Metabolic Consequences of Inflammatory Bowel Disease

Chronic inflammatory disorders have major metabolic implications for the host. Inflammation may produce fever and anorexia, which will have additive effects in contributing to an energy deficit. When energy deficit persists this inevitably leads to loss of body weight and alteration in body composition particularly loss of fat mass.     

Serum Metabolic Profiling in Inflammatory Bowel Disease

Background

The inflammatory bowel diseases (IBD), Crohn’s disease (CD), and ulcerative colitis (UC), are chronic inflammatory conditions of the gastrointestinal tract whose pathogenesis is not completely understood. ¹H nuclear magnetic resonance (NMR) spectroscopy of serum generates comprehensive metabolic profiles, reflecting systemic metabolism, which may be altered in disease states.

Aim

The aim of this study was to use ¹H NMR-based serum metabolic profiling in the investigation of CD patients, UC patients, and controls, potentially to provide insights into disordered metabolism in IBD, and into underlying mechanisms of disease.

Methods

Serum metabolic profiles were acquired from 67 individuals (24 CD patients, 20 UC patients, and 23 healthy controls). The multivariate pattern-recognition techniques of principal components analysis (PCA) and partial least squares discriminant analysis with orthogonal signal correction (OSC-PLS-DA) were used to investigate differences between cohorts.

Results

OSC-PLS-DA distinguished CD and UC cohorts with significant predictive accuracy, highlighting differences in lipid and choline metabolism. Metabolic profiles of both CD and UC cohorts, and the combined IBD cohort, differed significantly from controls: metabolites of importance in the OSC-PLS-DA models included lipoproteins (especially HDL cholesterol), choline, N-acetylglycoprotein, and amino acids.

Conclusions

¹H NMR-based metabolic profiling has identified distinct differences in serum metabolic phenotype between CD and UC patients, as well as between IBD patients and controls.     

Bone Density and Bone Metabolism in Patients with Inflammatory Bowel Disease

Background/Aims:

Patients with inflammatory bowel disease (IBD) are at high risk for low bone mineral density (BMD). This study aimed to evaluate BMD in IBD patients and its relationship with bone metabolism in a group of Iranian patients.

Patients and Methods:

A cross-sectional study was conducted on patients with IBD to assess BMD status and serum biochemical factors. After getting the demographic data from 200 patients, they were screened using dual-energy X-ray absorptiometry of the lumbar spine (L2–L4) and femoral neck for BMD status. Serum levels of calcium, phosphate, alkaline phosphatase (ALP), and 25-hydroxyvitamin D (25-OH vitamin D) were measured to assess the bone metabolism status.

Results:

Two hundred patients with IBD were enrolled in the study. One hundred and eighty three (91.5%) patients were identified as having ulcerative colitis (UC) and 17 (8.5%) as having Crohn''s disease (CD). Based on the lumbar and femoral neck bone mass densitometry, 148 (74.4%) patients had low BMD at either lumbar spine or femoral neck. Of these, 100 patients (50.3%) were osteopenic and 48 patients (24.1%) were osteoporotic. A 58.6% and 61% of patients with UC had low BMD in the lumbar and femoral neck, respectively. These results for those with CD were 76.5% and 70.6%, respectively. The mean of femoral neck and lumbar T-scores in patients with UC were -1.14 and -1.38, and in patients with CD were -1.24 and -1.47, respectively (P > 0.05). The mean (±SD) levels for calcium (Ca) in UC and CD were in the normal range. The mean (±SD) levels of ALP and 25-OH vitamin D in both the groups were in the normal range, and in comparison between groups (UC and CD), no significant differences were observed (P = 0.20 for ALP and P = 0.44 for 25-OH vitamin D). In the assessment of correlation between biochemical markers and BMD, an inverse correlation between lumbar T-score and ALP or 25-OH vitamin D only in patients with UC was observed.

Conclusions:

The high prevalence of low BMD in the Iranian population with IBD needs attention. The subclinical vitamin D deficiency may contribute to bone loss in IBD patients, which is more pronounced in patients with UC in this study because of the small population of patients with CD.     

Atopy in Inflammatory Bowel Disease

Thirty-nine patients with ulcerative colitis and 35 with Crohn's disease have been investigated for evidence of reaginic hypersensitivity and compared with control subjects. There was no difference in the frequency of a personal or family history of atopy or in serum IgE levels. Similarly, no overall difference was noted in prick test responses to 21 allergens. However, further analysis of prick test responses showed that patients with inflammatory bowel disease responded more frequently to food allergens. This was highly significant when compared with healthy controls (p < 0.001). The relevance of this finding to the aetiology of inflammatory bowel disease is discussed.     

Osteoporosis in Inflammatory Bowel Disease

Osteoporosis commonly afflicts patients with inflammatory bowel disease, and many factors link the 2 states together. A literature review was conducted about the pathophysiology of osteoporosis in relation to inflammatory bowel disease. Screening guidelines for osteoporosis in general as well as those directed at patients with inflammatory bowel disease are reviewed, as are currently available treatment options. The purpose of this article is to increase physician awareness about osteopenia and osteoporosis occurring in patients with inflammatory bowel disease and to provide basic, clinically relevant information about the pathophysiology and guidelines to help them treat these patients in a cost-effective manner.     

炎症性肠病的抗生素治疗

炎症性肠病（IBD）主要包括克罗恩病（CD）和溃疡性结肠炎（UC）,近年越来越多的证据提示肠道细菌在其发病中发挥重要作用.虽然目前尚未发现特异性细菌与IBD的发病相关,但随着现代微生物学的发展以及肠道细菌与IBD研究的进展,发现肠道细菌可能是参与IBD始动和持续的因素.因此,采用抗生素治疗IBD可能是一种有效的治疗措施.本文就抗生素对活动期CD,CD肛周病变、CD术后复发以及活动期UC和囊袋炎的疗效作一综述.     

Inflammatory Bowel Disease in Kuwait

Inflammatory bowel disease is considered to be rare or nonexistent in some Arab countries. During a period of 6 years, 91 patients with ulcerative colitis and 17 with Crohn's disease were seen for initial diagnosis in the Gastroenterology Department of Amiri Hospital, which serves 55% of the population of Kuwait. From this group, 43 patients with ulcerative colitis and 14 patients with Crohn's disease were followed up for an average of 30.9 months. In the remaining 51 patients, the diagnosis was established in the same manner as in this series, hut these patients were sent back to the referring physicians and therefore were not available for follow-up. The severity of the disease in the majority of patients with ulcerative colitis was mild to moderate. Nine of 14 patients with Crohn's disease underwent surgery as a diagnostic procedure in an acute abdominal emergency or for treatment of complications. The duodenum was involved in two patients with Crohn's disease and the endoscopic picture and histology of these were initially interpreted as immunoproliferative small intestinal disease which is highly prevalent in this area. We suggest that the assumption that inflammatory bowel disease is uncommon in our population is wrong.