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Inflammatory Bowel Disease

Inflammatory Bowel Disease

Crohn’s Disease and Ulcerative Colitis are a complex of autoimmune disorders caused by a chronic inflammatory process. Crohn’s disease can occur anywhere in the Gastrointestinal tract and Ulcerative Colitis is localized to the colon. They can both present with abdominal pain and diarrhea. The standard therapy targets the inflammation in order to improve symptomatology, prevent dysplasia and malignancy, and ultimately induce clinical and endoscopic remission. The etiology of the illness is complex and multifactorial. There are several proposed theories regarding etiology of the disorder.

First degree relatives are far more likely to be affected, but the genetic component is not clearly mapped to any gene. Epigenetics means “after genetics.” It is a process in which DNA is chemically modified by lifestyle and environmental changes and alters the expression of genes. This modification appears to be involved in Crohn’s Disease and Ulcerative Colitis. There is increased modification of DNA by methylation seen both diseases. Methylation is the addition of a carbon and three hydrogens via chemical bond. Methylation of DNA has been associated with inflammation, disease activity, anatomic extent, and dysplasia in Inflammatory Bowel Disease. (Gloria, L et al., 1996, Hsieh CJ et al., 1998, Tahara T., et al, 2009, Karatsas et al.,2014.)

There also appears to be a psychosocial component involved. Depression rates appear to be higher in Inflammatory Bowel Disease patients. Patients with Crohn’s have been shown to have an altered processing of emotional stress ( Agostini et al., 2017). Patient’s with Ulcerative colitis have been shown to have a blunted positive response to emotional stimuli. (Agostini et al., 2011). A perceived negative parental relationship was seen in both Crohn’s and Ulcerative Colitis (Agostini et al., 2010).

An altered mucosal barrier from increased intestinal permeability or “leaky gut” is a proposed mechanism of pathogenesis of Inflammatory Bowel disease. Dysbiosis or an abnormal bacterial population is often associated with increased intestinal permeability and is a treatment target. The gut microbiome is the term reflecting the bacteria (also viruses and fungi) which normally reside in and outside of our bodies. This microbiome plays an important role in digestion, immunity, and much more. It is affected by diet and stress management. The gut has trillions of neurons and vast connective network to the brain. The connection to the brain is partially mediated by the bacteria living in the digestive tract and the brain and the gut affect each other in a profound way.

The conventional therapy for Inflammatory Bowel Disease targets inflammation in the gut. In essence, it treats the “downstream” affect or the symptomatology. It is important to treat the root cause of the problem by addressing intestinal permeablility or “leaky gut” and the microbiome. The mind body connection needs to be addressed and diet needs to be modified in a strategic and personalized way.