Background: The inflammatory bowel disease (IBD) is a chronic lifelong inflammation that may affect the entire gastro-intestinal tract in Crohn’s disease and the colon in ulcerative colitis (UC). ...Diet plays an important role in IBD patients and many of them follow strict diet restriction in order to reduce complaints and prolong remission intervals. The aim of this study was to assess dietary beliefs, dietary behaviour and nutrition knowledge in Dutch adults with IBD to enable considering the patient’s perspective on dietary advice. Methods: A self-administered online questionnaire assessing general characteristics, dietary beliefs and behaviour, nutrition knowledge and sources and dietary advice was devised. The questionnaire was distributed to members of the Dutch Crohn and UC patient association of whom 294 participated in the study. Results: Fifty-nine per cent of the patients valued nutrition to be either more or equally important compared to medication for their treatment and 62% believed diet to be more important in influencing the disease course. Sixty-two per cent reported to be successful in controlling disease symptoms through dietary adaptations. Avoiding certain foods was preferred over eating more beneficial foods or following specific diets (77 vs. 57% and 48% respectively). Dietary supplements were used by 68% of the IBD patients. Although over 71% had received dietary advice mainly by dieticians, 81% stated that the main source of their nutritional knowledge related to IBD was their own experience. Conclusion: A subgroup of IBD patients considered diet to be a more important and successful managing tool than medication to relieve their disease symptoms.
Individuals with inflammatory bowel disease (IBD) often hold strong beliefs on how diet impacts their disease. This study aimed to compare dietary intakes between IBD patients and individuals from ...the general population and to assess associations of dietary factors with relapse in patients with IBD.
Patients with longstanding Crohn's disease and ulcerative colitis (n = 165) filled out food frequency questionnaires, as did individuals participating in a Dutch population-based study (controls) (n = 1469). Multivariable regression analyses were used to assess differences in habitual dietary intake between IBD patients and controls, and to estimate associations of dietary factors in patients in remission with the development of disease relapse at follow-up.
IBD patients had higher intakes of animal protein (3.50 g/d, 95% confidence interval (CI) 1.67–5.34) and carbohydrate (10.1 g/d, 95% CI 5.23–14.9) than controls and lower intakes of (unsaturated) fat (−3.53 g/d, 95% CI −5.57– −1.50), dietary fiber (−2.19 g/d, 95% CI −3.05– −1.32) and alcohol (−0.84 g/d, 95% CI −1.46– −0.22). This was explained by a higher consumption of carbonated beverages, meat and poultry and lower consumption of fruit, vegetables and dairy products (except cheese) by IBD patients compared with controls. Several dietary factors, particularly (saturated) fat and fiber, appeared to be associated with risk of relapse.
IBD patients had higher dietary intakes of (animal) protein and carbohydrate and lower intakes of (unsaturated) fat, dietary fiber and alcohol compared with a general Dutch population. The results further underscore that dietary factors may have a role in disease course.
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.
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.
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.
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.
Summary Background Infectious complications and associated mortality are a major concern in acute pancreatitis. Enteral administration of probiotics could prevent infectious complications, but ...convincing evidence is scarce. Our aim was to assess the effects of probiotic prophylaxis in patients with predicted severe acute pancreatitis. Methods In this multicentre randomised, double-blind, placebo-controlled trial, 298 patients with predicted severe acute pancreatitis (Acute Physiology and Chronic Health Evaluation APACHE II score ≥8, Imrie score ≥3, or C-reactive protein >150 mg/L) were randomly assigned within 72 h of onset of symptoms to receive a multispecies probiotic preparation (n=153) or placebo (n=145), administered enterally twice daily for 28 days. The primary endpoint was the composite of infectious complications—ie, infected pancreatic necrosis, bacteraemia, pneumonia, urosepsis, or infected ascites—during admission and 90-day follow-up. Analyses were by intention to treat. This study is registered, number ISRCTN38327949. Findings One person in each group was excluded from analyses because of incorrect diagnoses of pancreatitis; thus, 152 individuals in the probiotics group and 144 in the placebo group were analysed. Groups were much the same at baseline in terms of patients' characteristics and disease severity. Infectious complications occurred in 46 (30%) patients in the probiotics group and 41 (28%) of those in the placebo group (relative risk 1·06, 95% CI 0·75–1·51). 24 (16%) patients in the probiotics group died, compared with nine (6%) in the placebo group (relative risk 2·53, 95% CI 1·22–5·25). Nine patients in the probiotics group developed bowel ischaemia (eight with fatal outcome), compared with none in the placebo group (p=0·004). Interpretation In patients with predicted severe acute pancreatitis, probiotic prophylaxis with this combination of probiotic strains did not reduce the risk of infectious complications and was associated with an increased risk of mortality. Probiotic prophylaxis should therefore not be administered in this category of patients.
Introduction
Physical activity has been suggested to alleviate gastrointestinal (GI) symptoms in patients with irritable bowel syndrome (IBS); however, evidence is scarce. Running has become ...increasingly popular and may be beneficial for patients with IBS. To obtain more insight in the potential application of running as therapy, we aimed to explore the impact of running and its intensity on GI symptoms in patients with IBS.
Methods
Data from a large observational study in runners were used for this nested case–control study, which included 153 runners with IBS and 153 controls. All participants had completed a questionnaire on personal characteristics, running characteristics and GI symptoms. Regarding GI symptoms, the severity of nine symptoms was asked, both at rest and during and/or shortly (up to 3 h) after running. Each symptom could be scored on a scale from 0 (not bothersome) to 100 (very bothersome), resulting in a maximum total score of 900 points.
Key Results
The prevalence and total severity score of GI symptoms were higher in runners with IBS than in controls, both at rest and during running. Among runners with IBS, the median (25th–75th percentile) total severity score during/after running was significantly lower than at rest (118 50–200 vs. 150 90–217), while in controls no significant difference between running and rest was observed. Analyses stratified for running intensity revealed that the beneficial effect in runners with IBS was present when their most intensive training session was moderately intensive or intensive but not very intensive.
Conclusions & Inferences
Running, particularly on moderate intensity, could have a beneficial effect on GI symptoms in patients with IBS.
To explore the impact of running and its intensity on gastrointestinal (GI) symptoms in patients with irritable bowel syndrome (IBS). Running, particularly on moderate intensity, could have a beneficial effect on GI symptoms in patients with IBS.
Background
Irritable bowel syndrome (IBS) is the most prevalent functional bowel disorder, but its pathophysiology is still unknown. Although a microbial signature associated with IBS severity has ...been suggested, its association with IBS severity still remains largely unknown.
Aims
This study aims to assess longitudinal dynamics of fecal microbiota and short-chain fatty acids (SCFAs) in different IBS severity groups and study the association with stool pattern, diet, depression, anxiety, and quality of life (QoL).
Methods
A longitudinal study was performed, including
n
= 91 IBS patients and
n
= 28 matched controls. All participants collected fecal samples for microbiota composition and SCFA analysis and completed validated questionnaires regarding IBS severity, stool pattern, depression, anxiety, and IBS-QoL at two timepoints with four weeks in-between. Diet was assessed at the first timepoint.
Results
Over time, 36% of IBS patients changed in severity group, and 53% changed in predominant stool pattern. The largest proportion of microbiota variation was explained by the individual (
R
2
= 70.07%). Microbiota alpha diversity and composition, and SCFAs did not differ between IBS severity groups, nor between IBS and controls. Relative abundances of
Bifidobacterium, Terrisporobacter,
and
Turicibacter
consistently differed between IBS and controls, but not between IBS severity groups. Large dynamics over time were observed in the association of microbiota composition with questionnaire data where IBS symptom severity was associated at T1 but not at T2.
Conclusions
Fecal microbiota and SCFA signatures were not consistently associated with IBS severity over time, indicating the importance of repeated sampling in IBS research.
Background & Aims Ursodeoxycholic acid (UDCA) improves laboratory liver test results in patients with primary biliary cirrhosis (PBC). Few studies have assessed the prognostic significance of ...biochemical data collected following UDCA treatment. We performed a prospective multicenter study of patients with PBC treated with UDCA to compare prognosis with biochemical response. Methods PBC was classified as early (pretreatment bilirubin and albumin levels normal), moderately advanced (one level abnormal), or advanced (both levels abnormal). Biochemical response was defined as proposed by Pares (decrease in alkaline phosphatase ALP level >40% of baseline level or normal level), Corpechot (ALP level <3-fold the upper limit of normal ULN, aspartate aminotransferase level <2-fold the ULN, bilirubin level <1-fold the ULN), and our group (Rotterdam; normalization of abnormal bilirubin and/or albumin levels). Results The study included 375 patients, and median follow-up time was 9.7 (range, 1.0–17.3) years. The prognosis for early PBC was comparable with that of the Dutch population and better than predicted by the Mayo risk score. Survival of responders was better than that of nonresponders, according to Corpechot and Rotterdam criteria ( P < .001). Prognosis of early PBC was comparable for responders and nonresponders; prognosis of responders was significantly better in those with (moderately) advanced disease. Conclusions Prognosis for UDCA-treated patients with early PBC is comparable to that of the general population. Survival of those with advanced PBC with biochemical response to UDCA is significantly better than for nonresponders. Thus, UDCA may be of benefit irrespective of the stage of disease. Prognostic information, based on bilirubin and albumin levels, is superior to that provided by ALP levels.
Background:
Primary sclerosing cholangitis (PSC) is strongly associated with inflammatory bowel disease (IBD). The aim of this study was to assess the IBD phenotype associated with PSC in a large ...well‐phenotyped population‐based PSC cohort using endoscopic and histopathologic criteria.
Methods:
PSC cases were identified and ascertained, fulfilling well‐established criteria, in 39 hospitals in a geographically defined region of The Netherlands. IBD location was recorded according to the Montreal Classification. As this classification does not consider segmental inflammation, backwash ileitis, or rectal sparing, an additional subgroup analysis was performed in 80 cases and 80 age‐ and sex‐matched IBD controls, reviewing all endoscopy and pathology reports filed between 2000 and 2010.
Results:
In all, 380 (66%) of a total of 579 PSC patients had coexistent IBD, mainly ulcerative colitis (UC) (75%). Overall, 207 (83%) of the PSC‐UC patients had a pancolitis, 32 (13%) a left‐sided colitis, and 9 (4%) a proctitis only. Seventy (95%) PSC‐Crohn's disease (CD) patients had an (ileo)colitis and four (5%) ileitis only. In the subgroup analysis 53 (66%) PSC‐UC patients were identified, 24 (30%) PSC‐CD patients, and three (4%) PSC‐IBD‐U patients. Fifty (94%) PSC‐UC patients had a pancolitis, compared with 32 (62%) matched UC patients (P < 0.001). Left‐sided colitis was seen in 16 (31%) UC controls and in one PSC‐UC patient (P < 0.001). Backwash ileitis and rectal sparing were rare findings (<10%) in the cohorts under study.
Conclusions:
IBD in PSC patients represents a distinct phenotype in that pancolitis is observed in 94% of PSC‐UC and colitis in 96% of PSC‐CD patients. Backwash ileitis and rectal sparing were rare findings in the PSC‐UC patients. (Inflamm Bowel Dis 2012;)
The recent addition of immunoglobulin (Ig)G4‐associated cholangitis (IAC), also called IgG4‐related sclerosing cholangitis (IRSC), to the spectrum of chronic cholangiopathies has created the clinical ...need for reliable methods to discriminate between IAC and the more common cholestatic entities, primary (PSC) and secondary sclerosing cholangitis. The current American Association for the Study of Liver Diseases practice guidelines for PSC advise on the measurement of specific Ig (sIg)G4 in PSC patients, but interpretation of elevated sIgG4 levels remains unclear. We aimed to provide an algorithm to distinguish IAC from PSC using sIgG analyses. We measured total IgG and IgG subclasses in serum samples of IAC (n = 73) and PSC (n = 310) patients, as well as in serum samples of disease controls (primary biliary cirrhosis; n = 22). sIgG4 levels were elevated above the upper limit of normal (ULN = >1.4 g/L) in 45 PSC patients (15%; 95% confidence interval CI: 11‐19). The highest specificity and positive predictive value (PPV; 100%) for IAC were reached when applying the 4× ULN (sIgG4 > 5.6 g/L) cutoff with a sensitivity of 42% (95% CI: 31‐55). However, in patients with a sIgG4 between 1× and 2× ULN (n = 38/45), the PPV of sIgG4 for IAC was only 28%. In this subgroup, the sIgG4/sIgG1 ratio cutoff of 0.24 yielded a sensitivity of 80% (95% CI: 51‐95), a specificity of 74% (95% CI: 57‐86), a PPV of 55% (95% CI: 33‐75), and a negative predictive value of 90% (95% CI: 73‐97). Conclusion: Elevated sIgG4 (>1.4 g/L) occurred in 15% of patients with PSC. In patients with a sIgG4 >1.4 and <2.8 g/L, incorporating the IgG4/IgG1 ratio with a cutoff at 0.24 in the diagnostic algorithm significantly improved PPV and specificity. We propose a new diagnostic algorithm based on IgG4/IgG1 ratio that may be used in clinical practice to distinguish PSC from IAC. (Hepatology 2014;59:1954–1963)
Physical activity may affect disease activity in patients with inflammatory bowel disease. We used a survey to investigate this association and performed interviews to get a better understanding of ...patient experiences, and therefore the nature of this association.
Patients with Crohn's disease (CD, n = 176) and ulcerative colitis (UC, n = 162) completed the short Crohn's Disease Activity (sCDAI) or Patient Simple Clinical Colitis Activity Index (P-SCCAI) and the Short Questionnaire to Assess Health-enhancing physical activity (SQUASH). Associations were investigated by multiple linear regression. Semi-structured interviews (7 CD, 7 UC) were conducted to assess patient experiences with the role of physical activity in their disease.
The majority of survey participants were in remission (70%) and adhered to the Dutch physical activity guidelines (61%). In Crohn's disease, the total physical activity score was inversely associated with disease activity, even after adjustment for confounders (β = - 0.375; p = 0.013). No association between physical activity and disease activity was found in ulcerative colitis. Of the interviewees, 86% experienced beneficial effects of physical activity, such as improved general fitness, quality of life and self-image. However, during periods of active disease they struggled to find the motivation and perseverance to be physically active due to physical barriers.
Crohn's disease participants with a higher physical activity level had a lower disease activity. This inverse association was not found in ulcerative colitis. Interviews revealed that IBD patients generally experience beneficial effects from physical activity, although the barriers caused by active disease may put them off to be physically active.
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