conditions inflammatory-bowel-disease

RECND4766

Inflammatory Bowel Disease

Condition:Inflammatory Bowel Disease (IBD)
Other:Chron's disease, Ulcerative colitis
ICD-10 Codes:K50-51

Naturopathic Treatments

Lifestyle
• stress management
• treat hypochlorhydria (See "Conditions: Hypochlorhydria")

Diet
• elimination diet
• low disaccharide diet
• avoid fast-food
• total parenteral nutrition (TPN) - may be required during acute exacerbation
• fasting - may help reduce aggravations
• cruciferous vegetables (kale, broccoli, collards)- isothiocyanates decrease inflammation
• blueberries

Caution: high amounts of fiber is contraindicated during serious flare-ups

Specific Foods
• remove dairy - lactose intolerance often develops
• avoid carrageenan - irritates GIT
• apples

Botanicals (internal)
• frankincense (Boswellia serrata)
wormwood (Artemisia absinthium)
turmeric (Curcuma longa)
marijuana (Cannabis sativa)
greater celandine (Chelidonium majus)
• berberine containing herbs
- goldenseal (Hydrastis canadensis)
- barberry (Berberis vulgaris)
Andrographis (Andrographis paniculata)
• Coptis Detoxifying Formula Extract (Oren-gedoku-to; Huang Lian Jie Du Tang)

Supplements
zinc carnosine - vulnerary, antiulcerogenic
vitamin D - immunomodulating
• probiotics
• proteolytic enzymes

Other
• helminthic therapy (e.g. whipworm) - modulates immune system

Ineffective
• fructo-oligosaccharides (FOS)

Conventional Treatments

• 5-aminosalicylic acid
• corticosteroids
- hydrocortisone
- budesonide
• immunomodulating drugs
- azathioprine
- methotrexate
- cyclosporine
• anticytokine drugs
- infliximab
- certolizumab
- adalimumab
• antibiotics
- metronidazole
- ciprofloxacin

Signs & Symptoms

diarrhea
• colic
weight loss
fever
• malaise
• abdominal distension

Note: unlike ulcerative colitis bloody diarrhea is rarely seen and is associated with fissures and proctatitis in Cron's disease

Other symptoms
• nausea & vomiting,
• epigastric pain
• bowelvobstruction
• RLQ pain
• rebound tenderness

Associated symptoms
• uveitis
• arthritis
• ankylosing spondylitis
• erythema nodosum/multiforme
• primary sclerosing cholangitis
• toxic megacolon
• fistulas
• abscesses
• anemia

DDx

• ulcerative colitis
- diarrhea with bloody stools and mucus
- no skip lesions
- no fistulas
• gastroenteritis
• Clostridium difficile infection
tuberculosis
• intestinal lymphoma
• acute ischemic colitis
• diverticulitis

Pathogenesis

• activation of mucosal immune system in GIT
• leads to abnormal mucosal barrier function and increased intestinal permeability
• immune response driven by Th-1 helper cells, IL2 and IFN gamma --> self-sustaining cycle of activation, leading to further increases of the helper T cells and its inflammatory cytokines.
• eventually leads to broad inflammatory response
• most often affects distal ileum and proximal colon although can occur from throughout GIT
• there may be a microbial connection that stimulates the immune system leading to inflammatory problems

Diagnostics

• endoscopy
- sigmoidoscopy
- colonoscopy
• radiology tests
- multiphase CT
- MR enterography (MRE)
• QuestionaireL: "Harvey-Bradshaw"

References

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Inhibiting T-cell Proliferation and TH1/TH17 Responses. Inflamm Bowel Dis. 2012
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