Ulcerative Colitis - Stuart McLean

8/14/2019 Ulcerative Colitis - Stuart McLean

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Stuart McLean


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It is a chronic relapsing inflammatorydisorder of the large bowel


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Rectal bleeding

Diarrhoea with blood and mucous

Tenesmus

Abdominal pain

AnorexiaRaised temperature


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Immunologically mediated

Genetic influences

Environmental influences


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Tragnone et al1995 Dietary habits as risk factorsfor inflammatory bowel disease.Eur J Gastroenterol

Hepatol. Jan;7(1):47-51.

Reif et al1997 Pre-illness dietary factors ininflammatory bowel disease. Gut. Jun;40(6):754-60.

Sakamoto et al2005 Dietary risk factors forinflammatory bowel disease: a multicenter case-control study in Japan.Inflamm Bowel Dis.Feb;11(2):154-63.


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Jowett et al 2004 Influence of dietary factors on

the clinical course of ulcerative Colitis: a

prospective cohort study. GutOct;53: 1479 - 1484.

Magee et al2005 Associations between diet and

disease activity in ulcerative colitis patients using

a novel method of data analysis.Nutr J. Feb 10;4:7


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M - cells Ulcer

'Leaky' enterocytes

Antigen - bacterial, viral, protazoal?

Systemic manifestations

ofmalaise / fever

Leading todegranulation

of neutrophols

ActivatedCD-4 cell

IL - 4

Th - 2predominates

in UCMastcells

Production o f

cytokines

IL - 8

Activatedmacrophage

NF - kB

TNF - alpha IL - 1

Adhesion molecules(ICAM-1, E-Selectin)

To the bowel

leading to

Inflammation

Intestinal epithelium

CD-4cell

I N F L A M M A T I O N

Phospholipase A

Lipids in plasma membrane

Free fatty acid

cyclooxygenase-1 2,5-lipoxygenase

Prostaglandins Leucotrines

Prostaglandinsfrom

cyclooxygenase-2 LTB-4

adapted from Palmer and Penman 2000, Sands 1999, Boik 2001 and Rang et al 1999.

Macrophage


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Patient Details First Visit Oct 07 Advice /

Treatment

Outcome

Male: 34, BMI 2410 yr hist. Stablelast 5 yrs

Diet: meat, proc.Foods, wine, coffee

F&V, Omega-3

Lifestyle: Self-employ

Stress, poorsleep

Medication:Prednisalone 40mgomDipentum 1g tds

Prev. azathioprine

150mg om stopped

platelets

Colitis returned

within month.Rx Predsol enema

didnt work

Bloody stool 6x d,

Abdom. Cramps,

Fatigue, nightsweats, work

limited, v. anxious

Self Rx bland diet

Rx

Chamomile 25

Tormentil 25

Vib opulus 25

Symph fol. 25

5 ml tds 300ml

Lamberts Tumeric

Acidophilus 10

Diet: Add fish and

cooked veg.Rooibosh +

Chamomile tea

freely

3 wks pred 15 mg

More relaxed, sleep

better, n. sweats,

Freq loose stools,

no blood.-

Torm +Agrimonia,calendula

3 Months no pred.

Stools loose 1-

2x/day-

Agrim + Hydrastis-FOS 1 tsp

5 Months feeling

well

Stools normal

Rx tea ( treatingother issues)


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Constituents Curcumin one of the main

constituents

Action - anti-inflammatory action on the

enzymes 5-lipoxygenase and cycloxegenase(Ammon et al1993. Mechanism of antiinflammatory actions of

curcumin and boswellic acids. J Ethnopharmacol. Mar;38(2-

3):113-9.).

inhibit nuclear factor kappa B (NF-Kb) (Singhand Aggarwal (1995 ). Activation of transcription factor NF-kappa

B is suppressed by curcumin (diferuloylmethane) J Biol Chem.

Oct 20;270(42):2 4995-5000).


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Curcumin maintenance therapy for ulcerative

colitis: randomized, multicenter, double-blind,

placebo-controlled trial. (Hanai et al2006 ClinGastroenterol Hepatol Dec; 4(12): 1502-6. )


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Constituents

Phenolic compounds flavonoids

apigenin, quercetin, patuetin, luteolin

and their glycosides.

Essential oil terpenoids alpha-bisabolol and azulenes


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Actions Antioxidant, antimocrobial,

antiinflammatory, antispasmotic and

anxiolytic. ( McKay and Blumberg (2006) Phytother ResJul; 20 (7): 519-30 )

Chamazuline showed inhibition of the

formation of leucotrine B 4 (LTB4) throughantioxidant activity of 5-lipoxygenase, (Safayhiet al1994 Planta Med. Oct;60(5):410-3. ).


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complex interaction of constituents including

the polysaccarides - acemannan and

mannose

The action upon colonic tissue is thought to

be due to binding of the polysaccarides to

receptor sites lining the colon, therebyenhancing mucosal barrier function (Vazquez etal1996 J Ethnopharmacol 55(1): 69-71)


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In vitro

Anti-inflammatory effects of Aloe vera gel in

human colorectal mucosa ( Langmead et al2004Aliment Pharmacol Ther 19; 521 527)

Anti-inflammatory - interleuken-8 (IL-8)


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Randomized, double-blind, placebo-

controlled trial of oral Aloe vera gel for active

ulcerative colitis. ( Langmead et al 2004 AlimentPharmacol Ther 19; 739 747)

4 week trial 44 patients with mild to moderate

colitis.histological disease activity.

A ti b t i l i l t l?


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M - cells Ulcer

'Leaky' enterocytes

Antigen - bacterial, viral, protazoal?

Systemic manifestations

ofmalaise / fever

Leading todegranulation

of neutrophols

ActivatedCD-4 cell

IL - 4

Th - 2predominates

in UC Mastcells

Production of

cytokines

IL - 8

Activatedmacrophage

NF - kB

TNF - alpha IL - 1

Adhesion molecules

(ICAM-1, E-Selectin)

To the bowel

leading to

Inflammation

Intestinal epithelium

CD-4cell

I N F L A M M A T I O N

Phospholipase A

Lipids in plasma membrane

Free fatty acid

cyclooxygenase-1 2,5-lipoxygenase

Prostaglandins Leucotrines

Prostaglandinsfrom

cyclooxygenase-2 LTB-4

adapted from Palmer and Penman 2000, Sands 1999, Boik 2001 and Rang et al 1999.

Macrophage


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Number of factors associated with UCSmall number of studies that

demonstrate effectiveness of herbs

Need for more studies

Ulcerative Colitis - Stuart McLean

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