IBD and diverticulitis Flashcards
what inhibits beta glucuronidase?
calcium glucarate
Th2 mnemonic
Ah-choo! Two! (antibodies, allergies)
diet triggers for IBD
diet (high fat & sugar, processed foods),
IBD and SDH
42% of IBS had at least one SDH
lifestyle factors to reduce risk of IBD?
Physical activity Breastfeeding Bed sharing Tea consumption High levels of folate High levels of vitamin D H pylori infection
early life factors and CD
lower with BF
higher with maternal smoking in utero
Diet to decrease IBD risk
Fiber
Fruit
Vegetables
High n-3 FA
Diet factors that increase IBD risk
Animal Protein Heme iron, Sulfur Refined sugars High-fat (trans) emulsifiers
Diet, Microbiome and IBD
animal fat, milk fat, iron, emulsifiers - IBD flares
high sugar - leads to IP, AIEC
high fat diet - dysbiosis, ileitis
maltodextrin - AIEC and biofilms
iron, red meat - mitigated by resistant starches
low FODMAP diet and IBD
helps with Sx
eating rainbow and IBD
flavones and resveratrol decreased IBD
best alcohol for microbiome diversity
red wine
How do probiotics help with IBD
Inhibit Pathogenic Bacteria
Improve Epithelial Function
Immunoregulation
should you use prebiotics in CD?
No but yes for UC
“Reinoculate” for IBD
Probiotics
•Prebiotics
•Short chain fatty acids
“Repair” strategies for IBD
- Omega 3 Fatty Acids
- Immunoglobulin/protein
- Boswellia
- Vitamin D
- Curcuminoids
- L-Glutamine
L-glutamine doses
2 - 4 g/d in divided dosages for wound healing and
general intestinal support
• 10 - 30 g/d in divided dosages for critically ill and
advanced disease
other botanicals for IBD
Bioflavonoids: quercetin rutin wheatgrass ginger turmeric green tea boswellia
Nutraceuticals for IBD
Whey protein with concentrated immunoglobulins: • Serum Bovine-derived immunoglobulins • Glutamine • Larch (Arabinogalactans): butyrate
Artemisia absinthium (worm wood)
Induction of remission mild to
moderate disease in CD
Nutraceuticals for IBD
whey protein with concentrated Igs Serum Bovine-derived immunoglobulins Glutamine Larch (Arabinogalactans) vit D butyrate
alternative Tx for IBD
helminths
LDN
“Rebalance” for IBD
- Mindfulness-Based Interventions
- Stress Management
- Hypnotherapy
- Relaxation Training
- Acupuncture
Risk factors for diverticular disease
Age • DD in patients younger than 50 years is a more virulent disease and is more
predominant in men
• Incidence increases steeply with age, beginning at age 40 years
Diet DD is associated with a history of low-fiber diet
Gender Incidence is more predominant in men before 65 years of age, and more
predominant in women after 65 years of age
Geography • Most common in industrialized nations
• Less common in Asian countries, where it tends to be right-sided
Medication use • Chronic NSAID use doubles the risk for DD and quadruples risk of perforation
• Opioids and corticosteroids increase risk of perforation
• Calcium channel blockers reduce risk of perforation
Obesity Striking increase in incidence among the obese, especially before age 40 years
Physical activity Risk of developing DD is inversely proportionate to activity level
Smoking Contradictory findings
protective factors for diverticulitis
BMI 18-25 • Red meat <4/week • ≥ 23 g fiber/day • Exercise 2 hrs/week • No smoking
diverticulitis Tx - with abx?
Omitting antibiotics in the treatment of
uncomplicated acute diverticulitis did not
result in more complicated diverticulitis,
recurrent diverticulitis or sigmoid
resections at long-term follow up.
diverticulitis Diet
This systematic review and GRADE assessment conditionally
recommend the use of liberalized diets as opposed to dietary
restrictions for adults with acute, uncomplicated diverticulitis.
• It also strongly recommends a high dietary fiber diet aligning
with dietary guidelines, with or without dietary fiber
supplementation, after the acute episode has resolved
diverticulitis Tx
fiber
probiotics
rifaximin
Kefir and exercise, stress reduction
DD and age
increased!
DD in patients younger than 50 years is a more virulent disease and is more predominant in men
• Incidence increases steeply with age, beginning at age 40 years
Gender Incidence is more predominant in men before 65 years of age, and more
predominant in women after 65 years of age
Geography • Most common in industrialized nations
• Less common in Asian countries, where it tends to be right-sided
Medication use • Chronic NSAID use doubles the risk for DD and quadruples risk of perforation
• Opioids and corticosteroids increase risk of perforation
• Calcium channel blockers reduce risk of perforation
Obesity Striking increase in incidence among the obese, especially before age 40 years
Physical activity Risk of developing DD is inversely proportionate to activity level
Smoking Contradictory findings
DD and diet
associated with a history of low-fiber diet
DD and age
increased!
DD in patients younger than 50 years is a more virulent disease and is more predominant in men
• Incidence increases steeply with age, beginning at age 40 years
DD and geography
Most common in industrialized nations
• Less common in Asian countries, where it tends to be right-sided
DD and meds
Chronic NSAID use doubles the risk for DD and quadruples risk of perforation
• Opioids and corticosteroids increase risk of perforation
• Calcium channel blockers reduce risk of perforation
DD and obesity
Striking increase in incidence among the obese, especially before age 40 years
DD and physical activity
Physical activity Risk of developing DD is inversely proportionate to activity level
DD and smoking
Smoking Contradictory findings
meds that increase IBD
ocp NSAIDs
appy and tonsillectomy adn IBD
increase
vit deficiency that can cause IBD
D
IBD higher in urban or rural?
urban
does H pylori infection increase or decrease IBD
decrease
does smoking increase or decrease IBD
increase
