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Crohn's Disease- Pathophysiology and Conventional and Alternative Treatment Options

Crohn's Disease

Table 1: Subcategories of Crohn's Disease

Table 2: Signs and Symptoms of Crohn's Disease and Ulcerative Colitis

Risk Factors

Diagnosis

Etiopathogenesis:

    The Genetic Component of Crohn's Disease

    Stress in the Etiology of Crohn's Disease

    Microbial Factors

    Inflammation/Immune Response

    Intestinal Permeability

    Other Abnormalities Contributing to the Etiopathogenesis of Crohn's Disease

Conventional Treatment of Crohn's Disease

Table 5: Conventional Medications and their Mechanisms in Crohn's Disease

Nutrient Deficiences in Crohn's Disease

Table 6: nutrient Deficiencies Associated with Crohn's Disease

Dietary Interventions in Crohn's Disease

Table 7: Diet Therapies Compared to Steroid Medications in Crohn's Disease

Probiotics in the Treatment of Crohn's Disease

Fatty Acids for the Treatment of Crohn's Disease

Table 8: A Summary of Omega-3 Fatty Acid Studies in Crohn's Disease

Glutamine

N-acetyl Glucosamine

Remicade Increasing Risk of Cancer

Botanicals in the Treatment of Crohn's Disease

Dehydroepiandrosterone (DHEA)

Potential Sequelae of Crohn's Disease

References




Glutamine

The amino acid glutamine is the preferred fuel for small intestinal enterocytes and can decrease intestinal permeability, a potential benefit for Crohns Disease patients. Duodenal biopsies from healthy volunteers were cultured in the presence of the inflammatory cytokine-enhancing IL-1beta and increasing amounts of glutamine. Glutamine inhibited IL-1beta-induced production of pro-inflammatory cytokines IL-6 (found to be high in the serum and mucosa of Crohn's Disease patients83) and IL-8, and enhanced production of the anti-inflammatory IL-10.247

Despite theoretical indications for glutamine supplementation in Crohn's Disease, several small intervention trials have not yielded benefit. In a double-blind study to determine if glutamine decreases gut permeability in Crohn’s disease, 14 Crohn's Disease patients were randomly assigned to receive 7 g glutamine or placebo (glycine) three times daily along with their conventional treatment. There were no significant changes in permeability during the four-week trial in either the glutamine or placebo groups. In addition, no significant changes were seen in CDAI, CRP, or plasma glutamine/ glutamate levels.248

Two studies investigating high-glutamine diets in children with Crohns Disease also found no significant benefit. Eighteen children received either a low-glutamine (4% of amino acid content) polymeric diet or a glutamine-enriched (42% of amino acid content) polymeric diet to determine whether glutamine enhances rate of remission. After four weeks, 5/9 in the low-glutamine group and 4/7 (two patients dropped out of this group due to diet intolerance) in the high-glutamine group achieved remission. Pediatric CDAI was significantly lower in the low-glutamine group, indicating greater response to the low- than high-glutamine diet.249 In a second arm of the study, glutamine did not affect intestinal permeability.250

Growth is often stunted by childhood Crohns Disease and low serum levels of insulin-like growth factor- 1 (IGF-1) have been implicated. In double-blind fashion, 15 children with Crohn's Disease were assigned to receive one of two diets (same amino acid content as previous study) and the effect on IGF-1 assessed. No significant changes in IGF-1 were noted after four weeks of supplementation.251



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