ulcerative colitis - stuart mclean
TRANSCRIPT
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Stuart McLean
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It is a chronic relapsing inflammatorydisorder of the large bowel
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Rectal bleeding
Diarrhoea with blood and mucous
Tenesmus
Abdominal pain
AnorexiaRaised temperature
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Immunologically mediated
Genetic influences
Environmental influences
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Tragnone et al1995 Dietary habits as risk factorsfor inflammatory bowel disease.Eur J Gastroenterol
Hepatol. Jan;7(1):47-51.
Reif et al1997 Pre-illness dietary factors ininflammatory bowel disease. Gut. Jun;40(6):754-60.
Sakamoto et al2005 Dietary risk factors forinflammatory bowel disease: a multicenter case-control study in Japan.Inflamm Bowel Dis.Feb;11(2):154-63.
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Jowett et al 2004 Influence of dietary factors on
the clinical course of ulcerative Colitis: a
prospective cohort study. GutOct;53: 1479 - 1484.
Magee et al2005 Associations between diet and
disease activity in ulcerative colitis patients using
a novel method of data analysis.Nutr J. Feb 10;4:7
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M - cells Ulcer
'Leaky' enterocytes
Antigen - bacterial, viral, protazoal?
Systemic manifestations
ofmalaise / fever
Leading todegranulation
of neutrophols
ActivatedCD-4 cell
IL - 4
Th - 2predominates
in UCMastcells
Production o f
cytokines
IL - 8
Activatedmacrophage
NF - kB
TNF - alpha IL - 1
Adhesion molecules(ICAM-1, E-Selectin)
To the bowel
leading to
Inflammation
Intestinal epithelium
CD-4cell
I N F L A M M A T I O N
Phospholipase A
Lipids in plasma membrane
Free fatty acid
cyclooxygenase-1 2,5-lipoxygenase
Prostaglandins Leucotrines
Prostaglandinsfrom
cyclooxygenase-2 LTB-4
adapted from Palmer and Penman 2000, Sands 1999, Boik 2001 and Rang et al 1999.
Macrophage
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Patient Details First Visit Oct 07 Advice /
Treatment
Outcome
Male: 34, BMI 2410 yr hist. Stablelast 5 yrs
Diet: meat, proc.Foods, wine, coffee
F&V, Omega-3
Lifestyle: Self-employ
Stress, poorsleep
Medication:Prednisalone 40mgomDipentum 1g tds
Prev. azathioprine
150mg om stopped
platelets
Colitis returned
within month.Rx Predsol enema
didnt work
Bloody stool 6x d,
Abdom. Cramps,
Fatigue, nightsweats, work
limited, v. anxious
Self Rx bland diet
Rx
Chamomile 25
Tormentil 25
Vib opulus 25
Symph fol. 25
5 ml tds 300ml
Lamberts Tumeric
Acidophilus 10
Diet: Add fish and
cooked veg.Rooibosh +
Chamomile tea
freely
3 wks pred 15 mg
More relaxed, sleep
better, n. sweats,
Freq loose stools,
no blood.-
Torm +Agrimonia,calendula
3 Months no pred.
Stools loose 1-
2x/day-
Agrim + Hydrastis-FOS 1 tsp
5 Months feeling
well
Stools normal
Rx tea ( treatingother issues)
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Constituents Curcumin one of the main
constituents
Action - anti-inflammatory action on the
enzymes 5-lipoxygenase and cycloxegenase(Ammon et al1993. Mechanism of antiinflammatory actions of
curcumin and boswellic acids. J Ethnopharmacol. Mar;38(2-
3):113-9.).
inhibit nuclear factor kappa B (NF-Kb) (Singhand Aggarwal (1995 ). Activation of transcription factor NF-kappa
B is suppressed by curcumin (diferuloylmethane) J Biol Chem.
Oct 20;270(42):2 4995-5000).
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Curcumin maintenance therapy for ulcerative
colitis: randomized, multicenter, double-blind,
placebo-controlled trial. (Hanai et al2006 ClinGastroenterol Hepatol Dec; 4(12): 1502-6. )
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Constituents
Phenolic compounds flavonoids
apigenin, quercetin, patuetin, luteolin
and their glycosides.
Essential oil terpenoids alpha-bisabolol and azulenes
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Actions Antioxidant, antimocrobial,
antiinflammatory, antispasmotic and
anxiolytic. ( McKay and Blumberg (2006) Phytother ResJul; 20 (7): 519-30 )
Chamazuline showed inhibition of the
formation of leucotrine B 4 (LTB4) throughantioxidant activity of 5-lipoxygenase, (Safayhiet al1994 Planta Med. Oct;60(5):410-3. ).
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complex interaction of constituents including
the polysaccarides - acemannan and
mannose
The action upon colonic tissue is thought to
be due to binding of the polysaccarides to
receptor sites lining the colon, therebyenhancing mucosal barrier function (Vazquez etal1996 J Ethnopharmacol 55(1): 69-71)
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In vitro
Anti-inflammatory effects of Aloe vera gel in
human colorectal mucosa ( Langmead et al2004Aliment Pharmacol Ther 19; 521 527)
Anti-inflammatory - interleuken-8 (IL-8)
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Randomized, double-blind, placebo-
controlled trial of oral Aloe vera gel for active
ulcerative colitis. ( Langmead et al 2004 AlimentPharmacol Ther 19; 739 747)
4 week trial 44 patients with mild to moderate
colitis.histological disease activity.
A ti b t i l i l t l?
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M - cells Ulcer
'Leaky' enterocytes
Antigen - bacterial, viral, protazoal?
Systemic manifestations
ofmalaise / fever
Leading todegranulation
of neutrophols
ActivatedCD-4 cell
IL - 4
Th - 2predominates
in UC Mastcells
Production of
cytokines
IL - 8
Activatedmacrophage
NF - kB
TNF - alpha IL - 1
Adhesion molecules
(ICAM-1, E-Selectin)
To the bowel
leading to
Inflammation
Intestinal epithelium
CD-4cell
I N F L A M M A T I O N
Phospholipase A
Lipids in plasma membrane
Free fatty acid
cyclooxygenase-1 2,5-lipoxygenase
Prostaglandins Leucotrines
Prostaglandinsfrom
cyclooxygenase-2 LTB-4
adapted from Palmer and Penman 2000, Sands 1999, Boik 2001 and Rang et al 1999.
Macrophage
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Number of factors associated with UCSmall number of studies that
demonstrate effectiveness of herbs
Need for more studies