ABSTRACT
La enfermedad inflamatoria intestinal (EII), cuyos fenotipos más frecuentes son la enfermedad de Crohn (EC) y la colitis ulcerosa (CU), tiene una etiología multifactorial, que resulta de la interacción de factores genéticos, ambientales y del microbioma. Su incidencia ha aumentado en las últimas décadas, así como también lo ha hecho la occidentalización de la dieta: alta en grasas, carbohidratos refinados, azúcar, carnes rojas y alimentos procesados. Una dieta occidental es considerada como factor de riesgo para el desarrollo de EII, ya que está asociada a disbiosis, alteración de la barrera intestinal y de la inmunidad del huésped. Existen diversas dietas de eliminación que podrían ejercer un rol en la inducción/mantención de la remisión. Sin embargo, la mayoría requiere estudios de mejor calidad científica para poder recomendarlas. A su vez, existen suplementos nutricionales que estarían asociados a la incidencia y curso de la enfermedad. El objetivo de esta revisión es mostrar el posible rol de la dieta en la incidencia de la EII, y las estrategias dieto-terapéuticas, incluyendo suplementos específicos y nutrición enteral, considerando periodos de crisis y remisión.
Inflammatory bowel diseases (IBD), most frequent phenotypes Crohn's disease and Ulcerative colitis, have a multifactorial etiology, resulting from genetics, environmental triggers and microbiome alterations. Its incidence has been increasing as well as the western diet, high in fat, refined carbohydrates, sugar, red meat and processed foods. A western diet is considered a risk factor for the development of IBD, since it is associated with dysbiosis, alteration of the intestinal barrier and host immunity. There are several elimination diets that could play a role in induction/maintenance of remission. However, most of them require better quality scientific studies. Also, there are nutritional supplements associated with the incidence and evolution of the disease. The aim of this review is to show the possible role of the diet in the incidence, and diet-therapeutic strategies, including specific supplements and enteral nutrition, considering periods of active disease and remission
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Inflammatory Bowel Diseases/diet therapy , Inflammatory Bowel Diseases/etiology , Diet , Remission Induction , Colitis, Ulcerative/diet therapy , Colitis, Ulcerative/etiology , Crohn Disease/diet therapy , Crohn Disease/etiology , Diet, Western/adverse effectsABSTRACT
A inflamação é a resposta protetora do organismo contra uma lesão celular. O mastócito representa uma célula do tecido conjuntivo responsável pelo início da reação inflamatória e cronificação do processo. O objetivo deste estudo foi analisar possíveis modificações na população de mastócitos de ratos com colite experimental alimentados com diferentes emulsões lipídicas. Quarenta ratos Wistar, divididos em 4 grupos (controle e experimentais) recebendo dieta oral com óleo de linhaça (AGn-3), óleo de soja (AGn-6) e óleo de canola (AGn-9) untados na ração 20 dias antes da indução da colite com ácido acético a 10%. Cada grupo foi, então, subdividido em dois subgrupos de cinco animais e avaliada resposta inflamatória aguda e crônica. Apesar de o número médio de mastócitos não apresentar diferença estatisticamente significante entre os grupos (p>0,05), a redução no número médio dessas células nos grupos AGn-3 e AGn-9 é clinicamente relevante. Este trabalho e a literatura pertinente levantam a possibilidade de obter-se modulação mais efetiva da inflamação com emulsões lipídicas suplementadas com AGn-3 e AGn-9.
Inflammation is the body's protective response against cell damage. The mast cell is a connective tissue cell responsible for initiating the chronic inflammatory reaction and the process. The aim of this study was to examine possible changes in the population of mast cells in rats with experimental colitis fed different lipid emulsions. Forty Wistar rats were divided into four groups (control and experimental) received an oral diet with linseed oil (GNA-3), soybean oil (AGN-6) and canola oil (AGN-9) smeared in feed 20 days before the colitis induction with acetic acid to 10%. Each group was then subdivided into two subgroups of five animals and evaluated the acute and chronic inflammatory response. Although the average number of mast cells did not show a statistically significant difference between groups (p> 0.05), the reduction in the average number of these cells in groups AGN and AGN-3-9 is clinically relevant. This study and literature raise the possibility of obtaining more effective modulation of inflammation with lipid emulsions supplemented with AGN and AGN-3-9.
La inflamación es la respuesta de protección del cuerpo contra el daño celular. La célula del mástil es una célula del tejido conjuntivo responsable de iniciar la reacción inflamatoria crónica y el proceso. El objetivo de este estudio fue examinar los posibles cambios en la población de mastocitos en ratas con colitis experimental alimentado con diferentes emulsiones de lípidos. Cuarenta ratas Wistar se dividieron en cuatro grupos (control y experimental) recibió una dieta oral con aceite de linaza (GNA-3), aceite de soja (AGN-6) y el aceite de canola (AGN-9) untado en la alimentación de 20 días antes de la colitis inducción con ácido acético al 10%. Cada grupo se dividió luego en dos subgrupos de cinco animales y evaluar la respuesta inflamatoria aguda y crónica. La mediana del número de mastocitos no mostraron una diferencia estadísticamente significativa entre los grupos (p> 0,05), la reducción en el número promedio de estas células en los grupos de AGN y AGN-3 9-es clínicamente relevante. Este estudio y la literatura plantean la posibilidad de obtener la modulación más eficaz de la inflamación con emulsiones de lípidos suplementados con AGN y AGN-3-9.
Subject(s)
Animals , Fatty Acids/analysis , Fatty Acids , Colitis, Ulcerative/diet therapy , Eating , Metabolism/physiologyABSTRACT
La Colitis Ulcerosa (CU) es una entidad particularmente importante en niños por su carácter crónico, su alta morbilidad y su naturaleza pre-maligna. El objetivo del presente trabajo es realizar una puesta al día sobre el tratamiento de las enfermedades inflamatorias intestinales, principalmente de la colitis ulcerosa, en niños. Éste constituye un gran desafío, principalmente por la carencia de estudios controlados y randomizados en pacientes pediátricos. El manejo convencional de la CU consiste en aminosalicilatos y corticosteroides, mientras que los inmunosupresores como la azatriopina o 6-mercaptopurina han probado ser eficientes para mantener la remisión. En casos de CU severa refractaria a tratamiento, la ciclosporina es una alternativa útil pero que sólo pospondrá la colectomía. Los resultados de estudios preliminares con infliximab son auspiciosos, pero aún falta investigación para estandarizar su uso en niños con CU. En este trabajo se presenta por separado la evidencia actual de las distintas alternativas del manejo médico de la CU, y algunas reseñas respecto a la Enfermedad de Crohn.
Subject(s)
Humans , Child , Colitis, Ulcerative/diet therapy , Colitis, Ulcerative/drug therapy , Inflammatory Bowel Diseases , /therapeutic use , Anti-Bacterial Agents/therapeutic use , Cyclosporine/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Mesalamine/therapeutic use , Probiotics/therapeutic useABSTRACT
Eosinophilic colitis is one of the clinical manifestations of allergy to cow's milk during the first year of life. We report a series of 9 infants who, under 9 months of age and while clinically well, presented rectal bleeding of variable magnitude, with or without diarrhea, shortly after a cow's milk-based formula was initiated (n=6); yet, 3 cases received only breast feeding. Bleeding disappeared in all patients after milk withdrawal from the diet. Challenges were planned after 12 months of treatment; three patients have not yet reached this moment, 3 had a negative challenge at 12, 18 and 28 months of age and are on a complete diet, and 3 are still on cow's milk free diet because ingestion of milk at 12, 18 and 25 months still induced rectal bleeding. This series of patients gathered in 3 years, follows the trend reported in many countries that there is a relative increase of patients diagnosed with allergy conditions early in life
Subject(s)
Humans , Male , Female , Infant , Colitis, Ulcerative/etiology , Milk Hypersensitivity/complications , Eosinophilia/complications , Milk Proteins/adverse effects , Biopsy , Colitis, Ulcerative/diet therapy , Colitis, Ulcerative/pathology , Breast-Milk Substitutes , Gastrointestinal Hemorrhage/etiology , Intestinal Mucosa/pathology , EosinophilsABSTRACT
Backgrounds and aims: Total parenteral nutrition (TPN) has been traditionally used as an adjunctive therapy in severe ulcerative colitis patients. We performed a prospective study to ascertain the safety, nutritional efficiency, tolerance and costs of total enteral nutrition in this situation. Methods: After 48 hours of intensive medical treatment, severe ulcerative colitis patients initiated enteral feeding with a polymeric formula. The formula concentration and volume were increased daily. Results: 17 patients (7 women, 10 men; age 36,8ñ12,8 years) with a mean clinical activity score of 15,6ñ1,5 were included. In 14 patients (82,4percent) enteral nutrition was well tolerated, attaining in 11 of them more than 80percent of the caloric requirements by day 4. In 3 cases we observed vomiting and bloating. Prealbumin levels improved significantly from 11,1ñ3,4 mg/dl to 22,7ñ6,8 mg/dl (p= 0.002) at the end of enteral nutrition (11,8ñ4,7 days). Albumin and other nutritional parameters did not change. Conclusions: Total enteral nutrition could be considered a safe and well tolerated nutritional support in these patients. Although albumin and other nutritional parameters did not change during the study period, the increase in prealbumin levels suggests a favourable anabolic effect of total enteral nutrition
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Colitis, Ulcerative/diet therapy , Enteral Nutrition/methods , Treatment Outcome , Nutritional Support , Serum Albumin/analysis , Nutrition AssessmentABSTRACT
Se describe una paciente de 6 meses de edad con colitis ulcerosa. Las manifestaciones clínicas consistían en deposiciones sanguinolentas, fiebre, pérdida de peso, anemia significativa, leucocitosis, velocidad de eritrosedimentación globular aumentada e hipoalbuminemia. Los estudios bacteriológicos y copropararitológicos seriados descartaron infección. El enema baritado precipitó deterioro clínico de la paciente, requiriendo intervención quirúrgica. El examen histológico reveló abscesos de las criptas, pseudopólipos, distorsión de las criptas y disminución de las células caliciformes. El tratamiento con sulfasalazina y el manejo nutricional ha sido exitoso