Talk:Inflammatory bowel disease

Before any reinsertion, I think it needs to be specified what kind of inflammatory bowel disease (if even IBD) is referred to in the following study, since it appears to consist of multiple types with different pathogenesis. Mikael Häggström (talk) 16:20, 25 October 2010 (UTC)

Research^[1] has shown that IL-23 is overexpressed in tissues taken from mouse models of IBD. The group showed that knocking out IL-23 (heterodimer of IL-12p40 and IL-23p19) sharply reduced inflammation of the bowel, both in terms of cells and proinflammatory cytokine production. Also, they found that a novel group of CD4⁺ T lymphocytes, Th17 T cells, are highly unregulated in bowels of diseased mice. Taken together, the group shows that IL-23 but not IL-12 (a heterodimer of IL-12p40 and IL-12p35) drives innate and T cell mediated intestinal inflammation.

doi:10.1136/gut.2010.222893 - large cohort of pregnancy on thiopurines; they seem to be safe. JFW | T@lk 12:51, 5 January 2011 (UTC)

Prototype to material that should be considered when discussing causes of IBD

The low incidence of pathogens within modern societies are thought to have contributed to Inflammatory Bowel Disease vulnerability^[1] . This has been known as the Hygiene Hypothesis^[1] . Humanity has been exposed to a wide range of bacteria and viruses with the practice of agriculture in the Neolithic Revolution^[1] . This was due to an increase in population density and a sedentary lifestyle that accompanied agricultural practice^[1] . In the post Neolithic Revolution, humans adapted to the high rate of pathogens through developing a more active immune system^[1] . In the modern society, improved sanitation and medicine has lowered pathogen exposure^[1] . This leads to an evolutionary mismatch between adaptation and environment where the low pathogen exposure increases susceptibility to Inflammatory Bowel Disease^[1] . This is a result of an inappropriate response from the immune system that has not been exposed to many pathogens^[1] . Several lines of evidence have proven supportive of this hypothesis^[1] . Helminthic infection, which was common in a pre-modern setting, is shown to modulate a strong Th2 response^[1]. The increase in Th2 decreases the Th1 response which is associated with auto-immune and Crohn's Disease. Patients with IBD are shown to have lower prevalence of Helicobacter pylori, common in third world countries, to matched controls and disease controls.^[1] This observation suggests a protective role of H. pylori in the development of IBD^[1] . Taken together, these suggest that the active immune system is mismatched in the modern, low pathogen setting and may be a reason for vulnerability to IBD.^[1]

Anybody know what that's supposed to mean? Isn't milk fat just butter? How can you concentrate it? Looks like anti processed food POV pushing to me. --Ef80 (talk) 22:09, 19 December 2013 (UTC)

The intent may be to include both cheese and butter.187.210.137.17 (talk) 17:17, 20 December 2013 (UTC)

1st and most important sentence in the article, 2nd word "medicine" links to the wikipedia article on "medicine" which I think is ridiculous. As if "inflammatory bowel disease" might also apply to some other area, such as astronomy or economics.Jonny Quick (talk) 18:58, 27 July 2014 (UTC)

• I agree w/ (irrelevant detail on celiac disease)--Ozzie10aaaa (talk) 19:40, 15 March 2016 (UTC)

• no need to add Irritable bowel syndrome is excluded when there are inflammatory changes.[30] Celiac disease can't be excluded if specific antibodies (anti-transglutaminase antibodies) are negative,[31][32] nor in absence of intestinal villi atrophy.[33]...IMO--Ozzie10aaaa (talk) 20:01, 15 March 2016 (UTC)

Hi, Ozzie10aaaa and Jrfw51.

The World Gastroenterology Organisation believes that the warning about irritable bowel disease (IBS) is necessary:

World Gastroenterology Organisation Global Guidelines. Inflammatory Bowel Disease. Update August 2015 (page 16)

Table 4 - Main differential diagnoses for ulcerative colitis and Crohn’s disease

UC: Acute self-limiting colitis (ASLC), Amebic colitis, Schistosomiasis, CD, Colon cancer, IBS (if there are inflammatory changes, it is not IBS), Intestinal TB, NSAID enteropath

CD: Intestinal TB, Behçet’s disease, UC, NSAID enteropathy, IBS, Celiac disease

Crohn's disease and celiac disease may present associated, overlaped, or be confused, and sometimes Crohn's disease develops secondary to a pre-existing celiac disease. Also, they share genetic risk factors. Evaluate the association of both diseases and / or make a correct differential diagnosis is very important for the prognosis and treatment of the patient. Nevertheless, about 85% cases of celiac disease are unrecognized and undiagnosed.^[1] Among main problems for diagnosis are frequent errors in the interpretation of serology and biopsies.

Int J Colorectal Dis. 2005 Jul;20(4):376-80. Epub 2004 Dec 1. Association of Crohn's disease and latent celiac disease: a case report and review of the literature. Schedel J1, Rockmann F, Bongartz T, Woenckhaus M, Schölmerich J, Kullmann F. (Review) PMID 15578194

in most cases, Crohn's disease develops secondary to a pre-existing celiac disease (Note: when they present associated)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4009516/ World J Gastroenterol. 2014 May 7;20(17):4846-56. doi: 10.3748/wjg.v20.i17.4846. Inflammatory bowel disease and celiac disease: overlaps and differences. Pascual V, Dieli-Crimi R, López-Palacios N, Bodas A, Medrano LM, Núñez C.(Review) PMID 24803796

The present review summarizes the current knowledge of different features related to the two major clinical forms of IBD, Crohn’s disease (CD) and ulcerative colitis (UC), and CeD, paying special attention to the overlaps and differences between them. These two diseases share genetic risk factors, and it would be interesting to know whether this overlap also extend to other disease characteristics in order to gain knowledge about common pathogenic mechanisms and possible shared treatments.

Best regards. --BallenaBlanca (talk) 22:53, 15 March 2016 (UTC)

We already state that coeliac disease is in the differential diagnosis. Your WGGO Guidelines recommend coeliac antibody testing and we already talk about histological testing. A large study PMID 19786375 found coexisting IBD and coeliac to be less common than the general population. We need to retain a balance. Jrfw51 (talk) 09:06, 16 March 2016 (UTC)

You cited a 2010 primary source PMID 19786375, and I cited a 2004 review, secondary source per WP:MEDRS that doesn't support the conclusions of your 2010 primary source PMID 15578194. Recent reviews show a definite association between celiac disease and IBD in adults and in some children. Let's see another secondary source of January 2016:

Pol Merkur Lekarski. 2016 Jan 28;40(235):53-5. Coexistence of coeliac disease and inflammatory bowel disease in children. Krawiec P1, Pawłowska-Kamieniak A1, Pac-Kożuchowska E1, Mroczkowska-Juchkiewcz A1, Kominek K1. (Review) PMID 26891438

Coeliac disease and inflammatory bowel disease are chronic inflammatory conditions of gastrointestinal tract with complex aetiology with genetic, environmental and immunological factors contributing to its pathogenesis. It was noted that immune-mediated disorders often coexist. There is well-known association between coeliac disease and type 1 diabetes and ulcerative colitis and primary sclerosing cholangitis. However, growing body of literature suggests the association between coeliac disease and inflammatory bowel disease, particularly ulcerative colitis. This is an extremely rare problem in paediatric gastroenterology. To date there have been reported several cases of children with coexisting coeliac disease and inflammatory bowel disease. Herewith we present review of current literature on coexistence of coeliac disease and inflammatory bowel disease in children.

I agree in this edit removing detail of quotations, but there is no reason to withdraw the references nor to modify the text. It seems an attempt to bias the information. WP:NEU So I will correct to neutrality.

Best regards. --BallenaBlanca (talk) 11:01, 16 March 2016 (UTC)

I've been looking at this and scratching my head for a while. What exactly is the point of this information about celiac? Is the point to say that if you diagnose IBS, that it might actually be CD instead? WhatamIdoing (talk) 22:35, 16 March 2016 (UTC)

WhatamIdoing, it is "simple": IBD may present associated, overlapped, or be confused with celiac disease. Evaluate the association of both diseases and / or make a correct differential diagnosis is very important for the prognosis and treatment of the patient. The only treatment available for celiac disease is a longlife strict gluten-free diet. Celiac disease may affect any organ of the body. If remain untreated, people may have severe disease symptoms, may develope associated disorders (such autoimmune diseases) and are exposed to the risk of other long-term complications, which include cancers -lymphoma, small bowel adenocarcinoma, and other malignancies (gastric, oesophageal, bladder, breast, brain)- and greater mortality.^{[1][2][3][4][5][6]} But in everyday medical practice, celiac disease is often not correctly evaluated and most patients (85%) remain unrecognized, undiagnosed and untreated.^[7]

Best regards. --BallenaBlanca (talk) 13:09, 17 March 2016 (UTC)

Ballena, I know all that. What I'm trying to figure out is the purpose of this paragraph:

Irritable bowel syndrome is excluded when there are inflammatory changes.[30] Celiac disease can't be excluded if specific antibodies (anti-transglutaminase antibodies) are negative,[31][32] nor in absence of intestinal villi atrophy.

The paragraph appears to be about IBS (not IBD). Does the second sentence mean "If you think that you have IBSyndrome rather than Celiac because these two tests turned up negative, then you might still have Celiac instead of IBSyndrome"? WhatamIdoing (talk) 15:10, 17 March 2016 (UTC)

I agree. Our current entry is about Inflammatory Bowel Disease (IBD), and although Irritable Bowel Syndrome (IBS) and Celiac Disease can produce some similar symptoms, apart from including them in the list of differential diagnoses, I still feel this amount of detail is not appropriate for the IBD entry. We are writing an encyclopedia and not a diagnostic textbook. In reality this is a very small footnote when diagnosing IBD and of only some relevance for celiac disease. Jrfw51 (talk) 08:56, 18 March 2016 (UTC)

That is exactly my concern. This is not the page to explain how to diagnose IBSyndrome correctly. WhatamIdoing (talk) 03:01, 19 March 2016 (UTC)

yep(as noted on my first two points)--Ozzie10aaaa (talk) 13:51, 30 March 2016 (UTC)

Meta-meta-analysis if there is such a thing doi:10.1053/j.gastro.2019.04.016 JFW | T@lk 21:21, 26 August 2019 (UTC)

I added more information about the significance of B vitamins in nutrient absorption and lipid metabolism ^[1] JewelSciComm (talk) 23:00, 19 October 2020 (UTC)

I added information about the significance of short-chain fatty acids and secondary bile acids and how metabolomics can help us identify bacterial species that produce secondary bile acids. ^[1] JewelSciComm (talk) 23:00, 19 October 2020 (UTC)

Anyone can add information on this drug: Sulfasalazine ? AXONOV (talk) ⚑ 19:16, 23 November 2021 (UTC)