Comparative activities of milk components in reversing chronic colitis

Inflammatory bowel disease (IBD) is a poorly understood chronic immune disorder for which there is no medical cure. Milk and colostrum are rich sources of bioactives with immunomodulatory properties. Here we compared the therapeutic effects of oral delivery of bovine milk-derived iron-saturated lactoferrin (Fe-bLF), angiogenin, osteopontin (OPN), colostrum whey protein, Modulen IBD (Nestle Healthsciences, Rhodes, Australia), and cis-9,trans-11 conjugated linoleic acid (CLA)-enriched milk fat in a mouse model of dextran sulfate-induced colitis. The CLA-enriched milk fat significantly increased mouse body weights after 24d of treatment, reduced epithelium damage, and downregulated the expression of proinflammatory cytokines and nitrous oxide. Modulen IBD most effectively decreased the clinical score at d 12, and Modulen IBD and OPN most effectively lowered the inflammatory score. Myeloperoxidase activity that denotes neutrophil infiltration was significantly lower in mice fed Modulen IBD, OPN, angiogenin, and Fe-bLF. A significant decrease in the numbers of T cells, natural killer cells, dendritic cells, and a significant decrease in cytokine expression were observed in mice fed the treatment diets compared with dextran sulfate administered mice. The Fe-bLF, CLA-enriched milk fat, and Modulen IBD inhibited intestinal angiogenesis. In summary, each of the milk components attenuated IBD in mice, but with differing effectiveness against specific disease parameters.

Anti-inflammatory activity and mechanisms of a lipid extract from hard-shelled mussel (mytilus coruscus) in mice with dextran sulphate sodium-induced colitis

The anti-inflammatory effect of a lipid extract from hard-shelled mussel (HMLE) on dextran sulphate sodium (DSS)-induced colitis in mice was investigated. Salicylazosulphapyridine (SASP) and different doses of HMLE were administered by gastric gavage. HMLE significantly attenuated DSS-induced colitis disease activity index scores, tissue damage, splenic enlargement and colon myeloperoxidase accumulation. In addition, HMLE improved colon oxidative stress and production and expression of anti-inflammatory cytokine, interleukin (IL)-10, while HMLE inhibited the abnormal productions and mRNA expressions of pro-inflammatory cytokines, namely tumour necrosis factor-α, IL-1β, and IL-6, as well as the expression of key molecules in the toll-like receptor (TLR)-4/nuclear factor (NF)-κB signalling pathway. These findings suggest that HMLE has an anti-inflammatory effect on DSS-induced colitis, equivalent to that of SASP, and this effect might be related to the regulation of inflammatory mediators and key molecules in the TLR-4/NF-κB pathway.

Cognitive behavioral therapy for IBD

Despite a high burden of psychological comorbidity in inflammatory bowel disease (IBD) and recommendations that psychological care should be offered in IBD care,2 we have thus far been unable to show psychological treatment to be effective in this population.

Gastrointestinal diseases: psycho-social aspects

An interconnection between psychological and gastrointestinal (GI) functioning has long been recognized, incorporating multiple mechanisms and considering bidirectional processes. However, exciting discoveries regarding the role of stress and depression in etiology and disease course have shed new light on the understanding of biopsychosocial processes in chronic GI conditions. This article provides an introduction to GI tract functioning, GI disorders, and stress mechanisms in the gut, followed by an overview and discussion of the psychosocial impact of these disorders, the role of stress and mental comorbidity in GI disorders, and the current knowledge regarding psychological interventions for GI disorders.

Does the inclusion of moderate amounts of red meat in the diet of exercising older women impact on faecal markers of bowel health, including faecal lactoferrin?

Background: High intakes of red meat may be associated with increased risk of colorectal cancer (CRC), however, to determine CRC risk, it is important to assess faecal changes related to protein and carbohydrate metabolism.

Objective: To determine the influence of three weekly meals rich in red meat as opposed to a carbohydrate control diet on faecal markers which are involved in the aetiology of CRC.

Design: Twenty post-menopausal women (aged 60-75) undertook, 3 times a week for 12 weeks, a 30 minute exercise session followed immediately by a cooked meal that was high in lean red meat, low in carbohydrate (n= 10) or low in lean red meat, high in carbohydrate (n=10). Dietary fibre intake and macronutrients were kept constant. At the beginning and end of the study, three-day faecal samples were collected and by-products of protein fermentation and carbohydrate metabolism, undigested fibre residues, and faecal output and colonic bacterial microbiota changes measured.

Outcomes: No significant differences were observed in subjects on either diet when comparing faecal output, faecal pH, other faecal markers, nor faecal lactoferrin. There was a trend observed in changes in the population of colonic microbiota using FISH analysis. Bacteroides spp. and Prevotella spp. appeared to decrease in women consuming a high red meat diet compared with an increase in women consuming a high carbohydrate diet.

Conclusions: In this pilot study the trend in colonic microbiota change is interesting and suggests that dietary influence of colonic microbiota, especially changes in Bacteroidetes, may be indicative of risk of gut damage and disease compared to other faecal markers.

A preliminary analysis of the cost-effectiveness of the National Bowel Cancer Screening Program – demonstrating the potential value of comprehensive real world data

Background The complexity and cost of treating cancer patients is escalating rapidly and increasingly difficult decisions are being made regarding which interventions provide value for money. BioGrid Australia supports collection and analysis of comprehensive treatment and outcome data across multiple sites. Here we use preliminary data regarding the National Bowel Cancer Screening Program (NBCSP) and stage-specific treatment costs for colorectal cancer (CRC) to demonstrate the potential value of real world data for cost-effectiveness analyses (CEA).

Methods Data regarding the impact of NBCSP on stage at diagnosis was combined with stage-specific CRC treatment costs and existing literature. An incremental CEA was undertaken from a government healthcare perspective, comparing NBCSP to no-screening. The 2008 invited population (n=681,915) was modelled in both scenarios. Effectiveness was expressed as CRC-related life years saved (LYS). Costs and benefits were discounted at 3% per annum.

Results Over the lifetime and relative to no-screening, NBCSP was predicted to save 1,265 life-years, prevent 225 CRC cases and cost an additional $48.3 million, equivalent to a cost-effectiveness ratio of $38,217 per LYS. A scenario analysis assuming full participation improved this to $23,395.

Conclusions This preliminary CEA based largely on contemporary real world data suggests population-based FOBT screening for CRC is attractive. Planned ongoing data collection will enable repeated analyses over time, using the same methodology in the same patient populations, permitting an accurate analysis of the impact of new therapies and changing practice. Similar CEA using real world data related to other disease types and interventions appears desirable.

Psychosocial issues in evidence-based guidelines on inflammatory bowel diseases: a review.

AIM: To study statements and recommendations on psychosocial issues as presented in international evidence-based guidelines on the management of inflammatory bowel diseases (IBD). METHODS: MEDLINE, guidelines International Network, National Guideline Clearing House and National Institute for Health and Care Excellence were searched from January 2006 to June 30, 2013 for evidence-based guidelines on the management of IBD. RESULTS: The search yielded 364 hits. Thirteen guidelines were included in the review, of which three were prepared in Asia, eight in Europe and two in the United States. Eleven guidelines made statements and recommendations on psychosocial issues. The guidelines were concordant in that mental health disorders and stress do not contribute to the aetiology of IBD, but that they can influence its course. It was recommended that IBD-patients should be screened for psychological distress. If indicated, psychotherapy and/or psychopharmacological therapy should be recommended. IBD-centres should collaborate with mental health care specialists. Tobacco smoking patients with Crohn's disease should be advised to quit. CONCLUSION: Patients and mental health specialists should be able to participate in future guideline groups to contribute to establishing recommendations on psychosocial issues in IBD. Future guidelines should acknowledge the presence of psychosocial problems in IBD-patients and encourage screening for psychological distress.