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

Consensus recommendations for patient-centered therapy in mild-to-moderate ulcerative colitis: the i Support Therapy–Access to Rapid Treatment (iSTART) approach

Symptomatic ulcerative colitis (UC) can be a chronic, disabling condition. Flares in disease activity are associated with many of the negative impacts of mild-to-moderate UC. Rapid resolution of flares can provide benefits to patients and healthcare systems. i Support Therapy–Access to Rapid Treatment (iSTART) introduces patient-centered care for mild-to-moderate UC. iSTART provides patients with the ability to self-assess symptomology and self-start a short course of second-line treatment when necessary. An international panel of experts produced consensus statements and recommendations. These were informed by evidence from systematic reviews on the epidemiology, mesalazine (5-ASA) treatment, and patient use criteria for second-line therapy in UC. Optimized 5-ASA is the first-line treatment in all clinical guidelines, but may not be sufficient to induce remission in all patients. Corticosteroids should be prescribed as second-line therapy when needed, with budesonide MMX® being a preferred steroid option. Active involvement of suitable patients in management of UC flares has the potential to improve therapy, with patients able to show good accuracy for flare self-assessment using validated tools. There is a place in the UC treatment pathway for an approach such as iSTART, which has the potential to provide patient, clinical and economic benefits

Transcript levels of Toll-Like receptors 5, 8 and 9 correlate with inflammatory activity in Ulcerative Colitis

<p>Abstract</p> <p>Background</p> <p>Dysregulation of innate immune response by Toll-Like Receptors (TLRs) is a key feature in Ulcerative Colitis (UC). Most studies have focused on <it>TLR2, TLR3</it>, and <it>TLR4 </it>participation in UC. However, few studies have explored other TLRs. Therefore, the aim of this study was to evaluate the mRNA profiles of <it>TLR1 to 9 </it>in colonic mucosa of UC patients, according to disease activity.</p> <p>Methods</p> <p>Colonic biopsies were taken from colon during colonoscopy in 51 patients with Ulcerative Colitis and 36 healthy controls. mRNA levels of <it>TLR1 to 9, Tollip</it>, inflammatory cytokines <it>IL6 </it>and <it>TNF </it>were assessed by RT-qPCR with hydrolysis probes. Characterization of <it>TLR9 </it>protein expression was performed by Immunohistochemistry.</p> <p>Results</p> <p>Toll-like receptors <it>TLR8, TLR9</it>, and <it>IL6 </it>mRNA levels were significantly higher in the colonic mucosa from UC patients (both quiescent and active) as compared to healthy individuals (p < 0.04). In the UC patients group the <it>TLR2, TLR4, TLR8 </it>and <it>TLR9 </it>mRNA levels were found to be significantly lower in patients with quiescent disease, as compared to those with active disease (p < 0.05), whereas <it>TLR5 </it>showed a trend (p = 0.06). <it>IL6 </it>and <it>TNF </it>mRNA levels were significantly higher in the presence of active disease and help to discriminate between quiescent and active disease (p < 0.05). Also, <it>IL6 </it>and <it>TNF </it>mRNA positively correlate with TLRs mRNA with the exception for <it>TLR3</it>, with stronger correlations for <it>TLR5, TLR8</it>, and <it>TLR9 </it>(p < 0.0001). <it>TLR9 </it>protein expression was mainly in the lamina propria infiltrate.</p> <p>Conclusions</p> <p>This study demonstrates that <it>TLR2, TLR4, TLR8</it>, and <it>TLR9 </it>expression increases in active UC patients, and that the mRNA levels positively correlate with the severity of intestinal inflammation as well as with inflammatory cytokines.</p

Metas y estrategias de la terapia anti-TNF en pacientes con enfermedad inflamatoria intestinal

La terapia anti-factor de necrosis tumoral (anti-TNF) está dirigida a pacientes con enfermedad inflamatoria intestinal (EII) que han fallado o han sido intolerantes al tratamiento convencional a base de 5-aminosalicilatos, esteroides, inmunomoduladores como las tiopurinas, metotrexato e inhibidores de calcineurina. Las metas actuales de la terapia biológica anti-TNF van enfocadas a la cicatrización de la mucosa que ha impactado en la reducción en el número de hospitalizaciones y cirugías con la consecuente mejoría en la calidad de vida de los pacientes con EII. Además se han planteado otros objetivos como el tratamiento combinado, el protocolo descendente (top-down) para pacientes con factores de mal pronóstico como el patrón fistulizante (enfermedadperianal) en la enfermedad de Crohn (EC) y que la duración hasta el momento es indefinida. Finalmente resaltar que constituye una terapia segura ya que no incrementa el riesgo de infecciones graves ni cáncer

Nuevas terapias en enfermedad inflamatoria intestinal

Los avances en el campo de la investigación en la enfermedad inflamatoria intestinal (EII) han identificado nuevas moléculas involucradas en la etiopatogenia de la EII y ello ha permitido el desarrollo de nuevos blancos terapéuticos. Esta revisión se enfoca a los nuevos tratamientos que fueron recientemente aprobados en EUA y Europa como: 1) esteroide tópico como la budesonida MMX para pacientes con CUCI, previo al uso de esteroides sistémicos; 2) un nuevo agente anti-factor de necrosis tumoral alfa(anti-TNF) 100% humano como el golimumab como otra alternativa en el tratamiento de pacientes con CUCI; 3) inhibidor de las integrinas humanas como el vedolizumab, que ofrece buena eficacia y perfil de seguridad en pacientes con EII con actividad moderada a grave que han fallado a la terapia convencional incluyendo la terapia anti-TNF. Finalmente, nuevos agentes biológicos como el ustekinumab y tofacitinib formarán parte del algoritmo de tratamiento en pacientes con EC y CUCI, respectivamente. Otros agentes se encuentran en desarrollo en fase II para evaluar su eficacia y seguridad con el fin de ofrecer nuevas estrategias terapéuticas a pacientes con EII

Endoscopic assessment and current topics of treatment of inflammatory bowel disease

Biosimilars are defined as biologic products that are highly similar to reference products, notwithstanding minor differences in clinically&nbsp;inactive components, with no clinically meaningful differences between the biologic product and the reference product in terms of safety profile, purity, and potency. Due to the high&nbsp;cost of innovator biologics, as well as an increase in the number of these products reaching patent expiry, the development of a process for approving biosimilar products has&nbsp;become a crucial regulatory issue in the USA. Introducing competition to decrease the costs of biologics is an important component of an overall strategy to reduce healthcare costs worldwide. In 2014, total drug expenditure in the USA grew by 12% compared to the total expenditure in 2013, and it has grown by 7-9% in 2015.&nbsp

Mild Clinical Behaviour of Crohn Disease in Elderly Patients in a Latin American Country: A Case-Control Study

BACKGROUND: Crohn disease is characterized by fluctuating clinical behaviour, which is influenced by various factors. There are no data from Latin America that evaluate the clinical behaviour of Crohn disease in elderly patients

Anti-integrin antibodies as biologic therapy for patients with inflammatory bowel disease

The complex inflammatory cascade that forms part of the pathophysiological mechanisms underlying inflammatory bowel disease (IBD) has been subject of diverse studies since several years ago. Through time, many different molecular pathways have been elucidated and further identified as therapeutic targets for biologic therapy, which has potentially modified the classic therapeutic pyramid and consequently IBD clinical course. The current research has focused in studying and finding new therapeutic targets that allow us to maintain or improve the outcomes obtained with anti-tumor necrosis factor-α biologic agents and avoid or diminish their adverse events and related risks. Integrins and their receptors are particularly interesting and promising therapeutic targets for biologic agents under current clinical trials such as natalizumab, vedolizumab, abrilumab, etrolizumab, anti-MAdCAM-1, or alicaforsen. Here, we discuss and analyze widely the most recent advances in this regard, including the disadvantages and adverse events that we are still facing, ending with a quick look into the future of this type of therapy