Could inflammatory bowel disease and colon cancer be prevented by changing the shape of a single protein?
Monday 20 February 2017
Sunday 19 February 2017
Beyond Tired: Is Your Ulcerative Colitis
Causing Fatigue?
By Katie Kerns Geer Reviewed by Rosalyn Carson-DeWitt, MD
Brain fog, zombie mode, hitting a brick wall — real-life
patients and an expert explain what it’s like to live with
ulcerative colitis fatigue. And they suggest how you can
fight back.
Thinkstock
Before Abby Bales had surgery for ulcerative colitis, she
couldn’t make it through the day without a nap. But Bales
was more than just tired — she was experiencing fatigue,
a common symptom of ulcerative colitis that drains energy
and causes an overwhelming sense of exhaustion.
Before Abby Bales had surgery for ulcerative colitis, she couldn’t make
it through the day without a nap. But Bales was more than just tired — she
was experiencing fatigue, a common symptom of ulcerative colitis that
drains energy and causes an overwhelming sense of exhaustion.
“When I was flaring, and for the last year before surgery, the fatigue was
“When I was flaring, and for the last year before surgery, the fatigue was
absolutely unreal,” says Bales, a doctor of physical therapy in New York
City and author of the blog Run Stronger Every Day. “I required a nap in
the middle of the day just to make it to the end of the day.”
Like Bales, nearly 75 percent of people with an inflammatory bowel
Like Bales, nearly 75 percent of people with an inflammatory bowel
disease (IBD) such as ulcerative colitis experience fatigue when their
condition is flaring, according to a study published in 2011 in the journal
Inflammatory Bowel Diseases. What’s more, 30 percent of the people
in this study who were in remission — meaning that they weren’t
experiencing other symptoms of ulcerative colitis — also qualified
as having fatigue.
“Fatigue is not a universal symptom of ulcerative colitis, but it’s a c
“Fatigue is not a universal symptom of ulcerative colitis, but it’s a c
ommon one,” says William Katkov, MD, a gastroenterologist at
Providence Saint John's Health Center in Santa Monica, California.
“The important point is that fatigue should be addressed by both the
patient and the treating physician.”
If you’re living with ulcerative colitis and you're experiencing
If you’re living with ulcerative colitis and you're experiencing
fatigue, it may feel as if you’ll never get your energy back. But by
tightening control of your condition and making some healthy lifestyle
changes, you can manage your fatigue. Start here.
What Fatigue Feels Like
Fatigue is beyond just a passing feeling of being tired, explains Dr. Katkov.
What Fatigue Feels Like
Fatigue is beyond just a passing feeling of being tired, explains Dr. Katkov.
“People with ulcerative colitis can experience malaise, a profound kind of
fatigue that makes it difficult to carry out normal activities.”
Tina Haupert, who was diagnosed with ulcerative colitis in 2011, agrees.
Tina Haupert, who was diagnosed with ulcerative colitis in 2011, agrees.
“I'm pretty much always tired,” she says. “But I do my best to eat well and
exercise, which seems to help.”
One of the most frustrating aspects of ulcerative colitis fatigue is its
One of the most frustrating aspects of ulcerative colitis fatigue is its
unpredictable nature. From 2010 to 2014, the British organization Crohn’s
and Colitis UK assessed more than 500 people with IBDs to learn more
about their fatigue. Many participants complained that it would come on
suddenly, without warning, and vary from day to day. They also said that
this type of fatigue — which they described with the terms “brain fog,”
“completely wiped out,” and “zombie mode” — had a negative effect
on their quality of life. It affected their memory and concentration, made
it harder for them to exercise or attend social activities, and interfered
with their relationships and ability to work. And it often took a hefty
emotional toll, lowering their confidence or leading to depression.
Ensuring that fatigue doesn’t interfere with the quality of life, the ability
Ensuring that fatigue doesn’t interfere with the quality of life, the ability
to work, and the capacity to have a normal social life is central to the goal
of treating a chronic condition like ulcerative colitis, Katkov notes. “We
don’t want to settle for a lower quality of life than what can be achieved
with aggressive treatment,” he says.
What Causes Ulcerative Colitis Fatigue?
While people with ulcerative colitis may experience fatigue for a number
What Causes Ulcerative Colitis Fatigue?
While people with ulcerative colitis may experience fatigue for a number
of reasons, it may simply be caused by the body’s response to inflammation
in the colon, says Katkov.
In addition, fatigue is sometimes related to anemia, which is a common
In addition, fatigue is sometimes related to anemia, which is a common
complication of ulcerative colitis, caused by blood loss, diarrhea, and
malabsorption of nutrients. Other possible triggers include certain
medications, inadequate sleep, being overweight or underweight, and
pain, according to the findings of the Crohn’s and Colitis UK study.
And don’t rule out the emotions. “With any patient — but especially
And don’t rule out the emotions. “With any patient — but especially
someone with a chronic disease,” Katkov says, “you want to consider their
emotional life, stress, and depression.”
9 Tips for Managing Your Fatigue
The key to easing fatigue is not to ignore it. “Fatigue is a sign that something
requires attention,” Katkov says. Consider the following steps.
Get ulcerative colitis under control with treatment.
Get ulcerative colitis under control with treatment.
Since fatigue is often related to the symptoms and inflammation of ulcerative
colitis, it’s more prevalent when the disease is active. “When ulcerative colitis
is well controlled, a patient is not expected to have fatigue,” Katkov says.
Work with your doctor to find the best treatment approach for your condition.
Rule out other causes of fatigue.
“Go through the full list of diagnostic possibilities,” Katkov says. For
example, if your ulcerative colitis is in remission and you’re still
experiencing fatigue, have your healthcare provider run a blood test to
check for anemia or vitamin deficiencies. Or ask your doctor whether
a medication or a recent stressful situation might be triggering your
tiredness. Says Katkov, “Get to the root of the problem and address it.”
Move more.
It may seem counter intuitive, but exercise has been shown to have a
positive effect on fatigue in people with ulcerative colitis, according to a
2014 review of research in BioMed Research International. Haupert, who’s
a self-proclaimed fitness “nut” and the author of the blog Carrots 'N' Cake,
suggests that you try to do something active every day — “even if it's a
short walk around your neighborhood. Even though I battle fatigue, I
always feel better and more energized after some exercise.”
Try to sleep eight hours a night.
“A growing body of evidence suggests that disordered or inadequate sleep
can significantly impact health,” says Katkov. “And fatigue is central to
that.” As a rule of thumb, the National Sleep Foundation recommends that
adults get seven to nine hours of sleep each night. If tossing and turning at
night is leaving you feeling fatigued the next day, talk to your doctor about
ways to improve your sleep. Also, consider cutting back on caffeine and
removing distracting electronic gadgets from your bedroom.
Eat your vitamins.
There’s no cure-all diet for ulcerative colitis or fatigue, but eating well
certainly plays a role in overall health, says Katkov, who suggests that you
educate yourself about a healthy, balanced diet that's rich in a range of
vitamins.
Plan ahead.
Got a big event on the calendar? “Make sure you have time to rest before
and after,” Bales says. “Stress and lack of sleep don't do anything good
for your immune system.”
Rethink the 9-to-5 day.
“When fatigue is significant, adjustments in work are appropriate and
recommended,” Katkov says. If fatigue is hindering your ability to get
through the workday, consider asking your employer whether he or she
would allow you to work more flexible hours.
Try to reduce stress.
Try to reduce stress.
Practice relaxation techniques (for example, yoga, tai chi, and deep
breathing), and you may find the benefits to be twofold. According to a
review of research in Gastroenterology Research and Practice, easing your
level of tension may lower your risk of an ulcerative colitis flare — and
reducing stress may also help lessen fatigue.
Learn your fatigue triggers.
Everyone’s different, so try to figure out which habits wear you out and
which tend to put a little pep in your step — and act on them accordingly.
Manage your life in a way that works for you,” Bales recommends.
“If that means you work out in the morning and go to bed early in the
evening, that's the way you need to do it.”
Last Updated: 10/29/2015
Source - Everyday Health
Thursday 16 February 2017
Wednesday 15 February 2017
Cognitive Behavioral Therapy Seen as Best at Helping IBD Patients Improve Quality of Life
Psychological therapy, especially cognitive behavioral therapy, can help to ease depression and improve quality of life in patients with inflammatory bowel disease (IBD), but generally only for the short term, a study reported.
The study, a systematic review and meta-analysis, is titled “Effect of psychological therapy on disease activity, psychological comorbidity, and quality of life in inflammatory bowel disease: a systematic review and meta-analysis” and was published in The Lancet: Gastroenterology and Hepatology.
For the review, its lead author, Alexander Ford, MD, of the Leeds Gastroenterology Institute, and colleagues revisited relevant literature from 1947 up to Sept. 22, 2016. They included 14 randomized control trials evaluating psychological therapies, reporting outcomes in a total of 1,196 IBD patients.
Psychological therapies were not seen by the researchers to reduce a person’s relative risk of relapse in dormant IBD in comparison to other interventions, but all these therapies were associated with improvements in depression scores and quality of life.
Cognitive behavioral therapy, particularly, showed significant benefits on quality of life.
In one trial, cognitive behavioral therapy was associated with 21 percent of patients with active IBD entering clinical remission, compared to only 4 percent in the control group, after 18 months of follow-up. This therapy aims to change the way people think and behave.
Ford and his colleagues concluded that psychological therapies might provide a short-term aid in improving symptoms of depression and quality of life, but in order to maintain the results, treatment must be continued.
“These effects appear to be lost over time,” Ford and his team said in a press release. “The beneficial effect on quality of life was most notable when we only included randomized clinical trials that used cognitive behavioral therapy, which is thought to have the best evidence for efficacy in management of anxiety and depression.”
The authors add that patients with active IBD are known to carry a high psychological burden, suggesting that this group of patients could particularly benefit from these types of treatment.
“The strong association between depression and anxiety and unfavorable disease course suggests that clinicians should identify people with inflammatory bowel disease who also have substantial problems with anxiety and depression and refer them to appropriate treatment resources,” wrote John R. Walker, PhD, of the University of Manitoba, Canada, in a related editorial. “Attention to psychological functioning is likely to improve treatment outcome and reduce disability in patients with inflammatory bowel disease.”
Source - IBD News Today
Sunday 12 February 2017
Friday 10 February 2017
The Body’s Second Brain: How Your Gut Could Be Affecting Your Emotions
We’ve all had that feeling of butterflies in our stomach, or
what can be described as a gut-wrenching feeling, and we always told to follow
our “gut-instinct.”
All these phrases and feelings clearly show that our
emotions are affected by our gut.
We all have a
microbiome, and they are as unique as our neural pathways
The body has more bacteria than cells, which means we are
literally more bug than human. This huge amounts of bacteria is called
microbiome. Most of this bacteria resides in the gut.
The gut doesn’t just help with digestion, it’s a key player
in regulating inflammation and immunity.
A healthy gut is different for different people and it
certainly involves diversity.
The gut as a second
brain.
The gut has a complex system of about 100 million nerves.
This is called the enteric nervous system.
The ENS is called the second brain and arises from the same
tissues as our central nervous system during fetal development. It has many
chemical parallels to the brain.
The gut and the brain communicate a lot and involve
endocrine, immune and neural pathways.
Our emotions play a big
role in our gut health.
Given how closely the gut and brain interact, it has become
clear that emotional and psychosocial factors can trigger symptoms in the gut.
This is especially true in cases when the gut is acting up and there’s no
obvious physical cause.
Mental health impacts
gut wellness
In light of this new understanding, it might be impossible
to heal FGID’s without considering the impact of stress and emotion. Studies
have shown that patients who tried psychologically based approaches had greater
improvement in their symptoms compared with patients who received conventional
medical treatment.
Poor gut health can lead
to neurological and neuropsychiatric disorders
Vice-versa, poor gut health has been implicated in
neurological and neuropsychiatric disorders. Disturbances in gut health have
been linked to multiple sclerosis, autistic spectrum disorders, and Parkinson’s
disease. This is potentially related to pro-inflammatory states elicited by gut
dysbiosis-microbial imbalance on or inside the body. Additional connections
between age-related gut changes and Alzheimer’s disease have also been made.
Further, there is now research that is dubbing depression as
an inflammatory disorder mediated by poor gut health. In fact, multiple animal
studies have shown that manipulating the gut microbiota in some way can produce
behaviors related to anxiety and depression.
Experts on the gut on
Ideapod
Dr Rhea Mehta, the world renowned author and specialist on
nutrition, is on Ideapod sharing ideas about the gut being your second brain.
Check out her user profile and
engage with her ideas.
Saturday 4 February 2017
Introduction
An ileostomy is where the small bowel (small intestine) is diverted through an opening in the tummy (abdomen).The opening is known as a stoma. A special bag is placed over the stoma to collect waste products that usually pass through the colon (large intestine) and out of the body through the rectum and back passage (anus).
Ileostomy procedures are relatively common in the UK. More than 9,000 are carried out each year in England.
When is an ileostomy needed?
Ileostomies are formed to either temporarily or permanently stop digestive waste passing through the full length of the small intestine or colon.There are a number of reasons why this may be necessary, including:
- to allow the small intestine or colon to heal after it's been operated on – for example, if a section of bowel has been removed to treat bowel cancer
- to relieve inflammation of the colon in people with Crohn's disease or ulcerative colitis
- to allow for complex surgery to be carried out on the anus or rectum
Read more about why ileostomy procedures are carried out.
The ileostomy procedure
Before an ileostomy is formed, you'll normally see a specialist stoma nurse to discuss exactly where you'd like your stoma to be (usually somewhere on the right-hand side of the abdomen) and to talk about living with a stoma.
- loop ileostomy – where a loop of small intestine is pulled out through a cut (incision) in your abdomen, before being opened up and stitched to the skin to form a stoma
- end ileostomy – where the ileum is separated from the colon and is brought out through the abdomen to form a stoma
Alternatively, it's sometimes possible for an internal pouch to be created that's connected to your anus (ileo-anal pouch). This means there's no stoma and stools are passed out of your back passage in a similar way to normal.
End ileostomies and ileo-anal pouches are usually permanent. Loop ileostomies are usually intended to be temporary and can be reversed during an operation at a later date.
Read more about:
How an ileostomy is formed
Reversing an ileostomy
After surgery
You may need to stay in hospital for up to two weeks after an ileostomy operation. During this time you'll be taught how to look after your stoma by a specialist stoma nurse.Recovering from the procedure can be challenging. Many people experience short-term physical and psychological problems, ranging from skin irritation around the stoma to feelings of anxiety and self-consciousness.
However, with practise and support from a designated stoma nurse, many people adjust and often find their quality of life improves after surgery. This is especially true if they've been living for years with a condition such as Crohn's disease.
Read more about:
Recovering from an ileostomy procedure
Living with an ileostomy
Complications
As with any surgical procedure, having an ileostomy carries a risk of complications. Some of the problems people with an ileostomy experience include:- a bowel obstruction – where the output of digestive waste is blocked
- vitamin B12 deficiency – caused by the removal of part of the intestine that absorbs vitamin B12
- stoma problems – such as widening or narrowing of the stoma, making it difficult to attach the external bag
Read more about the risks of having an ileostomy.
Source - Nhs
Friday 3 February 2017
Thursday 2 February 2017
Researchers help the body protect itself against inflammation and colon cancer
January 27, 2017
Could inflammatory bowel disease and colon cancer be prevented by changing the shape of a single protein?
But Virginia Tech researchers found that modifying the shape of IRAK-M, a protein that controls inflammation, can significantly reduce the clinical progression of both diseases in pre-clinical animal models.
The altered protein causes the immune system to become supercharged, clearing out the bacteria before they can do any damage. The team's findings were published in eBioMedicine.
"When we tested mice with the altered IRAK-M protein, they had less inflammation overall, and remarkably less cancer," said Coy Allen, an assistant professor of inflammatory disease in the Department of Biomedical Sciences and Pathobiology in the Virginia-Maryland College of Veterinary Medicine and a Fralin Life Science Institute affiliate.
The next step, he said, will be to evaluate these findings in human patients through ongoing collaborations with Carilion Clinic and Duke University. The team is also evaluating their findings in laboratory-assembled 'mini-guts'—live tissue models that Allen and his team assembled by growing intestinal stem cells on petri dishes to form highly complex small intestinal and colon tissue.
"Ultimately, if we can design therapeutics to target IRAK-M, we think it could be a viable strategy for preventing inflammatory bowel disease and cancer," said Allen.
Colon cancer is the second leading cause of cancer-related deaths in the United States and the third most common cancer in men and women, according to the Centers for Disease Control and Prevention.
More than ten Virginia Tech faculty members and students are working on the project, including co-principal investigator Liwu Li, a professor of biological sciences in the College of Science; Clay Caswell, an assistant professor of bacteriology in the veterinary college; Rich Helm, an associate professor of biochemistry in the College of Agriculture and Life Sciences; Dan Slade, an assistant professor of biochemistry in the College of Agriculture and Life Sciences; and Tanya LeRoith, a clinical associate professor of anatomic pathology in the veterinary college.
"Working on this project alongside Dr. Allen and our fellow collaborators has personally been a great experience," said Rothschild. "It's really exciting when your findings have the potential for clinical implications that can be applied to help patients. From a scientist's perspective, that's what it's all about, and hopefully our findings provide a good avenue for development of future therapeutics to treat maladies such as inflammatory bowel disease and colon cancer."
Wednesday 1 February 2017
Surgery for IBD
For some people their inflammatory bowel disease (IBD) requires that they need surgery to manage their condition. For some surgery is needed in an emergency, life-saving situation but for most it can be planned ahead.
It’s estimated that around 70% of people with Crohn’s disease and 25% of people with ulcerative colitis (UC) will need surgery during their life to help treat their IBD. Surgery is less common in people who have microscopic colitis.
In general, surgery for IBD removes part the part of the bowel (large or small intestine) which is damaged and/or inflamed or treats strictures (narrowing) or abscesses or fistulas. In some cases surgery can mean a stoma is created on the surface on your stomach and your bowel waste goes into a bag, in others the bowel is reconnected. The type of surgery, though, varies from person to person depending on the type of IBD you have and the severity of any damage to your bowel.
Before opting for surgery it is important to understand what the aim of the surgery is, what will happen during the procedure, the recovery period needed and take into account any other considerations. It is also helpful to understand about how the digestive system works and where your IBD is so that you can see what the surgery is trying to achieve.
IBD is a lifelong, chronic condition and having surgery to remove diseased parts of your gut does not cure you, though it may remove some or all of your symptoms. There is also a risk that the inflammation will return to parts of the gut which remain. If you have UC and have all of your large bowel, rectum and anus removed then there is no risk of inflammation returning (however you may still experience symptoms such as fatigue, joint pain).
Reasons for having surgery for your IBD
The reasons for surgery vary from person-to-person. In extreme cases a person is rushed to hospital and the surgery takes place with little notice - in others you have time to consider the surgery and decide if it’s for you.
Some of the reasons people opt for surgery include:
- Poor response to medication
- Strictures (Crohn’s)
- Abscesses or fistulas (usually Crohn’s)
- Delayed growth in children (Crohn’s)
- Cancer
- Emergency reasons
Surgery for Crohn’s disease
It is estimated that around 7 in 10 people with Crohn’s disease receive surgery at some point in their life.
The most common operations for Crohn’s disease include:
- Strictureplasty/Stricturoplasty - reshaping of the bowel to treat strictures (narrowing) and blockages
- Resection - the damaged part of the small intestine or large intestine are removed and the healthy sections are reconnected
- Ileocaecal resection - the terminal ileum (the last part of the small intestine) and the caecum are removed and the small intestine and large intestine are directly connected
- Colectomy with ileostomy - all or part of the colon is removed and the opening of the small intestine is brought to the surface of the abdomen to create an ileostomy (a type of stoma) and a bag is connected to collect waste
- Colectomy with ileo-rectal anastomosis - if the colon is diseased but the rectum remains healthy the small intestine is connected directly to the rectum, bypassing the colon
- Proctocolectomy and ileostomy - if the rectum and colon are diseased then they are both removed and an ileostomy is created with the small intestine
- Surgery for abscesses and fistulas - Abscesses may need to be lanced and drained while fistulas can be treated with a resection or by opening and cleaning them and then leaving them to heal
Surgery for ulcerative colitis
Around one in four people with UC receive surgery at some time during their life.
The most common operations for UC include:
- Proctocolectomy and ileostomy - if the rectum and colon are diseased then they are both removed and an ileostomy is created with the small intestine
- Restorative Proctocolectomy with ileo-anal pouch (J-pouch) - the whole colon and rectum is removed. A pouch is then made using the ileum (lower end of small intestine) and joined to the anus. This is generally done over two operations and a temporary ileostomy is required in between the operations
- Colectomy resection - some of the large bowel is removed and rejoined
If you have ulcerative colitis and have all of your colon, rectum and anus removed then there is no risk of the inflammation returning (as there is nowhere colon for it to return to!), however you may still suffer from other IBD symptoms such as fatigue and joint pain.
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