IBD

Planning for a Baby:  https://youtu.be/2iwLh6XCnq8

Pregnancy with IBD: https://youtu.be/br0kciD8xJk

Motherhood with IBD: https://youtu.be/TQjt8pnMv4I


Our aim is to provide an understanding of the experience of women with inflammatory bowel disease (IBD) who have made the transition to motherhood. A total of 22 mothers with IBD were recruited from around the United Kingdom. Semi-structured interviews were conducted and analyzed using thematic analysis. The central concept—Blurred Lines—offers a novel frame for understanding the transition to motherhood with IBD through identifying parallels between having IBD and becoming, and being, a mother. Parallels clustered into three main themes: Need for Readiness, Lifestyle Changes, and Monitoring Personal and Physical Development. Hence, women with IBD are in some ways well prepared for the challenges of motherhood even though, as a group, they tend to restrict their reproductive choices. We recommend health professionals initiate conversations about reproduction early and provide a multidisciplinary approach to pregnancy and IBD in which women have confidence that their ongoing treatment will be integrated successfully with their maternity care.

Keindahan pada dasarnya adalah alamiah. Alam itu ciptaan tuhan. Ini berarti bahwa keindahan itu ciptan tuhan. Keindahan menyangkut kualitas hakiki dari segala benda yang mengandung kesatuan (unity), keselarasan (harmony), kesetangkupan (symetri), keseimbangan (balance), dan pertentangan (contrast). Dari ciri-ciri itu diambil kesimpulan,bahwa keindahan tersusun dari keselarasan dan pertentangan dari garis, warna, bentuk, nada dan kata-kata. Keindahan adalah kebenaran dan kebenaran adalah keindahan. Dua hal yang indah yang selalu berdampingan. Dua hal tersebut juga berdampingan dengan Manusia. Manusia diberikan keindahan yang sangat luar biasa oleh Tuhan Yang Maha Esa. Oleh sebab itu, manusia diharapkan untuk selalu menjaga keindahan-keindahan yang dimilikinya, yang ada pada dirinya agar senantiasa keindahan tersebut dapat berguna dan dinikmati oleh semua orang, serta untuk mengetahui suatu keindahan dibutuhkan hal-hal seperti renungan, keserasian, kehalusan dan kontemplasi.

Pediatric Crohn disease is characterized by clinical and endoscopic relapses. The inflammatory process is considered to be progressive and may lead to strictures, fistulas, and penetrating disease that may require surgery. In addition, medically refractory disease may be treated by surgical resection of inflamed bowel in an effort to reverse growth failure. The need for surgery in childhood suggests severe disease and these patients have an increased risk for recurrent disease and potentially more surgery. Data show that up to 55% of patients had clinical recurrence in the first 2 years after initial surgery. The current clinical report on postoperative recurrence in pediatric Crohn disease reviews the risk factors for early surgery and postoperative recurrence, operative risk factors for recurrence, and prevention and monitoring strategies for postoperative recurrence. We also propose an algorithm for post-operative management in pediatric Crohn disease.

IBD is an overarching term that defines severe digestive disorders such as Crohn's disease and ulcerative colitis Comment on this article Women with inflammatory bowel disease (IBD) need more advice about pregnancy in order to make informed choices about their pregnancy. A research project that documented the experiences of 22 women and found that some had decided not to have children, or restrict their family size, and many women feared the consequences of pregnancy. 'It is desperately sad that women are opting to remain childless because they are unable to get an accurate picture of the risks they face,' said Anna Madill, a supervisor of the research. 'If they have access to that information, they may make an entirely different choice. The healthcare system needs to make sure that women living with IBD have access to all the facts necessary to make a fully informed decision.' Participants were concerned that they would pass down the condition to their children as well as worried that they would be unable to cope with a small child during periods when their condition would flare-up. IBD is an overarching term that defines severe digestive disorders such as Crohn's disease and ulcerative colitis, both of which can cause severe stomach pains, weight loss, and recurring diarrhoea. There is no cure for IBD and people living with the condition will experience periods of stability, with no symptoms, and then periods of flare-ups which be debilitating and affect quality of life. In the UK, 1 in 250 people have the condition and its incidence is increasing. The researchers, from the University of Leeds, made three films featuring participants describing their experiences of living with, being pregnant with, and being a mother with IBD. 'One of the main points to emerge from the study is that learning to live with a chronic illness has helped the women prepare for motherhood,' added Ms Madill. 'These women coped well with becoming parents.'

Several studies have shown the protective function of trefoil factors in the gastrointestinal tract and their up-regulated expression at the site of mucosal damage. However, the role of trefoil factor 3 (TFF3) in inflammatory bowel disease (IBD) still needs to be clarified. The aim of the current study was to evaluate the role of serum human TFF3 as a biomarker in patients with IBD. Sixty-four patients with IBD and 16 healthy controls were enrolled in this study. The patients were divided into four groups: with active ulcerative colitis (UC) (n = 16), with UC in remission (n = 16), with active Crohn's disease (CD) (n = 16), and with CD in remission (n = 16). Serum levels of TFF3 were measured by ELISA. The patients with active UC had the highest TFF3 levels. They were significantly higher than those of the controls (p < 0.001), active CD patients (p < 0.001), UC patients in remission (p < 0.001) and CD patients in remission (p < 0.001). UC patients in remission had really close mean values of TFF3 to those of the control group, however, with no significant difference (p = 0.720). In conclusion, serum human TFF3 was able to identify patients with active UC and could possibly be used as a marker for mucosal healing. It has potential for development as a serum biomarker that could decrease the need for regular endoscopy in UC patients. Further validation is needed to better establish the utility of TFF3 in IBD patients.

Perianal fistulization is the result of a chronic inflammation of the perianal tissues. A wide spectrum of clinical manifestations, ranging from simple to complex fistulas, can be seen, the latter especially in patients with Crohn disease. Failure to detect secondary tracks and hidden abscesses may lead to therapeutic failure, such as insufficient response to medical treatment and relapse after surgery. Currently, magnetic resonance (MR) imaging is the preferred technique for evaluating perianal fistulas and associated complications. Initially used most often in the preoperative setting, MR imaging now also plays an important role in evaluating the response to medical therapy.

Inflammatory bowel disease and food allergies are a growing topic in the field of nutrition science. Polyphenols, which are the most important secondary metabolites of plants, demonstrated to modulate the expression and/or production of numerous proteins, but also to regulate the intestinal ecosystem. In this context, our aim was the investigation of protective effects against the gastrointestinal mucosa of fortified milk kefir obtained by adding seeds extract from Sangiovese cv. Pomace. Methods: An ultrasound-assisted method was used to obtain the extracts. All the extracts were assayed for the antioxidant activity. The best extract was used as an additive of fermented milk kefir to obtain a fortified final product. Kefir samples were analyzed by NMR spectroscopy. The efficiency of the barrier functions was evaluated by measuring trans-epithelial electric resistance (TEER) using a voltmeter. Results: the enriched kefir (Ksgn) possesses higher antioxidant performances compared to the unfortified sample (Kwht). Kwht and Ksgn did not alter Caco-2 TEER in basal condition.

Le nombre de cas de MICI connait une progression importante aujourd’hui. La prise en charge de ces pathologies fait partie des priorités de santé publique. Ce qui implique notamment la production des connaissances sur le vécu de cette maladie en lien avec la qualité de vie (QDV). Un des enjeux majeurs pour la psychologie de la santé est d’étudier l’expérience vécue de ces maladies et les déterminants de la QDV. Pour ce faire, nous avons cherché à explorer les liens entre la QDV et la perspective temporelle (PT).

Quarante-six patients (Agem : 32 ans, 37 % d’hommes, 63 % de femmes) recrutés au service d’hépato-gastro-entérologie du CHU Nord (Marseille), ont complété un questionnaire comprenant deux mesures de QDV : une spécifique: l’IBDQ (Inflammatory Bowel Disease Questionnaire), et une généraliste : la SF-36, la version française de la ZTPI (Zimbardo Time Perspective Inventory) mesurant la PT et des informations sociodémographiques.

Les analyses corrélationnelles illustrent les liens entre la PT et la QDV. Les analyses de régression réalisées montrent que le « passé négatif » et le « présent fataliste » prédiraient la QDV dans son ensemble, et surtout aux niveaux des symptômes associés, de la douleur physique et de la santé psychique. Plus les patients focalisent sur un de ces registres temporels, plus leur qualité de vie est altérée.

Ces premiers résultats exploratoires suggèrent l’intérêt de considérer la PT en tant que déterminant psychologique de la QDV. Ils viennent corroborer des résultats antérieurs sur le lien entre la PT et la QDV associée à d’autres pathologies (Préau & Apostolidis, 2007). Les registres « passé négatif » et « présent fataliste » renvoient à la souffrance psychologique et nous renseignent sur l’importance de l’expérience du temps psychologique dans l’évaluation de la QDV.

Women with inflammatory bowel disease (IBD) should be given more advice about pregnancy so they can make informed choices about whether to have a family, say researchers. In their paper in the journal Qualitative Health Research, the scientists draw on evidence that women with the disease often decide not to have children, or to restrict the size of their family, because of fears the pregnancy would affect their health or that of their baby. Although inflammatory bowel disease can cause complications during pregnancy, research shows that one third of women with the condition will not get worse and another third will actually see an improvement in their health. The study, led by the University of Leeds, chronicled the experiences of 22 women who have had children, to plug an information gap about the realities of becoming a mother with IBD.

This video talks about how women with IBD cope with young children within the early years of motherhood. If you want to find out more about planning for a baby with IBD click here: https://www.youtube.com/watch?v=2iwLh6XCnq8&t=4s

For more information on pregnancy and IBD click here: https://www.youtube.com/watch?v=br0kciD8xJk&t=5s

Background music "Where I am From" by Topher Mohr and Alex Elena (taken from YouTube audio Library, free to use)

If you wish to know more about the study "IBD and Mums-to-Be" you can follow us on Facebook or Twitter @IBDandMumstoBe

This video talks about the challenges and considerations women with IBD face when planning for a baby. The stories end well for all the mums we interviewed as they all went on to have successful pregnancies and healthy babies.

For more information on planning for a child within the context of IBD check Crohn's and Colitis UK's website: https://www.youtube.com/watch?v=2iwLh6XCnq8&t=4s
To watch a video on pregnancy with IBD click here: https://www.youtube.com/watch?v=br0kciD8xJk&t=5s

To watch a video on the early years of motherhood with IBD click here: https://www.youtube.com/watch?v=TQjt8pnMv4I&t=10s

Background music "Where I am From" by Topher Mohr and Alex Elena (taken from YouTube audio Library, free to use)

If you wish to know more about the study "IBD and Mums-to-Be" you can follow us on Facebook or Twitter @IBDandMumstoBe

AIM
To examine patient knowledge and factors influencing knowledge about pregnancy in British women with inflammatory bowel disease (IBD).
METHODS
This is a post hoc analysis of a study of female members of Crohn’s and colitis United Kingdom, aged 18-45 years who were sent an online questionnaire recording patient demographics, education, employment, marital status, and disease characteristics. Disease related pregnancy knowledge was recorded using Crohn’s and colitis pregnancy knowledge score (CCPknow).
RESULTS
Of 1324 responders, 776 (59%) suffered from Crohn’s disease, 496 (38%) from ulcerative colitis and 52 (4%) from IBD-uncategorised. CCPKnow scores were poor (0-7) in 50.8%, adequate (8-10) in 23.6%, good (11-13)
in 17.7% and very good (≥ 14) in 7.8%. Multiple linear regression analysis revealed that higher CCPKnow scores were independently associated with higher educational achievement (p < 0.001), younger age at diagnosis (p = 0.003) and having consulted a health care professional about pregnancy and IBD (p = 0.001).
CONCLUSION
Knowledge was poor in 50%. Speaking with healthcare professionals was a modifiable factor associated with better knowledge. This illustrates the importance of disease related pregnancy education.

Inflammatory Bowel Disease (IBD) is a multifactorial disorder with many different putative influences
mediating disease onset, severity, progression and diminution. Spontaneous natural IBD is classically
expressed as Crohn’s Disease (CD) and Ulcerative Colitis (UC) commonly found in primates;
lymphoplasmocytic enteritis, eosinophilic gastritis and colitis, and ulcerative colitis with neuronal
hyperplasia in dogs; and colitis in horses. Spontaneous inflammatory bowel disease has been noted in a
number of rodent models which differ in genetic strain background, induced mutation, microbiota
influences and immunopathogenic pathways. Histological lesions in Crohn’s Disease feature noncaseating
granulomatous inflammation while UC lesions typically exhibit ulceration, lamina propria
inflammatory infiltrates and lack of granuloma development. Intestinal inflammation caused by CD and
UC is also associated with increased incidence of intestinal neoplasia. Transgenic murine models have
determined underlying etiological influences and appropriate therapeutic targets in IBD. This literature
review will discuss current opinion and findings in spontaneous IBD, highlight selected transgenic rodent
models of IBD and discuss their respective pathogenic mechanisms. It is very important to provide
accommodation of induced putative deficits in activities of daily living and to assess discomfort and pain
levels in the face of significant morbidity and/or mortality in these models. Epigenetic, environmental
(microbiome, metabolome) and nutritional factors are important in IBD pathogenesis, and evaluating
ways in which they influence disease expression represent potential investigative approaches with the
greatest potential for new discoveries.
Keywords: Transgenic rodent models, intestinal microbiota, IBD

Several attempts have been made in the last two decades to investigate ulcerative colitis (UC) patients during the natural course of the disease so as to identify appropriate surrogate markers of disease activity. Most patients with quiescent inflammatory bowel disease have low grade inflammation and it is possible that relapse occurs only once the inflammatory process crosses a critical intensity. Since inflammation is a continuous process, its direct assessment may provide us a quantitative pre-symptomatic measure of imminent relapse. If substantial, it may allow targeted treatment early, to avert relapse or formulate newer therapeutic strategies to maintain symptomatic remission. It is clinically very important to identify these patients at a subclinical stage, noninvasively, by various biomarkers. Biomarkers help to gain an objective measurement of disease activity as symptoms are often subjective. Biomarkers also help to avoid invasive procedures which are often a burden to the patient and the health care system. If an ideal biomarker existed for UC, it would greatly facilitate the work of the gastroenterologist treating these patients. Both “classical” and “emerging” biomarkers of relevance for UC have been studied, but the quest for an ideal biomarker still continues. In this brief review we describe various biomarkers of clinical importance.

A study chronicling the experiences of women with inflammatory bowel disease (IBD) during and after pregnancy found nurses and midwives were often unable to provide information and advice.

The qualitative research, led by the University of Leeds, is based on detailed interviews with 22 women who have both been diagnosed with the condition and have given birth to children.......

La prévalence des MICI connait une progression importante. Leur prise en charge fait partie des priorités de santé publique impliquant la production de connaissances sur l’expérience vécue et les actions mises en œuvre. L’enjeu réside dans l’étude de cette expérience dans une visée de compréhension et de prise en charge psychosociale. Grâce à la théorie des représentations sociales, dans une démarche comparative et exploratoire, l’objectif est de comprendre les raisons de l’engagement dans une démarche de soutien.

13 patients suivis dans le cadre de leur pathologie ont participé à une enquête qualitative via des entretiens semi-directifs sur l’expérience de la maladie ; explicative d’une participation à un dispositif de soutien. Ce dispositif correspond à une offre de soin de support visant le soutien de malades entre pairs. Les données recueillies ont fait l’objet d'une analyse par le logiciel Alceste©, suivie d’une analyse de contenu.

Trois grandes thématiques sont mises en évidence par les analyses Alceste© (Parcours de la maladie, Passage de la maladie au bénévolat, Pratique de bénévolat). L’analyse de contenu a permis de les approfondir en nous informant sur différents thèmes (l’histoire de la maladie, ses représentations, son impact et sa gestion, le rapport à la maladie et les prémices d’une expérience collective), activés différemment selon le statut (malade vs malade-bénévole)

Ces résultats exploratoires suggèrent l’intérêt pour les représentations sociales de la maladie. Elles contribuent à l’explication du vécu et à l’engagement des malades dans une démarche de bénévolat, et plus largement, la manière dont les patients « s’approprient » leur pathologie et la vivent sur un mode « collectif ». Si pour certains la maladie semble être « destructrice », elle s’avère être « libératrice » voire se rapprocher d’une forme de « métier » pour des malades bénévoles (Herzlich, 1969).

Background: High concentration mesalazine formulations are more convenient than
conventional low concentration formulations for the treatment of ulcerative colitis
(UC).
Aim: To compare the efficacy and safety of 1600 mg and 400 mg tablet mesalazine
formulations.
Methods: Patients with mild-to-moderate active UC (Mayo Clinic Score >5; N=817)
were randomised to 3.2 g of oral mesalazine, administered as two 1600 mg tablets
once, or four 400 mg tablets twice daily. We hypothesised that treatment with the
1600 mg tablet was non-inferior (within a 10% margin) to the 400 mg tablet for
induction of clinical and endoscopic remission at week 8. Open-label treatment with
the 1600 mg tablet continued for 26-30 weeks based on induction response. Predictors
of treatment response were also explored.
Results: At week 8, remission occurred in 22.4% and 24.6% of patients receiving
the 1600 mg and 400 mg tablets, respectively (absolute difference
2.2%, 95% CI:

8.1% to 3.8%, non-inferiority P=.005). Endoscopic and histopathologic disease
activity, leucocyte concentration and age were significantly associated with clinical
remission (P=.022, .042, .014 and .023, respectively). At week 38, 43.9% (296/675)
of patients who continued treatment with the 1600 mg formulation were in remission,
including 70.3% (142/202) of patients who received a reduced dose of mesalazine
(1.6 g/d). The overall incidence of serious adverse events was low.
Conclusions: Induction therapy with 3.2 mg mesalazine using two 1600 mg tablets
once-daily was statistically and clinically non-inferior to a twice-daily regimen using
four 400 mg tablets (NCT01903252).

Keratin 8 (K8) is a major intermediate filament protein present in enterocytes and serves an antiapoptotic function in hepatocytes. K8-null mice develop colonic hyperplasia and colitis that are reversed after antibiotic treatment. To investigate the pathways that underlie the mechanism of colonocyte hyperplasia and the normalization of the colonic phenotype in response to antibiotics, we performed genome-wide microarray analysis. Functional annotation of genes that are differentially regulated in K8(-/-) and K8(+/+) isolated colon crypts (colonocytes) identified apoptosis as a major altered pathway. Exposure of K8(-/-) colonocytes or colon organ ("organoid") cultures, but not K8(-/-) small intestine organoid cultures, to apoptotic stimuli showed, surprisingly, that they are resistant to apoptosis compared with their wild-type counterparts. This resistance is not related to inflammation per se because T-cell receptor α-null (TCR-α(-/-)) and wild-type colon cultures respond similarly upon induction of apoptosis. Following antibiotic treatment, K8(-/-) colonocytes and organ cultures become less resistant to apoptosis and respond similarly to the wild-type colonocytes. Antibiotics also normalize most differentially up-regulated genes, including survivin and β4-integrin. Treatment of K8(-/-) mice with anti-β4-integrin antibody up-regulated survivin, and induced phosphorylation of focal adhesion kinase with decreased activation of caspases. Therefore, unlike the proapoptotic effect of K8 mutation or absence in hepatocytes, lack of K8 confers resistance to colonocyte apoptosis in a microflora-dependent manner.

The significance of amebiasis is a global problem, with prevalence that may reach as high as 40% in some areas of the world. Disease can be severe and fatal in some, but there are no accurate disease prevalence estimates to help define the true burden. Transmission is fecal–oral and so cannot easily be prevented when there is poverty, inadequate sanitation, and insufficient hygiene. Globalization, immigration, international travel, and sexual practices place everyone at risk of infection. The hardiness of the cyst further lends to ease of spread, predisposing to risks of epidemics among military, the general population, and even as a potential biological threat. The emergence of hypervirulent strains has been newly reported. Treatment options are limited, and there are no other reliably effective options if resistance develops to the nitroimidazole agents, as has already been documented with other protozoan parasites treated by this class of drugs. We still lack a viable vaccine candidate ready to enter into clinical development. Funding agencies dedicated to support research in neglected tropical diseases control should include E. histolytica as a priority pathogen in order to encourage the development of new innovative technologies for diagnosis, discovery of new drug targets, and strategies for control, including vaccine development. Now is the time to stop neglecting amebiasis.

Purpose: Little is known about the pharmacological effects of the phenolic compounds of Pennyroyal (Mentha pulegium). This Mediterranean aromatic plant, used as a gastronomic spice and as food preservative by the food industry has been studied mainly due to its essential oil antibacterial properties, composed primarily by monoterpenes. With this work, we aimed to evaluate the effects of a phenolic extract of pennyroyal in the impairment of inflammatory processes in Inflammatory Bowel Diseases (IBD) and in the potential inhibition of progression to colorectal cancer (CRC).

Methods: To that purpose, we evaluated the effect of pennyroyal extract administration in a model of TNBS-induced colitis in mice and further determined its effect on human colon carcinoma cell proliferation and invasion.

Results: The phenolic extract of pennyroyal exhibited antioxidant properties in in vitro assays and administration of the extract in a rat model of carrageenan-induced paw oedema led to significant anti-inflammatory effects. Further results evidenced a beneficial effect of the phenolic extract in the attenuation of experimental colitis and a potential antiproliferative effect on cultured colon cancer cells, effects not previously described, to our knowledge. A reduction in several markers of colon inflammation was observed following administration of the extract to colitis-induced mice, including functional and histological indicators. A successful inhibition of cancer cell invasion and proliferation was also observed in in vitro studies with HT-29 cells. Furthermore, the extract also led to a reduced expression of iNOS/COX-2 in the colon of colitis-induced mice, both being crucial mediators of intestinal inflammation.

Conclusions: Taking into consideration the central role of inflammation in the pathophysiology of CRC and the recognised connection between inflammatory events and cancer, these results enlighten the relevance of the phenolic constituents of pennyroyal as important pharmacological sources in the investigation of new treatment options for patients with inflammatory bowel diseases.

Background There is evidence that fat mass is correlated with bone mineral density (BMD) in inflammatory bowel disease (IBD), but data on the role of adipokines on this association are limited. The aim of this study was to investigate the serum levels of chemerin, visfatin, and vaspin, hormones that act as adipokines, in relation to BMD in patients with ulcerative colitis (UC) and Crohn's disease (CD). Patients and methods Serum from 120 IBD patients (68 CD, 52 UC) and 98 matched healthy controls (HC) was collected. Chemerin, visfatin, and vaspin levels were assessed using an enzyme-linked immunosorbent assay. BMD was determined for the lumbar spine and the proximal femur using dual-energy X-ray absorptiometry. Full-body composition scans were analyzed using enCORE software based on the absorptiometry system. Results Serum chemerin was higher in IBD patients than HC [CD 13.67.1 ± 5.8, UC 13.9 ± 4.3 vs. HC 7.8 ± 2.6 ng/ml, odds ratio (OR): 0.95, 95% confidence interval (CI) 0.93–0.98, P < 0.0001]. Serum visfatin levels in CD patients were significantly higher than those in UC patients (9.3 ± 14.01 vs. 6.5 ± 7.2 ng/ml, OR: 0.86, 95% CI 0.80–0.92, P = 0.039). In multivariate logistic regression analysis, a significant independent association of osteoporosis (T-score ≤ 2.5 SD) with age (OR: 1.04, 95% CI 1.01–1.08, P = 0.02), visfatin (OR: 0.78, 95% CI 0.63–0.97, P = 0.02), and chemerin levels (OR: 0.83, 95% CI 0.70–0.98, P = 0.03), but not with BMI or body composition, was found. Conclusion Serum visfatin and chemerin levels are associated with the development of osteoporosis in IBD. These results suggest a role of visfatin and chemerin in the pathophysiology of osteoporosis in IBD. Eur J Gastroenterol Hepatol 00:000–000