Crohn's disease therapy with Dietzia: the end of anti-inflammatory drugs

Abstract Disseminated histoplasmosis is a life-threatening disease usually seen in immunocompromised patients living in endemic areas. We present an apparently immunocompetent patient with gastrointestinal histoplasmosis who was initially diagnosed as biopsy-proven Crohn’s disease. Following discontinuation of anti-inflammatory drugs and institution of antifungal therapy, his GI illness completely improved. Specific fungal staining should be routinely included in histopathologic assessment of tissue specimens diagnosed as Crohn’s disease.

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Riboflavin Supplementation in Patients with Crohn’s Disease [the RISE-UP study]

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz208 ◽

2019 ◽

Vol 14 (5) ◽

pp. 595-607 ◽

Cited By ~ 3

Author(s):

Julius Z H von Martels ◽

Arno R Bourgonje ◽

Marjolein A Y Klaassen ◽

Hassan A A Alkhalifah ◽

Mehdi Sadaghian Sadabad ◽

...

Keyword(s):

Oxidative Stress ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Activity ◽

Clinical Symptoms ◽

Fish Analysis ◽

Markers Of Inflammation ◽

Anti Inflammatory ◽

Faecal Microbiome ◽

Chronic Intestinal Inflammation

Abstract Background and Aims Crohn’s disease [CD] is characterised by chronic intestinal inflammation and dysbiosis in the gut. Riboflavin [vitamin B2] has anti-inflammatory, antioxidant and microbiome-modulatory properties. Here, we analysed the effect of riboflavin on oxidative stress, markers of inflammation, clinical symptoms, and faecal microbiome in patients with CD. Methods In this prospective clinical intervention study, patients received 100 mg riboflavin [DSM, Nutritional Products Ltd] daily for 3 weeks. Clinical disease activity [Harvey-Bradshaw Index: HBI], serum biomarkers of inflammation and redox status [plasma free thiols], and faecal microbiome taxonomical composition and functionality [fluorescent in situ hybridisation: FISH; and metagenomic shotgun sequencing: MGS], were analysed before and after riboflavin intervention. Results In total, 70 patients with CD with varying disease activity were included. Riboflavin supplementation significantly decreased serum levels of inflammatory markers. In patients with low faecal calprotectin [FC] levels, IL-2 decreased, and in patients with high FC levels, C-reactive protein [CRP] was reduced and free thiols significantly increased after supplementation. Moreover, HBI was significantly decreased by riboflavin supplementation. Riboflavin supplementation led to decreased Enterobacteriaceae in patients with low FC levels as determined by FISH; however, MGS analysis showed no effects on diversity, taxonomy, or metabolic pathways of the faecal microbiome. Conclusions Three weeks of riboflavin supplementation resulted in a reduction in systemic oxidative stress, mixed anti-inflammatory effects, and a reduction in clinical symptoms [HBI]. FISH analysis showed decreased Enterobacteriaceae in patients with CD with low FC levels, though this was not observed in MGS analysis. Our data demonstrate that riboflavin supplementation has a number of anti-inflammatory and anti-oxidant effects in CD.

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Immune system alterations in patients with inflammatory bowel disease during remission

Medicina ◽

10.3390/medicina44010005 ◽

2008 ◽

Vol 44 (1) ◽

pp. 27 ◽

Cited By ~ 14

Author(s):

Jurgita Šventoraitytė ◽

Aida Žvirblienė ◽

Gediminas Kiudelis ◽

Rimantas Žalinkevičius ◽

Aurelija Žvirblienė ◽

...

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Bowel Disease ◽

Immune Homeostasis ◽

Th2 Cytokines ◽

Inflammatory Bowel ◽

Anti Inflammatory ◽

And Control

Objective. Perturbed immune homeostasis elicited by misbalanced production of proinflammatory and anti-inflammatory cytokines is characteristic of inflammatory bowel disease. The aim of this study was to evaluate cytokine profile in patients with different forms of inflammatory bowel disease – ulcerative colitis and Crohn’s disease – during clinical remission phase. Material and methods. Production of proinflammatory Th1 cytokines (tumor necrosis factoralpha (TNF-a), interferon-gamma (IFN-g)) and anti-inflammatory Th2 cytokines (interleukin- 10 (IL-10) and interleukin-13 (IL-13)) was analyzed in peripheral blood mononuclear cells of patients with inflammatory bowel disease (9 with ulcerative colitis and 9 with Crohn’s disease) and control subjects (n=11) by enzyme-linked immunosorbent assay (two-site ELISA). Results. The results of the study revealed that the level of TNF-a after stimulation with phytohemagglutinin in patients with Crohn’s disease was significantly higher in comparison to both patients with ulcerative colitis and controls (P<0.001 and P<0.01, respectively). The secretion of IFN-g both in patients with Crohn’s disease and ulcerative colitis was lower than that in controls (P=0.05 and P<0.01, respectively), but it normalized after stimulation with phytohemagglutinin. The levels of IL-10 and IL-13 were significantly (P<0.01) higher in patients with Crohn’s disease than in patients with ulcerative colitis and control group before and after stimulation with phytohemagglutinin. Conclusions. The results of our study provide evidence that in patients with inflammatory bowel disease, the imbalance between production of proinflammatory Th1 and anti-inflammatory Th2 cytokines persists even during remission of the disease, and disturbances of immune homeostasis are significantly more expressed in patients with Crohn’s disease than in patients with ulcerative colitis.

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The association between inflammatory potential of diet and disease activity: results from a cross-sectional study in patients with inflammatory bowel disease

BMC Gastroenterology ◽

10.1186/s12876-020-01435-4 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Carlijn R. Lamers ◽

Nicole M. de Roos ◽

Ben J. M. Witteman

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Activity ◽

Bowel Disease ◽

Activity Index ◽

Statistical Significance ◽

Inflammatory Bowel ◽

Anti Inflammatory

Abstract Background Diet may play a role in disease status in patients with inflammatory bowel disease. We tested whether the inflammatory potential of diet, based on a summation of pro- and anti-inflammatory nutrients, is associated with disease activity in patients with Crohn’s disease and ulcerative colitis. Methods Participants completed a disease activity questionnaire (short Crohn’s Disease Activity (sCDAI) or Patient Simple Clinical Colitis Activity Index (P-SCCAI)) and a Food Frequency Questionnaire (FFQ). FFQ data were used to calculate the Dietary Inflammatory Index (DII) which enables categorization of individuals’ diets according to their inflammatory potential on a continuum from pro- to anti-inflammatory. Associations with disease activity were investigated by multiple linear regression. Results The analysis included 329 participants; 168 with Crohn’s disease (median sCDAI score 93 [IQR 47–156]), and 161 with ulcerative colitis (median P-SCCAI score 1 [IQR 1–3]). Mean DII was 0.71 ± 1.33, suggesting a slightly pro-inflammatory diet. In Crohn’s disease, the DII was positively associated with disease activity, even after adjustment for confounders (p = 0.008). The mean DII was significantly different between participants in remission and with mild and moderately active disease (0.64, 0.97 and 1.52 respectively, p = 0.027). In ulcerative colitis, the association was not significant. Conclusions Disease activity was higher in IBD participants with a more pro-inflammatory diet with statistical significance in Crohn’s disease. Although the direction of causality is not clear, this association strengthens the role for diet in medical treatment, which should be tested in an intervention study.

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Trends in Inflammatory Bowel Disease Therapy: A Meta-Analytic Approach

Canadian Journal of Gastroenterology ◽

10.1155/1995/283251 ◽

1995 ◽

Vol 9 (7) ◽

pp. 405-411 ◽

Cited By ~ 2

Author(s):

Gregory W Whiting ◽

Joseph Lau ◽

Bruce Kupelnick ◽

Thomas C Chalmers

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Meta Analysis ◽

Statistical Significance ◽

Analytic Approach ◽

Disease Therapy ◽

The Matrix ◽

Inflammatory Bowel ◽

Acute Attacks ◽

New Treatments

OBJECTIVE: To illustrate the current meta-analytic approach to extracting clinically useful information from the glut of randomized controlled trials (RCTs) of the treatment of acute attacks of Crohn's disease.PROCEDURE: Acceptable RCTs were classified in a matrical format so that the feasibility of a meta-analysis of each treatment could be quickly determined. Each potential inclusion was then photocopied after blinding the source and outcome to minimize bias by the investigators.RESULTS AND CONCLUSIONS: The search was started in 1990, when a previous meta-analysis was completed. Over 100 citations in MEDLINE contained 21 RCTs of the treatment of acute attacks of Crohn's disease, and 11 more were culled from the references of recent papers. The meta-analysis most indicated by the matrix was a comparison of several different immunosuppressive regimens with a placebo. The previously demonstrated statistical significance was confirmed and the point made that it is no longer justified to compare any new treatments with a placebo. Cumulative meta-analysis, the process of performing a new analysis every time a new trial is published, revealed the importance of employing both random and fixed effect models when heterogeneity of treatment results is appreciable, as in this case.

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