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| Title: |
Vitamin D status in children and young adults with inflammatory bowel disease. |
| Author(s): |
Pappa HM, Gordon CM, Saslowsky TM, Zholudev A, Horr B, Shih MC, Grand RJ. |
| OBJECTIVES: Previous studies of vitamin D status in pediatric patients with inflammatory bowel disease have revealed conflicting results. We sought to report (1) the prevalence of vitamin D deficiency (serum 25-hydroxy-vitamin D concentration < or = 15 ng/mL) in a large population with inflammatory bowel disease, (2) factors predisposing to this problem, and (3) its relationship to bone health and serum parathyroid hormone concentration. PATIENTS AND METHODS: A total of 130 patients (8-22 years of age) with inflammatory bowel disease, 94 with Crohn disease and 36 with ulcerative colitis, had serum 25-hydroxy-vitamin D, intact parathyroid hormone, and lumbar spine bone mineral density (using dual-energy x-ray absorptiometry) measured at Children's Hospital Boston. RESULTS: The prevalence of vitamin D deficiency was 34.6%. Mean serum 25-hydroxy-vitamin D concentration was similar in patients with Crohn disease and ulcerative colitis, 52.6% lower among patients with dark skin complexion, 33.4% lower during the winter months (December 22 to March 21), and 31.5% higher among patients who were taking vitamin D supplements. Serum 25-hydroxy-vitamin D concentration was positively correlated with weight and BMI z score, disease duration, and serum albumin concentration and negatively correlated with erythrocyte sedimentation rate. Patients with Crohn disease and upper gastrointestinal tract involvement were more likely to be vitamin D deficient than those without it. Serum 25-hydroxy-vitamin concentration was not associated with lumbar spine bone mineral density z score or serum parathyroid hormone concentration. CONCLUSIONS: Vitamin D deficiency is highly prevalent among pediatric patients with inflammatory bowel disease. Factors predisposing to the problem include having a dark-skin complexion, winter season, lack of vitamin D supplementation, early stage of disease, more severe disease, and upper gastrointestinal tract involvement in patients with Crohn disease. The long-term significance of hypovitaminosis D for this population is unknown at present and merits additional study. |
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Title:
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Prevalence of and risk factors for vitamin B(12) deficiency in patients with Crohn's disease. |
| Author(s): |
Headstrom PD, Rulyak SJ, Lee SD. University of Washington, Department of Medicine, Division of Gastroenterology, Seattle, Washington. |
| Background: Crohn's disease (CD) can commonly involve the terminal ileum, which is the site of B(12) absorption. The aim of this study was to define the prevalence of vitamin B(12) abnormalities in a population with CD and to identify risk factors associated with B(12) abnormalities in CD.Methods: The medical records of 201 patients with CD evaluated at a tertiary care center were retrospectively reviewed to determine the prevalence of B(12) deficiency and to evaluate factors associated with B(12) deficiency. The prevalence of B(12) deficiency in a control population of 40 patients with ulcerative colitis was also assessed.Results: The prevalence of an abnormal serum B(12) concentration in patients with CD was 18.4% (95% confidence interval [CI] 13.1-23.8%) compared with 5% (95% CI, 0-11.8%) (P = 0.035) in ulcerative colitis controls. Risk factors for B(12) deficiency in patients with CD included prior ileal (odds ratio [OR], 7.22; 95% CI, 1.97-26.51) or ileocolonic (OR, 5.81; 95% CI, 2.09-16.12) resection and the need for ongoing medical therapy (OR, 2.59; 95% CI, 1.03-6.47). Neither disease location nor duration was independently associated with the risk of B(12) deficiency.Conclusions: Vitamin B(12) abnormalities are common in patients with CD and patients with a prior ileal or ileocolonic resection are at particular risk. Routine screening for B(12) deficiency in patients with CD is warranted.(Inflamm Bowel Dis 2007). |
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Prevalence of occult celiac disease in patients with iron-deficiency anemia: a prospective study. |
| Author(s): |
Karnam US, Felder LR, Raskin JB. |
| BACKGROUND: Occult celiac disease has been reported in 0 to 6% of adults presenting with iron-deficiency anemia. Most prior studies have been retrospective or screened only a selected population of patients with small bowel biopsies. To more accurately define the true prevalence of this disorder in patients presenting with iron-deficiency anemia (with or without stool hemoccult positivity), we initiated this prospective study. METHODS: Esophagogastroduodenoscopy with small bowel biopsies and colonoscopy were performed in all iron-deficiency anemia patients (including those with hemoccult-positive stools) referred to the gastroenterology service during a 2-year period (1998-2000). Inclusion criteria included iron-deficiency anemia as defined by a serum ferritin < 25 ng/ml and anemia with hemoglobin < 12 g/dl. Patients were excluded for documented prior erosive, ulcerative, or malignant disease of the gastrointestinal tract, previous gastrointestinal surgery, overt gastrointestinal bleeding within the past 3 months, or inability to access the duodenum for biopsy. All patients underwent upper endoscopy with more than two biopsies of the distal duodenum and colonoscopy. A serum immunoglobulin A antiendomysial antibody test was to be performed in those patients with a positive small bowel biopsy to confirm the diagnosis of celiac disease. RESULTS: One hundred five of 139 consecutive patients with iron-deficiency anemia met the inclusion criteria and were enrolled in the study. Fifty-seven men (mean age, 51.6 yr) and 48 women (mean age, 54.1 yr) constituted the study population. The demographics of this study population included 36 blacks, 38 Hispanics, and 22 whites. Nine patients were of mixed or unknown ethnic background. Forty-three and eight-tenths percent of the men and 37.5% of women had hemoccult-positive stools, accounting for a total of 40.9% of the study patients. Upper endoscopic findings included gastritis in 22.8%, gastric ulcers in 9.5%, duodenitis in 8.5%, esophagitis in 7.6%, Barrett's ulcer in 2.8%, duodenal ulcer in 2.8%, gastric polyp in 2.8%, and celiac disease in 2.8%. Colonoscopic findings included colon polyps in 21.9%, diverticula in 10.4%, and hemorrhoids in 16.1%. Multiple findings were found in 32.3% of patients, and there were no findings in 28.5% of patients. CONCLUSION: The prevalence of occult celiac disease in this prospective study of patients presenting with iron-deficiency anemia was 2.8%. A significant number of other gastrointestinal lesions amenable to therapy were also found on upper and lower endoscopy in these patients. Given the treatable nature of celiac disease, it should be screened for in patients with unexplained iron-deficiency anemia with or without hemoccult-positive stools. |
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Title:
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A randomized controlled trial of a probiotic, VSL#3, on gut transit and symptoms in diarrhoea-predominant irritable bowel syndrome. |
| Author(s): |
Kim HJ, Camilleri M, McKinzie S, Lempke MB, Burton DD, Thomforde GM, Zinsmeister AR. |
| AIM: : To investigate the effects of a probiotic formulation, VSL#3, on gastrointestinal transit and symptoms of patients with Rome II irritable bowel syndrome with predominant diarrhoea. METHODS: : Twenty-five patients with diarrhoea-predominant irritable bowel syndrome were randomly assigned to receive VSL#3 powder (450 billion lyophilized bacteria/day) or matching placebo twice daily for 8 weeks after a 2-week run-in period. Pre- and post-treatment gastrointestinal transit measurements were performed in all patients. Patients recorded their bowel function and symptoms daily in a diary during the 10-week study, which was powered to detect a 50% change in the primary colonic transit end-point. RESULTS: : There were no significant differences in mean gastrointestinal transit measurements, bowel function scores or satisfactory global symptom relief between the two treatment groups, pre- or post-therapy. Differences in abdominal bloating scores between treatments were borderline significant (P = 0.09, analysis of covariance). Further analysis revealed that abdominal bloating was reduced (P = 0.046) with VSL#3 [mean post- minus pre-treatment score, - 13.7; 95% confidence interval (CI), - 2.5 to - 24.9], but not with placebo (P = 0.54) (mean post- minus pre-treatment score, - 1.7; 95% CI, 7.1 to - 10.4). With the exception of changes in abdominal bloating, VSL#3 had no effect on other individual symptoms: abdominal pain, gas and urgency. All patients tolerated VSL#3 well. CONCLUSION: : VSL#3 appears to be promising in the relief of abdominal bloating in patients with diarrhoea-predominant irritable bowel syndrome. This is unrelated to an alteration in gastrointestinal or colonic transit. |
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Title:
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Polyunsaturated fatty acids and inflammatory diseases. |
| Author(s): |
Gil A. |
| Inflammation is overall a protective response, whose main goal is to liberate the human being of cellular lesions caused by micro-organisms, toxins, allergens, etc., as well as its consequences, and of death cells and necrotic tissues. Chronic inflammation, which is detrimental to tissues, is the basic pathogenic mechanism of hypersensitivity reactions against xenobiotics. Other frequent pathologies, for instance atherosclerosis, chronic hepatitis, inflammatory bowel disease (IBD), liver cirrhosis, lung fibrosis, psoriasis, and rheumatoid arthritis are also chronic inflammatory diseases. Chemical mediators of inflammation are derived from blood plasma or different cell-type activity. Biogenic amines, eicosanoids and cytokines are within the most important mediators of inflammatory processes. The different activities of eicosanoids derived from arachidonic acid (20:4 n-6) versus those derived from eicosapentaenoic acid (20:5 n-3) are one of the most important mechanisms to explain why n-3, or omega-3, polyunsaturated fatty acids (PUFA) exhibit anti-inflammatory properties in many inflammatory diseases. Dietary supplements ranging 1-8 g per day of n-3 PUFA have been reportedly beneficial in the treatment of IBD, eczema, psoriasis and rheumatoid arthritis. In addition, recent experimental studies in rats with experimental ulcerative colitis, induced by intrarectal injection of trinitrobenzene sulphonic acid, have documented that treatment with n-3 long-chain PUFA reduces mucosal damage as assessed by biochemical and histological markers of inflammation. Moreover, the defence antioxidant system in this model is enhanced in treated animals, provided that the n-3 PUFA supply is adequately preserved from oxidation. |
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Title:
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A novel treatment for constipation-predominant irritable bowel syndrome using Padma Lax, a Tibetan herbal formula. |
| Author(s): |
Sallon S, Ben-Arye E, Davidson R, Shapiro H, Ginsberg G, Ligumsky M. |
| BACKGROUND AND AIMS: Padma Lax, a complex Tibetan herbal formula for constipation was evaluated for safety and effectiveness in treating constipation-predominant irritable bowel syndrome in a 3-month double-blind randomised pilot study. METHODS: Patients were recruited from Hadassah Hospital's Gastroenterology clinic, using the Rome I Criteria for irritable bowel syndrome, and the international consensus criteria for constipation. Symptom severity was evaluated monthly by patients and gastroenterologist, using categorical and numerical rating scales. A patient diary recorded daily stool habit and trial medication. RESULTS: In 61 patients, (34 Padma Lax, 27 placebo), significant improvement was demonstrated after 3 months in the Padma Lax group compared to placebo in constipation, severity of abdominal pain, and its effect on daily activities, incomplete evacuation, abdominal distension and flatus/flatulence. A global assessment indicated that significantly more Padma Lax patients, compared to placebo, rated the current treatment superior to previous therapies tried for irritable bowel. Laboratory parameters displayed no clinically significant changes. Side effects, primarily loose stools in 7 Padma Lax patients responded well to lowering treatment dosage from 2 to 1 capsule/day. CONCLUSIONS: Padma Lax is a safe and effective treatment for constipation-predominant irritable bowel syndrome and may offer an alternative to the current multi drug approach. Copyright 2002 S. Karger AG, Basel |
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Title:
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Botanical perspectives on health peppermint: more than just an after-dinner mint. |
| Author(s): |
Spirling LI, Daniels IR. |
| Throughout history different species of mint have been used across the globe for their varying properties, both medicinal and culinary. Today, the commercial sales of mints are expanding each year--and at the end of a large meal after-dinner mints are frequently served. But why do we take them? Peppermint (Mentha piperita) is usually taken after a meal for its ability to reduce indigestion and colonic spasms by reducing the gastrocolic reflex. It is a naturally occurring hybrid cross between water mint (M. aquatica) and spearmint (M. spicata) and is best known for its role as a popular flavouring agent. Less well recognised is peppermint's potential role in the management of numerous other medical conditions including certain procedures, e.g. colonoscopy. With the growing popularity of herbal remedies, among both the public and medical practitioners, it would seem that now is an opportune time to consider further what peppermint has to offer the world of medicine. |
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Title:
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Clinical Observation with Padma Lax - preliminary data |
| Author(s): |
A. Gabryelewicz,M.D. |
| Padma Lax was applied in patients with obstipation lasting longer than one year. The patients were suffering from obstipation for 3-4 days with unsatisfactory results after previously using laxative drugs. Our preliminary observations are based on hospitalized (group A) and ambulatory patients (group B). Group A patents were divided into 2 groups: 1. Habitual obstipation in patients over 60 years old 2. Patients with obstipation in the course of peptic ulcer (gastric or duodenal). Group A1 In 9 patients with habitual obstipation diagnosed after elimination of organic cause of obstipation, Padma Lax was applied in the dose of 2 tablets per night. Good results were obtained in 7 patients who take Padma Lax at home as a lone treatment. In 2 patients in this group the drug was not successful and after 8 days of treatment was discontinued. Group A2 In all ulcer patients the hyper acidity of gastric secretions was found. Patients were suffering from obstipation before they were admitted to the hospital. It is necessary to underline that the obstipation evidently increased after including anti-secretory treatment of the ulcer (atropine, daricon). X-ray examination showed the spastic or mainly paralytic origin of obstipation. Padma Lax was applied in the dose of 1 or 2 tablets per night. In 9 out of 10 patients the drug was successful. After 5 days treatment the number of tablets was reduced to 1 per night. The felling of our patients evidently improved and anti-secretory therapy of the ulcer was continued. The observation in this group continued for 2.5 to 3 months. Before and during the treatment with Padma Lax the level of K and NaCl in the serum was measured every 3-4 weeks (Table 1). Group B The ambulatory observation were carried out on two groups of patients; 1. Habitual obstipation (n=10) 2. Patients with cholelithiasis and concomitant obstipation (n=10) In patients with habitual obstipation, only in two cases the drug was without any effect. In cholelithiasis group the normalization of stools was noted in every patient. The electrolytes were measured in the same way as in hospitalized patients (Table 2 and 3). No side effects were observed in any of the subjects. Preliminary Conclusions: a) Padma Lax is very useful drug in treatment of habitual obstipation. I works as well in hospital situations as it does in ambulatory practice. b) Padma Lax is very indicated in the treatment of obstipation as a concomitant syndrome in peptic ulcer or cholelithiasis. c) 2.5-3.0 months treatment with Padma Lax does not evidently disturb the balance of K and NaCl in the serum. d) Further observations are needed: 1. The number of patients in each group should be increased to 30 in each group. 2. Observation time in each patient should be prolonged to 4-6 months. |
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Title:
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A Lamaist Prescription Formula for the Treatment of Chronic Constipation |
| Author(s): |
H. Fluck and W. Ph. Bubb |
| A formula for a prescription originating in lamaist medicine has ben used in the treatment of "chronic obstipation". The results of treatment are being announced following a pharmacognostic assessment. |
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