Natural Tx of IBD Flashcards
what are the 4 forms of IBD?
Crohn’s
indeterminate colitis
UC
microscopic colitis
where does Crohn’s mostly affect the GI?
SI, ileocecal valve and surrounding area, splenic flexure of colon, just before sigmoid colon
what can be a tell-tale appearance for Crohn’s?
cobblestoning appearance of bowel wall
what will the bowel wall look like in UC?
pseudopolyps, ulceration, loss of haustra
microscopically what will Crohn’s look like?
crypts are non-existing
lamina propria is extremely thickened
microscopically what will UC look like?
severe crypt distortion and less organized
besides the distal ileum and the R colon, where else can Crohn’s appear? what percentages are associated with each spot?
besides the R colon and distal ileum (MC spots) Crohn’s can appear gastroduodenally 5% of the time, in the SI alone 5% of the time and in the colon alone 20% of the time
what is progression (complication) that can occur with Crohn’s?
stenosis or inflammation of the ileocecal valve both of which can lead to fistula formation of the SI directly with the colon
stenosis occurs 50% of the time, inflammation 30% of the time and fistula formation appears 20% of the time
what are some common sxs to see in the following organs/systems w/Crohn's? eyes? KD? skin? mouth? liver? biliary tract? joints? circulation?
eyes: episcleritis, uveitis
KDs: stones, hydronephrosis, fistulae, UTI
skin: erythema nodosum, pyroderma grangrenosum
mouth: stomatitis, apthous ulcers
liver: steatosis
biliary tract: gallstones, sclerosing cholangitis
joints: sponylitis, sarcoilitis, peripheral arthritis
circulation: phlebitis
4 step pathogenesis process of Crohn’s
2 factors that can impact the progression/end of the possible first step?
- causative agent (bacteria, virus, dietary)
- immune response
- inflammation
- tissue injury
modifying factors: environmental, genetic
luminal factors: luminal bacteria, digestive enzymes, bile acids
what kind of an immune response is Crohn’s? explain the immune cell cascade that happens
Th1 response
MOs activate T cells which generate a Th1 response
what demographic is most likely to be dx with Crohn’s?
caucasian jews
what are some hostile factors that could lead to a pt developing Crohn’s? what protective factors usually keep the GI healthy?
hostile: bacteria, bile acids, bacterial and dietary ags, digestive enzymes, Th1 lymphocytes
protective: impermeable mucosa, mucus, sIgA, PGE2, PGI2, UL-1ra, cortisol, IL-4, IL-10, TGF-b, VIP, somatostatin, glutamine, SCFA, Th2 lymphocytes
compare-contrast the depth to which Crohn’s affects the GI tract vs UC
Crohn’s: affects the mucosal and submucosal layers
UC: only affects the mucosal layer
in UC what happens to the normal intestinal crypts and what can form?
crypts get distorted and lost their goblets cells
abscesses can form
describe UC pathogenesis
microbial pathogens are introduced to the GI, there is an ineffective immune response
dietary ags or non-pathogenic microbes come into contact with the GI and we get an abn immune response
luminal ags are present which leads to an immune response to the luminal ag along with to the person’s own epithelium= auto-immune
3 forms of UC? where does each affect in the GI? which has the greatest risk of colon CA
proctitis: rectum
left-sided colitis: descending colon through the rectum
pancolitis: ascending, transverse, descending colon through the rectum
greatest risk of colon CA in pts w/pancolitis, even if they go/are in remission
what is the main complication in UC?
toxic megacolon b/c of the loss of haustra and ‘tubularization’ of the LI
how do you dx UC?
endoscopy
can go all the way into the terminal ileum
antibiotics is more associated with which IBD dz? increases the risk in what population specifically? what abx is not associated with an IBD? which 2 are more strongly associated?
Crohn’s
increases risk in children
penicillin was not associated with increased risk
metronidazole and fluoroquinolones are strongly associated with new-onset IBD
what OTC can be associated with IBD relapse?
NSAIDs, even just one time use
what lifestyle factor doubles the risk of Crohn’s? effect on UC?
smoking doubles the risk of Crohn’s, actually decreases risk of UC
what are 3 supplements that can help decrease the side effects of IBD meds and protect against complications?
folic acid
DHEA
withania somniferi (ashwagandha)
what CBC marker could you use to assess tissue levels of folic acid?
neutrophilic hypersegmentation index (earliest sign of folate deficiency)
what gene polymorphism could lead to folate deficiency?
MTHFR b/c it controls the synthesis of methylene tetrahydrofolate reductase and is responsible for taking inactive folate to active folate
folic acid deficiency can occur during what UC tx?
sulfasalazine
what dosage of what vitamin could decrease the risk of colorectal CA by 89%?
taking >1 mg of folic acid daily
what are some side effects of higher doses of prednisone
hyperglycemia muscle wasting osteoporosis HTN delayed healing immune suppression
what could you supplement with so as to negate the side effects of long term cortisol use without affecting the cortisols efficacy?
DHEA
risk factors for osteoporosis?
disease activity (acute flare) lifetime steroid dosage >10 g active IBD multiple bowel resection age low body mass index
what 2 tests can you do for bone density? what supplements could help?
DEXA scans and N-telopeptide urine assays
monitor and supplement vits D and K2 and Ca2+ as well as DHEA
what marker could be useful in distinguishing between IBD and IBS? what does it correlate with? what is it?
fecal calprotectin
can do this before a colonoscopy if trying to determine if a colonoscopy is indicated
it is able to distinguish IBD from IBS and correlates w/the severity of inflammation
it is a protein and antimicrobial factor in WBCs
is fecal calprotectin better for predicting IBD that is ileal or colonic?
colonic
what level of calprotectin is normal/insignificant? mild/moderate inflammation? more significant inflammation? active dz, impending relapse of IBD?
normal/insignificant inflammation= less than 50 ug/g
mild/moderate inflammation= 50-100 ug/g
more significant inflammation= more than 100 ug/g
active dz, impending relapse of IBD= more than 250 ug/g
Dr. Lawton’s Crohn’s General formula?
hepaglycerite: 10 mL silybum gylcerite: 10 mL withania: 30 mL rehmannia: 30 mL matricaria: 10 mL solid ext. glycyrrhiza: 10 mL leptandra: 10 mL calendula: 10 mL sig: 4 droppersfull BID
Dr. Lawton’s Acute Crohn’s Formula
chamomilla: 30 mL
foeniculum: 20 mL
kalmerite: 20 mL
viburnum opul: 30 mL
valerian: 20 mL
atropa belladonna: 120 gtt
sig: 4 droppersfull Q20 min (up to 8x’s/d)
what medication helps increase endorphin levels in the body?
low dose naltrexone
adult dosing of naltrexone?
how long until you can expect to see results? how long do they have to take for? pediatric dosing?
start w/1.5 mg qhs x 4 nights
if no sleep issues increase to 3 mg qhs x 4 nights
if no sleep issues increase to 4.5 mg qhs
tx should show results in 2-3 mos
tx must be continued indefinitely in order to have lasting benefit
pediatric dosing: 0.1 mg/kg body wt
when is it best to take naltrexone?
10 pm- 2 am (earlier in day if necessary or taking opiates at night)
what does curcumin have inhibitory effects on?
cyclooxygenases 1 and 2 lipoxygenase TNF-alpha interferon gamma inducible nitric oxide synthase nuclear factor kappa B also an anti-oxidant
what four diets may be beneficial for people with IBD? which showed significantly longer periods of remission and fewer relapses?
specific carbohydrate diet, elimination diet, elemental diet (esp helpful in pts w/ileal involvement) and GAPS diet
elimination diet showed significantly longer periods of remission and fewer relapses
what are the most reactive foods for people with IBD?
corn, wheat, yeast, dairy products, eggs, potatoes, rye, tea and coffee (in this order)
what is the optimal intake of the elemental formula?
900 Kcal/d
what specific type of nutritional protocol has been shown to be successful for pediatric cases of Crohn’s? what is it specifically? duration?
exclusive enteral nutrition
resulted in pediatric Crohn’s pts going into remission at as great of a rate as with steroids with much fewer side effects and better intestinal mucosal healing
liquid only diet and no other food intake, formula may be elemental or whole protein
6-8 wks or longer
what risk is increased in Crohn’s pts w/fistulae, strictures or motility disturbances?
SIBO
SIBO is also more frequent with partial colectomy, multiple intestinal surgeries, ileocecal resection and both colon and SI Crohn’s involvement
SIBO is more likely in Crohn’s pts w/terminal ileum involvement
ssxs of Crohn’s?
malabsorption, weight loss, watery diarrhea, meteroism, flatulence and abdominal pain
what are some natural txs for UC?
boswellic acids aloe vera Dr. Yarnell's UC Relapse Prevention Formula salmon (600 gm/wk for up to 8 wks) fish oil supplementation retarded release phosphatidylcholine VSL#3 probiotic fecal microbiota transplantation
