Could migraine increase the risk of inflammatory bowel disease? A new study found a link. Michela Ravasio/Stocksy
More than 1 billion people around the world have at least one migraine attack each year.
Previous research shows that migraine can potentially increase a person’s risk for several health issues, including gastrointestinal conditions.
New research from Seoul National University College of Medicine in South Korea says there may also be a link between migraine and an increased risk for inflammatory bowel disease (IBD).
Now, researchers from Seoul National University College of Medicine in South Korea say there may also be a link between migraine and an increased risk for irritable bowel disease (IBD), which is an umbrella term that includes Crohn’s disease and ulcerative colitis.
According to Dr. Brooks D. Cash, professor and chief of the division of Gastroenterology, Hepatology, and Nutrition at UTHealth Houston in Texas, who was not involved in this study, the field of gastroenterology has recognized for many years that migraine has been associated with many chronic gastrointestinal syndromes and diseases.
“The data in this report supports previous reports of an association between migraine headaches and IBD,” Dr. Cash told Medical News Today.
Dr. Rudolph Bedford, a board-certified gastroenterologist at Providence Saint John’s Health Center in Santa Monica, CA, who was also not involved in this study, told MNT that the research results were not surprising.
“[With] inflammatory bowel disease we do see some extra-intestinal manifestations including things involving the eye or ocular findings, which may be neurogenic in nature, so it wasn’t surprising,” Dr. Bedford added.
This is not the first study to look at a connection between migraine and IBD.
A study published in March 2021 of people in the United States found a higher prevalenceTrusted Source of migraine or severe headaches among adults with IBD than in those without.
Research published in March 2023 reported an increased prevalence of IBD in people with migraine with and without aura.
For the current study, researchers analyzed data from more than 10 million people through the nationwide healthcare system for South Korean citizens. About 3% of the study population had IBD.
Through the data, scientists found the incidence of IBD was significantly higher in people who had migraine compared to those who did not.
Scientists also reviewed the data through subgroups of Crohn’s disease and ulcerative colitis incidences. People with migraine in both subgroups had a higher risk of developing either condition when compared to people without migraine.
After a migraine diagnosis, researchers found people were at a higher risk of developing Crohn’s disease, with a significant rise after a 5-year follow-up.
Additionally, within the subgroups, scientists reported that the impact of migraine on the risk of developing ulcerative colitis was more prominent in men than women.
Based on these findings, the research team suggests that people with migraine be monitored carefully for the development of IBD.
However, Dr. Cash stated that the data presented do not convincingly support that approach or recommendation.
“The odds ratios that were reported in this study, which can be thought of as the increased odds of an outcome (e.g., developing IBD) with a given exposure (e.g., migraine headaches), were consistently between one to two, which is not far from definitive and can be easily misinterpreted or misrepresented,” he explained.
“The results are, at best, suggestive of an association between migraines and IBD, which we were already aware of based on previous research and deserve to be further evaluated. However, the minimal increase in the odds of developing IBD reported in this study is not sufficient to recommend increased monitoring of patients with migraines for the development of Crohn’s disease or ulcerative colitis.”
Dr. Bedford said it is important to identify potential health issues that may trigger IBD, as a doctor may be able to mitigate the symptoms of IBD if they know what may be associated with it.
“Migraines can be very debilitating and you may want to identify those people with migraines,” he continued. “We don’t normally question patients with inflammatory bowel disease whether or not they have migraine headaches, so it probably rates as something that should be done more frequently.”
“These results add to an already relatively robust body of research suggesting that chronic pain syndromes are statistically more common in patients with chronic GI syndromes or diseases,” Dr. Cash said.
“We do not have enough information or proof yet to establish a causal relationship either way. But this data can be used to explain some therapeutic approaches that may benefit both GI and neurologic symptoms in patients with migraines,” he added.
Regarding the next steps for this research, Dr. Cash said that mechanistic data evaluating the possible reasons for these consistent observations of association is needed.
“Right now, all we have are hypotheses,” he continued. “Are there changes in the gut-brain communication pathways or sensory perceptions in the enteric and central nervous systems? Is the gut microbiome involved? Are there psychological and stress-mediated factors at play?”
“Once clinical relationships such as these have been identified, we need to move toward trying to explain why those relationships may exist,” Dr. Cash added. “That, in turn, may lead us to develop more targeted and effective therapies that can address multiple symptoms/syndromes.”
Dr. Bedford suggested researchers look for an association between IBD flares and migraine occurring at the same time. As migraine is associated with serotonin release, he encouraged researchers to examine how the serotonin transporters within the GI tract, small bowel, and colon might play a role.
“I think just questioning our patients in terms of quality of life issues — is there any way that we can mitigate their migraine headaches, potentially preventing their inflammatory bowel disease flare, or vice versa, is certainly something to look into,” Dr. Bedford said.
Food antigens are thought to play a vital role in the initiation and perpetuation of Crohn’s disease (CD). The main purpose of this study was to evaluate the potential association of serum food specific IgG antibodies and small bowel (SB) inflammation in CD patients.
Methods
We conducted a prospective observational study with 96 CD patients. Demographic, disease-related data and inflammatory parameters were collected. Serum food IgG antibodies were measured using enzyme-linked immunosorbent assay (ELISA). Capsule endoscopy was performed to detect SB inflammation quantified by the Lewis Score.
Results
Seventy-eight of (81.3%) CD patients were detected positive for at least one food-specific antibody. The five most prevalent food antibodies in CD patients were tomato, egg, corn, rice, and soybean. Patients with SB inflammation had a higher positive rate of food IgG antibodies (P = 0.010) and more IgG-positive food items (P = 0.010) than those without. Specifically, patients with SB inflammation were more likely to have positive food-specific IgG against egg (P = 0.014), corn (P = 0.014), and wheat (P = 0.048). Additionally, the number of positive food IgGs ≥ 3 and elevated ESR were independently associated with concurrent SB inflammation (P = 0.015 and P = 0.013, respectively).
Conclusion
Our study confirmed that CD patients with SB inflammation had a higher positive rate of food IgG antibodies and more IgG-positive food items. The number of food positive IgGs ≥ 3 and elevated ESR were independently associated with concurrent SB inflammation.
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Abstract
Background/aims
Food antigens are thought to play a vital role in the initiation and perpetuation of Crohn’s disease (CD). The main purpose of this study was to evaluate the potential association of serum food specific IgG antibodies and small bowel (SB) inflammation in CD patients.
Methods
We conducted a prospective observational study with 96 CD patients. Demographic, disease-related data and inflammatory parameters were collected. Serum food IgG antibodies were measured using enzyme-linked immunosorbent assay (ELISA). Capsule endoscopy was performed to detect SB inflammation quantified by the Lewis Score.
Results
Seventy-eight of (81.3%) CD patients were detected positive for at least one food-specific antibody. The five most prevalent food antibodies in CD patients were tomato, egg, corn, rice, and soybean. Patients with SB inflammation had a higher positive rate of food IgG antibodies (P = 0.010) and more IgG-positive food items (P = 0.010) than those without. Specifically, patients with SB inflammation were more likely to have positive food-specific IgG against egg (P = 0.014), corn (P = 0.014), and wheat (P = 0.048). Additionally, the number of positive food IgGs ≥ 3 and elevated ESR were independently associated with concurrent SB inflammation (P = 0.015 and P = 0.013, respectively).
Conclusion
Our study confirmed that CD patients with SB inflammation had a higher positive rate of food IgG antibodies and more IgG-positive food items. The number of food positive IgGs ≥ 3 and elevated ESR were independently associated with concurrent SB inflammation.
ArticleOpen access18 January 2021
Introduction
Crohn’s disease (CD) is a chronic, progressive and relapsing inflammatory disease characterized by transmural inflammation involving any part of the entire gastrointestinal tract. Relapsing bowel inflammation will accumulate structural bowel damage, which increases the risk of developing severe complications necessitating surgical intervention. Furthermore, small bowel (SB) involvement is associated with a poor prognosis and a higher likelihood of suffering complications [1, 2].Therefore, it is very important to closely monitor disease activity and achieve clinical persistent remission and mucosal healing to avoid the progression of bowel damage [3].
As to endoscopic assessment, ileocolonoscopy with biopsy is considered the first-line procedure to evaluate intestinal lesions among patients with CD. However, disease may be confined only to the SB in one-third of patients [4]. It is more challenging to evaluate the small bowel disease because ileocolonoscopy cannot reach the involved upper or medium bowel segment. Small bowel capsule endoscopy (SBCE) was introduced in 2000 to provide a reliable method to visualize directly the entire small bowel [5]. SBCE is considered a useful tool for the evaluation of suspected and established CD. SBCE has been shown to be more sensitive in detecting lesions in the proximal small bowel than magnetic resonance imaging enterography (MRE) and computed tomography enterography (CTE), with comparable accuracy for distal lesions [6,7,8]. It has been reported that SBCE is also useful for treatment guidance in patients with established CD [9]. Recently, a recent prospective cohort study also found that SBCE could predict both short-term and long-term risk of CD flare during follow-up [10]. Although noninvasive and generally well tolerated, SBCE is time consuming and costly to perform and entails the small but significant risk of capsule retention [11, 12].
A noninvasive inflammatory biomarker with good accuracy for diagnosing and monitoring CD is crucial in clinical practice. C-reactive protein (CRP) and Fecal calprotectin (FCP) are the most commonly used inflammatory biomarkers in clinical practice. However, the accuracy of CRP to predict intestinal inflammation was modest [13]. CRP can underestimate SB inflammation detected by SBCE in quiescent CD [14, 15], limiting its clinical utility for disease surveillance. FCP has a high accuracy in the evaluation of colonic inflammation, so it can be used as a reliable marker to predict disease relapse and guide treatment. However, accumulating evidence suggests that FCP shows a weak correlation with SBCE findings, limiting its utility in the prediction of SB inflammation [16,17,18].
Several studies have found that CD patients have a higher prevalence and titer of serum food-specific IgG antibodies than ulcerative colitis (UC) patients and healthy individuals [19,20,21]. Patients with SB involvement may be more likely to develop food-specific IgG antibodies than patients without small bowel involvement [20]. A possible explanation is that intestinal barrier dysfunction allows food antigens to enter the submucosa and contact with immune cells directly, leading to the production of food antibodies. Therefore, food-specific antibodies may serve as a potential marker for predicting SB inflammation. The purpose of this study was to investigate the prevalence of food specific IgG antibodies in CD patients. We also sought to confirm the association between food-specific IgG antibodies and SB disease activity evaluated by SBCE.
Material and methods
The study population
From April 2017 to April 2019, CD patients with known SB involvement were prospectively recruited for this study. This study was conducted at the First Affiliated Hospital of Fujian Medical University, a tertiary care center for the management of CD in Fujian Province, China. The diagnosis of CD was established based on a combination of clinical, endoscopic, radiological, and histological criteria [22]. All patients signed an informed consent, and the study protocol was approved by the Ethics Committee of the First Affiliated Hospital of Fujian Medical University, China, in accordance with the Declaration of Helsinki.
The inclusion criteria included: a previous diagnosis of CD with SB involvement; age older than 14 years; and willingness to undergo CTE or MRE at enrollment. The exclusion criteria were: inability to understand or unwillingness to provide informed consent; serious liver, kidney, brain or cardio-respiratory comorbidities; difficulty in swallowing, history of dysphagia or aspirations; use of non-steroidal anti-inflammatory drugs within the previous month; definite intestinal stricture identified by imaging or bowel obstruction at enrollment.
Sample size estimation
A non-probability convenience sampling method was used to recruit CD patients. The sample size was calculated using PASS version 11.0 (NCSS Statistical Software, Kaysville, UT, United States). According to previous reports [19,20,21], the estimated positive rate of food-specific antibodies in CD patients is approximately 80%. The sample size obtained was 96 at a margin of error of 5% and a confidence level of 95%.
Data collection
The disease activity in CD patients was scored by the CD activity index score (CDAI) [23]. Demographic data, body mass index (BMI), smoking status, history of intestinal surgery, disease duration, disease location and behavior were collected for each patient at the time of enrollment. Information about medical treatment was also collected.
At enrollment, peripheral blood was collected from each patient for analysis of total white blood cell count, eosinophil ratio, hemoglobin, platelet count, and inflammatory markers, such as CRP and erythrocyte sedimentation rate (ESR). A stool sample was also collected to determine FCP using a commercially available colloidal gold immunofiltration assay (Wizbiotech, Xiamen, China).
Serum food-specific IgG antibodies test
A commercially available enzyme-linked immunosorbent assay (ELISA) kit (HOB Biotech Group Corp., Suzhou, China) was used to quantitatively determin serum IgG antibodies against 14 common food-derived antigens, including beef, codfish, chicken, corn, egg, crab, mushroom, milk, rice, pork, shrimp, soybean, wheat and tomato. The whole detection process was carried out in accordance with the manufacturer’s instructions, and the final results were obtained by the ELISA plate reader (Infinite F50, TECAN, Männedorf, Switzerland) at an absorbance of 450 nm.
A food IgG concentration less than 50 U/mL was considered negative (Grand 0). Levels of 50–100 U/mL, 100–200 U/mL, and greater than 200 U/mL were classified as mild sensitivity (Grade 1+), moderate sensitivity (Grade 2+) and high sensitivity (Grade 3+), respectively.
Capsule endoscopy examinations
MRE or CTE were performed in all patients before CE examination to detect severe intestinal stricture and avoid capsule retention. On the day before examination, patients underwent bowel preparation with 2-L of 6.8% polyethylene glycol electrolyte oral solution (Shutaiqing, Staidson Beijing Biopharmaceuticals Co., Ltd., Beijing, China). After a 12-h overnight fast, patients swallowed the capsule (Jinshan Science & Technology Co., Ltd., Chongqing, China). After 8–10 h of recording, the images were downloaded to the OMOM capsule endoscopy workstation (Jinshan Science & Technology Co., Ltd., Chongqing, China).
All images were reviewed carefully by two experienced gastroenterologists blinded to the study design and clinical data of the patients. SB inflammation was quantified using the Lewis score (LS) [24]. LS is considered as SB mucosal healing or no clinical significant inflammation if lower than 135 points, mild inflammation 135–790 points, and severe inflammation 790 points [24].
Statistical analysis
Data were analyzed using SPSS software version 22.0 (IBM, Armonk, New York, USA). Continuous variables with normal distribution were presented as mean ± standard deviation (SD) and continuous variables with non-normal distribution were presented as median ± interquartile range. Either the Student’s t test or the Mann–Whitney U-test was used for comparisons between two groups in term of continuous variables. Variance was compared with the F-test. Categorical data were presented as counts, and assessed using Fisher’s exact test or the χ2 test. Univariate and multivariate logistic regression analysis were used to identify the association between SB inflammation and clinical characteristics and food IgGs. A P value < 0.05 was considered statistically significant.
Results
Clinical and demographic characteristics of the included patients
A total of 96 patients with CD were finally included in this study. The baseline clinical and demographic characteristics of the included patients are shown in Table 1. The median age of patients was 25 (18, 31) years and 63 (66%) were men. The median disease duration from the time of disease onset to study enrollment was 24 (10, 48) months. 21/96 (21.9%) were in the active stage (CDAI ≥ 150) at entry. Thirty-seven (38.5%) had elevated CRP (>10 mg/dL), and twenty-one (21.9%) had elevated FCP (>100 µg/g). SBCE examinations demonstrated SB inflammation in 71(74%) patients (LS ≥ 135).Table 1 Baseline characteristics of the included Crohn’s disease patients.
The levels of serum food-specific IgG antibodies of CD patients against fourteen common food antigens are shown in Table 2. In this study, at least one food antibody was detected positive in 78 (81.3%) patients with CD, and among them 15.6% (15/96), 15.6% (15/96), and 50.0% (48/96) of patients had one, two and more than two types of food antibodies respectively. The mean number of food antibodies was 3.0 ± 2.5. The five most prevalent food antibodies in CD patients were tomato (58/96, 60.4%), egg (51/96, 53.1%), corn (51/96, 53.1%), rice (43/96, 44.8%), and soybean (23/96, 24.0%).Table 2 Distribution of positive food IgG antibodies in Crohn’s disease patients.
Comparison of clinical characteristics between patients with and without small bowel inflammation
As shown in Table 3, there was no statistically significant difference between CD patients with and without SB inflammation with respect to age, gender, BMI, disease location, disease duration, allergic disease history, current treatment with 5-amino salicylic acids (5-ASAs), steroids or immunosuppressants. Moreover, statistical analysis failed to show any significant difference between patients with and without SB inflammation in terms of the median CDAI (49.0 vs. 66.2, respectively; P = 0.233) and serum CRP levels (4.18 vs.8.39, respectively; P = 0.133). Among patients with SB inflammation, 17 (23.9%) had a CDAI ≥ 150, and 30 (42.3%) had an elevated CRP level. By contrast, 4 (16.0%) patients without SB inflammation had a CDAI ≥ 150 and 7 (28.0%) had an elevated CRP level (P > 0.05 for both comparisons). Conversely, patients with SB inflammation tended to have a higher incidence rate of perianal involvement (70.4 vs 48.0%, P = 0.044) and higher inflammatory activity with an ESR > 20 mm/h (69.0 vs 36.0%, P = 0.004), compared to patients without SB inflammation.Table 3 Demographic and Clinical characteristics in Crohn’s disease patients according to the presence of small bowel inflammation.
Comparison of food-specific IgG antibodies in sera of patients with and without small bowel inflammation
As shown in Table 4, CD patients with SB inflammation showed a higher positive rate of food IgG than those without (87.3vs 64.0%, P = 0.010). The mean number of food positive IgG items in patients with SB inflammation was higher than patients without SB inflammation (3.4 vs 1.9, P = 0.010). Patients with SB inflammation were more likely to develop more than two different food IgGs than patients without SB inflammation (57.7 vs 28.0%, P = 0.011). Specifically, patients with SB inflammation were prone to have a higher positive rate of food specific IgG against egg (60.6 vs 32.0%, P = 0.014), corn (60.6vs 32.0%, P = 0.014), and wheat (21.1 vs 4.0%, P = 0.048), compared to those without SB inflammation. Furthermore, patients with SB inflammation were more likely to have positive food IgG against rice with a marginally significance than those without SB inflammation (50.7 vs 28.0%, P = 0.050). No significant difference in food IgGs against chicken (P = 0.173), crab (P = 0.260), shrimp (P = 0.435), codfish (P = 0.467), pork (P = 0.396), milk (P = 0.165), soybean (P = 0.278), tomato (P = 0.140), or mushroom (P = 0.752) were observed between patients with and without SB inflammation. Figure 1 shows the distribution of positive food antibodies in CD patients with and without SB inflammation.Table 4 Comparison of serum food-specific IgG antibodies positivity between patients with and without small bowel inflammation.
Fig. 1: Distribution of positive food antibodies in Crohn’s disease patients with and without small bowel inflammation.
Association between small bowel inflammation and clinical characteristics and food IgGs antibodies in CD patients
As shown in Table 5, univariate logistic regression analysis indicated that SB inflammation was significantly associated with age, perianal involvement, biologicals treatment, elevated ESR and number of positive food IgGs ≥ 3. Multivariate analysis revealed that biologicals treatment (odds ratio [OR] = 3.945, 95% confidence interval [CI] 1.333–11.680, P = 0.013), elevated ESR (OR = 3.587, 95% CI, 1.278–10.068, P = 0.015) and number of positive food IgGs ≥ 3 (OR = 3.814, 95% CI 1.284–11.333, P = 0.016) remained significantly and independently associated with SB inflammation.Table 5 Results of univariate and multivariate analyses examining factors associated with small bowel inflammation in Crohn’s disease patients.
Our prospective study shows that food-specific IgG antibodies are highly prevalent in CD patients. The five most prevalent food antibodies in CD patients are tomato, egg, corn, rice, and soybean. Interestingly, serum food IgG antibodies were found to be associated with concurrent SB inflammation evaluated by SBCE. Patients with SB inflammation had a higher positive rate of food IgG antibodies and more IgG-positive food items. Additionally, equal or more than three IgG-positive food items and elevated ESR were independent predictors of SB inflammation.
Most (81.3%) of CD patients were detected positive for at least one food specific antibody, which is consistent with previous studies [19,20,21]. This result is not surprising because increased intestinal permeability is a typical feature of CD patients, which facilitates food antigens into the circulation and then stimulates the production of relevant antibodies. More than two different food specific antibodies were detected positive in half of the patients in present study. The five most prevalent food antibodies in CD patients were tomato (60.4%), egg (53.1%), corn (53.1%), rice (44.8%), and soybean (24.0%), similar to a previous study [21]. Wang and colleagues [25] recently reported that CD patients exhibited more intense immune response to food antigens than UC and controls, and the number of food IgG-positive items could be used to discriminate CD from UC and healthy controls, with high diagnostic value.
Previous studies have shown that CD patients with SB involvement are significantly associated with lactose maldigestion [26, 27]. Notwithstanding, ref. [20] reported that patients with only small intestine involved were prone to have a higher positive rate of food antibodies (82.5%) with an unremarkable statistical difference. When patients were regrouped, those with small bowel involved had a significantly higher positive rate than those without (79.7 vs. 60.5%, p = 0.005). However, no significant correlation was found between positive rates of food-specific IgG and disease location in CD patients in the studies by ref. [19] and ref. [21]. This may be due to the fact that disease location determined according to the Montreal classification cannot distinguish active small bowel mucosal inflammation. LS based on CE findings may be more precise for reflecting the real state of small bowel. In our study, we used LS to identify whether patients had active SB inflammation. Higher positive rates of food IgG antibodies and more IgG-positive food items were found in patients with SB inflammation (LS ≥ 135) in the present study. It is not surprising that intestinal stenosis, food indigestion and increased intestinal mucosa permeability are commonly presented in patients with small intestinal CD, which might allow more chances for food antigens to be recognized by the immune system and produce specific antibodies. The types of food IgG antibodies may differ owing to the diversity of diet habits in different regions, while the number of food-positive antibodies may be more precise to reflect the current bowel state. In this study, we found that patients with active SB disease had a higher positive rate of food antibodies, and more food-positive items. The number of food-positive items (≥3 positive) was an independent predictor of SB inflammation. This finding may provide a noninvasive method for diagnosing and monitoring CD in clinical practice.
Our study also has several main drawbacks. Firstly, it was a single center, cross-sectional analysis that included a relatively small number patients. Secondly, this research was not a follow-up study to investigate whether improvement of SB disease severity could be paralleled by a reduction in the positive rate of food-specific IgG after medical treatment. Thirdly, children with CD were excluded in our study. Additionally, the study did not investigate the patient’s dietary habits, which may have an impact on the types and titers of food IgG.
In conclusion, our study confirms that serum food-specific IgG antibodies are highly prevalent in CD patients. Notably, CD patients with SB inflammation have a higher positive rate of food IgG antibodies and more IgG-positive food items. The number of food-positive IgGs (≥3) is independently associated with concurrent SB inflammation. This finding may provide a convenient and noninvasive method for predicting SB inflammation in clinical practice.
Wearable technology, including wrist-worn smartwatches that monitor heart rate variability, may help identify and predict flares of inflammatory bowel disease, according to data presented at the Crohn’s and Colitis Congress.
“It is challenging to identify and predict IBD flares, and we lack easy and convenient means to monitor patients,” Robert P. Hirten, MD, assistant professor of medicine at the Icahn School of Medicine at Mount Sinai,told Healio. “Currently we rely on the use of blood or stool tests, imaging tests such as CT scans or MRIs, colonoscopies [and] symptom reporting by patients. It is our hope to one day be able to use wearable devices, which are commonly used, convenient and passive, to be able to monitor for changes in the body that could alert us to a current or impending disease flare.”
Wrist-horn smart watches and wearable technology that monitors heart rate variability may help identify and predict flares of IBD.
To determine whether wearable technology assessing physiological metrics — including heart rate variability, a marker of autonomic nervous system function — may be able to predict IBD flares and other inflammatory events, Hirten and colleagues launched The IBD Forecast study.
Within this prospective study, the researchers enrolled patients with IBD (n = 125) aged 18 years or older in the United States, who were willing to use a commercially available wearable device, download a custom eHive app and answer daily questions.
Hirten and colleagues analyzed heart rate variability metrics using a mixed-effect cosigner model that integrated BMI, age and sex. They also used daily patient reported outcome (PRO)-2 surveys to assess clinical flares (flare; PRO-2 Crohn’s disease >7, PRO-2 ulcerative colitis >2), while inflammatory flare was evaluated through patient-reported C-reactive protein, defined as at least 5 mg/L.
According to preliminary analysis, the mesor of the circadian pattern of heart rate variability metrics was higher among patients undergoing clinical flare (mean = 44.43; 95% CI, 41.25-47.75) vs. those in clinical remission (mean = 43.03; 95% CI, 39.94-46.22). Additionally, the mesor of the circadian pattern was lower in patients with an inflammatory flare (mean = 38.16; 95% CI, 30.86-45.72) vs. patients with normal inflammatory markers (mean = 49.51; 95% CI, 43.12-56.26).
“We find that there are significant changes in autonomic nervous system function, reflected in heart rate variability measurements, when individuals with IBD develop symptoms or develop inflammation,” Hirten said. “This demonstrates the possibility of using wearable devices to identify, and possibly, predict flares.”
Although the IBD Forecast Study is still ongoing, Hirten noted that he hopes machine-learning algorithms can be developed with data from wearable devices to reliably track changes in autonomic function that precede an IBD flare.
“These early results demonstrate that wearable devices may hold promise in the ability to identify and predict IBD flares, though much more work is still needed,” Hirten told Healio. “I hope these results demonstrate that in the future we can use new technologies, like wearable devices, to monitor our patient’s health and improve their care.”
Described in a paper in Science Advances, these nanoparticles can fight harmful molecules, called reactive oxygen species (ROS), that can worsen IBD in excessive amounts. They are made from poly(propylene sulfide) – a polymer that can neutralize ROS – and hyaluronic acid, a compatible compound commonly used in medicine.
The nanoparticles – the researchers call them “backpacks” – can be attached to probiotics, which deliver them to the gut.
“Due to the colonizing property of probiotics in colon tissues, the nanoparticles could be delivered to colon tissues by probiotics and released slowly,” says study author Quanyin Hu, PhD, a biomedical engineer and assistant professor at the University of Wisconsin-Madison School of Pharmacy.
This helps give the nanoparticles time to bring the ROS level back down to normal. But that’s only part of the IBD treatment the researchers envision.
Signs Your IBD Is Getting Worse
With mild IBD, most people feel better with medication, but there are severe cases and symptoms to look out for.
The technology builds on a previous development from Hu and his team – a protective probiotic shell coating. The coating, which is about 330 nanometers thick, helps probiotics survive long enough to establish and multiply in the gut.
“The harsh environment of gastric acid and bile salt would kill most probiotics,” Hu says. “Moreover, antibiotics usually used in inflammatory bowel disease treatment also harm probiotic growth.”
Early results are promising, he says. Mice with IBD that received the full treatment – combining the ROS-targeting nanoparticles with the coated probiotics – had fewer IBD symptoms, like less weight loss and colon shortening, than those treated with the encapsulated probiotics alone.
By attacking the disease on multiple fronts – reducing the ROS and improving the balance of gut microbiota – a healthy gut environment could be restored, Hu says. In other words: “[It] might be possible to finally cure inflammatory bowel disease.”
Nanotechnology offers all kinds of unique advantages over traditional IBD treatments, he says. Nanoparticles can be designed to target specific tissues, like colon tissues. And compared to small molecules, they can circulate throughout the body longer, so they have more time to build up and do their job.
The next steps will be to test the treatment in large animals and “to develop a stable formulation that can be stored for a long time and produced in a scalable and economical manner,” Hu says.
Current IBD treatments “can only relieve symptoms,” not cure the disease, he says.
“This study is our first try to fundamentally treat inflammatory bowel disease by recovering a healthy microenvironment in the intestines, and our preliminary data demonstrated that this strategy is delivering promises to pave a new treatment strategy for IBD,” Hu says.
Findings bolster guidelines for IBD patients with extensive colitis or left-sided colitis
Inflammatory bowel disease (IBD) patients diagnosed with colorectal cancer (CRC) had better cancer outcomes when they had undergone a recent surveillance colonoscopy, a retrospective study of military veterans found.
In the analysis of over 550 such patients, surveillance colonoscopy in the 6 months to 3 years prior to the CRC diagnosis was associated with a lower likelihood of late-stage cancer compared with no prior surveillance colonoscopy:
6 months to 1 year: adjusted odds ratio (aOR) 0.40, 95% CI 0.20-0.82 (P=0.01)
1 to 3 years: aOR 0.56, 95% CI 0.32-0.98 (P=0.04)
And patients with a surveillance colonoscopy in the year prior to their CRC diagnosis had lower all-cause mortality, regardless of IBD type or duration (adjusted hazard ratio [aHR] 0.56, 95% CI 0.36-0.88, P=0.01), reported Jason Hou, MD, MS, of the Baylor College of Medicine in Houston, and colleagues, writing in Clinical Gastroenterology and Hepatology.
“Our findings support current practice guidelines that recommend colonoscopy intervals from 1 year to 3 years among patients with IBD who have extensive colitis or left-sided colitis,” the group wrote.
Hou and colleagues noted that IBD patients are at greater risk for CRC, yet only about a fourth undergo routine colonoscopy surveillance, and the comparative benefit of different intervals for colonoscopy in IBD patients remains unknown.
“This is a particularly hard condition to study because it is not very common and there are a lot of variables that can affect colon cancer detection and colonoscopy performance,” Hou told MedPage Today.
“Current colonoscopy surveillance guidelines for IBD patients are very onerous and burdensome,” he said. “We were interested to see if we could stratify which patients would benefit the most from more intensive colonoscopy surveillance, and potentially patients who may not need as frequent colonoscopy.”
For their study, they examined National Veterans Health Administration data on 566 IBD patients who were diagnosed with CRC from 2000 to 2015. Patients were grouped based on the timing of their last surveillance colonoscopy prior to their CRC diagnosis: 6 months to 1 year (n=55), 1 to 3 years (n=100), 3 to 5 years (n=18), or never (n=393).
Those with a follow-up of 1 year or more after their CRC diagnosis or who died within the first year were included. Patients who had a prior colectomy, secondary CRC diagnosis, dysplasia, or carcinoma in situ were excluded. Analyses adjusted for demographic confounders, as well as age at CRC diagnosis, IBD type, IBD duration and extent of involvement, comorbidity score, primary sclerosing cholangitis status, and tobacco or alcohol abuse, among other factors.
Three-fourths of the cohort were white, 98% were men, half were smokers, and about two-thirds had a comorbidity score of 0.
The average age at IBD diagnosis was 54 years (ulcerative colitis in 63%, Crohn’s disease in 34%). For CRC, the average age at diagnosis was 68 years: 30% had stage 0-II disease, 30% had stage III/IV disease, and the rest had an undetermined stage.
Most patients received treatment for their CRC (87%), though those with late-stage cancers were less likely to receive treatment (OR 0.24). Overall, 70% of the patients died during the study period, with 23% of the deaths being related to CRC.
Reached for comment, Dana Lukin, MD, PhD, of Weill Cornell Medicine in New York City, noted that the study “did not use prospectively evaluated endoscopy — so preparation quality, true disease extent, severity, and phenotype, and disease activity assessments were not possible.”
The authors acknowledged other limitations to the data as well, including that most patients were eligible for surveillance colonoscopy because of their age, potentially minimizing the observed benefit. Participants were also identified by ICD-9/ICD-10 codes, which could underestimate diagnoses and mortality.
The quality of information on the web about medical marijuana for inflammatory bowel disease (IBD) was only “average,” a researcher reported here.
On the validated DISCERN questionnaire used to assess quality of information, the average score was 42.6, which was classified as average, according to Marie Borum, MD, and colleagues from George Washington University in Washington.
IBD is one of the conditions for which medical marijuana has been approved as a treatment. “Based on observational and animal studies, it is thought that modulation of endocannabinoid receptors may improve inflammation and therefore the symptoms of IBD,” Borum’s group explained in a poster at the Advances in Inflammatory Bowel Diseases annual meeting.
Patients increasingly use the internet to find information about alternative treatments, and no studies have evaluated online resources about medical marijuana for IBD. This study aimed to evaluate claims, warnings, and evidence on the available internet resources for IBD.
On the DISCERN quality questionnaire, scores of 66 to 75 were considered excellent, 56 to 65 were very good, 46 to 55 were good, 36 to 45 were average, and <35 were poor.
A total of 89 web sites were included, of which 75 (84%) were intended for use by consumers and 14 (16%) were aimed at medical professionals.
The average Flesch-Kincaid grade of readability was 13.3, with no significant difference between sites intended for consumers (13.2) and for medical professionals (14, P=0.41). This test estimates the grade level for readability, and reflects the average sentence length and the average number of syllables per word. For example, a Flesch-Kincaid grade of 10.6 represents an 11th grade reading level, while a grade of 14 represents the second year of college.
On the discernment quality score, there was no difference between the consumer and medical professional web sites (40 vs 48, P=0.08).
Consumer web sites did, however, offer significantly more claims of improvement in disease pathology than did sites for professionals (45% vs 15%, P=0.04) and significantly less often provided evidence-based references (40% vs 85%, P=0.04).
Only 21.3% of the sites included precautionary information regarding marijuana use in IBD, with no significant difference seen between sites aimed at consumers and those intended for medical professionals.
The study demonstrated that a multitude of online resources exist with information of medical marijuana as an alternative treatment for IBD patients.
The majority of sites were intended for consumers, but their readability grade level exceeded the NIH recommendation of a sixth grade reading level for medical information, the researchers pointed out.
There also was variability in the available evidence-based references, and inconsistency in the inclusion of precautionary information and therapeutic claims.
“It is critical that readily available online information about cannabis treatment in IBD be readable, evidence-based, and comprehensive in order to allow patients to make informed medical decisions,” they concluded.
Toilets are a source of interaction, social structures, organisation, norms and values. So why aren’t sociologists discussing them more?
Toilets are a private side of life that is rarely discussed, or if we do disclose our habits we do so with hesitation, euphemisms or a nervous giggle. But toilets are a very public issue.
It may be a turn of the stomach, a nervous flutter, a morning coffee or a sudden, unpredictable rush. You may look for a sign, if you are lucky enough to live in a society where they are readily available. There may or may not be a queue, often depending on the room of your gender. You may look for disabled access, whether you are in a wheelchair or have an invisible illness. You may select a space based on who is there, or your perception of its cleanliness. For some, it is an unwritten rule that one cannot go next to another person relieving themselves. What are you looking for?
A lavatory.
Also known as a toilet, bog, ladies, gents, pisspot, restroom, dunny, convenience, powder room, and the WC, to name a few alternatives.
Toilets are mundane, an everyday space, a common fixture in the home and the workplace, a thing that we all use, in diverse ways. Toilets have historically been(and continue to be) shaped by our cultures, gender, social class and ethnicity with clear boundaries, distinctions and divisions imposed. This, in turn, shapes our social identities.
Toilets are a personal thing; a private side of life that is rarely discussed. If we do disclose our habits or toilet trips we do so with hesitation, euphemisms or a nervous giggle. However, toilets are a very public issue. They are in department stores, coffee shops, pubs, restaurants and on trains. There is a declining number of public toilets, now often vandalised and abandoned, perceived as unhygienic, or a place of illegal activity and other “hazards”.
Toilets are a source of interaction, of social structures, organisation, norms and values. So why aren’t sociologists discussing them more?
I have a bowel problem. I live with an unpredictable bowel, one that changes every day, with symptoms ranging from abdominal pain to bloating and urgency to find a toilet. Bowel conditions are not socially accepted and discussed conditions: a disclosure is often regarded as “too much information”. The anxiety of the symptoms and the urgent need to use toilets led me to toilet mapping: making mental notes of the nearest toilets, and the quickest way to get to them. Toilets became not just a functional space, but also a place of safety and relief, in more than one sense.
I am not alone. There are a variety of conditions for which knowledge of toilet locations are crucial for managing symptoms – conditions such as bladder incontinence, Inflammatory Bowel Disease (IBD) and Irritable Bowel Syndrome (IBS), for example. My PhD research is focusing on the common condition of IBS. According to NHS Choices, 20% of the UK population lives with IBS – arguably more, given the concealment of the condition. Despite this, bowel conditions and the symptoms of constipation, diarrhoea, flatulence, (in)continence and other activities that take place in the “private” realm of the toilets remain heavily taboo topics in contemporary western society.
My research explores the lived experience of managing symptoms of IBS, particularly in the spaces where symptoms are mostly managed: the bathroom.
My research examines how places such as toilets can be reflective of our practices of privacy and containment of our bodily excretions. We may divide ourselves and our relations to each other in such a way that makes life with conditions such as IBS incredibly isolating. This means that the coping strategies and challenges faced in the day-to-day life of people who live with these conditions are underappreciated, hidden and, crucially, misunderstood.
Some would argue that bathrooms and toilets are the backstage of social life. However, there are many performances still going on within the toilet cubicle: the holding on until another person has left the toilet; waiting until the hand dryer goes on; blaming the time spent in the toilet on a fictional queue. Whilst this may seem an obvious behaviour of privacy and dignity, the strategies of toilet mapping and negotiating toilet spaces to keep one’s IBS identity private question the boundaries of society, the public and the private, the clean and the dirty, self and other.
In discussing my research, I often face a reception of pure horror, a nervous laugh or a joke, but very rarely an open, honest, discussion of our own bowel habits and toilet behaviours. The awkwardness around the topic creates greater challenges for those living with bowel conditions, and reinforces stigma. Some may laugh at the fact I talk about poo and toilets in my academic life. There may be banter about bowels, a joke that I need a colon in my future research papers or conference presentations. But is the difficulty of living with an unpredictable bowel in an unaccommodating society really that funny? It’s time to talk shit.
Findings differ from what’s seen in other inflammatory diseases
Patients with inflammatory bowel disease (IBD) had no increased risk for acute myocardial infarction (MI) compared with the general population — or even with patients with other chronic inflammatory conditions, a researcher reported here.
Among hospitalizations included in the National Inpatient Sample from 2000 to 2011, 1.3% of patients with IBD were admitted for MI compared with 3.2% of the general population (P<0.001), according toEdward L. Barnes, MD, of Brigham and Women’s Hospital in Boston, and colleagues.
They also had fewer MI hospitalizations than did patients with systemic lupus erythematosus (SLE), whose admission rate was 2.3%, or rheumatoid arthritis (RA), with a rate of 3%, he reported at the annual Digestive Disease Week.
“In some studies, IBD has been linked with increased cardiovascular risks, including coronary artery disease and MI, yet traditional risk factors such as hyperlipidemia, obesity, and hypertension are less common among patients with IBD and questions remain regarding the true prevalence of events such as MI among this population,” Barnes said in a poster session.
To address this question, he and his colleagues identified 567,438 hospitalizations among IBD patients and 78,121,000 admissions for the general population during the study period.
Comparisons of patients with and without IBD demonstrated that IBD patients were younger (51.6 vs 57, P<0.001), and had significantly less hyperlipidemia (12.6% vs 18.4%, P<0.001), diabetes (12.4% vs 20.6%, P<0.001), and hypertension (26.9% vs 34.9%, P<0.001). They also had lower rates of obesity (4.7% vs 6.7%, P<0.001).
In an unadjusted model, the risk for MI among patients with IBD was 0.42 (95% CI 0.41-0.43) compared with the general population, Barnes reported.
And in a multivariate analysis that adjusted for risk factors including age, sex, race/ethnicity, hyperlipidemia, hypertension, obesity, Charlson comorbidity index, insurance, and tobacco use, the odds ratio for MI among patients with IBD was 0.54 (95% CI 0.52-0.55), Barnes reported.
In an additional unadjusted analysis, the risk for MI was lower among IBD patients than among those with SLE or RA:
SLE: OR 1.74 (95% CI 1.69-1.80)
RA: OR 2.32 (95% CI 2.26-2.38)
Risks were also lower in an adjusted multivariate analysis:
SLE: OR 1.72 (95% CI 1.67-1.77)
RA: OR 1.45 (95% CI 1.41-1.49)
As to why there shouldn’t be a similar risk for MI and CAD among patients with IBD compared with diseases such as SLE and RA that also are characterized by systemic inflammation, Barnes explained toMedPage Today that in patients with the latter two diseases, the cytokine/chemokine pattern seems to favor a risk on the arterial side, conferring a higher MI/CAD risk. In contrast, in the IBD population, the higher risk is for venous events.
For instance, it’s been shown that patients with IBD have a higher baseline rate than the general population for deep vein thrombosis (0.93% vs 0.66%, P<0.001) and pulmonary embolism (0.89% vs 0.76%,P<0.001). Moreover, they also less often had preventive surgery such as coronary artery bypass grafts (0.33% vs 0.94%, P<0.001).
“This is a hypothesis at this point,” Barnes noted. “It isn’t just systemic inflammation that leads to cardiovascular risk in diseases such as lupus, rheumatoid arthritis, and IBD. There appear to be differences in cytokines involved in the chronic inflammation.”
In a large, observational study, hospitalizations for inflammatory bowel disease and infectious gastroenteritis increased with heat-wave durations.
Heat waves are associated with increases in mortality, commonly reported in patients who are sick or elderly. To examine the effect of heat waves on inflammatory bowel disease (IBD) and infectious gastroenteritis (IG), investigators conducted a retrospective, observational study involving 2030 patients admitted to the University Hospital of Zurich with IBD (738 patients), IG (786 patients), or non-IBD, noninfectious intestinal inflammation (NII; 506 controls). The study period was from 2001 through 2005, during which there were 17 heat waves, defined as ≥6 consecutive days with temperatures ≥9 degrees Fahrenheit above the average daily maximum.
Admissions for IBD rose 34.4% overall during heat-wave periods and 4.6% for each additional day of a heat wave. Admissions for IG, which was not distinguished as bacterial or viral, rose 34.8% overall during heat-wave periods and 4.7% for each additional day of a heat wave; however, the maximum increase in admissions per day was estimated at 7.2% when a 7-day lag in the development of IG was considered. No such lag effect was observed with IBD. NII controls experienced no increase in hospital admissions during the heat waves.
COMMENT
Presumably, the increases in hospitalizations for infectious gastroenteritis are related to greater environmental growth of pathogens with higher temperatures. The cause of the increase in inflammatory bowel disease hospitalizations is uncertain, and could reflect increased physical stress associated with heat, changes in growth rates of infectious pathogens, or other factors.
Endometriosis is the result of implantation of menstrual products from the endometrium that are not cleared by the immune system. To determine whether endometriosis is associated with inflammatory bowel disease (IBD) — also an autoimmune-related disorder — investigators in Denmark conducted a nationwide cohort study involving 37,661 women (mean age, 38.6 years) hospitalized with endometriosis during a 40-year period.
During >492,000 person-years of follow-up, the standardized incidence ratio was 1.5 for ulcerative colitis and 1.6 for Crohn disease. The risk for ulcerative colitis was highest among women diagnosed with endometriosis between the ages of 25 and 34. The risk for Crohn disease was highest among women diagnosed before age 25. The mean interval between endometriosis diagnosis and diagnosis of IBD was 10.8 years for ulcerative colitis and 9.8 years for Crohn disease. Risks for IBD remained elevated after >20 years of observation and were even higher when the analysis was confined to women with surgically verified endometriosis.
Comment: These data suggest a shared immunologic basis for endometriosis and IBD. Patients with endometriosis and clinical features associated with IBD should undergo gastrointestinal evaluation.
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