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Obesity has become a global pandemic with over one billion people world-wide are presently overweigh and/ or obese which surpasses malnutrition as the world’s most serious health problem. The number of Americans who are overweight and/or obese has doubled in adults and more than tripled in children and adolescents. Two-thirds of adults and one-third of children in the United States are overweight and obese. In June 2013, the American Medical Association (AMA) declared obesity a disease. Weight management is a branch of medicine that helps individuals achieve and maintain a healthy body weight. Integrative medicine embraces all evidence-based complementary and alternative medicine (CAM), conventional and traditional treatment modalities. Integrative Weight Management offer practitioners a weight management textbook that integrates the evidence about CAM-based therapies along with conventional and traditional weight management methods. This first chapter provides an overview of the entire book to assist the reader.

Obesity is a global pandemic and has become a serious health problem worldwide by producing considerable morbidity and mortality. Thus it is imperative for the scientific community to become familiar with the key etiological factors that are ultimately responsible for the development of obesity. The objective of this chapter is to review the important events involved in the pathophysiology of obesity leading to the dysregulation of energy balance, appetite, and metabolism.

Integrative weight management : , Integrative weight management : , کتابخانه دیجیتالی دانشگاه علوم پزشکی و خدمات درمانی شهید بهشتی

Patients with symptoms, signs, or laboratory evidence suggestive of malabsorption, such as chronic diarrhea with weight loss, steatorrhea, postprandial abdominal pain, and bloating, should be tested for CD (Strong recommendation, high level of evidence). Patients with symptoms, signs, or laboratory evidence for which CD is a treatable cause should be considered for testing for CD (Strong recommendation, moderate level of evidence). Patients with a first-degree family member who has a confirmed diagnosis of CD should be tested if they show possible signs or symptoms or laboratory evidence of CD.

Evaluation of the small intestine for inflammation has traditionally relied on small-bowel follow-through (SBFT), but multiple studies have demonstrated its low diagnostic accuracy. Capsule endoscopy (CE) transmits high-quality images of the small intestinal mucosa; it can be used to visualize the entire length of the small bowel and much of the mucosa. We compared the diagnostic yields of CE vs SBFT in a prospective study of patients with suspected small-bowel Crohn's disease.Eighty patients with signs and/or symptoms of small-bowel Crohn's disease (age, 10-65 years) underwent CE, followed by SBFT and ileocolonoscopy. Readers were blinded to other test results. The primary outcome was the diagnostic yield for inflammatory lesions found with CE before ileocolonoscopy compared with SBFT and ileocolonoscopy. A secondary outcome was the incremental diagnostic yield of CE compared with ileocolonoscopy and CE compared with SBFT.The combination of CE and ileocolonoscopy detected 107 of 110 inflammatory lesions (97.3%), whereas the combination of SBFT and ileocolonoscopy detected only 63 lesions (57.3%) (P.001). The diagnostic yield of CE compared with ileocolonoscopy was not different (P = .09). The diagnostic yield was higher for CE than for SBFT (P.001). Of the 80 patients with suspected Crohn's disease, 25 (31.3%) had the diagnosis confirmed. Eleven were diagnosed by CE findings alone and 5 by ileocolonoscopy findings alone. In the remaining 9 patients, diagnostic findings were identified by at least 2 of the 3 modalities. No diagnoses were made on the basis of SBFT findings alone.CE was better than SBFT and equivalent to ileocolonoscopy in detecting small-bowel inflammation. Although ileocolonoscopy remains the initial diagnostic test of choice, CE is safe and can establish the diagnosis of Crohn's disease in patients when ileocolonoscopy results are negative or the terminal ileum cannot be evaluated. ClinicalTrials.gov Number: NCT00487396.

The use of nutraceuticals, as a form of complementary and alternative medicine (CAM), is becoming progressively popular. It is estimated that at least 50% of adults worldwide are using some form of CAM to improve and treat health problems including inflammation. Several of the most studied nutraceuticals have shown promise in treating inflammation through antioxidant and anti-inflammatory mechanisms. The following text explores some of the more researched complementary and alternative nutraceutical treatments that have shown promise in this regard, namely, resveratrol, green tea, curcumin, boswellia, fish oil, vitamin D, and probiotics.

Crohn's disease (CD) and ulcerative colitis (UC) are idiopathic inflammatory bowel diseases (IBD) that are characterized by chronic intestinal inflammation and are associated with abnormalities of peripheral and mucosal immune function. The aim of our study was to determine whether CD or UC is characterized by discrete profiles of intestinal lymphokine production. Total cellular RNA was isolated from biopsies of healthy controls and from patients with IBD. Messenger RNA transcript levels in biopsies were determined for interleukin-2 (IL-2), IL-4, IL-5, and interferon-γ (IFN-γ), using a quantitative reverse transcriptase polymerase chain reaction method. Compared with inflamed UC mucosa and controls, CD mucosal lesions contained higher IL-2 and IFN-γ mRNA (p < 0.05), which is consistent with a T-helper cell 1 (Th1)-like pattern. In UC, IL-5 mRNA content was higher in involved areas compared with controls (p < 0.05) and inflamed CD lesions (p < 0.05), suggestive of a Th2 pattern. We conclude that the intestinal mucosa of CD and UC have inflammatory responses characterized by discrete T-helper profiles of lymphokines. This strongly suggests that the immunopathogenesis of these two forms of IBD are different.

Wireless capsule endoscopy (CE) is now routinely used for non-invasive diagnosis of small bowel diseases. But, it still requires manual assessment of the approximately 50,000 study images. Literature has recently investigated automated methods to detect and analyze various anomalies in CE images to improve reading efficiency and reduce variability. We propose such a computer aided diagnosis (CAD) approach to detect small bowel polyps. For supervised classification of polyps, we investigated fusing multiple statistical classifiers based on color, texture and edge features. The combined boosted classifier when evaluated using 1200 CE images outperformed all individual classifiers and achieved a ~90% classification accuracy.

Capsule endoscopy (CE) provides noninvasive access to a large part of the small bowel that is otherwise inaccessible without invasive and traumatic treatment. However, it also produces large amounts of data (approximately 50 000 images) that must be then manually reviewed by a clinician. Such large datasets provide an opportunity for application of image analysis and supervised learning methods. Automated analysis of CE images has only focused on detection, and often only for bleeding. Compared to these detection approaches, we explored assessment of discrete disease for lesions created by mucosal inflammation in Crohn's disease (CD). Our work is the first study to systematically explore supervised classification for CD lesions, a classifier cascade to classify discrete lesions, as well as quantitative assessment of lesion severity. We used a well-developed database of 47 studies for evaluation of these methods. The developed methods show high agreement with ground truth severity ratings manually assigned by an expert, and good precision (>;90% for lesion detection) and recall (>;90%) for lesions of varying severity.

Obesity is a global public health issue. Although the etiology of this global epidemic is multifactorial, most sufferers would be delighted to find a relatively effortless way to lose weight. Herbal "weight loss pills" can fit the bill. The authors systematically review the scientific evidence concerning various weight loss agents that are available over the counter or in food stores. The review provides a starting point to make informed choices among nutraceutical agents promoted for weight loss, as well as advice for incorporating healthy alternatives in the diet.

Major Components of the Gastrointestinal System and Their Role in Digestion Monica Van Dongen and Gerard E. Mullin Malabsorption Babatunde Adeyefa and Carla W. Brady The Role of the Gut Microbiota and Probiotics in Gastrointestinal Disease Prevention and Management Gerard E. Mullin Short Bowel Syndrome Laura E. Matarese Celiac Disease S. Devi Rampertab Food Allergy and Food Intolerance John Leung and Sheila E. Crowe Anatomy and Physiology of the Liver Melissa Palmer Nutrition and Alcoholic Liver Disease Melissa Palmer Nutrition and Nonalcoholic and Viral Liver Diseases Melissa Palmer General Nutritional Guidelines for Liver Disease, Cirrhosis, and Its Complications Melissa Palmer Nutrition and Liver Transplantation Melissa Palmer Nutritional Considerations in Acute and Chronic Pancreatitis Deepa Gosine, Mohammed Kaleel, and Vikesh K. Singh Nutrition in Irritable Bowel Syndrome Gerard E. Mullin and Ashley Koff Inflammatory Bowel Disease S. Devi Rampertab, Amy Brown, and Gerard E. Mullin Nutrition and Colorectal Disease Myles R. Joyce and Victor W. Fazio Nutrition and Colorectal Cancer Mitra Rangarajan and Gerard E. Mullin The Influence of Bitter, Aromatic, and Pungent Medicinal Plants on Gut Function James Snow and Kevin Spelman Obesity and Nutrition Katrina B. Seidman and Lawrence J. Cheskin Micronutrients Omar S. Khokhar and Timothy O. Lipman The Role of Fiber, Prebiotics, and Probiotics in Gastrointestinal Health and Disease Martin H. Floch and Violeta B. Popov An Overview of Genomics and Gastrointestinal Health and Disease Ruth DeBusk Enteral Access and Enteral Nutrition Amy Berry and Mark H. DeLegge Parenteral Nutrition Mandy Corrigan, Bijo K. John, and Ezra Steiger Pediatric Enteral and Parenteral Nutrition Jenifer Hampsey and Tiffani Hays Drug-Drug and Drug-Nutrient Interactions in Gastrointestinal Disease Mark G. Klang Nutrition Assessment Tina Colaizzo-Anas Critical Care Nutrition Tara Nealon and Jonathan Waitman Perioperative Nutrition Support Jill Schuman and Kishore R. Iyer Bariatric Surgery Scott A. Shikora, Kerri Anne Hawkins, and Meghan Ariagno Home Parenteral Nutrition (HPN) Alice Illian, Kevn McNamara, and Carol Ireton-Jones An Integrative Nutrition Approach to Eating Disorders Carolyn Coker Ross and Gerard E. Mullin Ethical and Medical-Legal Considerations Julie O'Sullivan Maillet

Analysis of Wireless Capsule Endoscopy (CE) images has become a very active area of research since this novel technology enabled access to previously inaccessible areas of the gastrointestinal tract, especially the small intestine. Art has investigated automatic segmentation of organ boundaries, detection of lesions and bleeding as well as other supervised and unsupervised analysis. However, all of this art has focused on treating the images as individual and independent observations that contribute towards a unique and separate decision. Given the overlap between the images, this is clearly not the case. A human, by contrast, performs assessment by combining the information seen in all neighboring views of the anatomy in a study. This article makes two significant contributions. Towards combining information from multiple images, we propose a supervised classification approach using an HMM framework. Secondly, we use a weak (k-NN) classifier to prototype and evaluate such a framework for regions of the GI tract containing polyps. The combined framework significantly improves the performance of the individual classifier and experiments show promising performance with accuracy > 0.9.

The prevalence of malnutrition in the hospitalized setting is 30% to 55%. Previous studies reported an association of malnutrition with an increased hospital length of stay (LOS), morbidity, and mortality of patients. This study evaluated the role of early nutrition intervention on LOS, diagnosis coding of malnutrition cases, calculating case mix index, and reducing delays in implementing nutrition support to patients.Demographic data, anthropometric measurements, LOS, and serum albumin levels were collected from 400 patients in 2 medical wards to determine the prevalence of malnutrition and potential delays in nutrition consultation. Based on these results, a nutrition intervention study was conducted in 1 ward; the other ward served as a control. Patients were classified as normally nourished or malnourished. Multivariate general linear regressions were used to reveal the impact of intervention on the change in LOS, controlling for other potential confounding factors on the cohort and a subset with severe malnutrition.Of the 400 patients assessed, 53% had malnutrition. Multiple general linear regressions showed that nutrition intervention reduced LOS an average of 1.93 days in the cohort group and 3.2 days in the severe malnourished group. Case mix index and female gender were positively associated with LOS in the malnourished group. Nutrition intervention reduced the delays in implementing nutrition support to patients by 47%.Results highlight the positive impact of nutrition intervention in terms of reduced LOS in malnourished hospital patients. Reduction in LOS with diagnosis coding of malnutrition cases yielded substantial economic benefits.

This paper presents a novel system for image matching in optical endoscopy. The proposed metamatching system approaches the challenge of matching images in a complex scene by incorporating multiple matchers and a decision function. Experiments are presented for Crohn's disease lesion matching in capsule endoscopy with a metamatcher consisting of five independent matchers. We compare the performance of six different types of decision functions. Results show that the F-measure of the metamatching system containing all five matchers is 4%-7% greater than the performance of using the best matcher only, with a maximum F-measure of 0.811. The robustness of the method is validated using simulated data generated by controlled deformations of the image. We also demonstrate how the addition of simulated data to the training set can be used to augment the performance of the metamatcher by up to 10%.

A Wireless Capsule Endoscope (WCE) is a small device that is capable of acquiring thousands of images as it travels through the gastrointestinal track. WCE is becoming a widely accepted method which physicians use in the diagnosis of Crohn's disease, an inflammatory disease that occurs mainly in the small intestine. In this article we present a novel method to detect those images showing inflammation among the thousands of images acquired by the WCE. Further, our method is capable of delineating the inflammation region(s) in each detected frame. Our system utilizes the mean-shift algorithm to find centers of candidate regions that may show Crohn's disease inflammation. Then the system classifies these regions by a trained Support Vector Machine. We have trained, validated and tested our method on three mutually exclusive sets. Our system's testing accuracy, specificity and sensitivity are 87%, 93% and 80% respectively.

The current procedure for diagnosis of Crohn's disease (CD) from Capsule Endoscopy is a tedious manual process which requires the clinician to visually inspect large video sequences for matching and categorization of diseased areas (lesions). Automated methods for matching and classification can help improve this process by reducing diagnosis time and improving consistency of categorization. In this paper, we propose a novel SVM-based similarity learning method for distinguishing between correct and incorrect matches in Capsule Endoscopy (CE). We also show that this can be used in conjunction with a voting scheme to categorize lesion images. Results show that our methods outperform standard classifiers in discriminating similar from dissimilar lesion images, as well as in lesion categorization. We also show that our methods drastically reduce the complexity (training time) by requiring only one half of the data for training, without compromising the accuracy of the classifier.

Crohn's disease (CD) is characterized by granulomatous inflammation of the intestinal mucosa, but the etiology and pathogenesis of the inflammatory lesions are unknown. The aim of this study was to determine whether T-cell activation and lymphokine production occurs in the mucosal lesions of this disease. Total cellular RNA was isolated from peripheral blood lymphocytes and from colonoscopic mucosal biopsies of normal individuals and patients with CD of the colon or ulcerative colitis (UC). Levels of interleukin-2 (IL-2) messenger RNA (mRNA) transcripts in samples were determined using a quantitative reverse transcriptase polymerase chain reaction method. IL-2 mRNA transcripts were detected in histologically normal intestinal mucosal biopsies obtained from control subjects. In CD, higher levels of IL-2 mRNA transcripts were detected in the mucosa from areas of active inflammation, but in areas that were histologically normal, levels were similar to control subjects. The levels of IL-2 mRNA transcripts in biopsies from active and inactive UC were similar to control subjects. Levels of IL-2 mRNA in peripheral blood lymphocytes were low and not significantly different in all groups of subjects. In conclusion, the normal intestinal mucosa contains IL-2 mRNA transcripts and may be an important source of IL-2. Furthermore, the inflammatory lesions of CD, but not UC, have higher levels of IL-2 mRNA transcripts, suggesting that T-cell activation and lymphokine secretion in the intestine may be important in the pathogenesis of CD. These data provide further evidence that the pathogenesis of CD and UC are different.

Background: The medical literature states that solid radionuclide gastric emptying studies are more sensitive than liquid studies for detection of gastroparesis and thus liquid studies are rarely indicated. At our institution, patients are often referred for both studies. Our initial purpose was to review the results in those patients. The surprising results led us to initiate a prospective investigation to more directly determine the relative value of solid versus liquid emptying studies. Methods: The retrospective review included 21 patients who had both studies performed on separate days. The subsequent prospective investigation was initiated so that the solid and liquid emptying studies were acquired sequentially on the same day. A total of 40 consecutive patients with symptoms suggestive of gastroparesis (mean age 44.8, 12 males, 28 females) were investigated. All ingested 300 mL water with radiotracer and were imaged each minute x 30. They then ingested the radiolabeled solid meal and were imaged each hour x 4. A liquid emptying rate (T 1/2 ) and solid percent emptying each hour x 4 was determined. Results: In the retrospective review, 17 of 21 patients had normal solid emptying; of those, 13 had delayed liquid emptying. In the subsequent prospective study, 30/40 (75%) had normal solid emptying; of those, 10 (33%) had delayed liquid emptying. Nine patients (23%) had delayed solid emptying; 13 (32%) had delayed liquid emptying. Conclusions: Liquid gastric emptying is commonly abnormal in patients who have normal solid studies. Liquid studies should be routinely performed in addition to solid studies to fully evaluate gastric motility in patients with symptoms suggestive of gastroparesis.

Background: Extraintestinal manifestations of Crohn's disease (CD) have not previously included the central nervous system (CNS). Restless legs syndrome (RLS) is a CNS disorder that is either idiopathic or secondary to a number of diseases. The aim of this study was to determine if RLS was associated with CD because both are associated with iron deficiency, inflammation, and bacterial overgrowth. Methods: Consecutive CD outpatients (N = 272) were prospectively surveyed at 4 centers for criteria for RLS. Incidence (having RLS at any point in time), prevalence (having RLS at time of survey), clinical characteristics, risk factors, and potential qualitative relationship between RLS and gastrointestinal symptoms were queried. Results: The incidence of RLS in patients with CD was 42.7%. Prevalence was 30.2% compared with 9% of spouses. CD patients with and without RLS had a mean age of 46.8 versus 42.6 years, small intestine involvement in 77.9% versus 66.7%, colon involvement in 39.7% versus 63.2%, and prior iron deficiency anemia in 49.3% versus 33.1%. There was no difference between the CD groups with respect to current iron deficiency, RLS family history, or rare prevalence of concomitant RLS disorders. In 91.8% of patients with RLS and CD, RLS started during or after the onset of CD diagnosis. Among 73 patients with RLS, 67 (44.5%) stated there was a relationship between qualitative RLS symptom improvement with overall CD symptom improvement. Conclusions: These results demonstrate that RLS occurs frequently in CD and appears to be a possible extraintestinal manifestation. The potential relationship of RLS with CD activity warrants further investigation. (Inflamm Bowel Dis 2009;)

Wireless capsule endoscopy (CE) is increasing being used to assess several gastrointestinal(GI) diseases and disorders. Current clinical methods are based on subjective evaluation of images. In this paper, we develop a method for ranking lesions appearing in CE images. This ranking is based on pairwise comparisons among representative images supplied by an expert. With such sparse pairwise rank information for a small number of images, we investigate methods for creating and evaluating global ranking functions. In experiments with CE images, we train statistical classifiers using color and edge feature descriptors extracted frommanually annotated regions of interest. Experiments on a data set using Crohn's disease lesions for lesion severity are presented with the developed ranking functions achieve high accuracy rates.

This paper presents a new approach to evaluation of registration using a general discriminative learning model that is independent of the type of registration method. We select features by association of a registration with a set of metrics (pixel based, patch based and histogram based statistics) and learn a classifier that discriminates mis-registrations from correct registrations using Adaboost. Experiments on a set of wireless capsule endoscopy (CE) images and images extracted from minimally invasive surgical endoscopic video data are presented. Results show that the proposed method outperforms any single classifier.

Capsule endoscopy (CE) is aimed at diagnosing disease in areas of the gastrointestinal (GI) tract beyond the reach of conventional endoscopy. Recent work has addressed various methods for reducing the complexity of CE diagnosis and the time needed for analyzing the data. This includes detection of lumen and its contractions, fluids such as blood and intestinal juices, as well as extraneous matter such as food and bubbles. This paper outlines our ongoing work to segment lesions (in particular Crohn's disease) and other abnormalities in CE images. In particular, here we describe the data collection and clinical analysis for our project and preliminary results for segmenting abnormal and extraneous images from a set of 10 CE studies.

A variety of pixel and feature based methods have been proposed for registering multiple views of anatomy visible in studies obtained using diagnostic, minimally invasive imaging. A given registration method may outperform another depending on anatomical variations, imaging conditions, and imaging sensor performance, and it is often difficult a priori to determine the best registration method for a particular application. To address this problem, we propose a registration framework that pools the results of multiple registration methods using a decision function for validating registrations. We refer to this as meta registration. We demonstrate that our framework outperforms several individual registration methods on the task of registering multiple views of Crohn's disease lesions sampled from a Capsule Endoscopy (CE) study database. We also report on preliminary work on assessing the quality of registrations obtained, and the possibility of using such assessment in the registration framework.

The findings presented above and in other studies provide substantial evidence that lymphocytes in the intestinal lamina propria differ from lymphocyte populations in the circulation or in other tissue sites in a number of ways. First, lamina propria lymphocytes are phenotypically distinct and have evidence of activation. Lymphocytes in the intestinal lamina propria are different in their potential for expression of lymphokine gene products, since activated cells from the lamina propria have high expression of mRNA for IL-2, IL-4, IL-5 and IFN-gamma in comparison to circulating lymphocytes. Mesenteric lymph node T cells also differ from circulating lymphocytes in their high expression of IL-4 and IL-5 mRNA. A further difference between mesenteric lymph node and lamina propria T cells is that the former are capable of proliferating in response to IL-4, whereas the latter are not. These phenotypic and mRNA differences of lamina propria lymphocytes also correlate well with their high helper activity in vitro for immunoglobulin synthesis in the pokeweed mitogen system. Finally, lamina propria T cells at a site of inflammation are able to provide high helper activity in response to specific antigens. These observations are all consistent with the conclusion that T cells in the lamina propria are pleomorphic, but are highly enriched for subpopulations of activated memory cells that are geared for effector functions. These functions are likely to be critical in maintaining normal host defense in the mucosal environment.

Current Western therapies for many gastrointestinal diseases are suboptimal and potentially toxic. The majority of patients with digestive diseases are turning to complementary and alternative medicine for symptom relief and improved quality of life, due to dissatisfaction with conventional medical therapies. There is emerging evidence that many of these complementary and alternative medicine modalities are highly effective in modulating the immune system, disrupting the proinflammatory cascade and restoring digestive health while improving patients' quality of life. We present evidence to support the potential utility of complementary and alternative medicine modalities for irritable bowel syndrome and inflammatory bowel disease. For each condition, we detail the proposed mechanisms of action and explore the current data for the prevention and/or treatment of disease.

Background: The effect of small bowel transit time (SBTT) on diagnostic yield during capsule endoscopy (CE) has not been previously evaluated. Our study aim was to assess the effect of SBTT on the likelihood of detecting intestinal pathology during CE. Methods: We reviewed collected data on CE studies performed at Johns Hopkins Hospital from January 2006 to June 2007. In patients investigated for anemia or obscure bleeding, the following lesions were considered relevant: ulcers, erosions, AVMs, red spots, varices, vascular ectasias, and presence of blood. In patients with diarrhea or abdominal pain, ulcers, erosions, and blood were considered relevant. Age, gender, study indication, hospital status, and quality of bowel preparation were identified as candidate risk factors affecting SBTT. Univariate logistic and linear regression analyses were performed to study the effect of SBTT on diagnostic yield. Results: Total of 212 CE studies were analyzed; most were in outpatients (n=175, 82.9%) and with excellent bowel preparation (n=177, 83.5%). Mean SBTT was 237.0min (3.9hrs). Age, gender, bowel prep, hospital status, and study indication did not significantly affect SBTT. However, increased SBTT was independently associated with increased diagnostic yield; OR=1.7 in SBTT=2-4hr (p=0.41), OR=1.8 in SBTT=4-6hrs (p=0.30), OR=9.6 in SBTT=6-8hrs (p=0.05). Conclusion: Prolonged SBTT during CE (>6 hr) is associated with an increased diagnostic yield. This may be due to a positive effect on image quality during a “slower” study. The use of promotility agents may adversely affect the ability of CE to detect significant intestinal pathology.