MM19 Conference Book V1final
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5/17/2017<br />
reasons not fully understood.<br />
Ulcerative Colitis<br />
IBD Pathogenesis<br />
• No published evidence for consistent effectiveness<br />
• Improved clinical responses noted in limited research<br />
• Studies criticized for being small, poorly constructed<br />
and containing insufficient data<br />
• May be underutilized for unsubstantiated reasons<br />
• Some physicians implement in refractory cases.<br />
• Recommended in UC cases with under-nutrition<br />
and SIBO.<br />
Apthous<br />
Ulcers Apthous<br />
Ulcers<br />
Apthous<br />
Ulcers<br />
Apthous<br />
Ulcers<br />
Apthous<br />
Ulcers<br />
Limited to colon<br />
(with ”backwash ilietus)<br />
Affects only mucosa<br />
Begins in rectum<br />
Progresses proximally<br />
contiguously and circumferentially<br />
Smoking<br />
Geography<br />
Stress/Psychological<br />
Antigens<br />
164 gene loci<br />
30 for CD<br />
23 for UC Host<br />
Genetics<br />
Diet<br />
Environment<br />
IBD<br />
Microbiota<br />
Medications<br />
Antibiotics, NSAIDS<br />
Micro and nano-particles<br />
Altered by Environmental Factors<br />
In context of host genetics<br />
Impaired<br />
Immunity<br />
Breakdown of Innate immunity<br />
Adaptive Immune response<br />
Pathophysiological consequences<br />
Under-nutrition and malnutrition in IBD<br />
Anemia,<br />
uveitis,fever,<br />
Primary<br />
sweats,<br />
Sclerosing<br />
Indeterminate Colitis jaundice<br />
Cholangitis<br />
Anxiety &<br />
Depression<br />
Apthous<br />
Ulcers<br />
↓<br />
↑<br />
↑ Nutritional requirements<br />
↓ Food Consumption<br />
Medication Side Effects<br />
Lack of appetite<br />
Nausea/Vomiting<br />
Abdominal<br />
pain<br />
Diarrhea,<br />
blood,<br />
mucus<br />
Nutritional Loss<br />
Crohn’s<br />
Disease<br />
Skin rash, pyoderma,<br />
erythema nodosum<br />
Ulcerative<br />
Colitis<br />
Arthritis<br />
arthralgia<br />
Weight<br />
Loss<br />
↑<br />
↑<br />
↑<br />
↓ GI Secretions<br />
Protein losing enteropathy<br />
Pancreatic insufficiency<br />
Bile acid malabsorption<br />
Gastric Acid Insufficiency<br />
↑ Malabsorption ↓ Absorption<br />
Inflamed mucosa Fistula formation<br />
SIBO<br />
Strictures<br />
Bowel Resection<br />
GI losses<br />
Diarrhea<br />
Blood<br />
Mucus<br />
Malnutrition in IBD<br />
Diarrhea<br />
Abdominal pain<br />
Hematochezia (blood in<br />
stool)<br />
Mucus Fever<br />
Malnutrition<br />
Weight Loss<br />
Malnutrition in IBD IBS?<br />
. “Clinically apparent malnutrition is more<br />
frequent [in IBD] and may serve as a<br />
clinical marker of poor IBD prognosis…”<br />
Compr Ther. 1994;20(9):523-30<br />
Protein-<br />
Energy<br />
Malnutrition<br />
Altered Body<br />
Composition<br />
Micronutrient<br />
Deficiencies<br />
Vitamin A, D, E, K, B6,<br />
B12, Folic Acid<br />
FE, Zn, Sn<br />
Systemic<br />
Complications<br />
Poor<br />
Treatment<br />
Outcomes<br />
Morbidity ↑<br />
Mortality ↑<br />
Wound Healing ↓<br />
Infections ↑<br />
Complications ↑<br />
Convalescence ↓<br />
30<br />
5
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