to intervene as an ‘Autocorrect’ service for cancer treatments around the world, with the availability of an unbiased consultation/treatment being our top priority.

Any patient, irrespective of the stage of their diagnosis/treatment, can send us their existing medical data and receive an accurate analysis of their treatment, and we will revert with any necessary course corrections, as well as suggestions about possible clinical trial engagements that can really make a difference. Not being affiliated to any hospital or treatment centre allows us to be focused only on the right advice for cancer patients, and lets us push forward into a world where everyone has access to the the diagnostic advantages that helped Steve Jobs live for 8 more years.

References & Bibliography

  1. Reference: Neuroendocrine Tumor Research Foundation
  2. Reference: An article that first appeared in Charlotte Observer
  3. Reference: National Cancer Institute – cancer.gov PDQ on Islet Cell Tumors

Here’s Why Your Poop Can Be So Freaking Weird on Your Period


You know what we’re talking about.
Poop-And-Periods

Most people are pretty open about the “joys” that come with having a period, like cramps, bloating, and sore boobs. But there’s one period side effect people really need to discuss more often, because maybe sharing the burden can at least make the load a little lighter: period poop.

Everyone’s situation is different, but it’s not uncommon for your regular poop habits to take a temporary vacation when you’re on your period, or be suddenly replaced with a whole lot of diarrhea, or both. “Many women do get bowel changes just before or during their period,” Kyle Staller, M.D., a gastroenterologist at Massachusetts General Hospital, tells SELF.

You’ve probably noticed this and dismissed it as just one of those body things, but there’s an actual biological cause you should know about.

“The reason that this happens is largely due to hormones,” says Dr. Staller. Pre-period constipation could be a result of an increase in the hormone progesterone, which starts to increase in the time between ovulation and when you get your period. Progesterone can cause food to move more slowly through your intestines, backing you up in the process.

So what about that diarrhea, though? Hormone-like substances called prostaglandins could be to blame for that. The cells that make up the lining of your uterus (known as endometrial cells), produce these prostaglandins, which get released as the lining of your uterus breaks down right before and during your period. If your body makes a lot of prostaglandins, they can make their way into the muscle that lines your bowels. There, they can cause your intestines to contract just like your uterus and push out fecal matter quickly, causing diarrhea in the process, Ashkan Farhadi, M.D., a gastroenterologist at MemorialCare Orange Coast Medical Center and director of MemorialCare Medical Group’s Digestive Disease Project in Fountain Valley, California, tells SELF. (Fun fact: These prostaglandins are also responsible for those painful cramps you might get every month.)

Of course, this can all vary in different people. But if you notice you experience constipation or diarrhea right around your period like clockwork, this may be why.

Having certain health conditions can also exacerbate period-related bowel changes.

If you struggle with a health condition like endometriosisCrohn’s diseaseirritable bowel syndrome, or ulcerative colitis, having your period can cause a flare-up of your symptoms. Ultimately, the symptoms you experience depend on your condition, Dr. Farhadi says.

For example, if you struggle with Crohn’s disease, which can often cause diarrhea, or IBS-D (a form of IBS that causes people to have diarrhea), your body’s release of prostaglandins during your period may cause you poop even more than usual. But if you suffer from IBS-C (IBS that causes people to have constipation), you may find yourself struggling even more to have a BM on your period as progesterone further slows your bowels’ activity. Since ulcerative colitis can lead to both diarrhea and constipation, you might experience an uptick in either during your period.

And unfortunately endometriosis can lead to pain during bowel movements around your period, Christine Greves, M.D., a board-certified ob/gyn at the Winnie Palmer Hospital for Women and Babies, tells SELF. Endometriosis is a disease where endometrial tissue that normally grows inside the uterus (or, as is up for debate, tissue similar to endometrial lining) grows outside of the uterus. This tissue can attach to your bowels and start trouble. “You then have bleeding around that area, and that can cause pain when you have a bowel movement,” Dr. Greves explains.

If your poop gets weird on your period, there are a few things you can do to cope.

The most important step is knowing what’s normal for you on your period and doing what you can to minimize any additional triggers. For instance, if you always get diarrhea during your period, and you know that coffee tends to make you poop more, it’s a good idea to cut back a little when you’re actually on your period, Dr. Farhadi says. You can also take Immodium on the first day of your period in anticipation of diarrhea, or carry it with you in case it strikes, he says. If you deal with constipation during your period, try upping your fiber and water intake in the middle of your cycle, when constipation-prompting progesterone levels start rising.

It can also help to pop some non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs, a common class of pain relievers, can block certain enzymes in your body from making prostaglandins. With fewer prostaglandins roaming around, you may get some relief from an achy belly and incessant pooping.

If you’re really having a hard time with poop issues on your period, talk to your doctor. They may be able to recommend next steps or refer you to a specialist who can. Your period is already annoying enough without spending forever on the toilet, either basically pooping water or straining hard to go in the first place.

Gastroenterologists Share 7 Things to Do When You Have Painful Gas


Pain is the cruel cherry on top.
Gas-Pains

Pretty much no one is happy to have gas (with the exception of the elementary school set, who of course finds it hilarious). Gas is a normal part of having a body, but it can also be straight-up painful sometimes.

Since you probably don’t feel comfortable calling out sick from work with gas or otherwise letting it disrupt your life, you likely want to get things sorted out ASAP. As it turns out, the key to fixing painful gas is knowing why it happens in the first place.

There are a few reasons gas can develop, and, well, it has to go somewhere.

Gas often happens as a normal part of your digestive process. Your stomach and small intestine don’t entirely break down certain carbohydrates you eat, so they end up getting to your large intestine intact, according to the National Institute of Diabetes and Digestive and Kidney Diseases. There, bacteria make gas as they process these undigested sugars, fibers, and starches. Certain foods, like dairy products and cruciferous vegetables such as Brussels sprouts, are more likely to cause gas than others, but everyone’s triggers are different.

You can also get gas if you swallow a lot of air. While it’s unlikely that you’re actually trying to suck down a bunch of oxygen, certain habits like regularly using a straw, drinking carbonated beverages, eating too quickly, and chewing gum can cause you to take in more air than normal. When this causes gas, it’s typically via burping, since the air comes back up before it can go all the way to your stomach.Beyond those causes, gas can happen if you have health conditions that affect your digestive system, like irritable bowel syndromeulcerative colitis, or Crohn’s disease, or bacterial overgrowth in the small intestine, according to the Mayo Clinic.

OK, but why does gas sometimes hurt so bad that you want to cry and check yourself into the ER?

Good question. Painful gas and other bothersome symptoms like bloating can happen if gas builds up in your system because you can’t expel it (like if you’re purposely holding it in), if you eat something that really doesn’t agree with you, or if you have an underlying condition that prevents gas from moving through your system normally. All of this can cause spasms and distension in your large intestine during the digestive process, which can be pretty painful, Jamile Wakim-Fleming, M.D., a gastroenterologist at the Cleveland Clinic, tells SELF.

Unfortunately, there isn’t one magic pill that will immediately get rid of any painful gas you may be experiencing. The drug simethicone, which is an anti-foaming agent present in medicines like Gas-X, is designed to reduce bloating and pain from gas and may help, but it’s not a guarantee, Kyle Staller, M.D., M.P.H., a gastroenterologist at Massachusetts General Hospital, tells SELF.

There are, however, a few tricks you can try to either make the gas go away or, at the very least, make you feel better.

1. Sip a glass of water slowly.

Drinking water does two things, says Dr. Wakim-Fleming: It can help move any gas-causing foods in your system through the digestive process, and it makes it harder for your intestines to contract in a way that gasses you up. See, your intestines contract to move food, and if they contract too strongly or for too long, that can lead to or exacerbate gas.

2. Try to stop swallowing so much air—seriously.

Downing some water can be counterproductive if you’re doing it in a way that will only lead to more gas. Until the pain abates, avoid habits that can lead to swallowing a ton of air, like taking big gulps of water at a time, using straws, drinking fizzy beverages, sucking your food down too quickly, talking a lot while eating, and chewing gum, Dr. Wakim-Fleming says.

3. Try getting up and walking around.

Exercise isn’t just great for your overall health—it can also help clear up painful gas and bloating. While a five-mile run probably isn’t first on your to-do list when you’re doubled over in pain, if you can manage a quick walk or other gentle movement, that can make a big difference.

“Exercise helps exercise your intestines, too,” Dr. Wakim-Fleming says. Experts don’t know exactly why exercise helps move gas along, but something about physical activity helps to boost your intestines’ muscle activity, Ashkan Farhadi, M.D., a gastroenterologist at MemorialCare Orange Coast Medical Center and director of MemorialCare Medical Group’s Digestive Disease Project in Fountain Valley, Calif., tells SELF. (This is part of why exercise is recommended for constipation.)

4. Consider if dairy is actually the culprit.

If you’re currently in the fetal position dealing with gas pain, think back to how much cheese, milk, and ice cream you had recently—even if you don’t think you’re lactose intolerant. You can spend years having zero issues when you drink a venti latte in the A.M., followed by a grilled cheese sandwich at lunch…until you suddenly do. As most people age, they start making less lactase, an enzyme that breaks down lactose, the sugar in dairy products, Dr. Staller says. This is one cause of lactase deficiency and lactose intolerance. As your digestive system’s bacteria tries to break down lactose without enough lactase to do the job, you may experience annoying symptoms like more painful gas than usual.

“Many people in their 20s and 30s have symptoms and don’t suspect that it’s the dairy products,” Dr. Staller says. If you think dairy is behind your painful gas, try cutting it out for a few weeks (or at the very least, the rest of the day) and see where that gets you.

5. Have some peppermint oil or peppermint tea.

It’s not just for your breath—peppermint can act as a spasmolytic, meaning it may help stop your intestines from spasming too much (which is what increases gas), says Dr. Staller. While this mechanism has mainly been studied in regard to irritable bowel syndrome, the muscle contractions in that disorder are the same ones that can make gas feel so terrible, he says.

Doctors aren’t totally sure whether it’s better to take peppermint in a capsule form or via something more standard like a mint or peppermint tea, so feel free to try whatever you have handy (but be sure to follow the instructions if you’re ingesting peppermint oil as a pill).

6. Snuggle under a blanket with a heating pad on your abdomen.

It’s not a hard sell when you feel like crap, but cozying up under a blanket with a heating pad on your abdomen can actually help fight gas. Like peppermint, warmth can have an antispasmodic effect on your body and help your intestines to relax instead of contract too hard or too much, lessening that achy sensation that all too often comes along with gas, Dr. Wakim-Fleming says. And don’t worry that lying down means your gas is having to struggle against gravity to exit—it makes no difference either way, Dr. Farhadi says. (Though, as we said, getting up and walking around for a bit can also be helpful to do before or after you settle in with a heating pad.)

7. And lastly, commit to keeping your fiber intake in check.

Fiber is a key part of a healthy diet and digestive system. It bulks up your stool, which helps you stay regular instead of getting constipated. But on the flip side, having too much fiber can make you gassy as the bacteria in your colon works to break this tough nutrient down, Dr. Farhadi says.

If you find that you’re always in pain after you eat a salad with both broccoli and Brussels sprouts, it’s really best to avoid those foods (or whatever the fiber-heavy food may be) until you feel better—and to try to space out when you eat them in the future.

These tips should, at the very least, help make your painful gas feel a bit better. But if you’re struggling with incredibly painful gas and nothing is helping, call your doctor. They should be able to help you find the root of the issue—and how to stop it.

Real Food Diet Therapy Helps Children With Crohn’s Disease and Ulcerative Colitis


Digestive issues are running rampant and the modern diet is to blame. Crohn’s disease is one of the most debilitating of these conditions. Of the 1.4 million Americans dealing with IBD today, about 700,000 are suffering from Crohn’s. Crohn’s disease is a type of inflammatory bowel disease (IBD) that occurs when an abnormal immune system response leads to chronic inflammation anywhere in the GI or digestive tract — from the mouth to the anus.

A recent study in Science Daily offers a glimmer of hope to Crohn’s and ulcerative colitis sufferers. Researchers from Seattle Children’s Hospital successfully treated children who suffer from these conditions with dietary changes alone.

The dietary changes mandated by this study all fall in the category of common sense. No sugar except for honey, no pasteurized dairy products, no processed foods and no grains. Instead, the children in the study were allowed to consume only nutritional and nourishing whole foods.

That this approach was successful should come as no surprise. The sugar-laden modern diet is to blame for the myriad health problems that plague the western world. Life expectancy is plunging in the US and obesity is on the rise. Poor nutritional choices play an outsized role in these negative health trends.

It can be daunting to navigate the vast amount of dietary information and misinformation that is available online. It is for this reason that I created a convenient and informative nutrition plan. The first step to a healthier diet is to jettison all processed foods from your diet. The convenience and perceived value they provide is entirely illusory. Instead, consume exclusively nourishing whole foods and plenty of healthy fats. Taking control of your health is a transformational journey that starts with a healthy diet.

Food-poisoning bacteria may be behind Crohn’s disease.


People who retain a particular bacterium in their gut after a bout of food poisoning may be at an increased risk of developing Crohn’s disease later in life, according to a new study.

Crohn’s disease is a debilitating bowel disease characterized by the inflammation of the intestines.

People who retain a particular bacterium in their gut after a bout of food poisoning may be at an increased risk of developing Crohn’s disease later in life, according to a new study led by researchers at McMaster University.

Using a mouse model of Crohn’s disease, the researchers discovered that acute infectious gastroenteritis caused by common food-poisoning bacteria accelerates the growth of adherent-invasive E. coli (AIEC) — a bacterium that has been linked to the development of Crohn’s.

Even after the mice had eliminated the food-poisoning bacteria, researchers still observed increased levels of AIEC in the gut, which led to worsened symptoms over a long period of time.

The study, published in the journal PLOS Pathogens, was funded by grants from the Canadian Institutes of Health Research and Crohn’s and Colitis Canada.

Crohn’s disease is a debilitating bowel disease characterized by the inflammation of the intestines. Today, one in every 150 Canadians is living with Crohn’s or colitis, a rate that ranks among the highest worldwide.

“This is a lifelong disease that often strikes people in their early years, leading to decades of suffering, an increased risk of colorectal cancer, and an increased risk of premature death,” said Brian Coombes, senior author of the study. At McMaster University he is a professor of biochemistry and biomedical sciences and a researcher at the Michael G. DeGroote Institute for Infectious Disease Research.

The study’s results, said Coombes, means that new diagnostic tools should be developed to identify AIEC-colonized individuals who may be at greater risk for Crohn’s disease following an episode of acute infectious gastroenteritis.

“We need to understand the root origins of this disease — and to use this information to invigorate a new pipeline of treatments and preventions. It has never been more pressing.”

Crohn’s Disease and Ulcerative Colitis: Find Out Their Similarities and Differences


Some people interchange Crohn’s disease and ulcerative colitis (UC) because there are certain similarities between these two ailments. They are two different types of inflammatory bowel disease (IBD)1 — this is the umbrella term for these conditions (Other lesser-known types of IBD include collagenous colitis and lymphocytic colitis).

ulcerative colitis

Story at-a-glance

  • Some people interchange Crohn’s disease and ulcerative colitis (UC) because there are certain similarities between these two ailments
  • Crohn’s disease and ulcerative colitis both occur in teenagers and young adults. They affect women and men equally, and their symptoms are very similar

Crohn’s disease and ulcerative colitis both occur in teenagers and young adults. They affect women and men equally, and their symptoms are very similar.

What’s more, their definitive causes have not yet been determined, although genes, environmental exposure, and poor immune response are both seen as contributing factors to both of these diseases.

However, what sets these two apart is the area (or areas) they affect. While they both cause chronic inflammation in the gastrointestinal (GI) tract, ulcerative colitis is limited to the rectum and colon, or the large intestine.

It begins in the rectum or sigmoid colon, and spreads up through the colon as the disease progresses. The inflammation and irritation mostly affect only the innermost layer of the intestine lining.2

On the other hand, Crohn’s disease can manifest generally on any area throughout the GI, from the mouth to the anus. It may also appear in patches. Some areas may be affected, while some sections can be inflammation-free.3 However, it occurs in all the layers of the bowel walls (unlike UC, which only affects the innermost layer).

As a result of the deep ulcers and tissue swelling, the bowel walls affected by Crohn’s disease become thicker, with a cobblestoned appearance.

In ulcerative colitis, the bowel walls remain thin, but lose their vascular pattern (meaning the blood vessels are not visible), and there are no patches of healthy tissue that can be seen in the affected areas.

Another telltale sign of Crohn’s disease is the presence of granulomas, which are inflamed cells that are lumped together to form a lesion. Since granulomas are present in Crohn’s disease, but not in ulcerative colitis, the presence of these can help your physician reach a definite diagnosis.

Crohn’s disease may also lead to complications like strictures, fistulas, and fissures, which are less frequent in UC cases. Both Crohn’s disease and UC are chronic conditions, meaning they may have periods of being symptom-free (remission), but with occasional flare-ups. Their symptoms are generally the same: cramping, persistent diarrhea, and abdominal pain.4

However, Crohn’s disease patients usually feel the pain in their lower right abdomen, while UC patients experience it in the lower left abdomen. Most UC patients also have some bloody discharge with their stool, while this occurs much less commonly in people with Crohn’s disease.

Parasitic worms may prevent Crohn’s disease by altering bacterial balance .


The parasitic worms that lurk in some people’s intestines may be revolting, but they seem to forestall Crohn’s disease and other types of inflammatory bowel disease (IBD). A new study might explain how, revealing that the worms enable beneficial microbes in the intestines to outcompete bacteria that promote inflammation. The results could lead to new ways of treating gut diseases by mimicking the effects of the parasites.

Parasites like this whipworm might protect us from Crohn’s disease by altering our intestinal bacteria.

“It’s a beautifully done paper,” says immunologist Joel Weinstock of Tufts University in Boston, who wasn’t connected to the work. “It had not been previously shown that one of the mechanisms [of IBD] is through changes in the intestinal flora.”

In people with IBD, inflammation in the digestive tract results in symptoms such as diarrhea and bleeding and can sometimes lead to intestinal obstructions or other severe complications. Because parasitic worms, or helminths, can be harmful, they appear to be unlikely allies against these diseases. “They are called parasites for a reason,” says immunologist Ken Cadwell of the New York University School of Medicine in New York City, a co-author on the new study. However, IBD is rare in parts of the world where helminths are prevalent, and it is surging in more developed countries, where few people now carry the intestinal intruders. That difference suggests, researchers say, that they are protective.

To determine how the worms could be our frenemies, Cadwell and colleagues tested mice with the same genetic defect found in many people with Crohn’s disease. Mucus-secreting cells in the intestines malfunction in the animals, reducing the amount of mucus that protects the gut lining from harmful bacteria. Researchers have also detected a change in the rodents’ microbiome, the natural microbial community in their guts. The abundance of one microbe, an inflammation-inducing bacterium in the Bacteroides group, soars in the mice with the genetic defect.

The researchers found that feeding the rodents one type of intestinal worm restored their mucus-producing cells to normal. At the same time, levels of two inflammation indicators declined in the animals’ intestines. In addition, the bacterial lineup in the rodents’ guts shifted, the team reports online today in Science. Bacteroides’s numbers plunged, whereas the prevalence of species in a different microbial group, the Clostridiales, increased. A second species of worm also triggers similar changes in the mice’s intestines, the team confirmed.

To check whether helminths cause the same effects in people, the scientists compared two populations in Malaysia: urbanites living in Kuala Lumpur, who harbor few intestinal parasites, and members of an indigenous group, the Orang Asli, who live in a rural area where the worms are rife. A type of Bacteroides, the proinflammatory microbes, predominated in the residents of Kuala Lumpur. It was rarer among the Orang Asli, where a member of the Clostridiales group was plentiful. Treating the Orang Asli with drugs to kill their intestinal worms reversed this pattern, favoring Bacteroides species over Clostridiales species, the team documented.

Cadwell and colleagues also asked whether Clostridiales and Bacteroides microbes were at odds in other people. They analyzed two sets of data on the frequencies of different intestinal microbes, which include results for healthy U.S. residents and kids in North America who have IBD. They saw the same relationship—when Clostridiales species are up, Bacteroides varieties are down, and vice versa.

The study’s findings suggest that parasitic worms deliver their benefits indirectly through their impact on the microbial mixture in the intestines. Worms are “having an anti-inflammatory effect by kicking out something that is inflammatory,” Cadwell says. Members of the Clostridiales group may get a boost when worms are around, he says, because the intestines produce more mucus, which the bacteria feast on.

“This is a good proof of concept,” says immunologist Gabriel Nunez of the University of Michigan, Ann Arbor, who wasn’t connected to the research. It supports “the principle that some of these diseases may be related to changes in the microbiome.” But he cautions that researchers still need direct evidence that Bacteroides species are responsible for Crohn’s disease.

Turning the results into a treatment for IBD could be difficult. Two recent clinical trials of helminth treatment for Crohn’s disease, in which participants drank a solution containing the worms’ eggs, stopped early because the results were disappointing. These studies may not be the last word, however. Cadwell says that worm therapy might work in the roughly 30% of Crohn’s patients who have the same genetic flaw as the mice. And Weinstock notes that if researchers can determine how the parasites trigger the shift in microbe composition, “we may be able to bypass the worms and develop a small molecule drug to get the effect in a safe way.”

Guidelines for the management of inflammatory bowel disease in adults


The management of inflammatory bowel disease represents a key component of clinical practice for members of the British Society of Gastroenterology (BSG). There has been considerable progress in management strategies affecting all aspects of clinical care since the publication of previous BSG guidelines in 2004, necessitating the present revision.

Key components of the present document worthy of attention as having been subject to re-assessment, and revision, and having direct impact on practice include:

  • The data generated by the nationwide audits of inflammatory bowel disease (IBD) management in the UK in 2006, and 2008.

  • The publication of ‘Quality Care: service standards for the healthcare of people with IBD’ in 2009.

  • The introduction of the Montreal classification for Crohn’s disease and ulcerative colitis.

  • The revision of recommendations for the use of immunosuppressive therapy.

  • The detailed analysis, guidelines and recommendations for the safe and appropriate use of biological therapies in Crohn’s disease and ulcerative colitis.

  • The reassessment of the role of surgery in disease management, with emphasis on the importance of multi-disciplinary decision-making in complex cases.

  • The availablity of new data on the role of reconstructive surgery in ulcerative colitis.

  • The cross-referencing to revised guidelines for colonoscopic surveillance, for the management of metabolic bone disease, and for the care of children with inflammatory bowel disease.

Vedolizumab as Induction and Maintenance Therapy for Crohn’s Disease.


BACKGROUND

The efficacy of vedolizumab, an α4β7 integrin antibody, in Crohn’s disease is unknown.

METHODS

In an integrated study with separate induction and maintenance trials, we assessed intravenous vedolizumab therapy (300 mg) in adults with active Crohn’s disease. In the induction trial, 368 patients were randomly assigned to receive vedolizumab or placebo at weeks 0 and 2 (cohort 1), and 747 patients received open-label vedolizumab at weeks 0 and 2 (cohort 2); disease status was assessed at week 6. In the maintenance trial, 461 patients who had had a response to vedolizumab were randomly assigned to receive placebo or vedolizumab every 8 or 4 weeks until week 52.

RESULTS

At week 6, a total of 14.5% of the patients in cohort 1 who received vedolizumab and 6.8% who received placebo were in clinical remission (i.e., had a score on the Crohn’s Disease Activity Index [CDAI] of ≤150, with scores ranging from 0 to approximately 600 and higher scores indicating greater disease activity) (P=0.02); a total of 31.4% and 25.7% of the patients, respectively, had a CDAI-100 response (≥100-point decrease in the CDAI score) (P=0.23). Among patients in cohorts 1 and 2 who had a response to induction therapy, 39.0% and 36.4% of those assigned to vedolizumab every 8 weeks and every 4 weeks, respectively, were in clinical remission at week 52, as compared with 21.6% assigned to placebo (P<0.001 and P=0.004 for the two vedolizumab groups, respectively, vs. placebo). Antibodies against vedolizumab developed in 4.0% of the patients. Nasopharyngitis occurred more frequently, and headache and abdominal pain less frequently, in patients receiving vedolizumab than in patients receiving placebo. Vedolizumab, as compared with placebo, was associated with a higher rate of serious adverse events (24.4% vs. 15.3%), infections (44.1% vs. 40.2%), and serious infections (5.5% vs. 3.0%).

CONCLUSIONS

Vedolizumab-treated patients with active Crohn’s disease were more likely than patients receiving placebo to have a remission, but not a CDAI-100 response, at week 6; patients with a response to induction therapy who continued to receive vedolizumab (rather than switching to placebo) were more likely to be in remission at week 52. Adverse events were more common with vedolizumab.

Source: NEJM

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