Role of Nutrition in Inflammatory Bowel Disease (IBD): New Therapeutic Approaches and Recent Outcomes

Inflammatory bowel disease (IBD) is the generic term given to a heterogeneous group of disorders of the gastrointestinal tract that are characterized by chronic inflammation. The major forms of IBD are Crohn's disease (CD) and ulcerative colitis (UC), which are increasing in incidence, prevalence and severity in many countries; these are characterized by intestinal inflammation and are believed to involve complex interactions between genetic, immunological and environmental factors. The incidence continues to rise, both in low and in high-incidence areas. Several dietary regimes may modify disease symptoms, in part through their actions on the host microbe. However, other dietary factors could affect the microbiotic or genetic expression in IBD patients in different ways. The purpose of this review is to discuss the most recent evidence from the literature on the use of nutritional therapy in the treatment of IBD and to review the role of environmental factors on the progressive increase of prevalence. The epidemiological data reveal an increasing incidence of IBD in recent years, which may be the result of increased intake of simple sugars and consumption disproportionate of fat (saturated and unsaturated). Intestinal permeability and inflammation could improve with proper diet in protein, probiotics and FA (n-3 and n-6). Diet and the host microbiota are likely to play important but as yet poorly defined roles therefore, is necessary to continue investigating to implement molecular findings in clinical treatments or adjunctive therapies

The effect of parental consanguinity and inbreeding in Hirado, Japan

A census of Hirado, Japan in the summer of 1964 produced data on the reproductive performances of husbands and wives for 10,530 marriages where either the husband, the wife, or both were alive and residing in the city at the time of the census. Approximately one in every 6 of these marriages involves spouses who are biologically related to one another, and in some 10 per cent of marriages the husband, wife, or both are inbred. Analysis of the effects of length of cohabitation, socio-economic status, and consanguinity and inbreeding on total pregnancies, total livebirths, and “net fertility” (total livebirths minus non-accidental deaths in the first 21 years of life) revealed the following insofar as marriages contracted in the years 1920–1939 are concerned: 1. Total pregnancies and total livebirths were significantly increased with consanguinity, but “net fertility” was not when allowance is made for the role of socio-economic factors, and religious affiliation is ignored. The latter finding is thought to reflect the increased risk of death to liveborn children born to consanguineous marriages. Among Buddhists, the only religious group large enough to warrant separate analysis, total pregnancies, total livebirths and “net fertility” are all significantly and positively associated with parental relationship. However, the regression coefficient associated with “net fertility” is less than half the value associated with either total pregnancies or total livebirths.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47633/1/439_2004_Article_BF00286995.pd

The Mexican consensus on the diagnosis and treatment of ulcerative colitis

The guidelines presented herein are an updated version of the recommendations published in 2007. Since then, there has been a rapid advance in the knowledge about the pathophysiology of ulcerative colitis and its therapeutic options. New drugs have been approved, novel targeted therapies have emerged, and new strategies have been developed to improve the previously available approaches to the disease.The aim of the present consensus is to promote the current knowledge of and Mexican perspective on the epidemiology, diagnosis, and medical and surgical treatment of chronic idiopathic ulcerative colitis.The final vote on the statements and their ultimate modifications were carried out at the consensus working group meeting. Evidence was evaluated through the GRADE classification. Resumen: Estas guías constituyen una actualización de las guías publicadas en 2007. Desde ese año, los conocimientos acerca de la fisiopatología, así como las opciones terapéuticas, han evolucionado rápidamente, con la aprobación de nuevos agentes, la aparición de nuevos blancos terapéuticos y nuevas estrategias para mejorar los abordajes disponibles previamente.El objetivo de este consenso es promover una actualización y perspectiva mexicana sobre la epidemiología, el diagnóstico así como el tratamiento médico y quirúrgico de la colitis ulcerosa crónica idiopática.Los enunciados fueron finalmente votados y se realizaron las modificaciones finales en la junta de consenso. La evaluación de la evidencia por la clasificación GRADE se realizó al momento del consenso. Keywords: Chronic idiopathic ulcerative colitis, Diagnosis, Treatment, Epidemiology, Colectomy, Pouchitis, Palabras clave: Colitis ulcerosa crónica idiopática, Diagnóstico, Tratamiento, Epidemiología, Colectomía, Pouchiti

Incidence of suboptimal response to tumor necrosis factor antagonist therapy in inflammatory bowel disease in newly industrialised countries: The EXPLORE study

Abstract Background Incidence of inflammatory bowel disease (IBD) is increasing in newly industrialised countries (NICs); however, data on suboptimal response to anti-tumor necrosis factor (anti-TNF) agents are limited. Objectives To assess incidence and indicators of suboptimal response to first anti-TNF therapy in IBD patients in NICs. Methods A chart review was conducted in ten countries from Asia-Pacific (APAC), Latin America (LatAm), and Russia and the Middle East (RME) regions among patients diagnosed with ulcerative colitis (UC) or Crohn's disease (CD), initiating anti-TNF therapy in 2010–2015. The cumulative incidence of suboptimal response to anti-TNF therapy was assessed using the following indicators: dose escalation or discontinuation, augmentation with non-biologic therapy, IBD-related hospitalization, or surgery. Results The study included 1,674 patients (570 UC; 1,104 CD). At 24 months, 32.9% of UC (APAC: 45.1%; LatAm: 38.2%; RME: 23.8%) and 41.2% of CD patients (APAC: 54.1%; LatAm: 42.5%; RME: 29.5%) had experienced suboptimal response. The most frequent first indicator was non-biologic therapy augmentation in LatAm (41.7%), IBD-related hospitalization in RME (UC: 50.7%; CD:37.3%) and in APAC for CD (39.1%), and anti-TNF discontinuation in APAC for UC (38.3%). Conclusion Suboptimal response to anti-TNF agents is common in IBD patients in NICs. Observed regional differences in the incidence and indicators may reflect local practice and anti-TNF restrictions in IBD management. NCT Registration Number NCT03090139

Epidemiología, carga de la enfermedad y tendencias de tratamiento de la enfermedad inflamatoria intestinal en México

Introducción y objetivos: En México no existe información sistematizada para determinar/ monitorizar la carga de la enfermedad inflamatoria intestinal (EII). El objetivo del estudio fue estimar la carga anual de la EII en el Sistema Nacional de Salud por número de pacientes atendidos, hospitalizaciones y muertes y por grupos de edad. Material y métodos: Utilizando registros específicos de bases de datos del Sistema Nacional de Salud codificados por CIE-10: K50 y K51, obtuvimos y analizamos datos correspondientes a los pacientes atendidos y hospitalizados por grupo etario, así como muertes específicas durante el año 2015. Asimismo, se exploró la tendencia de tratamiento entre médicos. Resultados: En 2015, el número total de casos atendidos (prevalencia de casos atendidos) fue: enfermedad de Crohn en mujeres 5,009 (8.1), en hombres 4,944 (8.4). Los pacientes ≥ 50 años representaron el 35.1% del total; colitis ulcerosa crónica idiopática en mujeres 17,177 (27.7), en hombres 15,883 (26.9). Los ≥ 50 años representaron el 31.6% del total. Los casos hospitalizados fueron (prevalencia de casos hospitalizados): enfermedad de Crohn 1,097 (0.91). Los pacientes≥ 50 años representaron el 43.7% del total; colitis ulcerosa crónica idiopática 5,345 (4.42). Los enfermos ≥ 50 años representaron el 47.6% del total. Las defunciones fueron (tasa de muertes específicas): en enfermedad de Crohn: mujeres 32 (0.52), hombres 36 (0.50); colitis ulcerosacrónica idiopática en mujeres 267 (4.31), en hombres 186 (3.15).Conclusiones: La EII representa una carga para la salud de los adultos mexicanos y el Sistema de Salud, y se espera que aumente en los próximos 15 años

Inflammatory bowel disease in Mexico: Epidemiology, burden of disease, and treatment trends

Introduction and aims: There is no systematized information for determining/monitoring the burden of inflammatory bowel disease in Mexico. The aim of the present study was to estimate the annual burden of inflammatory bowel disease on the Mexican National Healthcare System, by number of patients seen, hospitalizations, and specific deaths, stratified into age groups. Materials and methods: Utilizing specific databases of the Mexican National Healthcare System registries coded as ICD-10: K50 and K51, we retrieved and analyzed the data corresponding to the patients seen and hospitalized in 2015, stratified by age group, as well as the specific deaths. Treatment trends among physicians were also examined. Results: In 2015, 5009 women (8.1) and 4944 men (8.4) with Crohn’s disease received medical attention (prevalence of cases seen) and 35.1% of those patients were ≥50 years of age. In that same period, 17,177 women (27.7) and 15,883 men (26.9) with ulcerative colitis wereseen and 31.6% of those patients were ≥50 years of age. The hospitalized cases (prevalence ofhospitalized cases) were 1097 patients (0.91) with Crohn’s disease and 43.7% of those patientswere ≥50 years of age; and 5345 patients (4.42) with ulcerative colitis and 47.6% of thosepatients were ≥50 years of age. Deaths (specific mortality rate) were: 32 women (0.52) and 36men (0.50) due to Crohn’s disease, and 267 women (4.31) and 186 men (3.15) due to ulcerativecolitis.Conclusions: Inflammatory bowel disease is a burden on the health of Mexican adults and theMexican National Healthcare System, and it is expected to increase over the next 15 year