Over The Counter Medication For Crohn's Disease

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Over The Counter Medication For Crohn's Disease

Over The Counter Medication For Crohn's Disease

The selected studies represent cutting-edge research with significant potential in the field. This paper is a major original paper that incorporates multiple methods or approaches, provides an overview of future research directions, and describes potential research applications.

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Judith Wellens Judith Wellens Scilit Preprints.org Google Scholar , Séverine Vermeire Séverine Vermeire Scilit Preprints.org Google Scholar and João Sabino João Sabino Scilit Preprints.org Google Scholar *

Received: February 10, 2021 / Revised: February 26, 2021 / Accepted: February 27, 2021 / Published: March 3, 2021

Inflammatory Bowel Disease (ibd)

The foods you eat are thought to play a role in both the incidence and course of Crohn’s disease. What to eat and what to avoid is becoming an increasingly important question for both patients and doctors. Restrictive diets are widely used by patients and carry the risk of developing or worsening malnutrition without providing anti-inflammatory effects. However, there is an urgent need to explore new therapies to improve long-term disease management, and the widespread use of exclusive enteral nutrition in the initiation of pediatric Crohn’s disease leads us to question whether a similar approach would be useful in adults. patients. This narrative review reviews the current clinical evidence for whole food diets to achieve symptomatic and inflammatory control in Crohn’s disease and identifies gaps in knowledge as areas for future research.

Inflammatory bowel diseases (IBD) are chronic inflammatory conditions of the gastrointestinal tract that include two major clinical entities: Crohn’s disease (CD) and ulcerative colitis (UC) [ 1 , 2 ]. Both conditions are believed to arise from genetically susceptible individuals exposed to certain unknown environmental risk factors [1]. None of the diseases can be cured, but many classic and more innovative oral and biological therapies are available today with a good safety and tolerability profile [3]. Unfortunately, both primary and secondary responses to biological therapy are remarkable, and many patients still lack effective treatment options [4].

From an epidemiological point of view, migration studies show that when moving from low-incidence regions to high-incidence areas, the incidence of IBD in the second generation is similar to that of the resident population [ 5 , 6 ]. A common environmental problem is a Western-style diet high in sugar, fat, and protein, which has a strong and rapid effect on the gut microbiome compared to a plant-based diet [7]. With the development of diet in clinical use, there is strong evidence for diet-based therapeutic strategies in the treatment of pediatric CD, in which exclusive enteral nutrition is as effective as corticosteroids in inducing clinical and endoscopic remission, and is therefore generally used as first-line therapy. .. ; however, long-term adherence is difficult and disease relapse can be expected after resuming a regular diet [ 8 , 9 , 10 , 11 , 12 , 13 ].

Over The Counter Medication For Crohn's Disease

The question “Doctor, what should I eat?” is very common and leads doctors to prescribe a “healthy diet” or “eat what you can tolerate” in the absence of strong evidence [14, 15, 16]. However, survey data show that the majority of IBD patients report specific changes in their diet that are thought to have a beneficial effect on symptom severity and inflammatory episodes [ 17 , 18 ]. The choice of foods to avoid is usually based on self-awareness of unwanted symptoms or external recommendations from other patients or popular diet books [17, 18, 19]. Importantly, as patients with IBD are already at increased risk of malnutrition and weight loss, potential effects of a restrictive diet should be evaluated and closely monitored by a dietitian or physician [16]; thus, 40–78% of IBD patients are thought to have inadequate intake of folic acid, which is mainly found in (leafy) vegetables [ 18 , 20 , 21 ]. Avoidance of fruits and vegetables can be so severe that patients may develop scurvy due to vitamin C deficiency [22]. In addition, 80–86% of IBD patients are reported to have inadequate dietary calcium intake, possibly due to the exclusion of milk and milk products, which have also been identified as foods that worsen symptoms [ 18 , 23 ].

Crohn’s Disease: Diagnosis And Management

Although diet appears to have a central influence on the pathogenesis of the disease, it has been difficult for clinicians to provide evidence-based dietary recommendations. This leads patients to use different – ​​often restrictive and unsupervised – diets based on symptom control, while therapeutic treatment aims to achieve and maintain remission and prevent disease progression [24, 25]. Given the gap between patient preferences and physicians’ knowledge of dietary guidelines, we felt the need to continually update CD nutritional knowledge.

Our aim was to narratively review the current literature on nutritional strategies in Crohn’s disease patients (adults and children) for both inflammatory and symptomatic control. Therefore, we collected high-quality papers, including meta-analyses, systematic reviews, randomized controlled trials and observational data, to summarize the role of different diets. As exclusive enteral feeding in pediatric Crohn’s disease has been extensively reviewed elsewhere, it is beyond the scope of this review. Symptomatic control was defined as any improvement in quality of life scores, clinical remission (scores), or simply cases where patients reported “improvement in symptoms.” Inflammatory responses include endoscopic enhancement, mucosal healing, and C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), stool calprotein, cytokines such as interleukin-6 (IL-6), serum albumin, hematocrit, and platelets. measured by numbers.

We have included strategies aimed at inducing or maintaining remission of Crohn’s disease and/or affecting abdominal symptoms and/or quality of life. Only validated scoring systems or endoscopic results were considered acceptable. We also included studies aiming to reduce postoperative recurrence. For an up-to-date and comprehensive review, only full-text articles written in English and published within the last 20 years were included.

We excluded in vitro/ex vivo studies, animal studies, letters to the editor, editorials, case reports, narrative reviews, reviews, commentaries, and poster presentations. In addition, studies that included antibiotics, medical therapy (alone), parenteral nutrition, enteral nutrition as induction therapy in childhood and perioperative treatment as the primary endpoint were also excluded. Studies that primarily examined the epidemiology of Crohn’s disease, non-abdominal symptoms (eg, joint pain) or other endpoints (eg, bone density, vitamin D levels, etc.) were excluded.

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Enteral nutrition is a form of nutrition therapy for CD in which all (exclusive enteral nutrition, EEN) or some (partial enteral nutrition, PEN) calories are obtained from a diet based on a liquid formula administered orally into the gastrointestinal tract. or by nasogastric feeding (Table 1) [26]. Enteral formulas can be divided into 3 types: (1) polymeric preparations containing intact proteins, carbohydrates, and fats; (2) fear of foods containing peptides of various chain lengths, simple sugars, glucose polymers or starches, and fats, mainly in the form of medium-chain triglycerides; and (3) elemental preparations containing partially or fully hydrolyzed nutrients (shorter-chain amino acids and fatty acids with only 2-4% long-chain triglycerides) [16]. Narula et al. A Cochrane meta-analysis. In 2018, based on the composition of the formula, it could not show significant benefits, but clearly demonstrated the efficacy of EN in inducing remission in adult patients with CD [26]. This claim is supported by Yamamoto et al. In 28 active CD patients, it was shown that after 4 weeks of treatment with EEN, 71% of patients achieved clinical remission, 44% of terminal ileum and 39% of colon with endoscopic healing. Histological healing was observed in the terminal ileum in 19% and in the colon in 20% [27]. Yang et al. In a prospective study in 41 patients, EEN was shown to be effective in inducing early clinical remission, mucosal healing, promoting fistula closure, and reducing abscess size over 12 weeks [28].

Since EEN cannot be used indefinitely, a maintenance strategy must be sought. PEN, where only 25–50% of total calories are typically administered by formula, has been extensively studied in 14 studies (3 randomized controlled trials (RCTs), 6 retrospective and 5 prospective) over the past 20 years. Adults and children with CD, of which only 2 were negative [29, 30, 31, 32, 33, 34, 35, 36, 37, 38,

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