Epidemiology and the natural course of inflammatory bowel disease.
ABSTRACT Ulcerative colitis and Crohn's disease are inflammatory disorders of the gastrointestinal tract that are distributed unevenly within populations and throughout the world. Although the exact causes of inflammatory bowel disease (IBD) remain unknown, study of the epidemiology of IBD has provided insight into pathogenesis. This article examines the geographic, ethnic, and other trends of IBD; risk factors (including genetic and environmental); and the natural history of IBD.
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ABSTRACT: Turkey is a bridge between east and west and a midway for many emigrations. Although there is no big ethnical groups in this country,there is a great variation in culture, living conditions, dietary habits, environment, access to medical care. These factors topped by different socioeconomical conditions and genetic background lead to different epide-miology of certain diseases throughout the country. Improv-ing hygienic conditions and socioeconomical level made the seroprevalence of Helicobacter pylori infection to decrease from 78.5% to 66.4 over the past ten years. Similar to the western epidemiological data Hp tends to affect less the young age group as compared to adults. On the other hand increasing resistance to antimicrobials used to eradicate the bacterium will obviate the need for more powerful and effective regimens in the near future. Inflammatory bowel diseases are frequently encountered in Turkey Its incidence is less than North and West Europe but close to Middle East. (4.4/100.000 for UC and 2.2/100.000 for CD). The dis-ease affects both sexes to the same degree. Distal Colitis in UC and ileocolitis in CD are more frequent than other lo-calizations. Amebiasis occurs in about 1/3 of cases in UC and 10 % of cases with CD. This parasite is observed as a concomitant infestation with IBD or as a trigger for flare up in both conditions. Colorectal cancer is the second most common GI malignancy after gastric cancer in Turkey. The distribution of colorectal cancer shows variations from west to east.Whilst esophageal and gastric cancers are more prev-alent in the east, colon cancer is relatively more common in western parts of Anatolia. Males and females seem to be affected to the same degree and the 5 th and 6 th decades are the more frequent ages of involvement. Although some stud-ies reported a trend towards right sided involvement in co-lon cancer, rectum and sigmoid are still the sites of predi-lection for colon cancer. Many environmental and genetic factors play a role in the development of colon cancer but the existing small studies discussing the contribution of some etiological factors such as dietary habits, vitamin and mineral deficiencies, environment etc. have to be validated in larger,controlled trials. The common denominator of all three conditions is their strong link with some socioeco-nomical parameters, the threat of environmental factors, their changing incidence over the past decades and their malignant or potential malignant character which affects their prognosis. Whether it be infectious or non infectious the best would be to bring together all the existing informa-tion and to unite forces in such a direction that these disor-ders could be prevented or completely eradicated from the region.
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ABSTRACT: Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to reduce inflammatory pain and swelling in inflammatory bowel disease (IBD) patients with rheumatological manifestations. While these drugs effectively reduce musculoskeletal pain and stiffness, long-term use is limited by gastrointestinal (GI) adverse effects (AEs) and disease exacerbation. As an alternative to NSAIDs, selective cyclooxygenase 2 (COX-2) inhibitors were developed to improve GI safety and tolerability. COX-2 inhibitors include drugs such as celecoxib, rofecoxib, valdecoxib, etoricoxib, and lumiracoxib. Rofecoxib and valdecoxib have been withdrawn from the market worldwide due to safety concerns (most importantly for cardiovascular adverse events) and lumiracoxib has been withdrawn in many countries due to liver toxicity. However, celecoxib and etoricoxib continue to be available for use in many countries. Several studies have examined whether COX-2 inhibitors can be safely used for the treatment of rheumatological manifestations of IBD with inconsistent results. Some investigators report acceptable safety profiles associated with these drugs while others found that COX-2 inhibitors are associated with high rates of disease exacerbation.Cochrane database of systematic reviews (Online) 01/2014; 10(10):CD007744. DOI:10.1002/14651858.CD007744.pub2 · 5.70 Impact Factor
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ABSTRACT: Background: Free radicals are the known mechanisms responsible for inducing colitis with two origins: Inflammatory cells and tissues. Only the inflammatory cells can be controlled by corticosteroids. Our aim was to assess the importance of neutrophils as one of the inflammatory cells in inducing colitis and to evaluate the efficacy of corticosteroids in the treatment of inflammatory bowel disease (IBD). Materials and Methods: Thirty-six mice were divided into six groups of six mice each. Colitis was induced in three groups by exposing them to acetic acid through enema (group 1), ex vivo (group 3), and enema after immune suppression (group 5). Each group had one control group that was exposed to water injection instead of acetic acid. Tissue samples were evaluated and compared based on macroscopic damages and biochemical and pathological results. Results: Considering neutrophilic infiltration, there were significant differences between groups 1, 3, 5, and the control of group 1. Groups 3, 5, and their controls, and group 1 and the control of group 3 had significant differences in terms of goblet depletion. Based on tissue originated H2O2, we found significant differences between group 1 and its control and group 3, and also between groups 5 and the control of group 3. All the three groups were significantly different from their controls based on Ferric Reducing Ability of Plasma (FRAP) and such differences were also seen between group 1 with two other groups. Conclusion: Neutrophils may not be the only cause of oxidation process in colitis, and also makes the effectiveness of corticosteroids in the treatment of this disease doubtful.09/2014; 3:193. DOI:10.4103/2277-9175.140666