ENTERAL NUTRITION SUPPORT TO TREAT MALNUTRITION IN INFLAMMATORY BOWEL DISEASE

Malnutrition is a common consequence of inflammatory bowel disease (IBD). Diet has an important role in the management of IBD, as it prevents and corrects malnutrition. It is well known that diet may be implicated in the aethiology of IBD and that it plays a central role in the pathogenesis of gastrointestinal tract disease. Often oral nutrition alone is not sufficient in the pathogenesis of gastrointestinal tract disease. Often oral nutrition alone is not sufficient in the management of IBD patients, especially in children or elederly, and must be combined with oral supplementation or replaced with tube enteral nutrition. In this review, we describe several different approaches to enteral nutrition total-parenteral, oral supplementation and enteral tiube feeding in terms of results, patience compliance, risks and benefits. we also focus on the home enteral nutrition strategy as the future goal for treating IBD while focusing on patient wellness

The influence of some dietary components on intestinal microbiota

The gut microbiota is the set of symbiotic microorganisms that resides in our intestine. The interaction between the gut microbiota and the mucosal immune system can be altered as a result of shifts in the composition or metabolic activity of the intestinal microflora. Recent studies establish that diet is one of the main involved factors in determining the microbial composition of the gut suggesting its role as external factor able to promote the onset of specific diseases by disrupting the immune homeostasis. Starting from the evidence that the 57% of the gut microbiota’s entire variation are due to dietary alterations this review aims at providing an overview of the positive impact of some dietary components on gut microbiota composition

RECURRENT RENAL CARCINOMA MIMICKING A GOITRE: A CASE REPORT

Although the thyroid is a high vascularised gland, it is not common terget of metastases from extraglandular cancer. We reported a case of a 70 year-old woman who underwnt total thyroidectomy for multinodular goitre. In the patient's clinical hystory a nephrectomy was carried out 2 years before due to unspecified causes. The histopathological examination of the thyiroid showed a pattern compatible with clear cell renal carcinoma metastasis. The patient's relatives revealed, when questioned again, that the nephrectomy was due to the presence of a clear renal cell carcinoma keep concealed to the patients. Thanks to a timely intervention, the mass was removed and a better survival was guaranted to the patient

THE INTESTINAL ECOSYSTEM AND PROBIOTICS

The term "probiotic" comes from the greek "pro bios" and means "pro life": Nowadays, an increasing number of pharmaceutical preparations and functional foods are enriched with probiotics and for the patients it is increasingly important to receive information needed to know how to orient in the choice. The benefits from probiotics are many and include the modulation of the intestinal microflora (stimulation of beneficial bacteria and inhibition of pathogens), the support of bowel function and the stimulation of the immune system. This broad spectrum of beneficial effects to maintain efficient the intestinal ecosystem. Therefore, probiotics are an useful tool to prevent the formation of disorders and/or pathologies. The aim of this review is to describe the intestinal ecosystem and how probiotics could be effective in the treatment and prevention of possible alterations

VALIDATION OF A MODIFIED MODEL OF TNBS-INDUCED COLITIS IN RATS. HOW TO INDUCE A CHEMICAL COLITIS IN RATS.

Background: there are no standard practice in the induction of colitis by 2,4,6-trinitrobenzene sulfonic (TNBS) acid. Usually, the repeated administration of TNBS is preferred, because it will result in a local Th1 response that has the characteristics of Crohn's disease. material and Methods: A total of 30 rats were randomized into two groups, consisting of a saline control group of ten rats and a TNBS groups of 20 rats. After the animals were anesthesized, 0,5 ml of either 0,9 % saline 8controls) or TNBS 50 mg/Kg dissolved in 50% ethanol were instilled into the colon through a rubber catheter. The experiment was repeated weekly for four weeks, then, the rats were killed at day 40, and the distal colon removed. results: At day 40, the bowel wall basically normal in the control group. In the TNBS group, the bowel lumen became narrow with tickened wall, and the mucosal surface presented adherent membrane with brown black, linear ulcers, proliferous lymphocites tissue, inflammatory granulomas and submucosal neutrophil infiltration. The median score of the severity of the colonic damage was 0 in the control group, and 4,75 (range 4-5) in the TNBS group; the mean weight of the rats was 180+35 g in the TNBS group, while it was 215+25 in the control group. Conclusions: The presented experiment is a cost-effective and safe method to induce Crohn-like colonic damage using a lower dose of TNBS, thus avoiding the risk of a massive loss of rats. This model is rather suitable for the assessment of the effects of potential therapeutic agent

Enteral nutrition: our experience with percutaneous endoscopic gastrostomy (PEG) and revision of literature

Enteral nutrition (EN), as parenteral nutrition (PN), can be used in cases of patients whose medical conditions prevent the intake of food by mouth; unlike PN, EN keeps the functionality of the digestive tract and it makes home management of patients easier. However, the experience and literature have documented a number of serious complications, fortunately rare, which depend on the methods used in EN realization. We report in this paper our experience in 44 cases of percutaneous endoscopic gastrostomy (PEG), concluding that it is a safe and complications-free procedure. We believe that a nutritional intervention is indicated when, improving nutritional status, patients can obtain a better quality of life and have an average life expectancy

NUTRITION IN IBD PATIENT'S: WHAT ARE THE PROSPECTS?

Summary: Inflammatory Bowel Disease (IBD) is a chronic disorder characterized by a relapsing-remitting course, which alternates between active and quiescent states, ultimately impairing a patients quality of life. The two main types of IBD are Crohn's disease (CD) and Ulcerative Colitis (UC). In physiological conditions the gut is costantly exposed to various antigens, commensal microflora and pathogens and the inflammatory response is finely balanced. It is thought that a vast number of environmental risk factors may be implicated in the development of IBD, including smoking factors, dietary factors, psycological stress, use of non-steroidal anti-inflammatory drugs and oral contraceptives, appendicectomy, breastfeeding, as well as infections. Nutritional support, as a primary therapy, has a crucial role in the management of patients with IBD. The gut microbiota is clearly manipulated by dietary components such as n-3 polyunsatured fatty acids (n-3 PUFA) and coniugated linoleic acid (CLA) which favorably reduce endotoxin load via shifts in the composition and metabolic activity of the microbial community. in particular, the beneficial effect of n-3 PUFAs and fermentable fiber, during the remission/quiescent phase of both CD and UC is Highlighted. In fact, PUFAs are associated with a less grade of inflammation since they are metabolized to 3-series prostagliandins and thromboxanes and 5-series leukotrienes and, in addition, exert antiinflammatory effects when compared with their n-6 PUFA counterparts. In similar action to dietary n-3 PUFA, coniugated linoleic acid (CLA) have been reported to ameliorate intestinal inflammation in animal models of IBD. Currently, is still unclear the role of the fibers in helping the remission of the disease. Data about the consumption of fiber are controversial. On one hand, dietary fibers can act as effective prebiotics by altering the intestinal microbial composition and promoting the growth of beneficial bacterial communities within the large intestine. On the other hand, fibers can promote diarrhea, pain and gas aggravating the clinical sate. Cocnclusion: We suggest that the consumption of fermentable fibers may have a good impact on patient's health

PROBIOTICI E TERAPIA CONVENZIONALE: NUOVE FRONTIERE NELLA GESTIONE DELLE MANIFESTAZIONI ARTICOLARI DELLE MALATTIE INFIAMMATORIE INTESTINALI (IBD)

Summary: This work reports a clinical trial performed at palermo University Hospital "paolo Giaccone". From January 2004 to December 2011, 79 patients were enrolled (40 men and 39 women). All patients suffered from Inflammatory Bowel Disease (IBD) and were subjected to orthopedic consultation at the institute of Orthopaedics, University Hospital of palermo, for arthropathy to IBD. The patients were divided into two groups (A and B) and dealt with different therapies for the resolution of the inflammatory picture of the colonic mucosa and the treatment of the extraintestinal articular manifestations. Group A was treated with drug therapy: Diclofenac (75 mg im/ day for 10 days9 and Mesalazine (800 mg gastro-resistant tabletes, one tablet twice a day in mild forms, and one tablet three times per day in moderate forms). In group B, in addition to the previous treatment protocol, two probiotic mixture were added in a time of two weeks: in the first week, twice a day, one capsule containing mixture of Enterococcus faecium and saccharomices boluard was administered, with the main purpose to mitigate the intestinal inflammation; in the second week, twice a day too, one capsule containing a mixture of lactobacillus salivarius and lactobacillus acidophilus was administered, with the main purpose to mitigate the intestinal inflammation, in the second week, twice a day too, one capsule containing a mixture of lactobacillus salivarius and lactobacillus acidophilus was administered, with the aim to promote the restoration of a normal intestinal microenvironment. The attenuation of intestinal inflammation, improved by the presence of probiotics, could have important effects on the articular manifestations, resulting in a significant improvement of the arthropathy. All patients were evaluated with the Harvey-Bradshaw Index. Both Crohn Disease and Ulcerative Cholitis diagnosis was made with clinical, laboratory, endoscopic and instrumental tests; the degree of disease activity was evaluated using the criteria of Truelove and witts. The WOMAC-Score (Western Ontario Mcmaster) was used in our study to investigate the degree of articular involvement of the patients. The data were statistically evaluated and these are shown that the B group of patients treated with conventional therapy + probiotic mixture had a better resolution of the clinical and of this post-treatment parameters: WOMAC score, ESR, CRP and white blood cells; and also the B group of patients have a better response to standard therapy compared with patients who did not receive the probiotic with a remarkable statistic significance (p>0,0001)

NUTRITION, MALNUTRITION AND DIETARY INTERVENTIONS IN INFLAMMATORY BOWEL DISEASE

Inflammatory Bowel Disease (IBD), which includes both Crohn's disease (CD) and Ulcerative Colitis (UC), is a chronic idiopathic inflammatory disorder affecting the gastrointestinal tract. Diet, as a source of luminal antigens, is thought to be an important factor in the pathogenesis of IBD. often the nutritional status of patients is significantly compromised, particularly in CD. several factors, including drug-nutrient interactions, disease location, symptoms, and dietary restriction can lead to protein energy malnutrition and specific nutritional deficiencies. solid evidence regarding the accountability of certain dietary components in the etiology of IBD are lacking. With regard to malnutrition, its consequence are growth failure, weight loss, bone disease, and/or micronutrient deficiencies, although micronutrient deficiency in IBD in most cases does not tend to have any evident clinical manifestation, except with regardo of iron, folic acid, and vitamin B. Nutritional supplemantation is essential for patients with evidence of malnutrition to increase calorie, and protein intake. Nutritional supplementation can also have efficacy in the induction and maintenance of remission in adults with CD, however it does not replace other treatments. Aim of this review is to discuss the role of nutrition and nutrients' deficiencies in the clinical setting of IBD, and to analyze efficacy and safety of the dietary interventions in patients with IBD