Inflammatory bowel disease(IBD)is the consequence of a complex interplay between environmental factors,like dietary habits,that alter intestinal microbiota in response to luminal antigens in genetically susceptible in...Inflammatory bowel disease(IBD)is the consequence of a complex interplay between environmental factors,like dietary habits,that alter intestinal microbiota in response to luminal antigens in genetically susceptible individuals.Epigenetics represents an auspicious area for the discovery of how environmental factors influence the pathogenesis of inflammation,prognosis,and response to therapy.Consequently,it relates to gene expression control in response to environmental influences.The increasing number of patients with IBD globally is indicative of the negative effects of a food supply rich in trans and saturated fats,refined su-gars,starches and additives,as well as other environmental factors like seden-tarism and excess bodyweight,influencing the promotion of gene expression and increasing DNA hypomethylation in IBD.As many genetic variants are now associated with Crohn's disease(CD),new therapeutic strategies targeting modi-fiable environmental triggers,such as the implementation of an anti-inflammatory diet that involves the removal of potential food antigens,are of growing interest in the current literature.Diet,as a strong epigenetic factor in the pathogenesis of inflammatory disorders like IBD,provides novel insights into the pathophysio-logy of intestinal and extraintestinal inflammatory disorders.展开更多
Duodenal Crohn＇s disease is rare, and patients without obstruction are treated medically. We herein report one case whose duodenal Crohn＇s disease was successfully managed with low-speed elemental diet infusion thro...Duodenal Crohn＇s disease is rare, and patients without obstruction are treated medically. We herein report one case whose duodenal Crohn＇s disease was successfully managed with low-speed elemental diet infusion through a nasogastric tube. A 28-year-old female developed acute duodenal Crohn＇s disease. Upper GI radiologic and endoscopic examinations showed a stricture in the duodenal bulb. Using the duodenal biopsy specimens, mucosal cytokine levels were measured; interleukin （IL）-1β, IL-6, IL-8, and tumor necrosis factor-α levels were remarkably elevated. For initial 2 wk, powdered mesalazine was orally given but it was not effective. For the next 2 wk, she was treated with low-speed elemental diet therapy using a commercially available ElentalTM, which was infused continuously through a nasogastric tube using an infusion pump. The tip of the nasogastric tube was placed at an immediate oral side of the pylorus. The infusion speed was 10 mL/h （usual speed, 100 mL/h）. After the 2-wk treatment, her symptoms were very much improved, and endoscopically, the duodenal stricture and inflammation improved. The duodenal mucosal cytokine levels remarkably decreased compared with those before the treatment. Although our experience was limited, lowspeed elemental diet infusion through a nasogastric tube may be a useful treatment for acute duodenal Crohn＇s disease.展开更多
Although infliximab (IFX) is effective for inducing and maintaining remission in patients with Crohn’s disease (CD), it is much more expensive than other treatments. The aim of this study is to evaluate the cost-effe...Although infliximab (IFX) is effective for inducing and maintaining remission in patients with Crohn’s disease (CD), it is much more expensive than other treatments. The aim of this study is to evaluate the cost-effectiveness of several therapies, including IFX, for moderately to severely active CD. A Markov cohort model was constructed to simulate treatment effectiveness and costs. Transition probabilities, utilities, direct medical costs, and productivity costs were estimated using the results of published research. The primary effectiveness measurement was quality-adjusted life years (QALYs), as estimated by the 15D instrument. Expected effectiveness and total costs were calculated for a 10-year period using a yearly discount rate of 3% for QALYs and costs. Multiple one-way sensitivity analyses were performed by varying parameters that were likely to change QALYs and costs. As compared with nonbiologic therapy, therapy with IFX alone resulted in more QALYs and lower costs for the 10-year period. Combination therapy with IFX and elemental diet yielded an additional 0.252 QALYs at an additional cost of $18,522 as compared with nonbiologic therapy over 10 years. The resulting incremental cost-effectiveness ratio (ICER) of combination therapy vs nonbiologic therapy was $73,500/QALY. Patient body weight was the most important factor for cost-effectiveness. In conclusion it was revealed that combination therapy with IFX plus elemental diet appears not to be a cost-effective treatment for moderately to severely active CD.展开更多
AIM:To critically review and summarize the literature on nutritional and health outcomes of semi-elemental formulations on various nutritionally vulnerable patient populations who are unable to achieve adequate nutrit...AIM:To critically review and summarize the literature on nutritional and health outcomes of semi-elemental formulations on various nutritionally vulnerable patient populations who are unable to achieve adequate nutrition from standard oral diets.METHODS:We conducted a comprehensive literature search of Pubmed and Embase databases.We manually screened articles that examined nutritional and health outcomes(e.g.,growth,disease activity,gastrointestinal impairment,mortality,and economic impact)among various patient groups receiving semi-elemental diets.This review focused on full-text articles of randomized controlled clinical trials and other intervention studies,but pertinent abstracts and case studies were also included.Results pertaining primarily to tolerance,digestion,and absorption were summarized for each patient population in this systematic review.RESULTS:Results pertaining primarily to tolerance,digestion,and absorption were summarized for each patient population.The efficacy of semi-elemental whey hydrolyzed protein(WHP)diet have been reported in various nutritionally high risk patient populations including-Crohn’s disease,short bowel syndrome,acute and chronic pancreatitis,cerebral palsy,cystic fibrosis,cerebrovascular accidents,human immunodeficiency virus,critically ill,and geriatrics.Collectively,the evidence from the medical literature indicates that feeding with a semi-elemental diet performs as well or better than parenteral or amino acid based diets in terms of toler-ance,digestion,and nutrient assimilation measures across various disease conditions.CONCLUSION:Based on this comprehensive review of the literature,patient populations who have difficulty digesting or absorbing standard diets may be able to achieve improved health and nutritional outcomes through the use of semi-elemental WHP diets.展开更多
文摘Inflammatory bowel disease(IBD)is the consequence of a complex interplay between environmental factors,like dietary habits,that alter intestinal microbiota in response to luminal antigens in genetically susceptible individuals.Epigenetics represents an auspicious area for the discovery of how environmental factors influence the pathogenesis of inflammation,prognosis,and response to therapy.Consequently,it relates to gene expression control in response to environmental influences.The increasing number of patients with IBD globally is indicative of the negative effects of a food supply rich in trans and saturated fats,refined su-gars,starches and additives,as well as other environmental factors like seden-tarism and excess bodyweight,influencing the promotion of gene expression and increasing DNA hypomethylation in IBD.As many genetic variants are now associated with Crohn's disease(CD),new therapeutic strategies targeting modi-fiable environmental triggers,such as the implementation of an anti-inflammatory diet that involves the removal of potential food antigens,are of growing interest in the current literature.Diet,as a strong epigenetic factor in the pathogenesis of inflammatory disorders like IBD,provides novel insights into the pathophysio-logy of intestinal and extraintestinal inflammatory disorders.
文摘Duodenal Crohn＇s disease is rare, and patients without obstruction are treated medically. We herein report one case whose duodenal Crohn＇s disease was successfully managed with low-speed elemental diet infusion through a nasogastric tube. A 28-year-old female developed acute duodenal Crohn＇s disease. Upper GI radiologic and endoscopic examinations showed a stricture in the duodenal bulb. Using the duodenal biopsy specimens, mucosal cytokine levels were measured; interleukin （IL）-1β, IL-6, IL-8, and tumor necrosis factor-α levels were remarkably elevated. For initial 2 wk, powdered mesalazine was orally given but it was not effective. For the next 2 wk, she was treated with low-speed elemental diet therapy using a commercially available ElentalTM, which was infused continuously through a nasogastric tube using an infusion pump. The tip of the nasogastric tube was placed at an immediate oral side of the pylorus. The infusion speed was 10 mL/h （usual speed, 100 mL/h）. After the 2-wk treatment, her symptoms were very much improved, and endoscopically, the duodenal stricture and inflammation improved. The duodenal mucosal cytokine levels remarkably decreased compared with those before the treatment. Although our experience was limited, lowspeed elemental diet infusion through a nasogastric tube may be a useful treatment for acute duodenal Crohn＇s disease.
文摘Although infliximab (IFX) is effective for inducing and maintaining remission in patients with Crohn’s disease (CD), it is much more expensive than other treatments. The aim of this study is to evaluate the cost-effectiveness of several therapies, including IFX, for moderately to severely active CD. A Markov cohort model was constructed to simulate treatment effectiveness and costs. Transition probabilities, utilities, direct medical costs, and productivity costs were estimated using the results of published research. The primary effectiveness measurement was quality-adjusted life years (QALYs), as estimated by the 15D instrument. Expected effectiveness and total costs were calculated for a 10-year period using a yearly discount rate of 3% for QALYs and costs. Multiple one-way sensitivity analyses were performed by varying parameters that were likely to change QALYs and costs. As compared with nonbiologic therapy, therapy with IFX alone resulted in more QALYs and lower costs for the 10-year period. Combination therapy with IFX and elemental diet yielded an additional 0.252 QALYs at an additional cost of $18,522 as compared with nonbiologic therapy over 10 years. The resulting incremental cost-effectiveness ratio (ICER) of combination therapy vs nonbiologic therapy was $73,500/QALY. Patient body weight was the most important factor for cost-effectiveness. In conclusion it was revealed that combination therapy with IFX plus elemental diet appears not to be a cost-effective treatment for moderately to severely active CD.
文摘AIM:To critically review and summarize the literature on nutritional and health outcomes of semi-elemental formulations on various nutritionally vulnerable patient populations who are unable to achieve adequate nutrition from standard oral diets.METHODS:We conducted a comprehensive literature search of Pubmed and Embase databases.We manually screened articles that examined nutritional and health outcomes(e.g.,growth,disease activity,gastrointestinal impairment,mortality,and economic impact)among various patient groups receiving semi-elemental diets.This review focused on full-text articles of randomized controlled clinical trials and other intervention studies,but pertinent abstracts and case studies were also included.Results pertaining primarily to tolerance,digestion,and absorption were summarized for each patient population in this systematic review.RESULTS:Results pertaining primarily to tolerance,digestion,and absorption were summarized for each patient population.The efficacy of semi-elemental whey hydrolyzed protein(WHP)diet have been reported in various nutritionally high risk patient populations including-Crohn’s disease,short bowel syndrome,acute and chronic pancreatitis,cerebral palsy,cystic fibrosis,cerebrovascular accidents,human immunodeficiency virus,critically ill,and geriatrics.Collectively,the evidence from the medical literature indicates that feeding with a semi-elemental diet performs as well or better than parenteral or amino acid based diets in terms of toler-ance,digestion,and nutrient assimilation measures across various disease conditions.CONCLUSION:Based on this comprehensive review of the literature,patient populations who have difficulty digesting or absorbing standard diets may be able to achieve improved health and nutritional outcomes through the use of semi-elemental WHP diets.
