Frequency and significance of proximal extension of distal ulcerative colitis

The effect of the cholinergic anti-inflammatory pathway on experimental colitis

Inflammatory bowel diseases (IBD) are characterized by proinflammatory cytokines, tissue damage and loss of neuron in inflamed mucosa, which implies the cholinergic anti-inflammatory pathway may be destroyed during the process of inflammatory response. In the study, we identified the effect of cholinergic agonist as anabaseine (AN) and nicotinic receptor antagonist as chlorisondamine diiodide (CHD) on trinitrobenzene sulfonic acid (TNBS)-induced colitis, to investigate the potential therapeutic effect of the cholinergic anti-inflammatory pathway on IBD. Experimental colitis was induced by TNBS at day 1, 10 mug AN or 1.5 mug CHD was injected i.p. to mouse right after the induction of colitis, and repeated on interval day till the mice were sacrificed at day 8. Colonic inflammation was examined by histological analysis, myeloperoxidase (MPO) activity, and the production of tumour necrosis factor (TNF)-alpha in tissue. Lamina propria mononuclear cells (LPMC) were isolated, and NF-kappaB activation was detected by western blot. The mice with colitis treated by AN showed less tissue damage, less MPO activity, less TNF-alpha production in colon, and inhibited NF-kappaB activation in LPMC, compared with those mice with colitis untreated, whereas the mice with colitis treated by CHD showed the worst tissue damage, the highest MPO activity, the highest TNF-alpha level, and enlarged NF-kappaB activation in LPMC. Agonist of the cholinergic anti-inflammatory pathway inhibits colonic inflammatory response by downregulating the production of TNF-alpha, and inhibiting NF-kappaB activation, which suggests that modulating the cholinergic anti-inflammatory pathway may be a new potential management for IBD.

Fetal and perinatal risk factors for inflammatory bowel disease

AIM

To study the influence of specific factors and events during pregnancy and the perinatal period on the risk of children developing inflammatory bowel disease.

METHODS

Population-based national register study. Linkage between the Swedish Medical Birth Register and the Swedish Hospital Discharge Register during the period 1987 to 2000 identified 455 singleton infants who later developed inflammatory bowel disease. Data for these children were compared with data for all children born in Sweden during the same period.

RESULTS

Smoking during early pregnancy reduced the risk of inflammatory bowel disease (odds ratio (OR) 0.71, 95% CI 0.55-0.91). For ulcerative colitis the odds ratio was 0.70 (95% CI 0.56-0.86), and for Crohn's disease 0.73 (95% CI 0.58-0.94). Infections during the neonatal period seemed to increase the risk of inflammatory bowel disease (OR 17.6, 95% CI 3.6-51.6), but the number of observed events was small. The other factors examined did not influence the risk of inflammatory bowel disease.

CONCLUSION

Maternal smoking during early pregnancy reduces the risk for the child to be hospitalized with a diagnosis of inflammatory bowel disease. Severe neonatal infections may increase the risk. Thus, some exposures during the fetal and neonatal period seem to affect the risk of inflammatory bowel disease later in life.

Review article: smoking cessation as primary therapy to modify the course of Crohn's disease

This article aims to offer an updated review of the effects of smoking on inflammatory bowel disease, and provide a review of the methods of achieving smoking cessation. A systematic review of Embase and Medline databases was conducted. Smoking causes opposing effects on ulcerative colitis and Crohn's disease. The odds ratio of developing ulcerative colitis for smokers compared with lifetime non-smokers is 0.41. Conversely, smokers with Crohn's disease have a more aggressive disease requiring more therapeutic intervention. Smoking cessation is associated with a 65% reduction in the risk of a relapse as compared with continued smokers, a similar magnitude to that obtained with immunosuppressive therapy. Although difficult to achieve smoking cessation can best be encouraged by accessing appropriate counselling services, nicotine replacement therapy and bupropion. Using a combination of these treatments there is an improved chance of success of up to 20% compared with an unassisted quit attempt. Smoking cessation unequivocally improves the course of Crohn's disease and should be a primary therapeutic aim in smokers with Crohn's disease.

The urban diet and Crohn's disease: is there a relationship?

The aetiology and pathogenesis of Crohn's disease (CD) remain to be elucidated. In addition to genetic influences and immune mediated cytokine gene activation, various specific and non-specific environmental factors are considered to be associated with the induction and/or exacerbation of inflammatory bowel disease (IBD). The incidence of CD is higher in urban areas than in the rural, environment. Patients with CD have a higher dietary intake of sucrose, refined carbohydrates and (omega-6 fatty acids, and reduced intake of fruit and vegetables. Elemental and exclusion diets are known to be effective in CD. However, patients relapse on returning to a normal diet, which suggests that there is something in an ordinary diet which, on penetrating the mucosal defence mechanism of the terminal ileum, generates a pathogenic immune process. It has been suggested that the urban diet contains large quantities of inert inorganic non-nutrient microparticles, such as natural contaminants (soil and dust), food additives and anti-caking agents which may combine with intestinal luminal components such as bacterial cell wall lipopolysaccharides, to form antigenic particles. When these are taken up by mucosal mononuclear cells they can mediate immune reactions both locally in the mucosa and in the systemic circulation. In a study published in this issue of the journal, CD patients allocated to a low microparticle diet experienced a significant reduction in CD activity and the requirement for corticosteroids, when compared with the control group on a normal diet. The main advantage of the microparticle free diet, when compared with elemental and exclusion diets, is its enhanced tolerance by the patients and its relatively low cost. The preliminary results may give an explanation for the rising incidence of the disease in urban society. The results of an on-going multi-centre trial by the authors are awaited with interest.