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Wstęp. Choroba Leśniowskiego-Crohna jest chorobą zapalną jelit o nieznanej etiologii. Rozpoznana zostaje najczęściej u dzieci oraz nastolatków. Do objawów charakterystycznych dla choroby należą bóle brzucha, oddawanie biegunkowych stolców często z obecnością patologicznych domieszek: krwi, ropy czy śluzu, a także ubytek masy ciała. Podstawowym krokiem w procesie terapeutycznym jest nawodnienie dziecka drogą dożylną lub doustną, włączenie farmakoterapii oraz leczenia żywieniowego. Celem wdrożonej terapii jest utrzymanie pacjenta w jak najdłużej trwającej remisji. Cel. Praca ma na celu ukazać problemy opiekuńcze oraz terapeutyczne u dziecka z zaostrzeniem choroby Leśniowskiego-Crohna w warunkach szpitalnych oraz zadania personelu pielęgniarskiego wobec tego pacjenta. Prezentacja przypadku. Pacjentka lat 15 w drugiej dobie hospitalizacji przyjęta w oddział z podejrzeniem zaostrzenia choroby Leśniowskiego-Crohna. Pacjentka zgłasza liczne biegunki (od 10 do 15 wypróżnień na dobę) oraz ból brzucha. Przy przyjęciu temperatura ciała pacjentki wynosiła 38,4°C. Dziewczyna oraz jej rodzice wykazują deficyt wiedzy na temat choroby oraz postępowania w przypadku jej zaostrzenia. Wnioski. Bardzo ważnym aspektem w leczeniu choroby Leśniowskiego-Crohna u opisanej pacjentki jest stosowanie się do zaleceń żywieniowych oraz systematyczne przyjmowanie zleconych środków farmakologicznych. Całkowite wyleczenie choroby nie jest możliwe, lecz podjęte działania w walce z chorobą pozwalają na uzyskanie długiej remisji i zmniejszenie ryzyka wystąpienia jej poważnych powikłań.

Autoimmunological diseases are an increasing problem nowadays in societies. Due to complex etiology, effective therapy against immune disorders is still needed. A promising alternative for the current methods of treatment can be helminthic therapy. Series of tests on animal models as well as clinical studies indicates that parasitic infection can inhibit inflammation in inflammatory bowel diseases and multiple sclerosis. Effectiveness of therapy with helminths, mainly gut nematodes depends on the activity of many compounds released during infection. Despite hopeful results, mechanisms activated by nematodes aren't explained yet, besides, therapeutically use of live parasites is controversial. Most of studies are focused on searching parasitic factors. The use of this compound in autoimmunological diseases could be an alternative for current medicaments. The aim of current study is summarizing and discussing helminth therapy of autoimmunological disorder on multiple sclerosis and inflammatory bowel diseases examples as well as using parasitic compounds as a potential pharmaceutical component. [ABSTRACT FROM AUTHOR]

Copyright of Polish Nursing / Pielegniarstwo Polskie is the property of Poznan University of Medical Sciences Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Bile acids not only play a cardinal role in the digestion and absorption of fat and fat-soluble vitamins, but also significantly affect gastrointestinal motor, sensory and secretory functions, intestinal barrier permeability and the regulation of the inflammatory response. The results of recent studies have revealed complex interactions between bile acids and the gut microbiota. In addition, bile acids also play a role of signaling molecules regulating the activity of lipid and glucose metabolic pathways, as well as a role of ligands for transcription factors. Genetic factors associated with the regulation of bile acid synthesis, transport and action may significantly influence gastrointestinal function and predispose to diarrhea resulting from bile acid malabsorption. Methods used in the diagnosis of bile acid malabsorption include 75selenium-homotaurocholic acid test, serum C4 and fibroblast growth factor 19 (FGF19), as well as fecal bile acid levels. The paper presents the latest data on the role of bile acid in the pathogenesis of irritable bowel syndrome, inflammatory bowel diseases and colorectal cancer. Advances in the treatment of disturbances in bile acids absorption and synthesis are also presented. A better understanding of molecular mechanisms regulating bile acid action may have implication for colorectal cancer prevention. [ABSTRACT FROM AUTHOR]

Do nieswoistych zapaleń jelit zaliczamy wrzodziejące zapalenie jelita grubego i chorobę Leśniowskiego-Crohna. Ponieważ szczyt zapadalności na te choroby przypada między 15. a 35. rokiem życia, a więc dotyczy osób w okresie prokreacyjnym, rodzi się szereg pytań i wątpliwości na temat wpływu tych schorzeń oraz ich leczenia na płodność, a także przebieg ciąży, porodu i ewentualne bezpieczeństwo późniejszego karmienia piersią. W opracowaniu zostały przedstawione zasady leczenia nieswoistych zapaleń jelit u mężczyzn oraz u kobiet planujących posiadanie potomstwa, jak również kobiet będących w ciąży i karmiących. Należy podkreślić, że sam fakt rozpoznania nieswoistych chorób zapalnych jelit nie jest bezpośrednim przeciwwskazaniem do zajścia w ciążę. Ciąża nie stanowi również wskazania do przerwania leczenia tych chorób, tj. nieswoistych zapaleń jelit, gdyż zaostrzenie ich przebiegu wiąże się z większym ryzykiem dla potomstwa w porównaniu z niebezpieczeństwem wynikają- cym z wdrożenia nawet agresywnego, a skutecznego leczenia. Aktywacja tych chorób zwiększa zarówno ryzyko poronień, jak i porodów przedwczesnych oraz wewnątrzmacicznego obumarcia płodu. Nieprzerwana farmakoterapia nieswoistych zapaleń jelit środkami niemającymi działania karcynogennego ma istotny wpływ na urodzenie zdrowego dziecka. Optymalnym czasem do zajścia w ciążę w takim przypadku jest okres po trwającej przynajmniej 3 miesiące remisji choroby. W okresie planowania ciąży zaleca się suplementację kwasu foliowego.

Inflammatory bowel disease is a group of chronic medical conditions comprising Crohn's disease and ulcerative colitis that involves increased frequency of mental disorders. The most common psychiatric disorders in inflammatory bowel disease are depression and anxiety, however, some epidemiologic and biological evidence suggest that other disorders like bipolar disorder occur more often. Biological mechanisms concerning both inflammatory bowel disease and depression or anxiety explain susceptibility to developing mental disorders in inflammatory bowel disease. Interactions of brain gut-axis, immunological disturbances, oxidative stress and vagus nerve dysfunction play a role in pathophysiology of inflammatory bowel disease and mental disorders as well. Significance of these factors was covered in this paper. Psychiatric comorbidity in IBD may affect course of intestinal disease. It can increase frequency and severity of relapses and hinder the treatment so knowledge about relationship between IBD and mental health appears to be vital for proper management of patients with inflammatory bowel disease. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) is estimated to be the first leading cause of death from cancer among men and women in the EU. Every year in Poland, 15,254 cases of CRC are diagnosed, and 10,501 patients die of the disease, making it the second leading cause of death from cancer. In more than 90% of cases, the disease begins as adenomatous polyps with epithelial dysplasia as a common feature. Inflammatory bowel diseases (IBD), a group of chronic inflammatory diseases of the gastrointestinal tract characterized by remissions and relapses, constitute an independent risk factor of CRC development. CRC developing in IBD patients, however, has features distinct from sporadic cancer, suggesting the influence of unique factors. The high risk of CRC in IBD patients probably results from chronic inflammation. In most cases, neoplastic lesions arise within the inflamed gastrointestinal mucosa during the process of re-epithelization, which is a healing response to ulceration. The recently discovered Th17 lymphocytes, which demonstrate strong pro-inflammatory capabilities, might link the two diseases. Th17 lymphocytes produce a number of pro-inflammatory cytokines, such as interleukin (IL)-17A, IL-17F, IL-21, IL-22 and tumor necrosis factor (TNF)-a, and play a key role in mucosal defense against various pathogens. Numerous observations suggest that Th17 lymphocytes are involved in pathogenesis of different autoimmune diseases and pathologic inflammatory states. Mounting evidence suggests that Th17 cells contribute to the pathogenesis of IBD and CRC. However, their precise role in both diseases is unknown. [ABSTRACT FROM AUTHOR]

Hepcidin is a 25-amino-acid peptide synthesized predominantly in hepatocytes, which plays an essential role in the regulation of systemic iron homeostasis. As a result of inflammation, hepcidin binds to ferroportin resulting in its internalization and degradation in enterocytes and macrophages. Thus iron is trapped in both enterocytes and macrophages, leading to functional hypoferremia. In iron deficiency or enhanced erythropoiesis, hepcidin expression is reduced. That fact results in increase of iron absorption and releasing iron storage from macrophages. The discovery of the biological properties of hepcidin clarified the relationship between iron homeostasis, immune response, and anaemia of chronic disease. Anaemia is the most common extra intestinal manifestation of inflammatory bowel disease. Anaemia significantly reduces the quality-of-life among patients and can lead to a number of serious complications, even life- threatening. The main types of anaemia in inflammatory bowel diseases are iron deficiency anaemia and anaemia of chronic disease. These two types of anaemia coexist commonly. The key issue is differentiation these types of anaemia to implement a proper management. Commonly used parameters as iron concentration, ferritin and transferrin, are rather unreliable indices for the evaluation of anaemia in inflammatory bowel diseases. In recent studies the important role of hepcidin as a potential alternative marker of anemia and iron status has been shown. Moreover, there are data that antihepcidin treatment may be an effective treatment of anaemia of chronic disease in inflammatory bowel disease. This paper presents hepcidin structure, mechanism of action and regulation, and highlights hepcidin function in anaemia in inflammatory bowel disease. [ABSTRACT FROM AUTHOR]

Copyright of Pediatric Endocrinology, Diabetes & Metabolism is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Inflammatory bowel diseases (IBD) are chronic intestinal disorders of unknown etiology. Immune system, genetic factors and enviromental factors are involved in pathogenesis of Crohn disease (CD) and ulcerative colitis (UC). Clinical symptoms are various, nonspecific and often resemble those of other conditions especially in the first stadium of the disease, which may cause problems with proper diagnosis of IBD. From twenty five to thirty percent of patients with inflammatory bowel disease have at least one of its extraintestinal symptoms, which can sometimes appear earlier than intestinal disorders. [ABSTRACT FROM AUTHOR]

Introduction: There are many studies, which indicate the importance of sleep disturbances in various chronic inflammatory disorders. However, hale been no prior reported studies that address the role of sleep in inflammatory bowel diseases (IBD) in children. The aim of the study was to assess the frequency of sleep disturbances in children with IBD and characterize the nature of this problem. Material and methods: The study group included 29 patients aged from 10 to 18 years with IBD in the remission period. The control group included 50 healthy children (10-18 years old). Sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI). It differentiates poor (=5 points) from good sleep by measuring seven areas: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, daytime dysfunction. Results: Mean PSQI score in the study group was 5.03±2.1, and in the control group 3.9±1.56 (p=0.008). Sleep disturbances were reported in 65.5% of children with IBD and 36% of healthy children (p=0.011). No statistically significant differences were observed in sleep latency, efficiency and duration between both groups. However, there was a significant difference in sleep interruption frequency. Daytime sleepiness was a common problem in both groups. Most of the children rated their sleep as good or very good. Conclusions: Presented results suggest that sleep disturbances are common in children with IBD. However this study does not answer the question what is the nature of this problem. It seems that further studies including bigger research group should be performed. [ABSTRACT FROM AUTHOR]

Biologic therapies include recombinant human proteins, antibodies and fussion proteins with diverse immunomodulating properties. The importance of biological therapies among the currently available treatment options of inflammatory bowel disease (IBD) results from its potential efficacy in induction and maintenance of mucosal healing, and in consequence with hope for change of the natural history of chronic intestinal inflammation. To date infliximab (monoclonal chimeric human-mouse antibody directed against TNF-a) has been available for the longest period and remains the most commonly utilized biological agent in patients with IBD. Infliximab is registered for adult patients with moderate and severe Crohn Disease (CD) and ulcerative colitis (UC) and for children with CD (>7 years of age), unresponsive to conventional therapy. In Poland infliximab was introduced for adults in 1998 and in 2007 the reimbursed therapeutic program for children with CD was started. Infliximab treatment increases the likelihood of clinical remission, mucosal healing, and reducing the risk of complications necessitating major abdominal surgery in patients with IBD. At the same time the use of Infliximab allows for the decrease of GKS consumption. The biological therapy should be carefully monitored with respect to acute, chronic, latent and opportunistic infections. In children and adolescents one should strictly follow immunization rules and guidelines. The risk of lymphoproliferative diseases, including hepato-splenic T cell lymphoma (HSTCL) has also to be taken into consideration. Establishing the optimal time for the initiation and duration of biological treatment as well as of the mode of its combination with other immunomodulating agents needs further evaluation. [ABSTRACT FROM AUTHOR]

Maintenance therapy in inflammatory bowel disease (IBD) involves 5′-aminosalicylate derivatives, immunosuppressive drugs (azathioprine, 6-mercaptopurine, methotrexate), and biological agents, which are a breakthrough in the therapy of IBD. Among the biological agents currently available in clinical practice are the anti-tumor necrosis factor α (TNF-α) antibodies infliximab, adalimumab, and certolizumab. The effectiveness of anti-TNF-α antibodies in the maintenance therapy of Crohn's disease was confirmed in clinical trials. The anti-TNF-α agents have different routes of administration, but their effectiveness and safety profiles seem to be similar. Evaluation of the safety of long-term anti-TNF-α therapy requires further studies. This article discusses the rules of maintenance therapy in IBD and describes the special role of biological agents and their place in the guidelines on the management of inflammatory bowel disease. [ABSTRACT FROM AUTHOR]

First European Crohn's and Colitis Organization (ECCO) consensus regarding definition, diagnosis, management and special situations in Crohn's disease (CD) was published in 2006. At the beginning of 2010 new consensus was published, updated due to the new evidence. The paper discusses the differences between ECCO consensus from 2006 and 2010. A basic examination for establishing the diagnosis of CD is ileocolonoscopy with the biopsies of the terminal ileum and colon. MR and CT enterography or enteroclysis are recommended for small bowel evaluation. Faecal calprotectin and lactoferrin may be used in the initial assessment of patients with the suspicion of CD. Major change regarding the therapy is an increase of the number of indications for anti-TNF treatment, It seems that currently available anti-TNF agents have similar efficacy and safety profile. Thus, the choice of medication depends on the cost, availability, route of delivery, patient's decision and national recommendations. [ABSTRACT FROM AUTHOR]

Nutrigenomics/nutrigenetics is a developing field that deals with the interplay between the genome, gene polymorphisms, and dietary components. The pathogenesis of inflammatory bowel disease (IBD) may result in part from genetic polymorphisms that regulate innate and adaptive immune responses as well as epithelial barrier function. Polymorphisms of the CARD15, ATG15L1, OCTN1, OCTN2, and IL23R genes are associated with Crohn's disease. The gene-diet interaction seems to be important in personalizing or individualizing nutrition to prevent, delay, or reduce the symptoms of IBD. Despite extensive data on genetic variations, translating nutrigenomics into medical practice requires collecting population data on single nucleotide polymorphisms (SNPs) and also understanding the significance of a given SNP in disease. [ABSTRACT FROM AUTHOR]

Introduction: Malnutrition often occurs in patients with inflammatory bowel disease (IBD), especially in the acute phase but also in remission, mostly as a result of improper diet. The aim of the study was to assess the nutritional status of patients with Crohn's disease (CD) and ulcerative colitis (CU) in active phase and in remission. Material and methods: In this study were 64 CD patients (31 women and 33 men) and 111 CU patients (46 women and 65 men). The nutritional status in active disease was assessed using the Mini Nutritional Assessment (MNA), anthropometric measurements, and biochemical tests. The assessment of nutritional status in remission was performed on the basis of 24-hour dietary intake. Results: The MNA results showed malnutrition in 12.5% of the CD patients and a risk of malnutrition in ca. 50% of the CD and CU patients. The concentrations of iron and total cholesterol in serum as well as blood hemoglobin were below the normal ranges in 53.3, 34.5, and 52.1% of the total patients with IBD, respectively. Patients in remission consumed lower amounts of carbohydrates and polyunsaturated fatty acids compared with dietary recommendations. Inadequate amounts of Ca, Fe, Zn, Cu, thiamin, riboflavin, niacin, and pyridoxine were available in the IBD female diets and inadequate intake of Mg, Zn, and riboflavin was observed in the IBD males. [ABSTRACT FROM AUTHOR]

Twenty to thirty-five percent of patients with inflammatory bowel disease have at least one of its extraintestinal symptoms. Extraintestinal manifestations can affect every organ and system. They are found more often in patients with Crohn's disease. Extraintestinal symptoms can sometimes appear earlier than intestinal disorders. They can be connected with exacerbation of bowel diseases (e.g. arthritis, erythema nodosum, pyoderma gangrenosum) or not leg. ankylosing spondylitis, primary biliary cirrhosis, primary sclerosing cholangitis). [ABSTRACT FROM AUTHOR]

Inflammatory bowel disease (IBD) is considered to be common in developed countries of Europe and North America. Chronic disease, bowel and systemic symptoms debilitating daily functioning, coexisting extraintestinal complications, recurrent, not infrequently severe and unpredictable clinical course significantly lower patients' quality of life. However psychosocial factors seem to play an important role. Patients with IBD attain similar lever of education as healthy individuals. Sedentary indoor jobs and irregular shift working confer a risk of IBD. A majority of patients with IBD continue in the same employment position over years, disclose their diagnosis to their employers encountering understanding and readiness for compensation and gain income comparable to that of professionally active healthy controls. [ABSTRACT FROM AUTHOR]

Introduction: In recent years, a steady increase in the incidence of inflammatory bowel disease (IBD) can be observed, especially in the developed and urbanized countries. In etiopathogenesis of the disease, the genetic, environmental, immunological, bacterial, and psychosomatic factors have been taken into account, among others. Aim of study: This paper attempts to assess body build of patients with IBD: ulcerative colitis (UC) and Crohn's disease (CD). Material and methods: The following indicators were used for anthropometric analysis: height, body weight, chest circumference, body mass index (BMI), and Rohrer index. Results: The differences in body weight, chest circumference, BMI, and Rohrer index are statistically significant and indicate that patients with CD have statistically lower values of the studied parameters. Only with respect to height, no statistically significant difference was observed in the two studied groups of patients. Conclusions: Statistically, patients with CD have lower body weight, smaller chest circumference, lower BMI, and lower Rohrer index in comparison with patients with UC. [ABSTRACT FROM AUTHOR]

Introduction: The family doctors often refer patients to the gastroenterology departments with a preliminary diagnosis of irritable bowel syndrome (IBS). However, some of the patients report also "alarm symptoms", which suggest a presence of the organic disease. Diagnostic procedures can lead to the change of the preliminary diagnosis in some cases. Aim of study: Our study was designed to evaluate the frequency of a neoplasm and inflammatory bowel disease (IBD) in patients with the preliminary diagnosis of IBS. Material and methods: Medical records of the 581 consecutive patients admitted in years 2001-2008 to the Department of Gastroenterology and Hepatology of Wrocław Medical University with the preliminary diagnosis of IBS were reviewed. The group of the patients with the final diagnosis of neoplasm or IBD was selected. In the study group: age, gender, symptoms, the Rome III diagnostic criteria for the functional bowel disorders and diagnostic procedures were evaluated. Results: The neoplasm or IBD were finally diagnosed in 60 (10.3%) of the patients with the preliminary diagnosis of IBS. Among these patients 58.3% individuals met the Rome III diagnostic criteria for IBS. Conclusions: The knowledge of the Rome III criteria for IBS among family doctors is at insufficient level as we demonstrated low agreement between the preliminary diagnosis of IBS and the diagnostic criteria. Moreover, patients who meet Rome III criteria and report alarm symptoms always require careful diagnostic to exclude the neoplasm or IBD. [ABSTRACT FROM AUTHOR]

Introduction: In inflammatory bowel disease (IBD), symptoms regarding the liver and bile ducts involve fatty degeneration of the liver, primary sclerosing cholangitis, autoimmune hepatitis, and additionally in Crohn's disease (CD) - cholelithiasis (most frequently when the disease involves the ileum), which may lead to cirrhosis and bile duct cancer. Aim of study: The aim of the study was the evaluation of the incidence of chronic liver and bile duct diseases, the analysis of biochemical parameters of liver function and their relation to the clinical course of IBD in children. Material and methods: The study comprised 92 children (45 girls and 47 boys) aged 3-18 years with IBD. The diagnosis was established on the basis of the Porto criteria. In all the patients the following examinations were performed: biochemical tests evaluating liver and bile duct function, immunological examinations-levels of IgA, IgM, IgG, autoantibodies: (ANCA (antineutrophil cytoplasmic antibodies), ASCA (anti-Saccharomyces cerevisiae antibodies), ANA (antinuclear antibodies), AMA (antimitochondrial antibodies), ASMA (antismooth muscles antibodies) and LKM (anti-liver/kidney microsome antibodies)) and ultrasound examination of the abdomen. Results: The mean values of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), bilirubin and gammaglutamyltranspeptidase (GGTP) were higher in the patients with ulcerative colitis (UC) than in the children with CD. Increased levels of ALT were observed in 11/48 children with UC (23%) and in 6/44 children with CD (13.6%). Elevated values of GGTP were found in 5/48 (10.5%) children with UC. In all these children the further diagnostics (histopathological examination of liver bioptates and cholangio-MR) revealed primary sclerosing cholangitis. A coexistence of autoimmune hepatitis was diagnosed in one boy with UC. Conclusions: 1. The control of liver function parameters and cholestasis is necessary in all children with IBD. In children with UC increased parameters of liver cell damage were observed much more frequently in comparison with the patients with CD. 2. It seems that the presence of ANCA antibodies may indicate a potential future development of primary sclerosing cholangitis in patients with diagnosed UC. [ABSTRACT FROM AUTHOR]

It is currently believed that the pathogenesis of inflammatory bowel disease (IBD) includes genetic, immunological, and environmental factors. Dietetic factors are considered to be among the environmental factors. Results of epidemiological studies suggest that the diet of western countries, poor in fiber and rich in sugar and animal fat, may influence the risk of IBD. However, there are no studies strongly confirming the involvement of dietetic factors in IBD's pathogenesis. Therefore there are no dietetic recommendations to decrease the risk of IBD. The influence of diet on disease course has also not been confirmed. However, malnutrition, anemia, iron deficiency, osteopenia, and osteoporosis are significant clinical problems in IBD patients which require appropriate diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Bile acids not only play a cardinal role in the digestion and absorption of fat and fat-soluble vitamins, but also significantly affect gastrointestinal motor, sensory and secretory functions, intestinal barrier permeability and the regulation of the inflammatory response. The results of recent studies have revealed complex interactions between bile acids and the gut microbiota. In addition, bile acids also play a role of signaling molecules regulating the activity of lipid and glucose metabolic pathways, as well as a role of ligands for transcription factors. Genetic factors associated with the regulation of bile acid synthesis, transport and action may significantly influence gastrointestinal function and predispose to diarrhea resulting from bile acid malabsorption. Methods used in the diagnosis of bile acid malabsorption include 75selenium-homotaurocholic acid test, serum C4 and fibroblast growth factor 19 (FGF19), as well as fecal bile acid levels. The paper presents the latest data on the role of bile acid in the pathogenesis of irritable bowel syndrome, inflammatory bowel diseases and colorectal cancer. Advances in the treatment of disturbances in bile acids absorption and synthesis are also presented. A better understanding of molecular mechanisms regulating bile acid action may have implication for colorectal cancer prevention.