Inflammatory Bowel Disease (IBD)

Inflammatory Bowel Disease Overview:

Inflammatory bowel disease is a recurring inflammatory condition in the lower gastrointestinal tract. There are 2 main types of inflammatory bowel conditions; Crohn's disease, and ulcerative colitis.

T cell regulation:

  • vitamin D
  • Zinc
  • Selenium
  • Probiotics
 

Aetiology:

Experienced by about 33,000 Australians and is most prevelent in the Jewish descent. 

In both of these conditions, an inflammatory response is triggered when contents of the intestinal tract (lumen) enter the inner layers of the epithelial tissue (lamina propria) where immunomodulatory macrophages are located. When these macrophages are activated, inflammatory cytokines are released including TNF-a, IL-1, IL-6, and interferon-gamma. This causes further inflammation, promotes coagulation of blood, and increases the release of free radical compounds from the macrophages in the area. 

Depending on the condition (Crohns or Ulcerative colitis), the distribution of TNF-a reactive macrophages are different, which results in slightly different symptoms. 

Ultimately, the end result of each condition is a self-perpetuating state of inflammation in the digestive tissue, causing contents to leak out from the lumen, and into the deeper layers of the intestinal tissue. Eventually, this damage becomes so severe, contents begin leaking into the blood stream directly, which then interferes with other organs like the liver, brain, lungs, and skin. 

+ Crohn's Disease

Increased TNF-a activity reduces anticoagulant mediators (such as thrombomodulin), [7], and promotes procoagulant factors [8] TNF-a activated macrophages clustering around the arterioles and venules infiltrate and disrupt the vascular endothelium [10].

In effect, Crohns has a stronger affect on the vascular tissues of the digestive tract, and tnds to form clusters of inflammation around these areas. It can appear anywhere along the digestive tract, from the mouth to the anus.


+ Ulcerative Cholitis

In ulcerative colitis, the majority of inflammatory activity can be attributed to the epithelioid macrophages, and is more evenly distributed within the lamina propria [8].

The result is a more widely distributed inflammatory picture with ulcerative colitis than Crohns, with less clotting and infiltration of the vascular tissue. Ulcerative colitis also has a higher affinity for the large intestines, which is likely the reason why bleeding from the rectum is more common in this condition (closer proximity).

Ulcerative colitis comes with an increased of colon cancer, perforations and obstructions in the digestive tract. Systemically this condition is linked with rheumatoid arthritis, liver disorders, and inflammation involving the sclera of the eyes.

+ Diverticulitis

This condition is sometimes included under the category of inflammatory bowel disease, but has slightly different pathology. it involves the formation of outpounchings (diverticulae) in the digestive mucosa, which pokes through musclular layers. This usually occurs in the sigmoid colon. Faeces and bacteria can accumulate in these pouches, resulting with infection. This infection si what we refer to as diverticulitis.

This condition is associated with a low fiber diet, poor gut wall integrity, increased intestinal pressure, and a narrowing of the intestinal lumen diameter.

Diverticulitis may be asymptomatic, but most commonly has similar symptoms to other forms of inflammatory bowel disease or IBS.

This condition comes with several red flags, including gastrointestinal hemorrhage, fistula formation, perforations, and abscess formations.

 

Symptoms:

Abdominal Cramping

Diarrhea

Constipation

Urgency With Bowel Movements

Fever

Rectal Bleeding

Weight Loss

Fatigue

Irregular Menstrual Cycle

 

Diagnostic Considerations:

From this pathophysiological process, Crohns has some distinct differences to ulcerative colitis including:
* The affected location can appear anywhere in the digestive tract, compared to ulcerative colitis mainly affecting the large intestine. 
* Inflammation tends to form patches, compared to large, uninterupted sections of inflammation with ulcerative colitis
* Rectal bleeding is much more common with ulcerative colitis than Crohns

Differences Between Crohns & Ulcerative Colitis

Crohns Ulcerative Colitis
Inflammation Patterns Multiple, separated sections of inflamed and damaged tissue. Large, ininterrupted area of inflammation.
Location Anywhere along the digestive tract. Most common in the large intestine.
Rectal Bleeding Not common. Common.
Inflammatory Factors Involved IL-1, IL-6, TNF-a, IFN-γ TNF-α, IL-12, IL-23, IL-17 and IFN-β

Lab Tests For IBD

Lab Test Crohns Ulcerative Colitis
CRP >5 mg/L. >5 mg/L
ESR Female: >19 mm in 1 hour
Male: >10 mm in 1 hour
Female: >19 mm in 1 hour
Male: >10 mm in 1 hour
Lymphocytes >7.5% >7.5%
Hemoglobin <140-150g/L <140-150g/L
Electrolytes Normal-Low Normal-Low
B12 <150pmol <150pmol
Bone Density Scan Normal-Low Normal-Low
pANCA Not likely Likely
ASCA Likely Not Likely

Cytokine Profiles Of CD and UC

Cytokine Crohns Ulcerative Colitis
IL-1 Normal in serum, increased in mucosa Normal in serum, increased in mucosa
IL-2 Increased Normal
IL-6 Increased Normal in serum, raised in mucosa
IL-8 Undetectable in serum Undetectable in serum, increased in mucosa
IFN-y Increased Normal
TNF-a Increased serum, increased mucosa Increased serum, increased mucosa
 

Therapeutic Aims:

1. Reduce Inflammation In The Digestive Tract

Regulate T cell, histamine, and inflammatory markers Systemically.

  • Immunomodulators(Ganoderma, Innonotus)
  • Antinflammatories(Boswellia serrata, Curcuma longa, Calendula officinalis)
  • Nutrients(Selenium, Vitamin D, Zinc)
  • Probiotics

2. Repair Gut Mucosa

  • Demulcents(Aloe vera, Althaea officnialis, Ulmus fulva, GLycyrhiza glabra)
  • Mucorestoratives(Hydrastis canadensis)
  • Astringents(Geranium maculatum)
  • Nutrients(Glutamine, Vitamins (A, B, C, and D), Zinc, Calcium, Iron)

3. Regulate Immune Function In The Presence Of Autoimmune Disorders

  • Immunomodulators(Ganoderma lucidum, Inonotus obliquus, Echinaceae purpurea, Andrographis paniculata, Hemidesmis indicus, Tylophora asthmatica)
  • TNF-a & NF-kB Inhibitors(Curcuma longa, Boswellia serrata)
  • COX/5-LOX Inhibitors(Curcuma longa, Boswellia serrata)
  • Antioxidants(Silybum marianum, Curcuma longa, Vaccinum myrtillus)
  • Nutrients(Zinc, Fish oil)

4. Improve Liver Function

  • Hepatics(Silybum marianum, Schisandra chinensis, Cynara scolymus)
  • Choleretics
  • Cholagogues

5. Fight Infection If Relevant

  • Antibacterials
  • Antifungals(Tabebuia impetiginosa)
  • Antiparasitics

6. Identify and Remove Food Intolerances

Such as dairy, gluten, fructose

6. Treat Diarrhea Symptomatically

Short term treatment only. The underlying cause should be the priority here.

  • Antidiarrheals(Matricaria recutita, Agrimonia eupatoria, Filipendula ulmaria)
  • Styptics(urtica dioica, Panax notoginseng, Achillea millefolium)
 

Differential Diagnosis:

  • Irritable bowel syndrome
  • Colon cancer
  • Celiac Disease
  • Food intolerances/allergies
  • Bacterial infection
 

Comorbidities:

  • Parasites
  • Candida
  • Asthma
 

Cautions:

Rule out colon cancer.

 

Herbs For IBD:

  • immunomodulators
    • echinacea
  • antinflammatories
    • calendula
    • curcuma longa
    • boswellia
  • Demulcents
    • aloe
    • linum 
    • trigonella
  • hepatics
    • cynara
    • silybum
    • berberis
    • hydrastis
    • berberis 
 

Author:

Justin Cooke

The Sunlight Experiment

Updated: March 2018


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References:

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