The Causes and Consequences of IBD
Vložit
- čas přidán 10. 10. 2021
- Crohn's disease and ulcerative colitis are the two main forms of inflammatory bowel disease (IBD). They can occur at any age but typically begin in adolescence / early adulthood. They have a marked impact on an individuals' life -
• gut symptoms (diarrhoea +/- blood, urgency, pain),
• systemic upset (weight loss, fevers, profound fatigue),
• extra-intestinal manifestations (affecting skin, joints, mouth, eyes and liver),
• psychological harm (anxiety and depression), and
• disruption to everyday life (studies, work, social life, relationships and sexual life).
The prevalence of IBD in the developed world is now 0.78% or 1 in every 125 people. This will exceed 1% by 2028. Elsewhere in the world IBD incidence is rapidly accelerating (e.g. Indian subcontinent, East Asia, Middle East, South America) or just emerging (e.g. Africa). This demonstrates the striking influence of environmental factor - notably diet - as root causes of IBD. Two decades of gene discovery and mucosal immunology has successfully identified many of the pathogenic pathway in IBD. Increasingly targeted therapies are either in the clinic or coming with the coming 2-5 years.
Over 300 independent susceptibility loci have been associated with the development of IBD. Further work is currently underway to massively expand the power of GWAS studies in the latest international meta-analysis and to translate gene discovery to biological function. The gut microbiome is undoubtedly heavily involved in the development of IBD. There is a clearly observed dysbiosis in the microbiomes from affected individuals. However, ascribing causality is a major challenge - what is cause and what is the effect of gut inflammation and treatment? This will require large longitudinal cohort of unaffected individuals to start the microbiome changes prior to the development of IBD
Without effective therapy early in the disease course Crohn's disease progresses for a purely inflammatory phenotype in 80% to a stricturing or penetrating phenotype in the majorities. This shift in the disease behaviour results in irreversible bowel damage over time. Hospitalisations, major surgery and stoma formation all result. Early effective therapy prevents this. Anti-TNF drugs - infliximab and adalimumab - have been our best therapies for 20 years but used too late in the disease course. Biosimilar versions have dramatically reduced costs and enabled early effective therapy to become routine - although it is not yet widespread.
Currently available therapies to treat IBD include
• 5-ASA for mild to moderately active UC
• anti-TNF biosimilars (infliximab and adalimumab)
• anti-p40 blocking IL-12 and IL-23 (ustekinumab)
• anti-a4b7 integrin (vedolizumab; gut specific blocks lymphycyte trafficking)
• tofacitinib (JAK inhibitor)
I developed this crap after vaccine . Most of them don’t but I have been monitoring my calprptectin since vaccine and it keeps increasing . So frustrated with everything
You might be correct! The covid virus binds to ACE2 receptors. And these receptors are not just in the lungs, but all over the body, including the gut... UC is sure miserable. (Remicade has helped me quite a bit.)
Thank you for sharing your work. Very appreciated. Looking forward to learning more.
Great video
Hey Charlie, thank you for your information on this great channel. Can you go into more detail about the “priming events” under pre clinical inclination. No one ever talks about this stage and just right into the full disease. I think we can learn so much from that early stage. Mine showed felt like it was a 20 year stage and in my 30s got really bad and by 38 I was in my first major flare. Thank you
Do you ask patients what they eat to determine if diet aids disease progression?
Great vid! What’s you opinion on the MAP bacteria being the cause?
We'll find out soon brother. Fingers crossed for the vaccine.
this guy just telling you what google tells you but no real research of root cause, typical book smart doctor, aka trash...doctors are not smarter than patients, facts 2022.
Cut all processed foods and sugar, try the carnivore diet it has helped me greatly.