No description available.

Bakgrund: Inflammatorisk tarmsjukdom (IBD) är ett samlingsnamn för de kroniska tarmsjukdomarna Crohns sjukdom (CD) och Ulcerös kolit (UK). Det gemensamma för de två sjukdomarna är att de löper i skov med försämringsperioder och långa besvärsfria perioder samt att de drabbar relativt unga personer. Det är viktigt att sjuksköterskan kan stödja dessa individer genom evidensbaserad och personcentrerad vård för att kunna ge en så god omvårdnad som möjligt.  Syfte: Beskriva individers upplevelse av att leva med inflammatorisk tarmsjukdom Metod: En litteraturöversikt valdes som metod. Artikelsökningen genomfördes i databaserna CINAHL Complete och PubMed. De begränsningar som gjordes i databassökningarna var vetenskapliga originalartiklar, skrivna på engelska, genomgått peer-review och publicerade mellan 2009-2019. Totalt inkluderades elva artiklar i resultatet, av dessa var tio artiklar kvalitativa och en var kvantitativ. Resultat: Resultatet visade att individerna upplevde att sjukdomen påverkade deras arbetsliv, sociala liv, känslor och identitet. Deras möte med hälso- och sjukvården påverkade personernas förtroende för vården samt deras vilja att söka vård framöver. Det visades även att personer med inflammatorisk tarmsjukdom genomgick en transitionsperiod efter deras diagnos. Hur personerna upplevde att leva med IBD påverkades av om de för tillfället befann sig i ett skov eller nyligen fått diagnosen. De personer som befann sig i ett skov eller nyligen fått diagnosen hade en övervägande negativ syn.  Diskussion: Resultatet diskuterades utifrån Katie Erikssons teori om lidande och hälsa. Författarna resonerade om individernas negativa påverkan kunde kopplas till stigman av sjukdomen. De diskuterade även angående den långsiktiga påverkan av frånvaron från arbetet och sociala sammanhang. Författarna fann i resultatet att individer med IBD upplevde sjukdomen olika i sin vardag beroende på hur länge de haft sjukdomen och vilken inställning de har gentemot sin IBD. Därmed bör vården anpassas efter de individuella behoven för att säkerställa att insatserna främjar hälsan. / Background: Inflammatory bowel disease (IBD) is a chronic illness that includes Crohn´s disease (CD) and ulcerative colitis (UK). Both diseases have in common that they have relapse and periods with improvement. The diseases effects relatively young people. It is important that the nurse can support these individuals through evidence based and person-centred care in order to provide the best possible care. Aim: Describe individuals experiences of living with inflammatory bowel disease  Method: A literature review was chosen as the method. The article search was carried out in the databases CINAHL complete and PubMed. The limitations made in the database searches were scientific original articles, written in English, peer-reviewed and published over the last ten years. A total of eleven articles was included in the result, of which ten were of qualitative design and one was quantitative design. Results: The results showed that the individuals experienced that the disease affected their working life, social life, feelings and identity. Their meeting with healthcare services affected their trust in the care and their willingness to seek care in the future. It was also shown that people with inflammatory bowel disease underwent a transition period after the diagnosis. How the individuals experienced living with IBD was affected by whether they were relapsing or in remission. People currently in a relapse had a more negative view of the disease.  Discussion: The result was discussed based on Katie Eriksson´s theory of suffering and health. The authors reasoned if the negative impact of the individuals could be linked to the stigma and shame of the disease. They also discussed the long-term impact of the absence from work and social activities. The authors found in the results that individuals with IBD experienced the disease differently in their daily lives depending on how long they had the disease and what attitude they had towards their IBD. The care should be adapted to the individual needs to ensure that the efforts promotes health.

Aim: VitaminD deficiency is a global health issue associated with increased health-care costs, and could play a role in the pathogenesis and management of inflammatory bowel disease. Prior studies show a high prevalence of vitaminD deficiency in veterans with inflammatory bowel disease. We aimed to examine the outcome differences in patients with inflammatory bowel disease, comparing treatment with ergocalciferol to cholecalciferol. Methods: A retrospective review of electronic medical records of patients with inflammatory bowel disease at a Veterans Affairs Medical Facility in the Southeastern United States was carried out. Those with at least one serum 25(OH) vitaminD level were included. Initial and follow-up vitamin D values were recorded. The type of vitaminD supplementation, whether cholecalciferol or ergocalciferol, was documented. Costs in the year after measurement of vitaminD were divided into separate inpatient and outpatient categories. Results: Veterans (n=108) with ulcerative colitis or Crohn's disease and an available 25(OH) vitaminD level were studied. There were differences in follow-up vitaminD levels; those who received weekly ergocalciferol had higher subsequent levels than those who received cholecalciferol, especially at a second follow up, although differences did not achieve statistical significance. However, those who received vitaminD3 were less likely to use laboratory, pharmacy, radiology and fee-based services, and had lower laboratory and pharmacy costs. Conclusions: Our data suggest that cholecalciferol replacement might improve outcomes to a greater extent than ergocalciferol, and might be better in limiting health-care costs and expenses in patients with inflammatory bowel disease.

Background Pediatric IBD can limit the dayly life and is associated with psychosocial strain and future illness. However, physical activity and exercise are at great importance through childhood. Health, as a health science concept was used as a theoretical framework to establish an understanding where a balanced rhythm of life between movement and rest is a part of experiencing wellbeing and health. Aim The aim of this study was to illuminate research about how IBD affects childrens and adolescents physical activity. Approach A literature study based on eight scientific articles. Result The results showed that IBD can complicate physical activity and exercise, especially in active disease but also in periods of remission. The results illustrated three areas related to physical activity in children and adolescents with IBD; physiological function, limitations in physical activity and movement in IBD. Two factors that significantly contributed a decreased physical activity were fatigue, and a psychosocial strain in teenagers. Conclusion The result indicate that physical activity and exercise is complicated with physical, physiological and social dimensions. To consider health from a holistic approach in the care of a child or a adolescent with IBD pay attention to the importance of physical activity in life and can forms the basis of the nurse´s care in order to strengthen wellbeing and a healthy lifestyle.

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第20292号 / 人健博第40号 / 新制||人健||4(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 岡 昌吾, 教授 藤井 康友, 教授 妹尾 浩 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24476号 / 医博第4918号 / 新制||医||1062(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 羽賀 博典, 教授 小濱 和貴, 教授 川口 義弥 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Despite advancements in the treatment of individuals with Inflammatory Bowel Disease (IBD), many patients will require the need to utilize biological therapies during their disease course. Moreover, some patients with IBD develop disease manifestations outside of the GI (gastrointestinal) tract termed extraintestinal manifestations (EIM). We sought to establish an association between prior EIM exposure and the sequential use of biological therapies in patients with IBD. A retrospective analysis of 555 patients with confirmed IBD and relevant EIM data was performed. EIM exposure was treated as both a dichotomized (ever, never) variable and a categorical (0, 1, 2 or more) variable in our analysis. Crude ratios were established using logistic regression and multinomial regression models. Bivariate analysis was used to test for significant confounding variables and significant confounders were included in the final multivariate regression model. We found female sex (p < 0.001), a disease duration of 13 years or longer (p = 0.001), and an ileocolonic disease location (p = 0.036) to be significantly associated with EIM exposure. We found that a disease duration of 13 years or longer (p = 0.037), diagnosis of Crohn’s Disease (CD) (p < 0.001), corticosteroid use (p < 0.001), and an ileocolonic disease location (p = 0.021) to be significantly associated with use of biologics. Our final adjusted model did not show statistical significance, but did notably indicate that individuals exposed to 2 or more EIM had 1.51 times the odds of progressing to biological therapy (95%CI: 0.67, 3.41; p = 0.32) compared to those patients with no EIM history. As a result, EIM exposure may be an indicator for high-risk IBD patients likely to require biological therapy, especially among particular groups. Our data emphasizes the need for further studies to characterize the association between EIM exposure and specific EIM with the utilization of biologics.

No description available.

Despite the chronic debate in the etiology of crohn's disease (cd), a debilitating inflammatory bowel disease (ibd) closely related to ulcerative colitis (uc), an emerging interest in a possible mycobacterial role has been marked. Granuloma and pathologic manifestations in cd resemble aspects found in tuberculosis, leprosy and paratuberculosis. The latter, a chronic enteritis in cattle, goat, sheep and primates, which is similar to human enteritis, also known as cd, is caused by a fastidious, slow growing mycobacterium avium subspecies paratuberculosis (map). Due to the similarities between cd and paratuberculosis, a mycobacterial cause in cd has been proposed. Recent discovery of a possible association between nod2/card15 mutations and risk of cd added support to microorganism-host interactions. In this study, a possible mycobacterial role in cd etiology has been evaluated by investigating the presence of map dna, the state of the cellular immune response and microarray gene expression profiling in peripheral blood and surgical tissue from cd, uc and healthy control subjects. Nested pcr detected map dna in tissue from 10/12(83%) cd patients compared to 1/6(17%) non-ibd subjects. Fluorescence in situ hybridization (fish) with the aid of confocal scanning laser microscopy (cslm) detected map dna in 8/12(67%) cd subjects compared to 0/6(0%) in non-ibd subjects. The detection of map dna by either technique in tissue from cd subjects is significant compared to non-ibd subjects (p < 0.05). Map dna was also detected in both inflamed and non-inflamed tissue from patients with cd suggesting map infiltration in human tissue. Correlation of possible map presence and the function of polymorphonuclear leukocytes (pmn) and peripheral blood mononuclear cells (pbmc) in 19 cd patients and 12 controls have been evaluated. Pmn phagocytosis of viable fitc-map was suppressed in 13/19(68%) cd patients compared to 0/12(0%) in healthy controls (p<0.05). Pbmc phagocytosis of viable fitc-map was suppressed in 5/19(26%) of cd patients compared to 0/12(0%) of healthy controls (p<0.05). The proliferative response of pbmc with t-cell majority from cd and controls subjects was evaluated against pha, candida albicans, pwm and map ppd. Dysfunctional proliferative response against pha was found in 8/19(42%) cd patients compared to 1/12(8.3%) in controls suggesting possible t-cell anergy. Pbmc from 11 cd subjects reacted normally to pha, 7/11(64%) reacted strongly to map ppd suggesting previous exposure to mycobacteria, and 3/11(27%) did not react with map ppd suggesting lack of pre-exposure to mycobacteria. From the seven mycobacterial pre-exposed samples, 6/7(86%) showed a normal ability to recall antigens by activated macrophages when exposed to c. Albicans, and all 7 samples had a normal pwm response. Finally, microarray-chip technology was employed to identify the expression profile of genes that have a role in the immune response of cd patients. Rna was isolated from fresh buffy coats from 8 healthy controls, 2 cd, and 1 uc patients. Chips with an estimated of 30,000 human genes were hybridized to cdna from these samples. We found that 17% of the total number of genes was differentially expressed. Over 200 genes were involved in the immune response, 7 genes where common to both forms of ibd (uc and cd), and 8 genes were found to be either downregulated in cd and upregulated in uc or viceversa. The ifngr1 gene, which encodes the ligand-binding chain of the ifn-gamma receptor, was found to be downregulated in 2/2(100%) of cd patients, but not in uc patients. It is known that defects in ifngr1 are a cause of atypical mycobacterial infection and bcg infection. Patients suffering from this deficiency have an immunologic defect predisposing them to infection with mycobacteria. This correlates with the proposed theory as map being the causative agent of cd. Furthermore, the results indicate a host susceptibility requirement for the establishment of mycobacterial infection in cd patients. Further characterization of ifngr1 using real-time pcr is underway. Collectively, detection of map dna in the majority of cd tissue and the alteration in pmn and pbmc to respond efficiently to map may be related to the fact that mycobacterial pathogens infect phagocytic cells of susceptible hosts and consequently the immune response is dysregulated. Furthermore, the fact that a gene linked to mycobacterial susceptibility was found to be downregulated in cd patients only, strengthens the mycobacterial etiology of cd. In general, the data suggest a possible role for a bacterial pathogen in cd pathogenesis.

In severe cases of ulcerative colitis (UC) unresponsive to current treatment options, patients require a complete proctocolectomy, or surgical removal of the colon. Ileal pouch anal anastomosis (IPAA) has become the preferred surgical technique for patients who require surgery, as this method restores rectal function. This procedure is also used to treat colorectal cancers such as adenocarcinoma and familial adenomatous polyposis (FAP). The surgery involves an abdominal colectomy with the construction of an ileal pouch created from folded tissue recovered from the ileal portion of the small intestine. Up to 50% of patients who require IPAA surgery experience an episode of pouchitis, a non-specific inflammation of the constructed ileal pouch with unknown etiology. Several hypotheses have been proposed regarding the pathogenesis of pouchitis. Current theories include bacterial overgrowth due to fecal stasis, microbial imbalance (dysbiosis), immune alteration, genetic susceptibility, metaplasia, ischemic complications of surgery, a recurrence of UC, or even a novel form of inflammatory bowel disease. The efficacy of antibiotics and probiotics in treating pouchitis and maintaining remission underscores the importance of gut microbiota in the development of this condition. In the study, we aimed to characterize the intestinal bacterial communities that inhabit IPAA pouches of both UC and FAP patients, in an effort to investigate the hypothesis that bacterial dysbiosis is involved in the pathogenesis of pouchitis. Mucosal biopsy and stool samples were analyzed from patients with UC and pouchitis (UCP), healthy UC controls (HUC) and healthy pouches with a background of FAP (FAP). Samples were examined through analysis of terminal restriction fragment length polymorphisms (TRF) and DNA sequencing. The data presented here demonstrate that a microbial imbalance exists in pouchitis, as bacterial communities in pouchitis differ significantly from healthy UC pouches and pouches constructed for FAP. Both methods identified potential groups of organisms that may play a role in the development of pouchitis, including decreases in protective Lactobacillus and Bacteroides and increases in mucin-degrading Clostridium and Akkermansia. A better understanding of the factors driving the pathogenesis of pouchitis will not only benefit patients with this disease, but also lead to a better understanding of the complex relationship that exists between the human host and the diverse community of organisms that inhabit the gastrointestinal tract.