Crohn’s disease is a chronic inflammatory condition affecting the gastrointestinal tract – causing injuries or wounds anywhere in between the mouth and anus. Symptoms usually start in young adults, but can also occur in children or later in life. Often, it takes quite some time until a doctor diagnoses it because of the wide variety of symptoms.

Patients suffering from Crohn’s disease often experience diarrhea, stomach pain, and unwanted weight loss. Furthermore, and these are all unspecific symptoms, they might report fever, fatigue, problems with their skin, joints or eyes. Symptoms come and go and might be severe at one point and relatively mild at another [1].

It is currently not completely understood what causes the disease. Data suggest a combination of genetic and environmental factors, like smoking, oral contraceptive, and antibiotic use. On the other hand, being exposed to pets and farm animals is believed to decrease the risk. Furthermore, a high fiber intake, fruit consumption, and physical activity have also been linked to a risk reduction [2,3].

Therapeutic options to treat Crohn’s disease are different types of medication, and treatment decisions are guided by the age of the patient, symptoms, and extent of the disease. Corticosteroids, immunomodulators, and biologics (these are monoclonal antibodies) are often used, sometimes also in combination [4].

Another possible treatment option is to provide nutrients that directly influence the intestines. This is called enteral nutrition. The benefit of this is that it avoids the side effects of medication – which is especially relevant for children. A recent Chinese meta-analysis of data even reports that exclusive enteral nutrition was equally effective as corticosteroid medication when given to children with Crohn’s disease [5, 6].

But what exactly is enteral nutrition and how does it work?

Over a period of 6-8 weeks, enteral nutrition provides the complete daily nutritional requirements through liquid formulations delivered orally or through nasogastric or gastrostomy tubes [7]. Beforehand, malnutrition and individual caloric needs need to be identified by a dietician. The treatment influences the bacterial milieu, shifting away from a pro-inflammatory state. It is established as a primary therapy in children, while it is less used in adults due to patients’ preference and availability of other therapeutic options such as biologics. Overall, enteral nutrition should be discussed with patients and offered especially if they desire a non-pharmacological therapy [8].

REFERENCES:

[1] Veauthier, B. and J.R. Hornecker, Crohn’s Disease: Diagnosis and Management. Am Fam Physician, 2018. 98(11): p. 661-669.

[2] Ananthakrishnan AN. Epidemiology and risk factors for IBD. Nat Rev Gastroenterol Hepatol. 2015;12(4):205–217

[3] Cholapranee A, Ananthakrishnan AN. Environmental hygiene and risk of inflammatory bowel diseases: a systematic review and meta-analysis. Inflamm Bowel Dis. 2016;22(9):2191–2199.

[4] National Institute for Health and Care Excellence. Crohn’s disease: management. https://www.nice.org.uk/guidance/ng129. Accessed February 06, 2020.

[5] Shaikhkhalil, A.K. and W. Crandall, Enteral Nutrition for Pediatric Crohn’s Disease: An Underutilized Therapy. Nutr Clin Pract, 2018. 33(4): p. 493-509.

[6] Yu, Y., K.C. Chen, and J. Chen, Exclusive enteral nutrition versus corticosteroids for treatment of pediatric Crohn’s disease: a meta-analysis. World J Pediatr, 2019. 15(1): p. 26-36.

[7] Wall C.L., Day A.S., Gearry R.B. Use of exclusive enteral nutrition in adults with crohn’s disease: A review. World J. Gastroenterol. 2013; 19:7652–7660. doi: 10.3748/wjg.v19.i43.7652.

[8] Hansen, T. and D.R. Duerksen, Enteral Nutrition in the Management of Pediatric and Adult Crohn’s Disease. Nutrients, 2018. 10(5).

 

 

 

Please share and like us:

Real time measurements of intestinal gases: a novel method to study how food is being digested

Researchers in Wageningen (The Netherlands), have been able to identify for the first time, how gut microorganisms process different types of carbohydrates by measuring in real time the intestinal gases of mice. This is not only a novel method to understand how food is digested but could also tell us more about the role of gut microorganisms in gut health.

Intestinal gases

The intestinal microbiota is a diverse and dynamic community of microorganisms which regulate our health status. The advancement of biomolecular techniques and bioinformatics nowadays allows researchers to explore the residents of our intestines, revealing what type of microorganisms are there. However, studying only the microbial composition of an individual provides limited insights on the mechanisms by which microorganisms can interact with the rest of our body. For example, far less is understood about the contribution of the gut microorganisms in the production of intestinal gases such as hydrogen, methane and carbon dioxide through the breakdown of food and how these gases affect the biochemical pathways of our bodies.

Intestinal gases consist mostly of nitrogen, and carbon dioxide, which originate primarily from inhaled air. Hydrogen and methane though, are produced as by-products of carbohydrate fermentation (break down), by intestinal microorganisms. However, not all carbohydrates are digested in the same way. For instance, food with simple sugars can be rapidly absorbed in the small intestine unlike complex carbohydrates such as fibers, which reach the colon where they are digested by the colonic microbiota.

Lower_digestive_system

Measuring hydrogen in mouse intestines

To study these interactions and gain knowledge on how microorganisms process carbohydrates, the research team led by Evert van Schothorst from the Human and Animal Physiology Group of Wageningen University (WU) in collaboration with the WU-Laboratory of Microbiology fed mice two different diets with the same nutritional values but with different types of carbohydrates (1). The first diet contained amylopectin, a carbohydrate which can be digested readily in the small intestine while the second diet contained amylose, a slowly digestible carbohydrate that is digested by intestinal microorganisms in the colon.

Animals fed the easily digestible carbohydrates showed minimal production of hydrogen whereas the group fed with the complex carbohydrates presented high levels of hydrogen. Moreover, the two groups were characterized not only by distinct microbial composition (different types of bacteria present) but also distinct metabolic profiles (short chain fatty acids), suggesting that the type of carbohydrate strongly affects microbial composition and function.

The importance of hydrogen

Hydrogen consumption is essential in any anoxic (without oxygen) microbial environment to maintain fermentative processes. In the intestine it can be utilised through three major pathways for the production of acetate, methane and hydrogen sulphide. These molecules are critical mediators of gut homeostasis, as acetate is the most predominant short chain fatty acid produced in mammals with evidence suggesting a role in inflammation and obesity (2). Methane, which is produced by a specific type of microorganisms, called archaea, has been associated with constipation related diseases, such as irritable bowel syndrome(3) and also recently with athletes’ performance (4)! Finally hydrogen sulphide is considered to be a toxic gas, although recent findings support the notion that it also has neuroprotective effects in neurodegenerative disorders such as Parkinson and Alzheimer diseases (5).

To the best of our knowledge, this is the first time that food-microbiota interactions have been studied continuously, non-invasively and in real time in a mouse model. Hydrogen is a critical molecule for intestinal health and understanding its dynamics can provide valuable information about intestinal function, and deviations in conditions such as Crohn’s disease or irritable bowel syndrome (IBS).

Further reading

1. Fernández-Calleja, J.M., et al., Non-invasive continuous real-time in vivo analysis of microbial hydrogen production shows adaptation to fermentable carbohydrates in mice. Scientific reports, 2018. 8(1): p. 15351.

https://www.nature.com/articles/s41598-018-33619-0

2. Perry, R.J., et al., Acetate mediates a microbiome–brain–β-cell axis to promote metabolic syndrome. Nature, 2016. 534(7606): p. 213

3. Triantafyllou, K., C. Chang, and M. Pimentel, Methanogens, methane and gastrointestinal motility. Journal of neurogastroenterology and motility, 2014. 20(1): p. 31.

4. Petersen, L.M., et al., Community characteristics of the gut microbiomes of competitive cyclists. Microbiome, 2017. 5(1): p. 98.

5. Cakmak, Y.O., Provotella‐derived hydrogen sulfide, constipation, and neuroprotection in Parkinson’s disease. Movement Disorders, 2015. 30(8): p. 1151-1151.

Please share and like us:


Welcome to New Brain Nutrition. You can enjoy FREE Online Courses when you Log In or Join here.

This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 728018

New Brain Nutrition is a project and brand of Eat2BeNice, a consortium of 18 European University Hospitals throughout the continent.

Partners:
You may log in here to our Intranet website with your authorized user name and password.